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Background: Post-term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High-income countries have responded to this risk by widely adopting labour induction protocols in late-term, but many low- and middle-income countries have not. However, understanding underlying mechanisms linking post-term births to adverse newborn and infant outcomes remains limited., Objective: To investigate the (a) prevalence of post-term, (b) the risk factors associated with post-term (c) the association between post-term births and the risk of small-for-gestational-age (SGA) neonates and of infant mortality in middle-income settings., Methods: We used existing electronic datasets from the general population of Brazil, Mexico, and Palestinian refugees. Regression models were used to explore the associations between post-term birth and SGA and infant mortality., Results: We analysed 21,335,033 live births in Brazil (2011-2018), 23,416,126 in Mexico (2008-2019), and 966,102 in Palestinian refugees (2010-2020) (N = 45,717,261). Post-term deliveries accounted for 3.1% of births in Brazil, 1.2% in Mexico, and 2.1% in Palestinian refugees. Post-term births had approximately three times the risk of resulting in SGA neonates compared to term births. Additionally, post-term neonates exhibited a 15% to 40% increased risk of infant mortality compared to term infants. Notably, post-term SGA neonates faced a significantly increased risk of infant mortality compared to term appropriate for gestational age neonates., Conclusions: These findings emphasise the critical significance of implementing induction strategies to prevent post-term pregnancies and mitigate the associated risks of SGA neonates and subsequent infant mortality. Moreover, the study highlights the importance of accurately determining gestational age and using INTERGROWTH-21st charts to improve the identification of SGA cases, enabling targeted interventions. This is especially relevant because post-term SGA neonates may not exhibit low birthweight (a commonly used risk marker) and, therefore, may miss out on required specialised attention., (© 2024 John Wiley & Sons Ltd.)

The suprachiasmatic nucleus (SCN) is the master clock that directly dictates behavioural rhythms to anticipate the earth's light/dark cycles. Although post-transcriptional regulators called microRNAs have been implicated in physiological SCN function, how the absence of the entire mature miRNome impacts SCN output has not yet been explored. To study the behavioural consequences of miRNA depletion in the SCN, we first generated a mouse model in which Dicer is inactivated in the SCN by crossing Syt10 Cre mice with Dicer flox mice to study behavioural consequences of miRNA depletion in the SCN. Loss of all mature miRNAs in the SCN shortened the circadian period length by ~37 minutes at the tissue level and by ~45 minutes at the locomotor activity level. Moreover, knockout animals exhibited a reduction in the precision of the circadian rhythm with more variable activity onsets under both LD 12:12 and DD conditions. We also observed that knockouts with higher onset variations were inclined to develop ultradian rhythms under constant light. In a second mouse model, recombination of Dicer flox via Cre delivery specifically in the SCN resulted in loss of behavioural rhythms in some animals depending on the injection efficiency. Together, our observations highlight the importance of microRNAs for a physiological SCN function and their pivotal role in robust circadian oscillations., (© 2024 The Author(s). European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Background: Postoperative atrial fibrillation occurs in 27% to 40% of patients after cardiac surgery. One cause of postoperative atrial fibrillation is pericardial effusion, which can be a significant source of inflammation. In this study, we investigated the effect of a drain placed in a posterior site to the heart to reduce pericardial effusion in the early postoperative period to prevent postoperative atrial fibrillation., Methods: Participants were patients who underwent initial standby aortic valve replacement at Saga-Ken Medical Centre Koseikan from January 2010 to December 2021. Patients with a history of atrial fibrillation, complex surgery, or emergency surgery were excluded. The patients were divided into two groups: those with a posterior cardiac drain in addition to the usual intrapericardial and subpleural drains from September 2017 (group P) and those without posterior cardiac drain from January 2010 to August 2017 (group N). Multiple logistic regression analysis was performed to evaluate the usefulness of posterior cardiac drain., Results: Of the 79 patients included the study, 40 were male and groups P and N comprised 27 and 52 patients, respectively. Of the 79 patients, 32 developed postoperative atrial fibrillation; among whom, 7/27 (25.9%) had posterior cardiac drain and 25/52 (48.1%) had no posterior cardiac drain ( p  = 0.09). When adjusted for body surface area, left ventricular end-diastolic and left atrial diameter, the incidence of postoperative atrial fibrillation was significantly lower in group P than in group N (adjusted odds ratio 0.270, 95% confidence interval 0.077-0.953, p  = 0.042). Furthermore, no patient in the group P underwent postoperative thoracentesis in the subanalysis., Conclusions: The results suggest that early postoperative reduction of pericardial effusion by posterior cardiac drain placement may reduce the incidence of postoperative atrial fibrillation., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The silkworm Nocardia infection model has been established as a useful animal model for screening the pathogenicity of Nocardia and evaluating the therapeutic effects of antimicrobial agents against Nocardia infection. No histopathological analysis of silkworms infected with Nocardia farcinica has yet been performed. In this study, we performed histological analyses on organs of silkworms infected with N. farcinica. One day after infection with N. farcinica, the organism developed a branching filamentous form from coccid cells in the hemolymph. In addition, we evaluated effective doses (ED 50 ) values by treating infected silkworms with amikacin 30 seconds and 24 hours after infection and found that the ED 50 values treated within 30 seconds and 24 hours after infection were 4.1 μg/larva and 5.6 μg/larva, respectively. Evaluation of treatment with amikacin against the infected silkworms was unaffected by the growth process form of Nocardia. These results suggest that the silkworm Nocardia infection model is a useful tool for evaluating the antimicrobial therapy in the growth process of the N. farcinica.

Fecal microbiota transplantation (FMT) is a therapeutic modality for treating neonatal calf diarrhea. Several practical barriers, including donor selection, fecal collection, and a limited timeframe for FMT, are the main constraints to using fresh feces for implementing on-farm FMT. We report the utility of FMT with pretreated ready-to-use frozen (F) or freeze-dried (FD) microorganisms for treating calf diarrhea. In total, 19 FMT (F-FMT, n = 10 and FD-FMT, n = 9) treatments were conducted. Both FMT treatments were 100% clinically effective; however, multi-omics analysis showed that FD-FMT was superior to F-FMT. Machine learning analysis with SourceTracker confirmed that donor microbiota was retained four times better in the recipient calves treated with FD-FMT than F-FMT. A predictive model based on receiver operating characteristic curve analysis and area under the curve showed that FD-FMT was more discriminative than F-FMT of the observed changes in microbiota and metabolites during disease recovery. These results provide new insights into establishing methods for preparing fecal microorganisms to increase the quality of FMT in animals and may contribute to FMT in humans., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics declarations The study was conducted in accordance with the Guidelines for Laboratory Animal Welfare and Animal Experiment Control promulgated by the ethics committee of Chiba NOSAI Kanji-kai (Approval No. CNS190901 and CNS190902). It is confirmed that the authors complied with the ARRIVE guidelines., (© 2024. The Author(s).)

People generally wish to return home after being evacuated due to disaster situations. Evacuation orders have now been lifted in the Fukushima region following the nuclear accident in 2011, and the Japanese government is promoting a return policy. However, many residents who wish to return home remain unable to and continue living in evacuation sites or other areas. Sixteen residents of Katsurao village were interviewed after evacuation orders were lifted in 2016 who have not yet returned. Concerns were cited regarding radiation, prolonged evacuation, health problems, buying a house in the evacuation area and schooling. The problems identified were primarily due to the rapid ageing and decline of the regional population, reflecting similar issues throughout Japan. In particular, health problems and intention to return were thought to be closely related. Over 10 y have passed since the evacuation, and many residents have experienced familial separation and divided living situations., (© The Author(s) 2024. Published by Oxford University Press.)

Background: Acetabular fractures are among the most challenging orthopaedic fractures, and a high total hip arthroplasty (THA) conversion rate has been reported in older patients with acetabular fractures. Bone quality is a poor prognostic factor after acetabular fracture fixation and has been assessed using computed tomography (CT). However, the relationship between Hounsfield unit (HU) values measured using CT and early acetabular fracture outcomes remains unknown. This study aimed to elucidate the effect of HUs on early acetabular fracture outcomes., Methods: 50 consecutive patients who underwent open reduction and internal fixation for acetabular fractures were included. The mean follow-up duration was 24 months. 27 hips had elementary fractures and 23 had associated fractures. The reduction quality assessed using CT was as follows: anatomical, 13 hips; imperfect, 10 hips; and poor, 27 hips. Secondary hip osteoarthritis was observed in 5 patients (10%), and the surgery was converted to THA in 1 patient (2%). The HU values of the fifth vertebral body and the unaffected side of the femoral head were measured. The fracture type, radiological secondary hip osteoarthritis, conversion to THA, and postoperative displacement gap were recorded., Results: The unaffected femoral head HU values in elementary fractures (250.5 ± 50.5) were significantly higher than those in associated fractures (221.5 ± 48) ( p   <  0.047). The HU values of the fifth vertebral body and the unaffected femoral head were significantly correlated with the postoperative residual displacement gap and were significantly lower in those with secondary osteoarthritis than in those without it. The cut-off value for predicting early osteoarthritic change after an acetabular fracture was approximately 180., Conclusions: The HU values were correlated with the fracture type, postoperative displacement gap, and early osteoarthritic change after acetabular fractures and are clinically useful prognostic factors for early acetabular fracture outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The mid-face has been rendered as the cornerstone of facial aesthetic improvement, since treating the mid-face has also beneficial effects on neighboring esthetic units and therefore should be one of the first areas to be assessed. Retaining ligaments (RL) bind soft tissue layers of the face to the underlying facial skeleton. It remains controversial whether RL suffers laxity with aging or if changes in 42 bone and other structures where ligaments are inserted lead to altered mechanical function of the latter. Enhancement of the supportive effect of the ligaments could help restore the soft tissues to their original anatomical positions and achieve a lifting effect. While injectable hyaluronic acid implants have been used to improve ligament support, calcium hydroxylapatite has one of the highest viscoelasticities when compared with other dermal fillers and can induce collagen synthesis, which could provide long-term laxity correction. In this preliminary report of a case series, our goal was to describe the use of calcium hydroxylapatite in different dilutions and combinations for different aging profiles to treat the midface as an alternative for hyaluronic acid injections and to describe the ultrasonographic behavior in the long run., Competing Interests: Dr Sato and Dr Muniz have been speakers for Merz Pharmaceuticals. The authors report no other conflicts of interest in this work., (© 2024 Sato et al.)

Chloroplasts are photosynthetic organelles that evolved through the endosymbiosis between cyanobacteria-like symbionts and hosts. Many studies have attempted to isolate intact chloroplasts to analyze their morphological characteristics and photosynthetic activity. Although several studies introduced isolated chloroplasts into the cells of different species, their photosynthetic activities have not been confirmed. In this study, we isolated photosynthetically active chloroplasts from the primitive red alga Cyanidioschyzon merolae and incorporated them in cultured mammalian cells via co-cultivation. The incorporated chloroplasts retained their thylakoid structure in intracellular vesicles and were maintained in the cytoplasm, surrounded by the mitochondria near the nucleus. Moreover, the incorporated chloroplasts maintained electron transport activity of photosystem II in cultured mammalian cells for at least 2 days after the incorporation. Our top-down synthetic biology-based approach may serve as a foundation for creating artificially photosynthetic animal cells.

Competing Interests: Funding Support and Author Disclosures Dr Yashima is a clinical proctor of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

We herein report a case of IgG4-related autoimmune hepatitis (AIH) in a patient with a history of type 1 autoimmune pancreatitis. A 56-year-old man presented with fatigue and jaundice at our hospital. A blood biochemistry analysis revealed significant liver dysfunction, positive results for antinuclear antibodies, and high serum IgG4 levels. A histopathological examination revealed interface hepatitis marked by IgG4-positive plasma cell infiltration in the portal area, leading to liver cell depletion and necrosis. Based on the diagnosis of IgG4-related AIH, prednisolone treatment was initiated, which led to the rapid resolution of liver dysfunction and jaundice. An accurate diagnosis of IgG4-related AIH is crucial to prevent secondary manifestations.

Context: The Bereaved Family Survey is an important method for evaluating the quality of palliative care., Objectives: To examine the distress and benefits of bereaved families of patients with or without cancer, who participated in a Bereaved Family Survey, and identify factors associated with distress and benefits., Methods: We conducted a nationwide cross-sectional, self-reported questionnaire mail survey among the bereaved families of patients who died of cancer, heart disease, cerebrovascular disease, pneumonia, or kidney failure. Participants answered questions on a four-point Likert scale measuring the distress and benefit associated with participating in the Bereaved Family Survey. We conducted a qualitative analysis of responses to open-ended questions about the distress and benefits of participating in the survey to comprehensively examine the distress and benefits of participating in the survey., Results: Questionnaires were distributed to 115,816 eligible bereaved family members between February 2019 and February 2020; 62,576 (54.0%) family members returned valid responses. Distress and benefits accounted for 51.4% and 49.3%, respectively. The results of the binomial logistic analysis for distress were significantly higher among cancer patients (p<0.001-0.003), 20-39-year-old patients (p<0.001), female bereaved family members (p<0.001), and bereaved family members with poor mental health statuses (p<0.001). Factors related to "benefit" were significantly higher among over-80-year-old bereaved family members (p<0.001), higher care evaluation scale (CES) scores (p<0.001), and higher good death inventory (GDI) scores (p<0.001)., Conclusion: Bereaved family members experience both distress and benefits. There is need to devise ways to reduce distress and increase its benefits to continue assessing the quality of palliative care., Competing Interests: Disclosure and Conflicts of interest The authors have no potential conflicts of interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Background: Water-soluble arabinoxylan exerts anti-colitic effect and exhibits ameliorative activity in an inflammatory bowel disease (IBD) mouse model. Water soluble fibre from wheat bran (WB) also exhibits anti-colitic effect. However, arabinoxylan is a primary compound of insoluble polysaccharide (hemicellulose) in WB. This study aimed to clarify the anti-IBD effects of the WB water-soluble (WBS) and water-insoluble (WBI) fractions., Methods and Results: WB suspension was autoclaved and fractionated to WBS and WBI. C57BL/6 mice were divided into control (CT), dextran sodium sulphate (DSS), WBI, and WBS groups. They were fed as follows from day 1: CT, standard diet and distilled water; DSS and WBI, 3% (w/v) DSS in drinking water; WBI, 8% (w/w) WBI diet; and WBS, 50% (v/v) WBS and 3% (w/v) DSS in water. DSS group mice showed diarrhoea, body weight reduction, and blood in faeces by day 5 and colon tissue damage by day 6. These inflammatory indices were significantly inhibited by treatment with WBI. Amplicon sequencing of the 16S rDNA (V4) gene of the caecal contents of the CT, DSS, and WBI groups showed that the abundances of Escherichia, Allobaculum, and Bacteroidaceae increased and that of Faecalibaculum decreased in the DSS group. KEGG pathway prediction showed that amino acid metabolism and lipopolysaccharide biosynthesis decreased and increased, respectively, in the DSS group. However, WBI treatment tended to suppress these effects., Conclusion: WBI, rather than WBS, reduces inflammation and maintains the gut microbiota. However, further studies are warranted to elucidate the properties of the WBI active components and efficacy of WBI metabolites on gut microbiota, particularly on Faecalibaculum., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background/aim: Salmonella typhimurium A1-R has been shown to target and inhibit many types of cancers in mouse models without continuous infection of normal tissue. The objective of the present study was to determine the effective dose of orally-administered Salmonella typhimurium A1-R, expressing-green fluorescent protein (GFP), on an HT1080 human-fibrosarcoma nude-mouse model., Materials and Methods: The HT1080-human- fibrosarcoma nude-mouse models were randomized into the following three groups: G1: untreated control; G2: Oral Salmonella typhimurium A1-R (5×10 7 colony forming units [CFU]/body, twice a week, 2 weeks); G3: Oral Salmonella typhimurium A1-R (3.3×10 8 CFU/body, twice a week, 2 weeks). Each group comprised five mice. Body weight and tumor volume were measured twice a week. The number of colonies of Salmonella typhimurium A1-R-GFP in excised tumors and excised livers in groups G2 and G3 were determined on day 3, day 7 and 14 by growth on agar plates. Tukey-Kramer analysis was used to examine the relationships between variables. Statistically-significant results are defined as those with p≤0.05., Results: Salmonella typhimurium A1-R was administered orally at a dose of 3.3×10 8 CFU, which successfully regressed the HT1080 tumor in nude mice. However, this effect was not observed at a lower dose of 5×10 7 CFU. After administering Salmonella typhimurium A1-R at 3.3×10 8 CFU, tumors and liver tissues were harvested, homogenized, and cultured on days 3, 7 and 14. Resulting GFP-expressing Salmonella typhimurium A1-R colonies were then counted. The number of GFP-bacterial colonies derived from excised tumors at intervals of 3, 7, and 14 days increased over time post-administration of oral GFP-Salmonella typhimurium. Conversely, the number of GFP-Salmonella typhimurium A1-R colonies that could be grown from excised livers decreased over time, following oral administration of GFP-Salmonella typhimurium. Additionally, the GFP-bacterial colonies grown from the excised tumors were significantly larger than those grown from the excised livers., Conclusion: The present study showed that an aggressive fibrosarcoma could be regressed by orally-administered Salmonella typhimurium A1-R which accurately targeted tumors without continuous growth in normal organs. The present results suggested the potential of orally-administered Salmonella typhimurium A1-R as a probiotic to treat aggressive soft-tissue sarcoma., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Methionine restriction selectively arrests cancer cells during the S-phase of the cell cycle. We hypothesized that DNA damage may occur in S-phase in cancer cells during methionine restriction. To determine if this occurs, we used MiaPaCa-2 Tet-On 53BP1-green fluorescent protein (GFP) pancreatic cancer cells, which report GFP fluorescence in real time after DNA-damage response (DDR) in these cells. We also determined whether a chemotherapy drug in combination with methionine restriction increases the rate of DNA damage., Materials and Methods: MiaPaCa-2 Tet-On 53BP1-GFP cells were used for in vitro experiments. The 25% and 50% inhibitory concentrations (IC 25 and IC 50 , respectively) of recombinant methioninase (rMETase) and paclitaxel on MiaPaCa-2 Tet-On 53BP1-GFP pancreatic cancer cells were determined. Cell viability and DDR with rMETase alone, paclitaxel alone, and their combination were measured in MiaPaCa-2 Tet-On 53BP1-GFP cells., Results: The IC 25 of rMETase on MiaPaCa-2 Tet-On 53BP1-GFP cells was 1.66 U/ml. The IC 25 for paclitaxel on MiaPaCa-2 Tet-On 53BP1-GFP cells was 3.31 nM. The combination of rMETase and paclitaxel synergistically reduced the viability of MiaPaCa-2 Tet-On 53BP1-GFP cells. The IC 50 of paclitacel on MiaPaCa-2 Tet-On 53BP1-GFP cells was 5.1 nM. The IC 50 of rMETase on MiaPaCa-2 Tet-On 53BP1-GFP cells was 2.3 U/ml. The combination of rMETase (IC 50 ) plus paclitaxel (IC 50 ) on MiaPaCa-2 Tet-On 53BP1-GFP cells also caused more DNA damage than either agent alone., Conclusion: The present study suggests the synergy of methionine restriction and chemotherapy is due, at least in part, to DNA damage of cancer cells., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: This study was aimed to compare the efficacy of two combination tablets of dipeptidyl peptidase-4 (DPP-4) inhibitors and metformin with different dosages, alogliptin/metformin (AM) and vildagliptin/metformin (VM), on glycemic control in patients with type 2 diabetes (T2D). Methods: This was a prospective, multicenter, open-label, randomized, parallel group, comparative trial. After a run-in period of treatment with metformin alone, a total of 59 Japanese outpatients with T2D, aged 20-79 years with glycated hemoglobin (HbA1c) levels of 6.5%-10% were randomly assigned to 12-week AM treatment, alogliptin 25 mg/metformin 500 mg combination tablet orally once a day, or VM treatment, vildagliptin 50 mg/metformin 250 mg combination tablet orally twice a day. The primary endpoints were the changes in HbA1c and fasting plasma glucose (FPG) levels from baseline to week 12 between the two groups. Blinded intermittently scanned continuous glucose monitoring (isCGM) was performed between weeks 10 and 12. The incidence of adverse events during the study was also evaluated. Results: In all, 52 participants were analyzed. Significant decreases in HbA1c and FPG levels from baseline to week 12 were observed in both treatment groups. However, there were no significant differences between the AM and VM groups in the change in HbA1c level (-0.3% and -0.4%, P = 0.309) or the FPG level (-9.0 and -15.0 mg/dL, P = 0.789). The isCGM revealed that both treatments achieved the recommended glycemic target range. No adverse events, such as severe hypoglycemia, were observed in either group. Conclusions: We concluded that there were no significant differences in the efficacy of two combination tablets of DPP-4 inhibitors and metformin with different dosages on glycemic control in patients with T2D.

Inequality in access to green and blue spaces is a major issue in the field of environmental justice. Various factors significantly influence visitations to these spaces, including residential, commuting, and shopping areas. However, studies have mainly focused on residential environments. Analyzing the coupling of environmental and socioeconomic factors, including age, income, and childhood experience, and examining the direct and indirect effects of these factors for different age groups are needed to better understand the detailed context of inequalities in access to ecosystem services. We conducted a questionnaire survey and analysis to address these needs in an urban setting. The results demonstrate that several land use categories (i.e., agricultural lands in residential areas, grasslands near shopping areas, and deciduous forests near commuting destinations) positively correlated with visitation frequency, suggesting the lack thereof may be the cause of access inequalities. In particular, the perimeter per unit area of some land cover types, which shows the complexity of the form of each land cover category, was found to be a significant factor. We identified inequality in nature experience to be the key factor correlated with inequality in nature visits among the young age group. For the middle-aged and old age groups, nature-relatedness was positively correlated with visitation frequency. Proper design of the local environment, such as through land use planning, can be an effective measure for all age groups. For instance, long-bordered green areas in the Monsoon Asian region are an attractive traditional landscape, with high accessibility and a comfortable thermal environment. The key factors for each age group should be considered in spatial design and inclusive information-sharing to reduce inequality in access to ecosystem services., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In the KEAP1-NRF2 stress response system, KEAP1 acts as a sensor for oxidative and electrophilic stresses through formation of S-S bond and C-S bond, respectively. Of the many questions left related to the sensor activity, following three appear important; whether these KEAP1 sensor systems are operating in vivo, whether oxidative and electrophilic stresses are sensed by the similar or distinct systems, and how KEAP1 equips highly sensitive mechanisms detecting oxidative and electrophilic stresses in vivo. To address these questions, we conducted a series of analyses utilizing KEAP1-cysteine substitution mutant mice, conditional selenocysteine-tRNA (Trsp) knockout mice, and human cohort whole genome sequence (WGS) data. Firstly, the Trsp-knockout provokes severe deficiency of selenoproteins and compensatory activation of NRF2. However, mice lacking homozygously a pair of critical oxidative stress sensor cysteine residues of KEAP1 fail to activate NRF2 in the Trsp-knockout livers. Secondly, this study provides evidence for the differential utilization of KEAP1 sensors for oxidative and electrophilic stresses in vivo. Thirdly, theoretical calculations show that the KEAP1 dimer equips quite sensitive sensor machinery in which modification of a single molecule of KEAP1 within the dimer is sufficient to affect the activity. WGS examinations of rare variants identified seven non-synonymous variants in the oxidative stress sensors in human KEAP1, while no variant was found in electrophilic sensor cysteine residues, supporting the fail-safe nature of the KEAP1 oxidative stress sensor activity. These results provide valuable information for our understanding how mammals respond to oxidative and electrophilic stresses efficiently., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Background: Defective hepatitis C virus (HCV) genomes with deletion of the envelope region have been occasionally reported by short-read sequencing analyses. However, the clinical and virological details of such deletion HCV have not been fully elucidated., Methods: We developed a highly accurate single-molecule sequencing system for full-length HCV genes by combining the third-generation nanopore sequencing with rolling circle amplification (RCA) and investigated the characteristics of deletion HCV through the analysis of 21 patients chronically infected with genotype-1b HCV., Result: In 5 of the 21 patients, a defective HCV genome with approximately 2000 bp deletion from the E1 to NS2 region was detected, with the read frequencies of 34-77%, suggesting the trans-complementation of the co-infecting complete HCV. Deletion HCV was found exclusively in decompensated cirrhosis (5/12 patients), and no deletion HCV was observed in nine compensated patients. Comparing the amino acid substitutions between the deletion and complete HCV (DAS, deletion-associated substitutions), the deletion HCV showed higher amino acid mutations in the ISDR (interferon sensitivity-determining region) in NS5A, and also in the TMS (transmembrane segment) 3 to H (helix) 2 region of NS2., Conclusions: Defective HCV genome with deletion of envelope genes is associated with decompensated cirrhosis. The deletion HCV seems susceptible to innate immunity, such as endogenous interferon with NS5A mutations, escaping from acquired immunity with deletion of envelope proteins with potential modulation of replication capabilities with NS2 mutations. The relationship between these mutations and liver damage caused by HCV deletion is worth investigating., (© 2024. Japanese Society of Gastroenterology.)

Aims/hypothesis: Clustering-based subclassification of type 2 diabetes, which reflects pathophysiology and genetic predisposition, is a promising approach for providing personalised and effective therapeutic strategies. Ahlqvist's classification is currently the most vigorously validated method because of its superior ability to predict diabetes complications but it does not have strong consistency over time and requires HOMA2 indices, which are not routinely available in clinical practice and standard cohort studies. We developed a machine learning (ML) model to classify individuals with type 2 diabetes into Ahlqvist's subtypes consistently over time., Methods: Cohort 1 dataset comprised 619 Japanese individuals with type 2 diabetes who were divided into training and test sets for ML models in a 7:3 ratio. Cohort 2 dataset, comprising 597 individuals with type 2 diabetes, was used for external validation. Participants were pre-labelled (T2D kmeans ) by unsupervised k-means clustering based on Ahlqvist's variables (age at diagnosis, BMI, HbA 1c , HOMA2-B and HOMA2-IR) to four subtypes: severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD) and mild age-related diabetes (MARD). We adopted 15 variables for a multiclass classification random forest (RF) algorithm to predict type 2 diabetes subtypes (T2D RF15 ). The proximity matrix computed by RF was visualised using a uniform manifold approximation and projection. Finally, we used a putative subset with missing insulin-related variables to test the predictive performance of the validation cohort, consistency of subtypes over time and prediction ability of diabetes complications., Results: T2D RF15 demonstrated a 94% accuracy for predicting T2D kmeans type 2 diabetes subtypes (AUCs ≥0.99 and F1 score [an indicator calculated by harmonic mean from precision and recall] ≥0.9) and retained the predictive performance in the external validation cohort (86.3%). T2D RF15 showed an accuracy of 82.9% for detecting T2D kmeans , also in a putative subset with missing insulin-related variables, when used with an imputation algorithm. In Kaplan-Meier analysis, the diabetes clusters of T2D RF15 demonstrated distinct accumulation risks of diabetic retinopathy in SIDD and that of chronic kidney disease in SIRD during a median observation period of 11.6 (4.5-18.3) years, similarly to the subtypes using T2D kmeans . The predictive accuracy was improved after excluding individuals with low predictive probability, who were categorised as an 'undecidable' cluster. T2D RF15 , after excluding undecidable individuals, showed higher consistency (100% for SIDD, 68.6% for SIRD, 94.4% for MOD and 97.9% for MARD) than T2D kmeans ., Conclusions/interpretation: The new ML model for predicting Ahlqvist's subtypes of type 2 diabetes has great potential for application in clinical practice and cohort studies because it can classify individuals with missing HOMA2 indices and predict glycaemic control, diabetic complications and treatment outcomes with long-term consistency by using readily available variables. Future studies are needed to assess whether our approach is applicable to research and/or clinical practice in multiethnic populations., (© 2024. The Author(s).)

We investigated the detailed characteristics and proportions of typical and atypical rashes in 28 patients with adult-onset Still's disease (AOSD) by retrospectively examining the clinical symptoms and pathological features. The patients consisted of six males and 22 females aged between 23 and 85 years. The skin rashes observed in the study population were as follows: (i) typical rash in six cases, (ii) atypical rash in 19, and (iii) both typical and atypical rash in three cases (in all three cases, typical rash preceded atypical rash). Furthermore, we classified atypical rashes into persistent pruritic papules and plaques (PPPP) and others. In 22 cases of atypical rashes, 10 cases had PPPP. In a comparison between young-onset (<65 years) (n = 16) and elderly-onset (≥65 years) (n = 12) AOSD cases, typical rashes were observed more frequently in the young-onset cases. Regarding atypical rashes, PPPP was significantly more common in the elderly-onset cases., (© 2024 Japanese Dermatological Association.)

Purpose: To assess the impact of genetic risk estimation for primary open-angle glaucoma (POAG) in Japanese individuals., Design: Cross-sectional analysis., Participants: Genetic risk scores (GRSs) were constructed based on a genome-wide association study (GWAS) of POAG in Japanese people. A total of 3625 Japanese individuals, including 1191 patients and 2434 controls (Japanese Tohoku), were used for the model selection. We also evaluated the discriminative accuracy of constructed GRSs in a dataset comprising 1034 patients and 1147 controls (the Japan Glaucoma Society Omics Group [JGS-OG] and the Genomic Research Committee of the Japanese Ophthalmological Society [GRC-JOS]) and 1900 participants from a population-based study (Hisayama Study)., Methods: We evaluated 2 types of GRSs: polygenic risk scores using the pruning and thresholding procedure and a GRS using variants associated with POAG in the GWAS of the International Glaucoma Genetics Consortium (IGGC). We selected the model with the highest areas under the receiver operating characteristic curve (AUC). In the population-based study, we evaluated the correlations between GRS and ocular measurements., Main Outcome Measure: Proportion of patients with POAG after stratification according to the GRS., Results: We found that a GRS using 98 variants, which showed genome-wide significance in the IGGC, showed the best discriminative accuracy (AUC, 0.65). In the Japanese Tohoku, the proportion of patients with POAG in the top 10% individuals was significantly higher than that in the lowest 10% (odds ratio [OR], 6.15; 95% confidence interval [CI], 4.35-8.71). In the JGS-OG and GRC-JOS, we confirmed similar impact of POAG GRS (AUC, 0.64; OR [top vs. bottom decile], 5.81; 95% CI, 3.79-9.01). In the population-based study, POAG prevalence was significantly higher in the top 20% individuals of the GRS compared with the bottom 20% (9.2% vs. 5.0%). However, the discriminative accuracy was low (AUC, 0.56). The POAG GRS was correlated positively with intraocular pressure (r = 0.08: P = 4.0 × 10 -4 ) and vertical cup-to-disc ratio (r = 0.11; P = 4.0 × 10 -6 )., Conclusions: The GRS showed moderate discriminative accuracy for POAG in the Japanese population. However, risk stratification in the general population showed relatively weak discriminative performance., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: Recurrent head and neck cancer presents a therapeutic challenge because of cumulative toxicity from initial radiation therapy, limiting reirradiation options. Boron neutron capture therapy (BNCT) offers a promising alternative, selectively delivering a radical dose to tumors while sparing adjacent normal tissue. This study investigates the initial clinical outcomes and prognostic factors associated with BNCT for recurrent squamous cell carcinoma of the head and neck., Methods and Materials: This retrospective analysis investigated the initial 47 patients treated with BNCT between May 2020 and February 2021 in Japan. All patients had received radiation therapy with a median dose of 70 Gy (range, 44-176) before BNCT. Median tumor size was 11 cm 3 (range, 1-117 cm 3 ), with 23% of tumors larger than 30 cm 3 , and 87% of patients had prior systemic therapy. The most common prescribed dose to the pharyngeal mucosa was 15 Gy-Eq (36%), followed by 18 Gy-Eq (34%). The minimum dose given to tumor was 27.4 Gy-Eq (range, 13.3-45.2). In 23 patients, 18 F-fluoro-borono-phenylalanine positron emission tomography was performed within 1 week before BNCT, and the tumor-to-blood 10 B ratio was 3.5 (range, 2.0-8.7)., Results: Efficacy analysis revealed a 51% complete response rate and a 74% overall response rate. Disease-free survival rates at 1 and 2 years were 34.6% and 26.6%, respectively. Overall survival rates at 1 and 2 years were 86.1% and 66.5%, respectively. Multivariate analysis revealed that, among the patient characteristics, whether the lesion was mucosal had a significant effect on achieving complete response., Conclusions: This study provided valuable insights into the early integration of BNCT into routine clinical practice, highlighting its efficacy and safety. Technical improvements are needed to ensure precise dose administration. Ongoing prospective studies, such as the phase II REBIVAL study, will further elucidate the role of BNCT in recurrent head and neck cancer., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Design: Multicenter prospective study., Objective: Patients with central sensitization (CS) are reported to be at high risk of poor outcomes after spinal surgery. However, the influence of CS on surgical outcomes for lumbar disc herniation (LDH) remains unknown. This study aimed to examine the association between preoperative CS and surgical outcomes in LDH patients., Methods: A total of 100 consecutive patients with LDH (mean age 51.2) who underwent lumbar surgery were included in this study. The extent of CS was evaluated using the central sensitization inventory (CSI), a screening tool for CS-related symptoms. The patients completed the following CSI and clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire (JOABPEQ), and Oswestry Disability Index (ODI). The association between preoperative CSI scores, and preoperative and postoperative COAs was analyzed, and the postoperative changes were statistically evaluated., Results: The preoperative CSI score significantly decreased 12 months postoperatively. Preoperative CSI scores showed a significant correlation with most COAs; however, a significant correlation was only identified in the social function and mental health domains of JOABPEC postoperatively. Higher preoperative CSI showed worse preoperative COAs; however, all COAs significantly improved regardless of CSI severity. There were no significant differences in any COAs among the CSI severity groups 12 months postoperatively., Conclusions: The results of this study showed that lumbar surgeries significantly improved the COAs regardless of preoperative severity of CS in patients with LDH., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The objective of this study is to investigate factors associated with outcomes after 3 months of instructed usage of hand-held digital devices (DD) in patients with acquired comitant esotropia (ACE)., Methods and Analysis: This prospective multicentre observational study included patients with ACE, aged 5-35 years, who used DD within 1 year of onset and were followed up for clinical findings and instructed use of DD. The outcomes were classified into four groups: cured, improved, unchanged and worsened. After the analysis of group differences in the clinical and DD use-related factors by univariate analysis, we used ordinal logistic regression models to identify factors associated with favourable outcomes., Results: Of 156 patients (mean age (SD): 16.4 (7.4) years), 10 (6%), 58 (37%), 67 (43%) and 21 (14%) were classified into the cured, improved, unchanged, and worsened, respectively. In the univariate analysis, consultation within 3 months of onset, small-angle strabismus at distance and good stereoacuity were associated with good outcomes. Ordinal logistic regression analysis on adjusting for age with stereoacuity or successful DD-use time halving showed that small-angle strabismus at distance (OR: 1.02, 95% CI 1.00 to 1.03, p=0.023), good stereoacuity (OR: 1.31; 95% CI 1.10 to 1.56; p=0.003) and successful halving of DD-use time (OR: 0.63; 95% CI 0.43 to 0.92; p=0.016) influenced favourable outcomes., Conclusion: Patients with small-angle esotropia, good stereoacuity on consultation and success in halving DD-use time had a higher chance of recovery through instructional DD usage. Further studies using objectively measurable systems are needed to ensure the accuracy of DD-use time., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Brownian dynamics simulations have been performed to investigate the structural dependence of the first epitaxial layer in colloidal heteroepitaxy. When the epitaxial particles were larger than the substrate particles and the interactions were dominated by the depletion force, a hexagonal structure formed on a closely packed hexagonal substrate. The orientation of this hexagonal structure varied with the size ratio of the epitaxial to substrate particles to make the interaction between the substrate and epitaxial particles strong. When the sizes of the substrate and epitaxial particles were similar, long-period structures formed instead of hexagonal structures to strengthen the interaction between the substrate and epitaxial layer at the expense of the interaction between particles in the first epitaxial layer.

Use of immune checkpoint inhibitors (ICIs) as cancer immunotherapy has advanced rapidly in the clinic; however, ICI initiation can also cause an unexpectedly rapid acceleration of cancer progression in some patients. Here, we used a murine syngeneic melanoma model to conduct mechanistic analysis of cancer-associated fibroblast (CAF) function in cancer progression in the context of immunotherapy. We found that after ICI treatment CAFs acquire inflammatory properties, which can promote tumor progression. Mechanistically, we show that T-cell-derived interferon-γ (IFN-γ) stimulates production of tumor necrosis factor-α (TNF-α) by macrophages, facilitating CAF conversion to inflammatory CAFs. Our findings suggest that CAF/immune cell crosstalk plays an essential role in ICI-associated tumor progression., (© 2024 Molecular Biology Society of Japan and John Wiley & Sons Australia, Ltd.)

Importance: Physical biomarkers for stratifying patients with lung cancer into subtypes suggestive of outcomes are underexplored., Objective: To investigate the clinical utility of respiratory sarcopenia for optimizing postoperative risk stratification in patients with non-small cell lung cancer (NSCLC)., Design, Setting, and Participants: This retrospective cohort study reviewed consecutive patients undergoing lobectomy and mediastinal lymph node dissection for NSCLC at 2 institutions in Tokyo, Japan, between 2009 and 2018. Eligible patients underwent electronic computed tomography image analysis. Follow-up began at the date of surgery and continued until death, the last contact, or March 2022. Data analysis was performed from April 2022 to March 2023., Main Outcomes and Measures: Respiratory sarcopenia was identified by poor respiratory strength (peak expiratory flow rate) and was confirmed by a low pectoralis muscle index (PMI; pectoralis muscle area/body mass index). Patients with poor peak expiratory flow rate but normal PMI received a diagnosis of pre-respiratory sarcopenia. Short-term and long-term postoperative outcomes were compared among patients with a normal status, pre-respiratory sarcopenia, and respiratory sarcopenia. Group differences were analyzed using the Kruskal-Wallis test and Pearson χ2 test for continuous and categorical data, respectively. Survival differences were compared using the log-rank test. Univariable and multivariable analyses were conducted using the Cox proportional hazards model., Results: Of a total of 1016 patients, 806 (497 men [61.7%]; median [IQR] age, 69 [64-76] years) were eligible for electronic computed tomography image analysis. The median (IQR) duration of follow-up for survival was 5.2 (3.6-6.4) years. Respiratory strength was more closely correlated with PMI than pectoralis muscle radiodensity (Pearson r2, 0.58 vs 0.29). Respiratory strength and PMI declined with aging simultaneously (both P for trend < .001). Pre-respiratory sarcopenia was present in 177 patients (22.0%), and respiratory sarcopenia was present in 130 patients (16.1%). The risk of postoperative complications escalated from 82 patients (16.4%) with normal status to 39 patients (22.0%) with pre-respiratory sarcopenia to 39 patients (30.0%) with respiratory sarcopenia (P for trend < .001), as did the risk of delayed recovery after surgery (P for trend < .001). Compared with patients with normal status or pre-respiratory sarcopenia, patients with respiratory sarcopenia exhibited worse 5-year overall survival (438 patients [87.2%] vs 133 patients [72.9%] vs 85 patients [62.5%]; P for trend < .001). Multivariable analysis identified respiratory sarcopenia as a factor independently associated with increased risk of mortality (hazard ratio, 1.83; 95% CI, 1.15-2.89; P = .01) after adjustment for sex, age, smoking status, performance status, chronic heart disease, forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, C-reactive protein, albumin, carcinoembryonic antigen, histology, and pathologic stage., Conclusions and Relevance: This study identified individuals at higher risk of poor outcomes by screening and staging respiratory sarcopenia. The early diagnosis of respiratory sarcopenia could optimize management strategies and facilitate longitudinal care in patients with NSCLC.

Land plants have evolved a hydrophobic cuticle on the surface of aerial organs as an adaptation to ensure survival in terrestrial environments. Cuticle is mainly composed of lipids, namely cutin and intracuticular wax, with epicuticular wax deposited on plant surface. The composition and permeability of cuticle have a large influence on its ability to protect plants against drought stress. However, the regulatory mechanisms underlying cuticular wax biosynthesis in response to drought stress have not been fully elucidated. Here, we identified three AP2/ERF transcription factors (DREB26/ERF12, ERF13 and ERF14) involved in the regulation of water permeability of the plant surface. Transmission electron microscopy revealed thicker cuticle on the leaves of DREB26-overexpressing (DREB26OX) plants, and thinner cuticle on the leaves of transgenic plants expressing SRDX repression domain-fused DREB26 (DREB26SR). Genes involved in cuticular wax formation were upregulated in DREB26OX and downregulated in DREB26SR. The levels of very-long chain (VLC) alkanes, which are a major wax component, increased in DREB26OX leaves and decreased in DREB26SR leaves. Under dehydration stress, water loss was reduced in DREB26OX and increased in DREB26SR. The erf12/13/14 triple mutant showed delayed growth, decreased leaf water content, and reduced drought-inducible VLC alkane accumulation. Taken together, our results indicate that the DREB26/ERF12 and its closed family members, ERF13 and ERF14, play an important role in cuticular wax biosynthesis in response to drought stress. The complex transcriptional cascade involved in the regulation of cuticular wax biosynthesis under drought stress conditions is discussed., (© 2024 The Author(s). The Plant Journal published by Society for Experimental Biology and John Wiley & Sons Ltd.)

A locomotor system that can function across different environmental conditions and produce a range of performances is one of the most critical abilities needed for extant and extinct animals in order to survive and maximise their competitive fitness. Recent engineering-inspired paleontological studies have reconstructed feasible locomotor patterns in extinct animals. However, it is still challenging to describe how extinct animals successfully adjust their locomotor patterns to new situations (e.g., changes in locomotor speed and morphology). In this study, we develop a novel reconstruction method based on a bio-inspired control system. We focus on plesiosaurs, an extinct aquatic reptile group which has two pairs of flipper-shaped limbs, and demonstrate that a highly optimised, flexible locomotor pattern for all four flippers can be reconstructed based on a decentralized control scheme formulated from extant animals' locomotion. The results of our robotic experiments show that a simple, local sensory feedback mechanism allows the plesiosaur-like robot to exploit the fluid flow between the flippers and generate efficient swimming patterns in response to changes in locomotor conditions. Our new method provides further evidence how decentralized control systems can produce a pathway between extinct and extant animals in order to understand the how extinct animals moved and how these movement patterns may have evolved., (© 2024. The Author(s).)

This rapid communication highlights the correlation between protein kinase B alpha (AKT1)-phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)- phosphatase and tensin homolog (PTEN) alterations and clinicopathological factors in Japanese patients with metastatic recurrent breast cancer (mBC). This study analyzed 1967 patients with luminal-type breast cancer who underwent cancer gene panel testing. The results demonstrated that AKT pathway alterations, including PI3K/AKT/PTEN, occurred in 1038 (52.8%) cases. Patients with AKT pathway mutations were older (p = 0.002) and had a higher rate of invasive lobular carcinoma (ILC) histology (p = 0.001), progesterone receptor (PgR) positivity (p = 0.006), and bone metastases (p = 0.001), and a lower rate of germline BRCA2 (p < 0.001). Comprehensive genomic profile results demonstrated a higher tumor mutational burden (TMB) (< 0.001) and lower tumor BRCA1/2 expression (< 0.001) in patients with mutations in the AKT pathway. These results are crucial for characterizing candidates for AKT pathway-targeted molecular therapies and conceptualizing optimal treatment strategies. Clinical trial registration: This study is an observational study and is therefore not registered with the clinical trials registration., (© 2024. The Author(s).)

Background: Malignant gliomas exhibit rapid tumor progression and resistance to treatment, leading to high lethality. One of the causes is the reduced progression of apoptosis in glioma cells. Layilin is a type 1 transmembrane protein with a C-type lectin motif in its extracellular domain. We previously reported that layilin is mainly localized to mitochondria or their close proximity and that layilin is essential for maintaining of the fragmented type of mitochondria. This study investigates the effects of layilin on mitochondria-mediated apoptosis, focusing on B cell lymphoma (BCL)-2 family proteins in a glioma cell line of A172 cells., Results: We compared the levels of pro-apoptotic BCL-2 family proteins of BAD, BAK, BAX, and BIM and anti-apoptotic BCL-2 family proteins of BCL-2 and BCL-X L between layilin- knockdown (KD) cells and control cells using western blot. The protein levels of BAD were significantly smaller in layilin-KD cells than in control cells, while those of BCL-2 were significantly larger. We then compared the mitochondrial membrane potential (ΔΨm) under p-trifluoromethoxyphenyl hydrazone (FCCP)-treated conditions using MT-1 staining. In layilin-KD cells, ΔΨm was significantly larger and FCCP-induced ΔΨm reduction was significantly lower than in control cells. Furthermore, we examined the levels of cell membrane-bound Annexin V and DNA-bound propidium idodide (PI) in layilin-KD cells with/without staurosporine (STS) treatment. Layilin-KD significantly decreased levels of cell membrane-bound Annexin V with/without STS treatment. On the other hand, PI levels were not changed by layilin-KD. We also investigated the amounts of the active caspase (CASP)-3, CASP-6, CASP-7, and poly (ADP-ribose) polymerase-1 (PARP1, cleaved form), as well as DNA fragmentation in layilin-KD cells under apoptotic conditions induced by STS, using western blot and the DNA ladder method, respectively. Under STS-treated conditions, the amounts of active CASP-3, CASP-7, and poly (ADP-ribose) PARP1 were significantly smaller in layilin-KD cells than in control cells. Accordingly, DNA fragmentation was significantly suppressed in layilin-KD cells compared to control cells under STS-treated conditions., Conclusion: This study demonstrates that layilin contributes to ΔΨm reduction to promote apoptosis by up-regulating BAD and down-regulating BCL-2 in glioma cells. Our data elucidates a new function of layilin: regulation of mitochondria-mediated apoptosis., (© 2024. The Author(s).)

Driving spin systems to states far from equilibrium is indispensable in investigations of functional nonlinearities of antiferromagnets for spintronics. So far, it has been shown that electric-field pulses in the spectral region from the visible to the terahertz range can be used to induce ultrafast switching between different spin states. Here we demonstrate that a multicycle terahertz magnetic-field pulse can be used to induce non-thermal spin switching in antiferromagnets. When a strong pulse is applied to Sm 0.7 Er 0.3 FeO 3 , the magnetic order parameter is first driven away from the barrier between the two potential minima of this antiferromagnet and then, in the subsequent inertial motion towards the opposite direction, it crosses the barrier. Our analysis reveals that the initial motion is driven by a dynamical modification of the magnetic potential, and this modification is enhanced through coupling between the two magnon modes., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Trigeminal neuralgia (TN) associated with a primitive trigeminal artery variant (PTAV) is a rare condition that causes severe facial pain. We report the case of an 81-year-old woman presenting with right facial pain. Brain magnetic resonance imaging revealed an aberrant artery originating from the cavernous portion of the right internal carotid artery (ICA), coursing laterally around the posterior clinoid process and running toward the anterior inferior cerebellar artery (AICA) territory, suggesting a PTAV. Although the pain subsided with carbamazepine, liver dysfunction developed; microvascular decompression was performed. Transposition of the PTAV in a lateral direction revealed a marked indentation at the root of the right trigeminal nerve. The PTAV was surgically transposed laterally and fixed to the pyramidal bone surface using a Teflon sling, whereas the proximal part was fixed downward to the brainstem. There was immediate facial pain relief, following surgery. We reviewed 27 cases of TN associated with PTA or PTAV reported in the literature, which showed that the average age of onset was similar to our case, at 56.5 years, with a male-to-female ratio of 1:2.85. The proportion of patients with PTAV with V2 region affected was highest (91.3%), with PTAV (AICA) being the most common aberrant blood vessel (40.7%). In cases of TN associated with PTA or PTAV, it is crucial to identify blood vessels that are compressing or contacting the nerve and transpose these arteries from the nerve. It is also critical to plan movement direction in order to prevent ischemia of perforators to the brainstem or internal auditory artery., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Japan Neurosurgical Society.)

Background : This study aimed to assess whether preoperative Hounsfield unit (HU) values differ in short-term clinical outcomes after lateral lumbar interbody fusion (LLIF) surgery. Methods : In a retrospective analysis, 109 patients undergoing LLIF for lumbar degenerative diseases (LDD) were reviewed. Preoperative Computed Tomography (CT) scans measured HU values at the L1-L4 vertebrae, dividing patients into low and high HU groups. After conducting a cluster analysis of preoperative Hounsfield unit (HU) values, patients were categorized into low and high HU groups using propensity score matching (PSM). The outcomes measured one-year post-surgery included pain intensity (Numeric Rating Scales for Low Back Pain (NRS LBP ), Leg Pain (NRS LP ), and Leg Numbness (NRS LN )) and quality of life (Japanese Orthopedic Association Back Pain Evaluation Questionnaire: JOABPEQ). Results : After PSM, there were 26 patients in each group. Significant improvements were noted in both low and high HU groups post-surgery, with the low HU group showing a decrease in NRS LBP from 6.2 to 3.7, NRS LP from 7.4 to 2.5, and NRS LN from 6.4 to 3.0. The high HU group exhibited similar improvements (NRS LBP : 6.5 to 3.6, NRS LP : 6.3 to 2.5, NRS LN : 6.2 to 2.4). JOABPEQ scores improved significantly in both groups across all domains, with no significant differences observed. Preoperative HU values have little correlation with the short-term outcomes of pain and quality of life in LLIF surgery. Conclusions : This study suggests reconsidering the role of HU values following indirect decompression via LLIF, particularly in evaluating pain and patient-reported outcome measures in patients with LDD.

Background: The health-related quality of life (HRQL) of people with food allergies should be evaluated to provide high-quality medical care. Currently, there is no available easy-to-use and reliable instrument for assessing HRQL clinically in Japan., Methods: The Food Allergy Quality of Life Questionnaire 10 (FAQLQ10) in English was translated into Japanese, and this was referred to as the Japanese version of the Food Allergy Quality of Life Questionnaire 10 (FAQLQ10-J). Participants aged up to 18 years, who had food allergy, and their parents were instructed to complete the FAQLQ10-J and the Food Allergy Independent Measure, a self-report instrument. For comparison, participants without food allergies were also included in the survey., Results: The FAQLQ10-J, which included forms for individuals aged 8-12 years, teenagers, and caregivers was developed. The responders completed each form within approximately 3 min. An analysis of responses showed that each form had a good internal consistency, test-retest reliability, construct validity, and discriminant validity. Moreover, based on an examination of the relationship between demographic data and FAQLQ10-J scores, items such as possession of an adrenaline auto-injector, participant age, and number of eliminated foods might influence HRQL., Conclusions: We developed the FAQLQ10-J, which is a simple, reliable, and effective tool for assessing HRQL among Japanese individuals with food allergy. Its use may provide a more detailed understanding of HRQL among individuals with food allergy in clinical settings and may facilitate the development of more individual-oriented treatments., Competing Interests: The authors report no competing interests., (© 2024 The Authors.)

Background: Gestational diabetes mellitus (GDM) is any degree of glucose intolerance first recognized during pregnancy. GDM awareness among pregnant women translates into GDM prevention and early diagnosis., Objective: To establish the underlying factors influencing GDM Knowledge Attitude and Practices (KAP) among pregnant women at Kinango District Hospital., Method: An explanatory mixed-methods design was implemented by initially assessing GDM KAP quantitatively [QUAN], followed by the qualitative [qual] exploration of contextual factors behind quantitative results. In the [QUAN] strand, 354 pregnant women were interviewed from January to February 2019. Thereafter, in the [qual] strand, key informant interviews were conducted among four pregnant women and three healthcare workers; a focus group discussion was held among nine pregnant women, from May to June 2019. STATA V15 software package was used to analyze the quantitative data. Qualitative data were analyzed manually using thematic analysis., Result: Among 354 pregnant women, 29.0% were knowledgeable, 46.98% had good attitude and 60.17% had good practice. Attending at least one antenatal clinic visit and having heard about diabetes mellitus were associated with good GDM attitude and practices. Among the knowledgeable pregnant women, one-third (33.33%) obtained GDM information from a health facility. Discussions with pregnant women and the interviews with healthcare workers highlighted that daily health talks during antenatal clinic, included GDM and diabetes mellitus information. Furthermore, attendance of at least one antenatal clinic visit was low (85.88%), among pregnant women (87.86%) who were expected to have attended at least one antenatal clinic visits., Conclusion: Despite low GDM knowledge, pregnant women had relatively good GDM attitudes and good GDM practices. Daily health talks conducted during antenatal clinic as well as indigenous knowledge among pregnant women, influenced the latter. Hence, GDM information dissemination needs to be enhanced for the improvement of GDM KAP among pregnant women for GDM prevention., (© 2024. The Author(s).)

Unsymmetric dinuclear Ir(I) complexes, [Ir 2 Cl 2 (L)( meso -dpmppp)] (L = XylNC ( 1aIr 2 ), t BuNC ( 1bIr 2 ), CO ( 1cIr 2 )), were synthesized using meso -Ph 2 PCH 2 P(Ph)(CH 2 ) 3 P(Ph)CH 2 PPh 2 (M meso -dpmppp), which supports cis (M P,P (M 1 ) and trans-P,P , and HCl. The IrRh heterodinuclear complexes, [M 2 M 2 , H 2 , and HCl. The IrRh heterodinuclear complexes, [M 1 M 2 ) (M 2 M meso -dpmppp)] ( 1 x M 1 M 2 ) (M 1 M 2 = IrRh, RhIr; L = XylNC, CO ( x = a , c -peroxide complexes [{M 2 complexes ( 1a,cRh }{M 2 ) to elucidate the role of each metal site. For the reactions of O 2 , 1aIr 2 and 1aRhIr showed higher reactivity than those of 1aIrRh and 1aRh 2 (M 2 , M 1 Cl 2 }{M 2 (η 2 -O 2 )(XylNC)}( meso -dpmppp)] ( 2aIr 2 , 2aRhIr ), from which O 2 would not dissociate. All the CO complexes 1cM 1 M 2 (M 1 , M 2 = Ir or Rh) showed no reactivity for O 2 . In the reactions with H 2 , 1aIr 2 reacted with H 2 }(μ-H){M 2 }{Ir(H) 2 L}( meso -dpmppp)] (M 11aIr 2 ); M 2 }(μ-H){Ir(H) 2 L}( meso -dpmppp)] ( 12aIr 2 ), while 1aRhIr ), the structures varying depending on M 1aIrRh and M 1aRh 2 gave no hydride complexes. Reactions of 1a,cM 1 M 2 with HCl afforded the dihydride complexes, [{IrCl 3 }(μ-H){Ir(H)Cl(XylNC)}( meso -dpmppp)] ( 14aIr 2 ), [{Ir(H)Cl 2 }(μ-H){M 2 Cl 2 (L)}( meso -dpmppp)] (M 2 = Ir, L = CO ( 15cIr 2 ); M 2 = Rh, L = XylNC ( 15aIrRh ), CO ( 15cIrRh )), and [{Rh(H)Cl 2 }(μ-Cl){Ir(H)Cl(XylNC)}( meso -dpmppp)] ( 18aRhIr ), the structures varying depending on M 1 and M 2 as well as L.

Purpose: In DRLs 2020, the entrance surface air kerma (Ka,e) was set to 17 mGy/min as the reference dose rate in fluoroscopy. But, Ka,e in fluoroscopy for different regions and Ka,e in exposure was not set. A multicenter survey was conducted to evaluate Ka,e by each area., Methods: Ka,e for each area was analyzed for 79 facilities attending this survey (274 machines and 461 protocols). When the protocols were changed by the difference in disease, angiography, or IVR, the difference rate of Ka,e was evaluated. Ka,e before and after modifying the incident air kerma at the patient entrance reference point (Ka,r) and air kerma area product (P KA ) difference rate were calculated when protocols were changed, considering the DRLs 2020., Results: There were dose differences in Ka,e by each area. Compared to DRLs 2020, 36 protocols from 13 facilities modified their protocols, all of which reduced Ka,e., Conclusion: Although reducing Ka,e does not necessarily reduce Ka,r, and P KA , comparison of Ka,e by each area is expected to optimize medical exposure protection, including evaluation of quality control.

Spinal cord infarction (SCI) is a rare vascular condition that can lead to the sudden onset of myelopathy, manifesting as paraplegia, bladder and bowel dysfunction, and/or sensory impairments. The primary arteries supplying the spinal cord are the anterior spinal artery (ASA) and the posterior spinal artery (PSA). The ASA mainly provides blood to the anterior two-thirds of the spinal cord, excluding the posterior columns, while the PSA primarily supplies the posterior one-third, which includes the posterior columns. It is relatively uncommon for vascular SCI to result in complete sensory loss, as the area supplied by the ASA is mainly associated with superficial sensation, while the PSA is related to deep sensation. In this report, we describe a case of SCI with pansensory deficits and explore the potential causes of pansensory loss in SCI. The patient was a 51-year-old healthy woman who experienced sudden lower back discomfort, progressing to bilateral lower limb weakness within 30 minutes, accompanied by urinary retention after lifting a heavy object. She was transferred to the hospital with stable vitals except for high blood pressure. A neurological examination revealed significant weakness in her lower limbs, hypesthesia below the Th10 level, bathyanesthesia, and areflexia. Spinal MRI showed hyperintensities at the Th11-Th12 levels, leading to a diagnosis of spinal cord infarction. She was treated with methylprednisolone, heparin, and rehabilitation. Over time, her muscle strength and sensory loss improved, though dysesthesia persisted. After 80 days of treatment and rehabilitation, she was able to walk independently with assistance and was discharged., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Izumi et al.)

Bubble printing is a patterning method in which particles are accumulated by the convection of bubbles generated by laser focusing. It is attracting attention as a method that enables the high-speed, high-precision patterning of various micro/nanoparticles. Although the bubble printing method is used for metallic particles and organic particles, most reports have focused on the patterning of solid particles and not on the patterning of liquid particles. In this study, liquid metal wiring patterns were fabricated using a bubble printing method in which eutectic gallium‒indium alloy (EGaIn) colloidal particles (≈diameter 0.7 µm) were fixed on a glass substrate by generating microbubbles through heat generation by focusing a femtosecond laser beam on the EGaIn colloidal particles. The wiring was then made conductive by replacing gallium oxide, which served as a resistance layer on the surface of the EGaIn colloidal particles, with silver via galvanic replacement. Fine continuous lines of liquid metal colloids with a line width of 3.4 µm were drawn by reducing the laser power. Liquid metal wiring with a conductivity of ≈1.5 × 10 5 S/m was formed on a glass substrate. It was confirmed that the conductivity remained consistent even when the glass substrate was bent to a curvature of 0.02 m -1 .