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Abstract Background Oral health professionals should have good COVID-19 vaccine literacy as should physicians and nurses. However, little is known about COVID-19 literacy and vaccine hesitancy among oral health professionals in Japan. Aims This study aimed to investigate the status of COVID-19 literacy and vaccine hesitancy among oral health professionals by comparing them with other healthcare workers (HCWs). Methods To compare these differences, a self-administered questionnaire-based survey of 596 staff members was conducted in March 2023 at schools, an affiliated hospital, and elderly care facilities after the staff who wished to receive it completed the fifth dose of COVID-19 vaccinations. Comparison between the recognition levels and number of vaccine doses among the HCWs were examined using the Kruskal–Wallis tests. Defining the third or lower doses of COVID-19 vaccine as vaccine hesitancy, factors associated with the hesitancy were examined using logistic regression analysis. Results In total, 408 (68.5%) participants were enrolled for the study. Dental hygienists’ COVID-19 literacy levels were lower compared to those of nurses and physicians. Dentists received a significantly lower number of vaccine doses than did physicians. Vaccine hesitancy was positively associated with younger age and higher concern about the adverse effects of the vaccine, but it was not associated with occupation. Conclusion Interventions to improve the low COVID-19 literacy and high COVID-19 vaccine hesitancy among oral health professionals, particularly young ones, are needed for COVID-19 and future pandemics.

Abstract Translocation t(6;11) occurs in approximately 5% of patients with acute myeloid leukemia (AML) corresponding to 11q23/mixed lineage leukemia (MLL) rearrangement. The AF6 gene on chromosome 6q27 is the fusion partner of the MLL gene on 11q23 in t(6;11), which results in a poor prognosis. The case of a patient with 11q23/MLL‐rearranged AML who successfully underwent a third allogeneic stem cell transplantation after treatment with azacitidine (AZA) and venetoclax (VEN) is presented in this article. This report suggests that a combination of AZA and VEN is an effective therapeutic approach for relapsed and refractory MLL‐rearranged AML.

Although the concentration of bromine in the Earth's crust is only approximately 2 µg g−1, it is one of the most crucial elements in daily human life. On the Earth's surface, bromine is thought to be widely transported and circulated in the hydrosphere, atmosphere, lithosphere, and biosphere. However, little is known regarding the dynamics of bromine in the terrestrial environments. In this study, waterlogging incubation tests were conducted on two soil types, Lowland soil and Andosol, to verify the solubilization effect of waterlogging on soil bromine. The amount of bromine in the soil extracts increased considerably with incubation time in Lowland soil and Andosol, proving that the soil reduction caused by waterlogging enhanced the solubilization of soil bromine. The amount of bromine solubilized by soil reduction tended to be higher in Andosols, which had a higher total bromine concentration than Lowland soil. The amount by soil reduction during the 28 days period ranged from 0.18 to 1.14 µg g−1 for the Lowland soil group and from 0.20 to 30.2 µg g−1 for the Andosol group. Solubilized bromine could not remain in the soil, and most of it leached out with the percolation water, as shown by the soil-filled column tests. To estimate the amount of bromine leached from a rice paddy field under waterlogged conditions, a percolation test was conducted using Wagner pot-cropped paddy rice plants. The results showed that 531 to 544 mg of bromine per square meter of soil surface leached during one growing season. The amount of bromine leached from the soil was much higher than the previously reported annual amount of bromine addition to land from atmospheric deposition. [ABSTRACT FROM AUTHOR]

Small studies in Western populations report a high prevalence of obstructive sleep apnea (OSA) in adults with Down syndrome. To date, ethnic differences have not been explored. A questionnaire sent to 2,752 adults with Down syndrome aged 16 years in Scotland and Japan (789 valid responses) estimated OSA prevalence based on reported symptoms. Symptoms were common in both countries, with snoring (p=0.001) and arousals (p=0.04) more prevalent in Japan. Estimated OSA prevalence in adults with Down syndrome was similar in the two countries, and raised in comparison with the general adult population (19.6% in Scotland and 14.3% in Japan; p = 0.08), though BMI was a confounder. Identification and treatment of OSA is recommended in adults with Down syndrome, regardless of ethnicity.

Abstract Background The pulmonary veins (PVs) have unique electrophysiological properties triggering and maintaining atrial fibrillation (AF). Bigeminal PV electrical activity (PV bigeminy) during sinus rhythm has been reported; however, its mechanisms and clinical implication remain unclear. We hypothesized that PV bigeminy indicates arrhythmogenic activities and influences clinical outcome. Methods and Results We retrospectively analyzed electrophysiological studies in 465 patients with AF who underwent first session PV isolation (PVI). PV bigeminy was observed in 30 PVs of 23 patients (4.9% of patients). PV bigeminy was observed in left inferior PV (LIPV) in 15 patients, which was the most prevalent, followed by left superior in seven and right superior in seven and right inferior in one. In response to atrial extra stimulus, the second PV potentials (PV2) showed decremental conduction properties, suggesting reentrant mechanisms involved (n = 5). Interestingly, AF was initiated from the 23 PVs with bigeminy in 21 patients (76.7% of 30 PVs with bigeminy), spontaneously or in response to drugs, which was significantly more prevalent from the AF initiation rate from each PV in the control 442 patients (182 firings in 1290 PVs, 14.1%, P

Indiscriminate regional lockdowns aim to prevent the coronavirus disease 2019 (COVID-19) infection by restricting the movement of people; however, this comes with psychological, social, and economic costs. Measures are needed that complement lockdowns and reduce adverse effects. Epidemiological studies, to date, have identified high-risk populations, but not workplaces appropriate for closure. This study was conducted to provide evidence-based measures that used exact and reliable follow-up data of the PCR-positive COVID-19 cases to complement lockdowns. The data are not subjected to selection or follow-up biases, since the Japanese government, by law, must register and follow all the PCR-positive cases until either recovery or death. Direct customer exposure may affect the quantity of viral inoculum received, which, in turn, may affect the risk of the severity of disease at infection. Therefore, the professions of the cases were grouped according to their frequency of direct customer exposure (FDCE) based on subjective observations, which resulted in five workplaces; hospital, school, food service, outdoor service, and indoor office being identified. Analyzing the follow-up data, we obtained precise estimates for the risk of severe disease, defined as intensive care unit (ICU) hospitalization or death, for the workplaces adjusted for age, sex, family status, and comorbidity. Major findings are as follows: hospital and school are the lowest risk, food and outdoor services are, despite higher FDCE, safer than indoor office. Unemployed and unclear are the highest risk, despite low FDCE. These results suggest the following workplace-specific measures complementing the lockdown: school should not be closed and indiscriminate closing of food and outdoor service industries should be avoided, since it would be more effective to reinforce their efforts to promote adherence to public health guidelines among students and customers. These actions would also reduce the adverse effects of the lockdown. This study is the first to address the causality between the workplaces and severe disease. We introduce FDCE and adherence to public health guidelines (APHGs) to associate the workplace characteristics with the risk of COVID-19 severity, which provided the basis for the measures complementing lockdowns.

Background Pulmonary vein isolation (PVI) is an established ablation procedure for atrial fibrillation (AF), however, PVI alone is insufficient to suppress AF recurrence. Non-pulmonary vein (non-PV) trigger ablation is one of the promising strategies beyond PVI and has been shown to be effective in refractory/persistent AF cases. To make non-PV trigger ablation more standardized, it is essential to develop a simple method to localize the origin of non-PV triggers. Methods We retrospectively analyzed 37 non-PV triggers in 751 ablation sessions for symptomatic AF from January 2017 to December 2020. Regarding non-PV triggers, intra-atrial activation interval from the earliest in right atrium (RA) to proximal coronary sinus (CS) (RA-CSp) and that from the earliest in RA to distal CS (RA-CSd) obtained by a basically-positioned duodecapolar RA-CS catheter were compared among 3 originating non-PV areas [RA, atrial septum (SEP) and left atrium (LA)]. Results RA-CSp of RA non-PV trigger (56.4 ± 23.4 ms) was significantly longer than that of SEP non-PV (14.8 ± 25.6 ms, p = 0.019) and LA non-PV (-24.9 ± 27.9 ms, p = 0.0004). RA-CSd of RA non-PV (75.9 ± 32.1 ms) was significantly longer than that of SEP non-PV (34.2 ± 32.6 ms, p = 0.040) and LA non-PV (-13.3 ± 41.2 ms, p = 0.0008). RA-CSp and RA-CSd of SEP non-PV were significantly longer than those of LA non-PV (p = 0.022 and p = 0.016, respectively). Sensitivity and specificity of an algorithm to differentiate the area of non-PV trigger using RA-CSp (cut-off value: 50 ms) and RA-CSd (cut-off value: 0 ms) were 88% and 97% for RA non-PV, 81% and 73% for SEP non-PV, 65% and 95% for LA non-PV, respectively. Conclusions The analysis of intra-atrial activation sequences was useful to differentiate non-PV trigger areas. A simple algorithm to localize the area of non-PV trigger would be helpful to identify non-PV trigger sites in AF ablation.

Aim: Nurses' skills and confidence in providing oral care to patients play important roles in healthcare. Studies have proved that peer‐to‐peer learning and assessment can help improve nurses' skills and confidence. However, no study has investigated it using an objective assessment checklist. This study investigated an oral hygiene practice training program for nursing students. It focused on their oral healthcare skills, confidence, and perspectives regarding implementing an objective structured clinical examination (OSCE). Methods: A pre‐ and post‐survey of 97 nursing students from a nursing school in Japan was conducted as a peer‐to‐peer oral health education training program that included an assessment and performance checklist. Results: Confidence in performing and assessing oral care significantly improved after attending the program. Furthermore, the changes were significantly greater in the developed program than in the training program without the checklist. The mean total assessment scores (0–25) of the first, second, third, and fourth participants in the four‐student groups were 22.1, 23.4, 23.9, and 24.1, respectively. The mean scores of the second, third, and fourth participant groups were significantly higher than that of the first participant group (p <.01). Fifty‐two positive and 58 negative comments were received regarding the implementation of the program with professional assessments and the checklist. The most common positive comment mentioned that the evaluation by professionals improved oral care learning and skills. Conclusions: This study developed a program to improve nursing students' confidence and oral care delivery skill building in an OSCE‐style delivery. [ABSTRACT FROM AUTHOR]

Abstract Background Induction test of atrial fibrillation (AF) is one of endpoint measures in catheter ablation (CA). However, its predictive value in long‐term outcome remains controversial. Methods Ninety‐eight patients (61 years, 77 males) with persistent AF who underwent pulmonary vein antrum isolation‐based CA were retrospectively analyzed. We determined whether inducibility of AF/atrial tachyarrhythmias (AT) by atrial burst pacing at the end of CA and other characteristics were associated with the recurrence of AF/AT. Atrial burst pacing was performed with 30‐beat from the coronary sinus; increasing from 240 to 320 ppm. Inducibility was defined as AF/AT lasting ≥5 minutes following atrial burst pacing. Results AF/AT was induced in 50 patients (51%). During 1 year of follow‐up, 71 patients (72.4%) had no recurrence of AF/AT. A logistic regression analysis showed that female gender (OR 3.8; P = 0.02), multiple sessions (OR 3.5; P = 0.02), and early recurrence of AF/AT (OR 5.3; P = 0.004) were associated with clinical recurrence. AF/AT Inducibility was not associated with clinical recurrence (P = 0.65). A subanalysis in patients with enlarged LA (LA diameter ≥45 mm, n = 40) showed that AF/AT inducibility was associated with recurrence (OR 8.1; P = 0.04). The positive and negative predictive values of AF/AT inducibility for AF/AT recurrence were 41 and 89%, respectively. Negative predictive value was increased to 92.3% when the inducibility was defined as AF/AT of ≥30 seconds following atrial burst pacing. Conclusions AF/AT inducibility cannot predict long‐term clinical recurrence in patients with persistent AF. However, it may have a prognostic value especially in patients with enlarged LA.

Abstract To expand our knowledge of the ontogeny of the T-cell receptor (TCR) repertoire of antigen-specific T-cell subsets, we combined next-generation deep sequencing and single-cell multiplex clonotype analysis to evaluate the diversity and frequency of paired TCRs, their functions and whether clonotypic TCRs are shared among different individuals. Using an HLA-A*02-restricted cytomegalovirus (CMV) pp65-derived immunogenic peptide, we found that the more dominant pp65-specific TCR clonotypes in the blood of healthy donors have higher binding affinities for the CMV peptide and arise from clonotypes that are highly shared among individuals. Interestingly, these highly shared HLA-A*02-restricted CMV-specific TCRs were detected in a CMV-seronegative individual as well as in HLA-A*02-negative donors albeit at lower frequency. More intriguingly, these shared TCR clonotypes were abundant in the stem memory T-cell subset, and TCR diversity of the stem memory T-cell repertoire was significantly lower than in the central memory and effector memory T-cell repertoires. These results suggest that the stem memory T-cell subset may serve as a reservoir of highly shared and highly functional memory T-cells.

Background: Precise mapping of the Purkinje fiber network is essential in catheter ablation of Purkinje‐related ventricular arrhythmias (PrVAs). We sought to evaluate the mapping ability of a multi‐spline duodecapolar catheter (PentaRay) for PrVAs. Methods: Mappings of Purkinje fibers by PentaRay catheters were compared with those by conventional mapping catheters in consecutive patients undergoing catheter ablation of PrVAs from 2015 to 2022. Results: Sixteen PrVAs (7 premature ventricular contractions or non‐reentrant fascicular tachycardias [PVCs/NRFTs] and 9 fascicular ventricular tachycardias [FVTs]) were retrospectively studied. In PVCs/NRFTs, earliest preceding Purkinje potentials (PPs) could be recorded by the PentaRay catheters but not by the mapping and ablation catheters in 5 cases. At the earliest PP sites, the precedence from the QRS onset was greater, and the amplitude of the preceding potentials was higher in the PentaRay catheter compared with those in the mapping and ablation catheter (−62.0 ± 42.8 vs. −29.4 ± 34.2 ms, P = 0.02; 0.45 ± 0.43 vs. 0.09 ± 0.08 mV, P = 0.02). In FVTs, late diastolic potentials (P1) were recorded by the PentaRay catheters but not by the mapping and ablation catheters or the linear duodecapolar catheter in 2 cases. The amplitude of P1 was higher in the PentaRay catheter compared with that in the linear duodecapolar catheter and the mapping and ablation catheters (0.72 ± 0.49 vs. 0.17 ± 0.18 vs. 0.27 ± 0.21 mV, P = 0.0006, P = 0.002). The localized critical PPs, defined as the earliest preceding potentials in PVCs/NRFTs and P1 in FVTs, could be recorded in all the patients by the PentaRay catheter. The mapping ability of critical PPs of PrVAs was better with the PentaRay catheter than with the conventional mapping catheters (16/16 vs. 9/16, P = 0.004 by McNemar exact test). Conclusions: The PentaRay catheter has clinical advantages in mapping of the Purkinje fiber network to reveal critical PPs as ablation targets of PrVAs. [ABSTRACT FROM AUTHOR]

Background: Sleep‐disordered breathing (SDB) is highly prevalent in individuals with Down syndrome (DS), who cease growing earlier than individuals without DS. These characteristics may be associated with increased obesity and subsequent SDB signs, such as snoring and apnoea or excessive daytime sleepiness (EDS). Thus, we assessed the influence of growth on the association between obesity and SDB signs or EDS; we used questionnaires sent to young individuals with DS and their caregivers, in a cross‐sectional study. Methods: We sent out 2000 questionnaires to individuals with DS and their caregivers. The surveys included questions about SDB signs (witnessed snoring or apnoea), subjective sleeping time including witnessed midnight arousal, the Epworth sleepiness scale and witnessed napping as well as sex, age, body weight and body height. Results: Of the 1222 questionnaires we received, 660 were from young individuals and were included in the analysis. SDB signs were highly prevalent (77.1%), and frequency of SDB signs increased with growth (P‐trend: P = 0.02) in individuals with DS. Multivariate analyses showed that EDS (Epworth sleepiness scale > 10 points) was associated with body mass index Z‐score (Z‐BMI) in the 6–9 years age group (odds ratio [OR] 95% confidence interval [95% CI]: 1.69 [1.09–2.62], P = 0.02). Conversely, SDB signs were associated with Z‐BMI in the 13–15 (OR [95% CI]: 1.99 [1.06–3.72], P = 0.03) and 16–18 years age groups (OR [95% CI]: 3.04 [1.22–7.59], P = 0.02). For the 19–21 years age group, SDB signs were associated with only male sex (OR [95% CI]: 7.28 [1.22–43.38], P = 0.03). Conclusions: This study showed that the association between Z‐BMI and SDB or EDS was age dependent. In early school‐age children with DS, high Z‐BMI could not accurately predict the presence of SDB, but it was associated with EDS. In the pubescent period (i.e. 13–18 years), high Z‐BMI was associated with SDB signs but not with EDS. Overall, obesity affected SDB signs and EDS differently based on age in young individuals with DS. [ABSTRACT FROM AUTHOR]

INTRODUCTION: As indication for implantable cardioverter defibrillators (ICDs) has expanded, prophylactic implantations have increased. It has been well understood that some ICD recipients have psychological problems. Some of those problems are recognized as maladjustment syndromes. METHODS: We studied 35 ICD recipients regularly followed at outpatient department of Kyushu University Hospital in order to clarify the psychological distress and the quality of their daily lives (QOL). By using questionnaire instruments (SF-8, Beck Depression Inventory, Impact of Event Scale Revised, and State-Trait Anxiety Inventory), we studied their psychological status. RESULTS: Depression, anxiety, and post-stress syndromes existed in 45.5% of the ICD recipients and their QOL was compromised. Female ICD recipients reacted to the stress related to ICD implantation differently from male recipients. Elder ICD recipients had a different way of adjustment from the younger recipients. Various ICD related psychological problems were noted in terms of magnitude and diversity. CONCLUSION: To support ICD recipients both physically and mentally, not only the cardiologists but also specialists from other fields such as psychologists and nurse specialists are needed. Ancillary care must be provided through the support team. Cardiologists who determine whether ICD implantation is required must keep in mind potential psychological sequelae.