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Background:An increased body mass index (BMI) is significantly associated with favourable prognosis in renal cell carcinoma (RCC). This study investigated the associations among sex, BMI, and prognosis in clear cell RCC patients.Methods:We retrospectively analysed 435 patients with clear cell RCC who underwent a nephrectomy. The associations among sex, BMI, clinicopathologic factors, and cancer-specific survival (CSS) were analysed.Results:As a continuous variable, increased BMI was associated with higher CSS rate by univariate analysis in the whole population (hazard ratio, 0.888 per kg m-2; 95% confidence interval, 0.803-0.982; P=0.021). A sub-population analysis by sex demonstrated that BMI was significantly associated with CSS in men (P=0.004) but not in women (P=0.725). Multivariate analysis revealed BMI to be an independent predictor of CSS in only men.Conclusion:Body mass index was significantly associated with clear cell RCC prognosis. However, the clinical value of BMI may be different between men and women. [ABSTRACT FROM AUTHOR]

Rationale: Increased production of mucus is a prominent feature of asthma. IL-13-driven mucous cell metaplasia is associated with decreased expression of the transcription factor FOXA2 and increased expression of the related transcription factor FOXA3 in animal and cell culture models.Objectives: Establish how changes in FOXA2 and FOXA3 expression contribute to mucous metaplasia and determine whether FOXA2 and FOXA3 expression is altered in asthma.Methods: Mice expressing a Foxa2 transgene in airway epithelial cells and mice deficient in Foxa3 were analyzed after allergen sensitization and challenge. Expression of FOXA2, FOXA3, MUC5AC, and the highly IL-13-inducible gene CLCA1 was analyzed in airway biopsies from subjects with asthma and control subjects.Measurements and Main Results: Expression of a Foxa2 transgene reduced allergen-induced mucous metaplasia by 45% compared with control transgenic mice (P < 0.05) whereas inactivation of Foxa3 had no detectable effects on mucous metaplasia. Expression of FOXA2 was reduced in subjects with asthma and was negatively correlated with MUC5AC and CLCA1 levels in subjects with asthma. In contrast, FOXA3 expression was not significantly correlated with MUC5AC and was positively correlated with CLCA1.Conclusions: Increasing Foxa2 expression reduced mucous metaplasia in an allergic mouse model. Subjects with asthma had decreased FOXA2 expression, suggesting that therapeutic approaches that increase FOXA2 expression or function could be beneficial for reducing mucus production in asthma. Unlike FOXA2, FOXA3 did not regulate mucous metaplasia. [ABSTRACT FROM AUTHOR]

We develop a general framework to deal with the unitary representations of quantum groups using the language of C*-algebras. Using this framework, we prove that the duality holds in a general context. This extends the framework of the duality theorem using the language of von Neumann algebras previously developed by Masuda and Nakagami. [ABSTRACT FROM AUTHOR]

Objective To investigate the immunology of host-tumour interaction, critical for the development of immunotherapy against cancers, by assessing the major histocompatibility complex (MHC) class I expression in both benign and malignant prostate disease, and the relationship between their expression and degree of tumour-infiltrating lymphocytes. Materials and methods Direct serial analysis of gene expression in tumours is an extremely sensitive and powerful tool for monitoring immunological changes in the immunotherapy of solid tumours. Most previous monitoring protocols rely mainly on the analysis of patient's peripheral blood but in the present study the direct molecular analysis of small tissue samples was used, and its accuracy compared with that of conventional immunohistochemical analysis. Twenty-four formalin-fixed, paraffin-embedded prostate samples (11 benign and 13 carcinoma) were used for the immunohistochemical analysis of CD8[SUP+] T lymphocytes and MHC class I expression. CD8[SUP+] T lymphocytes were counted using an ocular grid and MHC class I measured using digital image-analysis software. Twenty-seven frozen prostate tissue samples (12 benign and 15 carcinoma) were used for direct gene measurements of CD8 and interferon-&b.gamma; using a quantitative real-time polymerase chain reaction. Results There were significantly fewer CD8[SUP+] T lymphocytes in prostate carcinoma nests than in benign prostate. There was a significant correlation between the number of CD8[SUP+] T lymphocytes and MHC class I expression in the prostate. There was a strong correlation between the immunohistochemical estimates of CD8[SUP+] T lymphocytes and CD8 gene by polymerase chain reaction, but no significant difference between benign prostate and prostate carcinoma tissue in gene measurements. Conclusion Down-regulation of MHC class I expression by prostate cancer cells is associated with fewer CD8[SUP+] T lymphocytes and hence might be important in cancer growth. In... [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the association between unhealthy lifestyle factors and the development of depressive symptoms with adjustment for sociodemographic characteristics in university students using health checkup data., Methods: Among information obtained from university student health checkups conducted in 2017 and 2019, we analyzed both the clinical data and responses to questionnaires. The subjects used for analysis were 3190 individuals (2382 men and 808 women, mean age 19.0 years) who had been free of depressive symptoms in the 2017 survey and were available for a 2-year follow-up. The Patient Health Questionnaire (PHQ-2) was used as a self-rating scale for depressive symptoms. Multivariable logistic regression analysis was conducted to investigate the association between lifestyle factors (such as body mass index, self-rated health, whether breakfast was taken, degree of exercise, satisfaction with sleep, smoking, and alcohol drinking) in the 2017 survey and any development of depressive symptoms revealed in the 2019 survey, adjusting for sociodemographic variables and other lifestyle factors., Results: Multivariable logistic analysis showed that poor satisfaction with sleep (odds ratio [OR), 4.09; 95% confidence interval [CI), 1.96-8.53; p  < 0.01) and female gender (OR, 2.16; 95% CI, 1.01-4.60; p  = 0.05) were significantly associated with the development of depressive symptoms 2 years later., Conclusion: This study has revealed an association between poor satisfaction with sleep and the development of depressive symptoms. We believe that these findings may be useful for the prevention and treatment of depressive symptoms in university students., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Infectious complications (ICs) have been reported as major causes of postoperative mortality in patients with cancer. However, to the best of our knowledge, the impact of ICs after gastrectomy on non-gastric cancer-related deaths (NGCDs) remains unexplored. The present study aimed to identify the impact of ICs after gastrectomy on NGCDs. A retrospective analysis of 712 patients with gastric cancer who underwent curative gastrectomy was conducted. The participants were categorized into IC and non-IC groups based on the incidence of postoperative IC. Clinicopathological factors and non-gastric cancer-related survival (NGCS) rates were compared between groups. Further NGCD and associated risk factor analyses were performed in a background factor-adjusted cohort using multivariate analysis. Among the 712 patients, 112 developed ICs (Clavien-Dindo classification grade ≥II). In the entire cohort, the IC group had a significantly worse 5-year cumulative incidence of NGCD (17.8 vs. 10.6%; Gray's P=0.021) compared with the non-IC group. Although a number of clinicopathological factors differed between the groups, including patient background, operative factors and tumor factors, the risk factors for NGCD identified in the multivariate analysis were older age, low prognostic nutritional index, low skeletal muscle index and Charlson comorbidity index ≥1, excluding IC incidents. The IC group exhibited more background factors contributing to NGCDs, suggesting a potential increase in NGCD regardless of IC incidence., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Nakashima et al.)

Background: Internet-based cognitive behavioral therapy (iCBT) shows promise in the prevention of depression. However, the specific iCBT components that contribute to its effectiveness remain unclear., Objective: We aim to evaluate the effects of iCBT components in preventing depression among university students., Methods: Using a smartphone cognitive behavioral therapy (CBT) app, we randomly allocated university students to the presence or absence of 5 different iCBT components: self-monitoring, behavioral activation, cognitive restructuring, assertiveness training, and problem-solving. The active intervention lasted 8 weeks but the app remained accessible through the follow-up. The primary outcome was the onset of a major depressive episode (MDE) between baseline and the follow-up after 52 weeks, as assessed with the computerized World Health Organization Composite International Diagnostic Interview. Secondary outcomes included changes in the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, and CBT Skills Scale., Results: During the 12-month follow-up, 133 of 1301 (10.22%) participants reported the onset of an MDE. There were no significant differences in the incidence of MDEs between the groups with or without each component (hazard ratios ranged from 0.85, 95% CI 0.60-1.20, for assertiveness training to 1.26, 95% CI 0.88-1.79, for self-monitoring). Furthermore, there were no significant differences in the changes on the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, or for CBT Skills Scale between component allocation groups. However, significant reductions in depression and anxiety symptoms were observed among all participants at the 52-week follow-up., Conclusions: In this study, we could not identify any specific iCBT components that were effective in preventing depression or the acquisition of CBT skills over the 12-month follow-up period, but all participants with and without intervention of each iCBT component demonstrated significant improvements in depressive and anxiety symptoms. Further research is needed to explore the potential impact of frequency of psychological assessments, nonspecific intervention effects, natural change in the mental state, and the baseline depression level., (© Yukako Nakagami, Teruhisa Uwatoko, Tomonari Shimamoto, Masatsugu Sakata, Rie Toyomoto, Kazufumi Yoshida, Yan Luo, Nao Shiraishi, Aran Tajika, Ethan Sahker, Masaru Horikoshi, Hisashi Noma, Taku Iwami, Toshi A Furukawa. Originally published in JMIR Mental Health (https://mental.jmir.org).)

The efficacy of digital brief behavioural treatment for insomnia using a smartphone application in conjunction with light therapy was investigated in university students who had insomnia symptoms with late chronotypes. In this two-arm parallel randomized-controlled trial, participants with insomnia symptoms and late chronotypes were recruited between October and November 2023. The duration of the intervention program was 4 weeks. The smartphone application provides digital brief behavioural treatment for insomnia, including programs for advanced phases. The intervention group used blue-light-emitting diode glasses in the morning after waking up for 2-4 weeks. The primary outcome was a change in the Insomnia Severity Index during the study period. The Insomnia Severity Index was obtained weekly using a web questionnaire. Of the 28 students, 14 each were assigned to the intervention and control groups. The mean Insomnia Severity Index scores at baseline were 12.2 and 12.5; after 4 weeks, they declined to 7.2 and 10.6 in the intervention and control groups, respectively. Primary analysis using a linear mixed model showed a significant improvement in the temporal trends of the Insomnia Severity Index in the intervention group (p < 0.001). The scores on the Morningness-Eveningness Questionnaire (p = 0.008) and RU-SATED (p = 0.005) significantly improved in the intervention group relative to the control group following the intervention. This study demonstrated the effectiveness of the digital brief behavioural treatment for insomnia with light therapy in participants with both insomnia symptoms and late chronotypes., (© 2024 European Sleep Research Society.)

The optimal treatment strategy for neoadjuvant chemotherapy in elderly patients with pancreatic cancer (PC) remains unclear. Hence, this study was aimed at evaluating the safety and feasibility of neoadjuvant-modified FOLFIRINOX (mFOLFIRINOX) in elderly patients with PC. We retrospectively collected data from 62 patients who received neoadjuvant mFOLFIRINOX between May 2015 and October 2023 and comparatively analyzed the clinicopathological data and outcomes between the non-elderly group (age: <75 years) and elderly group (age: >75 years). The non-elderly and elderly groups comprised 39 and 23 patients, respectively. Although elevated levels of aspartate aminotransferase ( p = 0.0173) and alanine aminotransferase ( p = 0.0378) and nausea ( p = 0.0177) were more frequent in the elderly group, the incidence of severe adverse events was similar between the groups. Intergroup differences in resection rate ( p = 0.3381), postoperative severe complication rates ( p = 0.2450), and postoperative hospital stay ( p = 0.3496) were not significant. Furthermore, no significant intergroup differences were found in survival in either the whole or the resection cohorts. The perioperative and postoperative outcomes of elderly patients treated with neoadjuvant mFOLFIRINOX were comparable with those of non-elderly patients. Neoadjuvant mFOLFIRINOX should be considered a feasible option for elderly patients with PC.

The present study aimed to identify preoperative and perioperative risk factors for postoperative infectious complications in older patients with gastric cancer. The present retrospective study included 504 patients with gastric cancer aged >65 years who underwent radical gastrectomy. After determining the cutoff values for various perioperative factors in the receiver operating characteristic curve analysis, preoperative and perioperative risk factors for the development of infectious complications after gastrectomy were examined using logistic regression analysis. Of the 504 patients who underwent gastrectomy, 95 (18.8%) developed infectious complications of grade II-V based on the Clavien-Dindo classification. In an analysis restricted to preoperative factors, male sex, low prognostic nutritional index, high visceral fat area and total gastrectomy were independent risk factors for infectious complications after gastrectomy. Among all perioperative factors, a low prognostic nutritional index and long operative duration were identified as independent risk factors for infectious complications after gastrectomy. The patients were divided into five groups according to the number of positive preoperative risk factors for infectious complications, and the incidence of infectious complications differed among the five groups (0 factors, 6.7%; 1 factor, 10.4%; 2 factors, 18.9%; 3 factors, 27.8%; and 4 factors, 47.6%; P<0.001). Older patients with gastric cancer who have a number of preoperative risk factors require careful consideration of the indication for gastrectomy and a shorter operative time to reduce infectious complications., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Iida et al.)

Background: Training and practice in neuropsychiatry varies across the world. However, little is known about the experiences and opinions of early career psychiatrists (ECPs) across different countries regarding neuropsychiatry., Aims and Method: To investigate neuropsychiatry training experiences, practices and opinions among ECPs across different countries. An online survey was distributed to ECPs in 35 countries across the world., Results: A total of 522 participants took part in this study. Responses show that neuropsychiatry is integrated to a variable extent in psychiatric training curricula across the world. Most respondents were not aware of the existence of neuropsychiatric training or of neuropsychiatric units. Most agreed that training in neuropsychiatry should be done during or after the psychiatry training period. Lack of interest among specialty societies, lack of time during training, and political and economic reasons are regarded as the main barriers., Clinical Implications: These findings call for an improvement in the extent and in the quality of neuropsychiatry training across the world.