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Tomoko Takayama,1 Yoji Inoue,1 Rie Yokota,2 Masayo Hayakawa,1 Chikako Yamaki,1 Yasushi Toh3 1Cancer Information Service Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan; 2Department of Health Communication, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 3National Hospital Organization, Kyushu Cancer Center, Fukuoka, JapanCorrespondence: Tomoko TakayamaCancer Information Service Division, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1, Tsukiji, Chuo-Ku, Tokyo, 104-0045, JapanTel +81-3-3542-2511 Ex. 1621Fax +81-3-3547-8577Email totakaya@ncc.go.jpPurpose: It is crucial for health professionals to understand patients’ and families’ views and preferences (PVPs) to enhance their adherence to treatments and subsequent satisfaction. Regularly and consistently collecting comprehensive information on the needs and concerns of patients/families and utilizing the information is vital for improving clinical practice and the healthcare environment. As an initial approach, this study aimed to develop a new system for appropriately collecting PVPs regarding cancer from nationwide medical staff and consider the potential utilization of PVPs in clinical practice.Methods: Web-based anonymous surveys were conducted with medical staff in nationwide cancer care hospitals in Japan. The surveys queried the questions, values, desires, and experiences expressed by cancer patients or their families on five topics, namely two cancer sites (colorectal and esophageal cancers) and three symptoms and signs (lymphedema, urinary symptoms, and tingling/numbness/pain) within the past year. The PVPs were compared to the five topics and staff medical specialties, and those on tingling/numbness/pain were analyzed qualitatively.Results: Among the 904 medical staff who responded to this survey, the PVPs encountered by the staff differed according to the topic and staff medical specialty. Tingling/numbness/pain was the most frequently encountered symptom, and urinary symptoms were the least encountered. Only half or fewer of the medical staff had information available regarding urinary symptoms and tingling/numbness/pain. Further, qualitative content analysis of the expressed PVPs regarding tingling/numbness/pain raised clinical questions on this topic that led to the construction of a “Questions & Answers” section on a public website in Japan.Conclusion: This study suggests that collecting PVPs through nationwide cancer-related medical staff might be an efficient way to understand the specific requirements of patients/families. It would also be possible to document PVP trends according to changes in the environments of patients/families by nationwide, consistent, and continuous PVP collection.Keywords: patient’s needs, cancer information, health communication, quality of health care, trends in patients’ preferences

The parallel scaling of classical molecular dynamics simulations is limited by the communication of the 3D fast Fourier transform of the particle-mesh electrostatics methods, which are used by most molecular simulation packages. The Fast Multipole Method (FMM) has much lower communication requirements and would, therefore, be a promising alternative to mesh based approaches. However, the abrupt switch from direct particle-particle interactions to approximate multipole interactions causes a violation of energy conservation, which is required in molecular dynamics. To counteract this effect, higher accuracy must be requested from the FMM, leading to a substantially increased computational cost. Here, we present a regularization of the FMM that provides analytical energy conservation. This allows the use of a precision comparable to that used with particle-mesh methods, which significantly increases the efficiency. With an application to a 2D system of dipolar molecules representative of water, we show that the regularization not only provides energy conservation but also significantly improves the accuracy. The latter is possible due to the local charge neutrality in molecular systems. Additionally, we show that the regularization reduces the multipole coefficients for a 3D water model even more than in our 2D example. [ABSTRACT FROM AUTHOR]

Background: Calcifying fibrous tumor (CFT) arising from the pleura is a relatively rare benign lesion in young and middle-aged adults. We report a 31-year-old woman with pleural CFT who underwent successful complete thoracoscopic enucleation., Case Presentation: An asymptomatic woman presented with a mass in the right lower lung field that was incidentally detected on a chest X-ray during a routine medical checkup. Chest computed tomography showed a well-defined mass in the lower mediastinum, with a maximum diameter of approximately 5.5 cm. Esophagogastroduodenoscopy showed no abnormal findings in the esophagus. An endoscopic ultrasonography (EUS) revealed a well-defined tumor with no internal blood flow. EUS-fine needle aspiration failed to establish a definitive diagnosis. Therefore, thoracoscopic tumor enucleation was performed for diagnostic and therapeutic purposes. Based on the histopathological findings of the resected specimen, the presence of a tumor with a high fibrous component in a young woman, and the identification of granulomatous calcifications, a diagnosis of CFT was established., Conclusions: Complete thoracoscopic tumor enucleation was successfully performed for CFT arising from the pleura in a young adult woman., (© 2024. The Author(s).)

Background: Management and prevention of hypertension are important public health issues. Healthy dietary habits are one of the modifiable factors. As Twitter (subsequently rebranded X) is a digital platform that can influence public eating behavior, there is a knowledge gap regarding the information about foods and nutrients recommended for blood pressure control and who disseminates them on Twitter., Objective: This study aimed to investigate the nature of the information people are exposed to on Twitter regarding nutrients and foods for blood pressure control., Methods: A total of 147,898 Japanese tweets were extracted from January 1, 2022, to December 31, 2022. The final sample of 2347 tweets with at least 1 retweet was manually coded into categories of food groups, nutrients, user characteristics, and themes. The number and percentage of tweets, retweets, and themes in each category were calculated., Results: Of the 2347 tweets, 80% (n=1877) of tweets mentioned foods, which were categorized into 17 different food groups. Seasonings and spices, including salt, were most frequently mentioned (1356/1877, 72.2%). This was followed by vegetable and fruit groups. The 15 kinds of nutrients were mentioned in 1566 tweets, with sodium being the largest proportion at 83.1% (n=1301), followed by potassium at 8.4% (n=132). There was misinformation regarding salt intake for hypertension, accounting for 40.8% (n=531) of tweets referring to salt, including recommendations for salt intake to lower blood pressure. In total, 75% (n=21) of tweets from "doctors" mentioned salt reduction is effective for hypertension control, while 31.1% (n=74) of tweets from "health, losing weight, and beauty-related users," 25.9% (n=429) of tweets from "general public," and 23.5% (n=4) tweets from "dietitian or registered dietitian" denied salt reduction for hypertension. The antisalt reduction tweets accounted for 31.5% (n=106) of the most disseminated tweets related to nutrients and foods for blood pressure control., Conclusions: The large number of tweets in this study indicates a high interest in nutrients and foods for blood pressure control. Misinformation asserting antisalt reduction was posted primarily by the general public and self-proclaimed health experts. The number of tweets from nutritionists, registered dietitians, and doctors who were expected to correct misinformation and promote salt reduction was relatively low, and their messages were not always positive toward salt reduction. There is a need for communication strategies to combat misinformation, promote correct information on salt reduction, and train health care professionals to effectively communicate evidence-based information on this topic., (©Marina Terada, Tsuyoshi Okuhara, Rie Yokota, Takahiro Kiuchi, Kentaro Murakami. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.06.2024.)

Background: Immunocompromised individuals are not optimally protected by COVID-19 vaccines and potentially require additional preventive interventions to mitigate the risk of severe COVID-19. We aimed to characterise and describe the risk of severe COVID-19 across immunocompromised groups as the pandemic began to transition to an endemic phase., Methods: COVID-19-related hospitalisations, intensive care unit (ICU) admissions, and deaths (01/01/2022-31/12/2022) were compared among different groups of immunocompromised individuals vs the general population, using a retrospective cohort design and electronic health data from a random 25% sample of the English population aged ≥12 years (Registration number: ISRCTN53375662)., Findings: Overall, immunocompromised individuals accounted for 3.9% of the study population, but 22% (4585/20,910) of COVID-19 hospitalisations, 28% (125/440) of COVID-19 ICU admissions, and 24% (1145/4810) of COVID-19 deaths in 2022. Restricting to those vaccinated with ≥3 doses of COVID-19 vaccine (∼84% of immunocompromised and 51% of the general population), all immunocompromised groups remained at increased risk of severe COVID-19 outcomes, with adjusted incidence rate ratios (aIRR) for hospitalisation ranging from 1.3 to 13.1. At highest risk for COVID-19 hospitalisation were individuals with: solid organ transplant (aIRR 13.1, 95% confidence interval [95% CI] 11.2-15.3), moderate to severe primary immunodeficiency (aIRR 9.7, 95% CI 6.3-14.9), stem cell transplant (aIRR 11.0, 95% CI 6.8-17.6), and recent treatment for haematological malignancy (aIRR 10.6, 95% CI 9.5-11.9). Results were similar for COVID-19 ICU admissions and deaths., Interpretation: Immunocompromised individuals continue to be impacted disproportionately by COVID-19 and have an urgent need for additional preventive measures beyond current vaccination programmes. These data can help determine the immunocompromised groups for which targeted prevention strategies may have the highest impact., Funding: This study was funded by AstraZeneca UK., Competing Interests: ST, SD, SA, SV, LC, CF, RM are employees of and may own stocks or shares in AstraZeneca. RY is an employee of P95 Epidemiology & Pharmacovigilance, which received a consultancy fee for the conduct of the current study from AstraZeneca. YL, MY, KE, SG, NJ are employees of Evidera, which received funding for the conduct of the current study from AstraZeneca. EB reports receiving research grant from Vaccitech, consulting fee from AstraZeneca and Vaccitech, owning shares in Perspectum Diagnostics, and holding patents in HBV and HCV Viral Vectored Vaccine work. SB reports receiving consulting fees from AstraZeneca. RAE reports receiving funding from Evidera for providing advice throughout the current study, research grants from NIHR, UKRI, Wolfson Foundation, Genetec/Roche to her institution for works not related to current manuscript, speaker fee from Boehringer Ingelheim and Moderna, support from Chiesi for attending British Thoracic Society (BTS), and serving non paid as European Respiratory Society (ERS) Group 01.02 Pulmonary Rehabilitation and Chronic Care secretary and American Thoracic Society (ATS) Pulmonary Rehabilitation Assembly chair. PM reports receiving consulting fee from AstraZeneca and The Binding Site, speaker fee from AstraZeneca, Moderna, AbbVie, and support for attending meetings from AstraZeneca. JKQ reports receiving funding from Evidera for providing advice throughout the current study, research grants from Medical Research Council (MRC), Health Data Research UK (HDR UK), GSK, Boehringer Ingelheim, Asthma + Lung UK and AstraZeneca to her research institution, and consulting fee from GSK, Evidera, AstraZeneca, Insmed., (© 2023 The Authors.)

Hair regenerative medicine must involve practical procedures, such as cryopreservation of tissue grafts. This can aid in evaluating tissue safety and quality, as well as transportation to a clinic and multiple transplants. Hair follicle germs (HFGs), identified during in vivo development, are considered effective tissue grafts for hair regenerative medicine. However, to the best of our knowledge, methods for cryopreserving HFGs have not been explored yet. This study investigated the efficacy of slow vitrification methods for freezing HFGs. Cryoprotectants such as dimethyl sulfoxide (DMSO) and carboxylated poly-l-lysine were used for vitrification. The results indicate that DMSO vitrification yielded the most efficient de novo hair regeneration in mouse skin, comparable to that of non-cryoprotected HFGs. A microfinger was fabricated to scale up the cryopreservation method, considering that thousands of tissue grafts were required per patient in clinical practice. The microfinger can be used for a series of processes, holding the HFG, replacing it with a cryopreservation solution, freezing it in liquid nitrogen, thawing it in a warm medium, and transplanting it into the skin. Although de novo hair regeneration by HFGs cryopreserved using microfingers was reduced by approximately 20 % compared to those cryopreserved using flat plates for fertilized eggs, it exceeded 50 %. These findings demonstrate that vitrification with DMSO and microfingers could be a useful approach for the cryopreservation of tissue grafts in hair regenerative medicine for hair loss., (Copyright © 2023 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.)

Tools to evaluate pregnancy-specific anxiety are lacking in Japan. This study aimed to develop a Japanese version of the Pregnancy-Related Anxiety Questionnaire-Revised-2. After scale translation and cognitive interviews, we conducted a cross-sectional study among 120 ≥18-year-old, singleton (pregnant with one baby) Japanese women before 15 weeks of pregnancy, recruited from four facilities. A total of 112 women completed the questionnaires. We tested the internal consistency, measurement error and reliability, structural validity, measurement invariance across nulliparous and parous women, construct validity by calculating omega, standard error of measurement (SEM), intraclass correlation coefficient (ICC), confirmatory factor analysis (CFA), multigroup CFA, multitrait-scaling analysis, correlational analyses with other measurements, and t -test to compare nulliparous and parous groups. Omega was 0.90 for the total score. SEM was 3.4 and ICC was 0.76. The CFA revealed an optimal fit for the three-factor model based on the original scale. Multigroup CFA supported measurement invariance across the nulliparous and parous groups, and multitrait-scaling analysis revealed 100% scaling success. The correlation coefficients with other scales of childbirth anxiety and general anxiety were 0.70 and 0.24. The mean total score of the nulliparous women was higher than that of the parous women (34.5 vs. 30.3, p = 0.001). Therefore, the scale was determined to have good validity and reliability.

Rupture of inflammatory aortic aneurysm associated with retroperitoneal fibrosis (RF) is rare. We report a 62-year-old man with an inflammatory abdominal aortic aneurysm (IAAA) complicated with idiopathic RF, resulting in a contained rupture of the common iliac artery. The patient also presented with mild renal insufficiency due to urethral obstruction and left hydronephrosis. Surgical procedures including graft replacement and ureterolysis relieved the symptoms. Postoperative immunosuppressive treatment using corticosteroid and methotrexate successfully maintained clinical remission without signs of recurrence of RF and IAAA at the 2-year follow-up., Competing Interests: Disclosure StatementThe authors do not have any conflicts of interest to declare., (© 2023 The Editorial Committee of Annals of Vascular Diseases.)

Healthcare decision-makers face difficult decisions regarding COVID-19 booster selection given limited budgets and the need to maximize healthcare gain. A constrained optimization (CO) model was developed to identify booster allocation strategies that minimize bed-days by varying the proportion of the eligible population receiving different boosters, stratified by age, and given limited healthcare expenditure. Three booster options were included: B 1 , costing US $1 per dose, B 2 , costing US $2, and no booster (NB), costing US $0. B 1 and B 2 were assumed to be 55%/75% effective against mild/moderate COVID-19, respectively, and 90% effective against severe/critical COVID-19. Healthcare expenditure was limited to US$2.10 per person; the minimum expected expense using B 1, B 2, or NB for all. Brazil was the base-case country. The model demonstrated that B 1 for those aged <70 years and B 2 for those ≥70 years were optimal for minimizing bed-days. Compared with NB, bed-days were reduced by 75%, hospital admissions by 68%, and intensive care unit admissions by 90%. Total costs were reduced by 60% with medical resource use reduced by 81%. This illustrates that the CO model can be used by healthcare decision-makers to implement vaccine booster allocation strategies that provide the best healthcare outcomes in a broad range of contexts.

Background: The Patient Education Materials Assessment Tool (PEMAT) systematically evaluates the understandability and actionability of patient education materials. This study aimed to develop a Japanese version of PEMAT and verify its reliability and validity., Methods: After assessing content validation, experts scored healthcare-related leaflets and videos according to PEMAT to verify inter-rater reliability. In validation testing with laypeople, the high-scoring material group ( n = 800) was presented with materials that received high ratings on PEMAT, and the low-scoring material group ( n = 799) with materials that received low ratings. Both groups responded to the understandability and actionability of the materials and perceived self-efficacy for the recommended actions., Results: The Japanese version of PEMAT showed strong inter-rater reliability (PEMAT-P: % agreement = 87.3, Gwet's AC1 = 0.83. PEMAT-A/V: % agreement = 85.7, Gwet's AC1 = 0.80). The high-scoring material group had significantly higher scores for understandability and actionability than the low-scoring material group (PEMAT-P: understandability 6.53 vs. 5.96, p < 0.001; actionability 6.04 vs. 5.49, p < 0.001; PEMAT-A/V: understandability 7.65 vs. 6.76, p < 0.001; actionability 7.40 vs. 6.36, p < 0.001). Perceived self-efficacy increased more in the high-scoring material group than in the low-scoring material group., Conclusions: Our study showed that materials rated highly on Japanese version of PEMAT were also easy for laypeople to understand and action.

Laser metal-wire deposition (LMwD) exhibits a larger molten pool and layer height during printing, compared to powder bed fusion additive manufacturing; in the present study, these features revealed a more inhomogeneous but easily observable microstructure. The coaxial double laser used herein makes the energy distribution of the molten pool more complex than that afforded by a single laser source, and the microstructure of the LMwD parts was more heterogeneous as well. We observed the microstructure of Ti6Al4V by the double LMwD as-built samples by conducting a laboratory experiment and a simulation. The precipitated martensite (α') phase was defined after eliminating the influence of the β element in an X-ray diffraction analysis, which has not been discussed previously in the literature. We also propose a theory regarding the formation of heat-affected zone (HAZ) bands in an environment that includes the α' phase. Our experiments revealed only white HAZ bands, which can be attributed to the solute partitioning caused by sequential thermal cycling and the absence of the β element. The microhardness of the HAZ band areas was lower than that of both the upper and lower sides. The simulation results indicate that the maximum temperature of 2925 °C restrains the generating of HAZ bands in the final two deposited layers, due to its great difference from the β transus temperature. Moreover, the higher heat accumulation in the upper layers promoted the migration of β-grain boundaries, which may explain why the coarse columnar β grains tended to grow at the edge area in the layers deposited later. We also observed that with the use of high temperature, the nucleation of β grains is more easily promoted in the lower layers. We conclude that the concentration of residual stress in the fusion zone and the first layer is favorable to the nucleation of equiaxed grains.

The number of infertility treatment cycles in Japan is the highest worldwide. Studies have shown that stigma is a predictor of stress-related symptoms including anxiety and depression in women undergoing infertility treatment. Stress management to prevent stress-related symptoms may be crucial; however, few studies have examined the model of stigma and stress responses. Based on the stress-coping model, we hypothesized that stigma threatens the identity of such women and that coping failure increases stress responses. We aimed to explore the role of cognitive appraisals and coping strategies as mediators of the association between the stigma of infertility and stress responses. In December 2021, we conducted a cross-sectional study in Japan, in which 254 women undergoing infertility treatment completed a web-based survey. Hierarchical multiple regression analysis was conducted to analyze the associations between stigma, cognitive appraisals, coping strategies, and stress responses. The results showed that explanatory power increased with each additional variable in the following order: stigma, cognitive appraisals, and coping. Participants with a high level of stigma evaluated it as threatening, and used self-blame and venting coping strategies, and showed higher stress responses. Conversely, participants who used positive reframing coping strategies exhibited lower stress responses. Based on this, effective strategies to address stigma and stress responses are necessitated.

Cystic echinococcosis is an uncommon zoonosis in Japan. Typical location of the cyst is the liver and the lung. Mediastinal hydatidosis is found in less than 0.1% of all hydatid disease patients. We report a rare case of 68 years old male with mediastinal and liver hydatid cysts. Serological test confirmed the diagnosis of hydatidosis. The patient underwent complete resection of mediastinal and liver cysts successfully. Postoperative follow-up for two years has not shown any signs of recurrence. Simultaneous resection of the cysts in different sites including mediastinum is rare and has not been reported in Japan. Hydatid disease is an important differential diagnosis for patient who has cryptogenic liver cyst and history of contact to wildlife or unsterile water.

Purpose: In this follow-up of the R-NAC-01 study, we assessed the long-term oncological benefit of four courses of modified leucovorin, 5-fluorouracil (FU), and oxaliplatin (mFOLFOX6) chemotherapy before rectal surgery., Methods: In this prospective, multicenter study (UMIN 000012559) involving 11 hospitals in Japan, patients with lower rectal cancer underwent four cycles of mFOLFOX6 chemotherapy and subsequent surgery within four to six weeks. The 3-year recurrence-free survival and local recurrence rates were then reported., Results: Of 41 patients (36 males, 5 females; mean age: 60.8 years old) who received 4 courses of chemotherapy, 40 underwent total mesorectal excision, and 1 underwent total pelvic exenteration. R0 resection was achieved in 40 patients, but none showed a pathological complete response. Twenty-nine patients received adjuvant chemotherapy for an average of 4 months. The 3 year recurrence-free survival and local recurrence rates in patients undergoing curable resection were 72.8% and 8.5%, respectively. cStage III patients with adjuvant chemotherapy had a significantly higher 3 year recurrence-free survival than those without adjuvant chemotherapy (76.6 vs. 40.0%, log-rank p = 0.03)., Conclusion: Four courses of mFOLFOX6 chemotherapy before surgery may be a promising treatment strategy for locally advanced rectal cancer. Adjuvant chemotherapy might be needed for cStage III patients, even after four courses of neoadjuvant mFOLFOX6., (© 2022. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Sparked by the development of genome sequencing technology, the quantity and quality of data handled in immunological research have been changing dramatically. Various data and database platforms are now driving the rapid progress of machine learning for immunological data analysis. Of various topics in immunology, T cell receptor repertoire analysis is one of the most important targets of machine learning for assessing the state and abnormalities of immune systems. In this paper, we review recent repertoire analysis methods based on machine learning and deep learning and discuss their prospects., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Katayama, Yokota, Akiyama and Kobayashi.)

Aims: We aimed to investigate whether Saccharomyces boulardii strain might exert renoprotective effects by modulating renal renin angiotensin system, oxidative stress and intestinal microbiota in streptozotocin-diabetic mice., Main Methods: Thirty-six C57BL/6 male mice were divided into four groups: control (C), control + probiotic (CP), diabetes (D), diabetes + probiotic (DP). Diabetes was induced by one intraperitoneal injection of streptozotocin and Saccharomyces boulardii was administered by oral gavage for 8 weeks. Blood glucose, albuminuria and urinary volume were measured. Renal levels of angiotensin peptides (angiotensin I, II and 1-7) and the activities of angiotensin-converting enzyme (ACE) and ACE2 were determined, besides that, renal morphology, serotonin and dopamine levels and also microbiota composition were analyzed., Key Findings: Probiotics significantly increased C-peptide secretion and reduced blood glucose of diabetic animals. Saccharomyces boulardii also improved renal antioxidant defense, restored serotonin and dopamine concentration, and activated the renin-angiotensin system (RAS) vasodilator and antifibrotic axis. The modulation of these markers was associated with a beneficial impact on glomerular structure and renal function of diabetic treated animals. The phenotypic changes induced by Saccharomyces boulardii were also related to modulation of intestinal microbiota, evidenced by the decreased abundance of Proteus and Escherichia-Shigella, considered diabetic nephropathy biomarkers., Significance: Therefore, probiotic administration to streptozotocin-induced diabetic mice improves kidney structure and function in a murine model and might represent a reasonable strategy to counteract nephropathy-associated maladaptive responses in diabetes., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Japan has the highest number of cases of infertility treatment in the world. Studies have indicated that women undergoing infertility treatment feel stigmatized and suffer from psychological symptoms such as anxiety and depression. However, in Japan, few studies have quantitatively examined the association between the stigma of infertility and psychological symptoms, and, to our knowledge, no study has examined its association using a scale with tested reliability and validity. This study aims to quantitatively examine the relationship between infertility stigma and anxiety, depression, and psychological distress among women undergoing infertility treatment, using a scale that has been validated for reliability and validity. The cross-sectional study was conducted in December 2021 through a web-based survey of 254 participants undergoing infertility treatment. A multiple regression analysis was performed to examine the relationship between stigma and anxiety, depression, and psychological distress. Stigma was a statistically significant predictor of anxiety, depression, and psychological distress (standardized β = 0.58, p < 0.001; β = 0.50, p < 0.001; β = 0.62, p < 0.001, respectively) after controlling for sociodemographic and infertility characteristics. Future studies should examine the causal relationship between stigma and anxiety, depression, and psychological distress and how to intervene to reduce stigma among women undergoing infertility treatment.

The stigma of infertility negatively affects health, resulting in mental distress and poor quality of life. An appropriate scale is essential to examine the stigma experienced by infertile women and provide adequate interventions. Therefore, we developed a Japanese version of the Infertility Stigma Scale (ISS). After examining the content validity of this scale, we conducted an online survey of women undergoing fertility treatment to test the scale’s structural validity, internal consistency, intra-rater reliability, known-groups validity, convergent validity, and discriminant validity. A total of 254 participants were included in the analysis. The results of confirmatory factor analysis of four factors based on the original scale revealed the optimal fit. Cronbach’s alpha was 0.95 for the total score. Concerning test−retest analysis, the total score of the ISS and subscale had a high Spearman correlation coefficient (ρ = 0.61−0.88, p < 0.001). For convergent validity, the association between the ISS and social support, self-esteem, and family functioning was significantly negatively correlated. The results of the multitrait scaling analysis scale showed that correlations of all items exceeded 0.40, and scaling errors (7/81, 8.6%) were few. The Japanese version of the ISS was confirmed to have acceptable reliability and validity.

Objectives: Cardiovascular manifestations occur in over 80% of Williams syndrome (WS) patients and are the leading cause of morbidity and mortality. One-third of patients require cardiovascular surgery. Renal artery stenosis (RAS) is common in WS. No studies have assessed postoperative cardiac surgery-related acute kidney injury (CS-AKI) in WS. Our objectives were to assess if WS patients have higher risk of CS-AKI postoperatively than matched controls and if RAS could contribute to CS-AKI., Design: This was a retrospective study of all patients with WS who underwent cardiac surgery at our center from 2010 to 2020. The WS study cohort was compared with a group of controls matched for age, sex, weight, and surgical procedure., Setting: Patients underwent cardiac surgery and postoperative care at Lucile Packard Children's Hospital Stanford., Patients: There were 27 WS patients and 43 controls (31% vs 42% female; p = 0.36). Median age was 1.8 years (interquartile range [IQR], 0.7-3.8 yr) for WS and 1.7 years (IQR, 0.8-3.1 yr) for controls., Interventions: None., Measurements and Main Results: Postoperative hemodynamics, vasopressor, total volume input, diuretic administration, and urine output were collected in the first 72 hours. Laboratory studies were collected at 8-hour intervals. Multivariable analysis identified predictors of CS-AKI.Controlled for renal perfusion pressure (RPP) and vasoactive inotrope score (VIS), compared with controls, the odds ratio (OR) of CS-AKI in WS was 4.2 (95% CI, 1.1-16; p = 0.034). Higher RPP at postoperative hours 9-16 was associated with decreased OR of CS-AKI (0.88 [0.8-0.96]; p = 0.004). Increased VIS at hour 6 was associated with an increased OR of CS-AKI (1.47 [1.14-1.9]; p = 0.003). Younger age was associated with an increased OR of CS-AKI (1.9 [1.13-3.17]; p = 0.015)., Conclusions: The OR of CS-AKI is increased in pediatric patients with WS compared with controls. CS-AKI was associated with VIS at the sixth postoperative hour. Increases in RPP and mean arterial pressure were associated with decreased odds of CS-AKI., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Large-scale distributed training of deep neural networks results in models with worse generalization performance as a result of the increase in the effective mini-batch size. Previous approaches attempt to address this problem by varying the learning rate and batch size over epochs and layers, or ad hoc modifications of batch normalization. We propose scalable and practical natural gradient descent (SP-NGD), a principled approach for training models that allows them to attain similar generalization performance to models trained with first-order optimization methods, but with accelerated convergence. Furthermore, SP-NGD scales to large mini-batch sizes with a negligible computational overhead as compared to first-order methods. We evaluated SP-NGD on a benchmark task where highly optimized first-order methods are available as references: training a ResNet-50 model for image classification on ImageNet. We demonstrate convergence to a top-1 validation accuracy of 75.4 percent in 5.5 minutes using a mini-batch size of 32,768 with 1,024 GPUs, as well as an accuracy of 74.9 percent with an extremely large mini-batch size of 131,072 in 873 steps of SP-NGD.

Aim: The aim of this retrospective study was to investigate the incidence of cardiovascular thrombotic complications after laparoscopic resection in colorectal cancer., Methods: This study involved 2017 patients with stages 0-III colorectal cancer who underwent laparoscopic surgery at 17 Japanese hospitals between January 2010 and December 2013. We assessed the incidence of postoperative cardiovascular thrombotic and haemorrhagic complications., Results: Laparoscopic surgeries were performed in 1152 men and 865 women with 1405 colon and 612 rectal cancers, respectively. Overall, 3%, 38%, 17%, 8%, and 9% of patients had comorbidities of heart failure, high blood pressure, diabetes, history of stroke, and vascular disease, respectively. Antithrombotic agents were being consumed by 17% of patients. The types (and perioperative rest periods) of the antithrombotic agents were aspirin in 58% (18.6 days), clopidogrel in 19% (21.1 days), cilostazol in 13% (13.3 days), and warfarin potassium in 21% (14.6 days) of cases with antithrombotic agents. Surgical time and blood loss in the total cohort were 234 minutes and 56 mL. Four cases (0.2%) had cardiovascular thrombotic complications, including one severe cardiac infarction and one stroke with major sequelae (CHADS2 scores were 2 points in both cases). Hemorrhagic complications occurred in 19 cases (0.9%). In particular, the incidence of the major gastroduodenal haemorrhagic ulcer was higher in cases with antithrombotic agents than without them (0.05% vs 0%, P  = .02)., Conclusion: The incidence of cardiovascular thrombotic complications was rare, although severe cardiac infarction and stroke could occur even after minimally invasive surgery in colorectal cancer., (© 2021 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterology.)

Objectives: Public health institutions have alerted consumers about advertising for dietary supplements with false claims of preventing or treating COVID-19. We quantitatively and qualitatively examined newspaper advertisements for dietary supplements before and after the COVID-19 spread., Design: Content analysis., Participants: We analysed advertisements for dietary supplements in two major Japanese newspapers in February-July 2019 and February-July 2020. Our analysis covered 2167 advertisements., Results: The number of advertisements for dietary supplements that claimed to be effective in infection prevention (p=0.009) and improving joint (p=0.002) and digestive functions (p=0.002) significantly increased after the spread of COVID-19 compared with before. Dietary supplements that claimed to be effective in preventing infection were advertised in combination with recommendations for gargling and handwashing. Such terms as 'defence' and 'prevent' were used to promote the preventive effect., Conclusions: False and misleading claims in advertising for dietary supplements may result in consumer harm, such as overdosing and failure to take preventive behaviour. While the pandemic continues, there will be an increasing need for disseminating accessible information about the appropriate use of dietary supplements, consumer education and warnings to manufacturers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The changing pattern of anxiety and stress experienced by pregnant women during the COVID-19 pandemic is unknown., Objective: We aimed to examine the sources of anxiety and stress in pregnant women in Japan during the COVID-19 pandemic., Methods: We performed content analysis of 1000 questions posted on the largest social website in Japan (Yahoo! Chiebukuro) from January 1 to May 25, 2020 (end date of the national state of emergency). The Gwet AC1 coefficient was used to verify interrater reliability., Results: A total 12 categories were identified. Throughout the study period, anxiety related to going outdoors appeared most frequent, followed by anxiety regarding employment and infection among family and friends. Following the declaration of the state of national emergency at the peak of the infection, infection-related anxiety decreased, whereas anxiety about social support and mood disorders increased. Stress regarding relationships appeared frequent throughout the pandemic., Conclusions: The sources of anxiety and stress in pregnant women in Japan changed during the pandemic. Our results suggest the need for rapid communications in the early phase of a pandemic as well as long-term psychosocial support to provide optimal support to pregnant women in Japan. Health care professionals should understand the changing pattern of requirements among pregnant women., (©Ritsuko Shirabe, Tsuyoshi Okuhara, Rie Yokota, Hiroko Okada, Eiko Goto, Takahiro Kiuchi. Originally published in JMIR Pediatrics and Parenting (https://pediatrics.jmir.org), 15.07.2021.)

Dietary supplements are widely advertised and the market is expanding worldwide. Research suggests that dietary supplement advertising may lead consumers to make inappropriate health-related decisions, to express behaviors such as overdosing, and to neglect healthy lifestyle behaviors. We conducted a content analysis of video advertisements for dietary supplements and described the content of advertisements with high numbers and frequent views. We analyzed 82 video advertisements on YouTube that promoted fat-reduction effects. We extracted 22 themes and classified them into 10 categories. The categories with the highest numbers of advertisements were "Exemption" (i.e., consuming the product frees the audience from refraining from binge eating) (20 ads, 24.4%) and "Health Concerns" (i.e., the product intake solves the health concerns of the audience) (19 ads, 23.2%). These advertisements may stimulate negative audience attitudes toward appropriate health behaviors. The category with the most frequent views was "Lifestyle" (i.e., adding product intake to a healthy lifestyle) (3,035,298 views). "Lifestyle" advertisements portray physical activity in a positive light and may promote appropriate health behaviors in the audience. We discuss the possible effects of the advertisements on audiences and consider issues for future research and practice.