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We studied the clinical features of five Japanese cases with leucine-rich glioma inactivated-1 (LGI1) antibody-positive encephalitis. Their symptoms included seizures, hallucinations, memory impairment, apathy, anxiety, agitation, faciobrachial dystonic seizure (FBDS), and ictal piloerection. All five patients showed hippocampal fluid attenuated inversion recovery (FLAIR) hyperintensity on brain MRI even though their cell counts of cerebrospinal fluid (CSF) were normal range. Four patients had syndrome of inappropriate secretion of antidiuretic hormone. One patient with FBDS also showed basal ganglia lesion on her brain MRI. Sodium channel blockers apparently lowered the frequency of FBDS. One patient had a thyroid cancer and underwent thyroidectomy. Substantial response to immunotherapy was seen in four out of five cases. At follow-up ≥2 years, all five patients had never relapsed. In cases of limbic encephalitis with normal CSF cell counts and hyponatremia, we should consider LGI1 antibody-positive encephalitis and conduct immunotherapy immediately.

Objectives　Solitude is a state of being without social contact; it occurs when a person chooses not to interact with others, even when they are in the company of others. It is not necessarily accompanied by negative feelings. In contrast, loneliness, is a psychological state characterized by the feeling of needing the company of others. Most Japanese studies have regarded loneliness as an unpleasant and painful experience. In this study, focusing on solitude, we developed the Japanese version of Positive Solitude Scale (JPSS) developed by Palgi et al. and evaluated its reliability and validity. This scale assesses the "conscious and voluntary decision to be alone as a positive experience."Methods　A self-administered, anonymous questionnaire survey was conducted between May and August 2023, with 700 men and women participants aged 20 years or older living in Ward A, Sapporo. The survey items comprised basic attributes, the JPSS, subjective sense of health, subjective sense of well-being, and depression to verify convergent validity and social network and loneliness to verify discriminant validity. Additionally, principal component and correlation analyses were performed.Results　A total of 245 questionnaires were collected, and 237 valid responses were obtained (valid response rate: 33.9%). The participants' mean age was 58.5±1.2 years and 111 (46.8%) were men; the Cronbach's alpha coefficient for the JPSS was 0.92. The principal component analysis revealed that all nine items had principal component loadings above 0.6, with a cumulative contribution of 62.3% to the overall scale. The total scale score was significantly positively correlated with subjective health (ρ=0.210, P=0.001), positive affect (ρ=0.302, P<0.001), and life satisfaction (ρ=0.241, P<0.001). There were no significant correlations among depression, negative affect, social networks, and loneliness.Conclusions　The JPSS is a reliable and valid instrument unaffected by social networks and other social relationships. It is expected to be a promising new scale that can measure perceptions of time as a positive emotion, distinct from loneliness.

Objective　The aim of this study was to compare how Dietary Reference Intakes for the Japanese (DRIs), which are dietary guidelines proposing reference values for the intake of energy and nutrients by healthy Japanese people, are used by personnel whose work involves diet, food, or nutrition.Methods　A web-based questionnaire survey was conducted in July 2023 among those involved in work closely related to diet, food and/or nutrition. The frequency of the use of DRIs in daily work and the details of use, including the chapter used, difficulty of use, information source for revisions, and interest in a revised version, were compared among workplaces (e.g., medical institutions; school and welfare facilities; government institutions; dietitian training schools; companies; and freelancer in community and others).Results　Among 1,030 participants, 58% (n=597) used DRIs "very often" or "often" in their daily work. For example, DRIs were used to prepare institutional meals and facilitate nutrition management and guidance in medical institutions; prepare institutional meals in schools and welfare facilities; ensure nutrition management and guidance for citizens and prepare courses/materials for government institutions; and prepare courses/materials for dietitian training schools. Regarding the main parts of the DRIs used, most respondents chose the chapters entitled "Energy" (66%) and "Macronutrients" (72%). For all participants (n=1,030), the main difficulties in the use of DRIs were "a large number of sentences in the DRIs and an insufficient time to read" (stated by 54% of all respondents; the proportion did not significantly differ among workplaces). The main source of information on revised DRIs was "seminars and workshops by the Japan Dietetic Association" (70% of all respondents). However, many respondents in the government and dietitian training institutions also identified "workshops or public information by the Ministry of Health, Labour and Welfare" as major sources. Regarding participants' main interest in the revised version of the DRIs, general policy (77%) and revised reference values (74%) generated the highest levels of interest. Those working at dietitian training schools had a greater interest in change related to scientific evidence for each reference value than those working elsewhere.Conclusions　DRIs are frequently used by those involved in work related to food and nutrition. In this study, DRI use and related interests differed based on the workplaces surveyed. In future revisions of DRIs, the addition of further descriptions or appendices in line with their use in workplaces may be needed.

Japanese basic researchers, known for their dedication to the advancement of science without any expectation of economic benefit, are conventionally regarded as virtuous professionals. However, current social demand requires researchers to adopt a venture mindset, implement their research outcomes for societal benefit, and contribute to society through business. In this paper, I highlight the importance of overcoming the "valley of death" between society and researchers to create useful intersections between science and business, aimed at application of research outcomes to the society and encouraging a lifestyle and challenges as venture scientists who can contribute to the generation of new industries.

Objectives: The objectives of this study were to develop a Japanese version of the Pediatric Epilepsy Medication Self-Management Questionnaire Caregiver Version (PEMSQ-J) and to examine its reliability and validity., Methods: A quantitative cross-sectional study was conducted among primary caregivers (N=309) of children under the age of 18 taking epilepsy medication. The PEMSQ-J was the main instrument used to collect information such as basic demographics.Cronbach's α was calculated to determine internal consistency, and the intraclass correlation coefficient was calculated to assess reproducibility. In addition, confirmatory factor analysis with covariance structure analysis was performed to confirm the goodness of fit of the model. Finally, criterion-related validity was confirmed., Results: Analysis of responses to items on the PEMSQ-J revealed no ceiling or floor effects, and there was no marked bias in distributions in terms of skewness or kurtosis. Internal consistency assessed with Cronbach's α ranged from 0.847 to 0.935. A test of reproducibility revealed that the intraclass correlation for the total score was 0.730. Exploratory factor analysis identified two factors, which differed from the four factors in the original version. When their details and structure were examined, however, the two were interpreted as having a similar structure. Similarly to those of the original version, the goodness-of-fit indices for the four factors according to confirmatory factor analysis were close to the standard values., Conclusion: The PEMSQ-J, which consists of 27 items with a four-factor structure, was statistically acceptable, and it was found to have a certain degree of reliability and validity.

Researchers in the field of acute myeloid leukemia have long sought to establish a prognostic stratification system for clinical use that combines multiple genetic mutations. In 2022, the European LeukemiaNet (ELN) proposed a new prognostic model incorporating new genetic mutations. However, Japanese National Health insurance only recently began covering clinical genetic analysis for AML. We established the Multi-center Collaborative Program for Gene Sequencing of Japanese AML (GS-JAML) to contribute to clinical practice by providing rapid genetic analysis results. Retrospective analysis of this research program revealed (1) the clinical significance of CEBPA-bZIP mutations, and (2) the clinical significance of DNMT3A mutations in NPM1 mutated AML.

Objectives: Previous studies on the elderly have reported that they avoid fiber-rich and hard foods in favor of softer foods as chewing ability declines. However, evidence of worker chewing conditions and dietary habits is scarce. This study aimed to clarify the association between chewing conditions and dietary habits in workers., Methods: The subjects included 6,703 workers (45.6 ± 10.2 years, range 18-64 years) who underwent medical and dental check-ups from April 2018 to March 2019 with no missing data. We classified workers into two groups, those with good chewing conditions (GCC) and those with poor chewing conditions (PCC) according to their responses to the chewing condition item in our questionnaire. We performed logistic regression analysis using the questionnaire dietary habits item response as the objective variable and chewing conditions as the explanatory variable and adjusting for sex, age, number of present teeth, periodontal pocket depth, oral hygiene status, Body Mass Index, smoking habits, alcohol intake, exercise habits, history of present illness, and stages of transtheoretical model. Additionally, we performed subgroup analysis using a similar framework stratified by sex and age groups (under 40 or older)., Results: We found significant negative associations with PCC for the following dietary habits (p < .05): Awareness of balanced diet; Regular consumption of dark green and deep yellow vegetables; Eating slowly and chewing well; Frequent consumption of seaweed and small fish; Having three meals at almost at the same time every day; Having breakfast almost every day; Eating protein dishes with every meal; Frequently consuming dairy products; Finishing eating at least two hours before bedtime. Furthermore, we found significant positive associations with PCC for the following items (p < .05): Having on average two or more bottles/cans of juice or coffee a day; Frequently eating heavy meat dishes; Frequently eating deep-fried foods such as fried dishes and pork cutlets; Frequently having instant or processed foods; Eating two or more kinds of Western or Japanese confectioneries or snacks on average a day; Frequently eating salty food; Regularly having snacks or late-night meals. Additionally, similar trends were also observed following subgroup analysis, regardless of sex or age., Conclusions: This study suggests that workers with PCC may retain undesirable dietary habits, regardless of sex and age. Therefore, it is necessary to expand dental check-ups in the workplace and to promote dental health guidance that targets all workers.

The Japanese clinical guidelines for myasthenia gravis (MG) were revised in 2022. The major revision points in these guidelines are as follows. 1) A description of Lambert-Eaton myasthenic syndrome (LEMS) was included for the first time. 2) Revised diagnostic criteria of both MG and LEMS are proposed. 3) A high-dose oral steroid regimen with escalation and de-escalation schedule is not recommended. 4) Refractory MG is defined. 5) The use of molecular-targeted drugs is included. 6) MG is divided into six clinical subtypes. 7) Treatment algorithms for both MG and LEMS are presented.

Objectives　The purpose of this study was to evaluate the internal consistency and factorial validity of the Japanese version of HLS-Q12 health literacy rating scale when used with older adults.Methods　A questionnaire-based mail survey was conducted among older adults living in a community. The data collection period was from January to February 2022. The Japanese version of HLS-Q12 was used to obtain data on health literacy of older adults, and the internal consistency and factorial validity of the scale were evaluated using Cronbach's alpha coefficient and confirmatory factor analysis, respectively. In addition, a Rasch model was used to conduct a detailed analysis on each questionnaire item.Results　Questionnaires were distributed among 3,572 people, out of which, 1,082 responses were received from older adults (over 65 years of age). Cronbach's alpha coefficient was 0.8 or higher, indicating no internal consistency issues. According to the confirmatory factor analysis, CFI was equal to 0.933, AGFI, 0.876, and RMSEA, 0.092; thus, all indicators met certain evaluation levels. However, deviation from one of the multiple fit criteria was confirmed for the value of RMSEA, indicating that the error between the estimated value calculated by the scale and the true value was relatively large. Analysis of each question item using the Rasch model showed that all the questions met the criteria of Infit MSQ and were suitable in their question structure.Conclusion　Following the evaluation of the HLS-Q12 scale in older adults, the scale was found to be reliable and valid at a certain level. However, the value of RMSEA indicated that it was relatively large in terms of the error between the estimated value calculated by the scale and the true value.

Purpose: Recently, the targeted radionuclide therapy (TRT) was urgently required to adapt the practice and environment because of the implementation of novel therapeutic radiopharmaceuticals such as alpha- and beta- radionuclides therapy. The present study aimed to clarify the questionnaire survey with the current situation (safety controls for workers and patients) at Japanese TRT facilities., Methods: The massive questionnaire survey, 2 months from October to November 2021, was conducted among nationwide 251 facilities that have performed TRT in the past two years. The alpha- and beta- therapeutic radiopharmaceuticals were categorized and answered by one representative of the facility under anonymity. We analyzed the actual situation of each facility related to occupational exposure, radiation protection, contamination inspection, patient release criteria, and dosimetry for TRT., Results: The survey response rate was 69.1% (174 facilities). About 75% of these facilities reported that they either follow the guidelines or take their own measures to reduce occupational exposure. The confirmed means of patient release criteria were 68.0% with the administered radioactivity and 87.2% with the ambient dose rate. The cold run was not performed for the first time at 15.0% and 10.0% of the facilities for β- and α-emitting radionuclides, respectively. The facilities without attachment syringe shields were 39.2% for alpha-radionuclides therapy and 20.3% for beta-radionuclides therapy., Conclusion: We clarified the Japanese problem for TRT practice and environment by the questionnaire survey. Our findings indicated that the Japanese guidelines and manuals for TRT were not partly followed in the nationwide facilities.

Vaccine rollouts have been underway to combat the COVID-19 pandemic globally. Based on ongoing interviews with ten primary care physicians 'in the field', this paper elucidates how in practice the vaccinations were carried out in Japan in 2021 from a cultural anthropological perspective. We examine what the primary care physicians did to prepare for the rollouts, what problems they faced, and how they responded to these problems. Large-scale vaccination projects are supposed to proceed smoothly and quickly, or to have what Anna Tsing calls 'scalability'. In practice, however, they required a variety of tasks for coordination, information sharing, and promotion. Despite feeling stressed by the lack of information and exhausted by the work overload, the primary care physicians carried out the vaccinations as an important service to their patients and communities. The findings of this paper will provide valuable materials for improving future vaccine rollouts., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Kimura S et al.)

Objectives　The study aimed to clarify the association among health check-up results, death, and occurrence of the need for nursing care among Japanese older adults.Methods　The participants were 24,909 males and 28,742 females. A medical system for late-stage older adults in the Tochigi Prefecture (Japan) insured, not qualified for long-term care insurance certification, and participated in health check-ups from April 2020 to March 2021. We recorded the occurrence of death and loss of independence from the date of health check-ups through the end of August 2021. Furthermore, we divided the participants into two groups based on the judgment value of medical consultation recommendations for the specified medical check-ups. In addition, we calculated 1-year survival and independence rates using the Kaplan-Meier method and estimated hazard ratios (HRs) of death and loss of independence using the Cox's proportional hazard model.Results　During the follow-up, 424 cases of deaths (281 males and 143 females) and 1,011 cases of loss of independence (529 males and 482 females) were identified. In addition, 1-year survival and independence rates for low serum albumin were 0.920-0.958, with the lowest in both the sexes. The Cox's proportional hazards model after adjusting for age, body mass index, and responses to the late-stage older adult questionnaire revealed that HRs of death (3.05 [2.00-4.64]) and loss of independence (2.58 [1.87-3.56]) for low hemoglobin were the highest in males, and those of death (5.87 [2.45-14.07]) and loss of independence (3.00 [1.70-5.29]) for low serum albumin were particularly high in females. In a previous study analyzing the loss of independence among older adults who participated in health check-ups, HRs of death for low serum albumin and hemoglobin were 2.7 [1.2-6.0] and 1.8 [1.1-2.9], respectively, and the current study results showed a higher tendency than that in the previous study. In addition, previous studies showed an association between low serum albumin and stroke and low hemoglobin and death. However, in the current study, HRs for low serum albumin and hemoglobin could be particularly high because the Tochigi Prefecture has a high age-adjusted mortality rate for cerebrovascular and cardiac diseases, in addition to low nutrition among individuals with risk factors for these diseases.Conclusion　This study found that low nutrition among older adults in the Tochigi Prefecture was highly associated with the occurrence of death and the need for nursing care. In addition, the trends in mortality and the risk of loss of independence among older adults differed by region.

This study aimed to clarify the death causes among Japanese. National vital statistics data from 1995 to 2020 were analyzed using the mean polish process. The results showed that deaths from cancer increased after middle age, and deaths from heart disease, pneumonia, and cerebrovascular disease increased after later life (age effect). Recently, mortality from cerebrovascular disease, heart disease, and pneumonia is decreasing (time effect). More individuals in the birth cohort born after 1906 died from cancer compared to that of earlier generations who mainly died from heart disease, pneumonia, and cerebrovascular disease (birth cohort effect). The time effect is more modifiable and/or depending on social conditions and interventions compared to that of the age effect. In Japan, if lifestyle-related diseases that are risk factors for cerebrovascular and heart diseases, such as hypertension, are further prevented or treated, mortality from such diseases will decrease consequently.

Large granular lymphocytic (LGL) leukemia is a chronic lymphoproliferative disease of cytotoxic T cells or NK cells with LGL morphology and frequently complicated cytopenia and/or different autoimmune diseases, which often require medical interventions, although LGL leukemia itself is seldom lethal. Immunologic dysregulations in LGL leukemia contribute to the development of complications, for example, neutropenia with the involvement of Fas ligand system and, in pure red cell aplasia, which is a common complication among the patients of East Asian origin, impairing erythroid developments by cytotoxic T cells. Rheumatoid arthritis (RA) is the most prevalent nonhematological consequence, and Felty syndrome, a rare form of RA, and T-LGL leukemia have a lot in common. When patients have LGL leukemia-associated complications, immunosuppressive medication is a mainstay of treatment. Characteristic mutational features in STAT3, STAT5B, CCL22, and other genes in specific subtypes of LGL leukemia have been detected, that would be associated with immunologically mediated molecular pathogenesis in LGL leukemia, and these new findings may help in creating optimal diagnostic approaches or novel therapies for LGL leukemia.

(Objectives) To develop Japanese translations of the standard and short forms of the Neurogenic Bladder Symptom Score (Subjects and methods) The questionnaires were forward translated by a Japanese healthcare professional and non-medical professional and backward translated by two native English-speaking translators. Then, the products were harmonized by the participants involved in the translational processes. Finally, 15 persons with spinal cord lesions were interviewed to improve the provisional Japanese translations based on their suggestions. (Results) Throughout the forward and backward translations and their harmonization, no major translational problems were encountered, other than those attributable to differences in syntax between English and Japanese. The persons could complete the provisional Japanese translations of the standard and short forms in median 7.0 and 3.0 minutes, respectively. Although none of them reported difficulty in answering the questions, 6, 3, and 5 persons pointed out that the tenth question (the seventh question in the short form) and the answers to the nineteenth and twenty-second questions, respectively, were not easy to understand. Taking their suggestions into consideration, we finalized the Japanese translations with the help of a developer of the questionnaire as well as the back-translators. (Conclusions) After a multi-step review process, linguistically valid Japanese translations of the standard and short forms of the Neurogenic Bladder Symptom Score (Neurogenic Bladder Symptom Score Japanese version 1.0) were completed. We hope that these Japanese translations will facilitate future research on patient-reported outcomes in persons with neurogenic lower urinary tract dysfunction.

Ravulizumab is the first long-acting complement inhibitor approved for paroxysmal nocturnal hemoglobinuria (PNH) treatment. We evaluated patient preference for ravulizumab or eculizumab among Japanese adults with PNH. The ALXN1210-PNH-301 (NCT02946463) and ALXN1210-PNH-302 (NCT03056040) studies included 23 Japanese adults who are enrolled in complement inhibitor treatment-naive and eculizumab (≥6 months) treatment. Patient preference was assessed using the PNH-specific patient preference questionnaire (PNH-PPQ©). Most patients preferred ravulizumab (19/23, 82.6%), none preferred eculizumab, and four (17.4%) reported no preference (χ 2 test, p<0.005). The preference for ravulizumab was driven by its lower infusion frequency (every 8 weeks) compared with eculizumab (every 2 weeks). The included Japanese patients with PNH preferred ravulizumab because of its reduced infusion frequency, which increases activity planning ability, treatment convenience, and overall quality of life, as compared with eculizumab. These data provide useful insight into patient perspectives and may aid decision-making for PNH treatment.