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Epidermoid cysts develop through the inclusion of the ectoderm or epithelial tissue. They mostly occur at the floor of the mouth, but rarely at other loci in the oral region. Here, we report a case of an epidermoid cyst arising in the masticator muscle space. The patient was a 60-year-old man who was referred to our hospital complaining of swelling and pain in the inner part of the right mandibular ramus. Computed tomography and magnetic resonance imaging revealed a monocytic lesion in the right masticatory muscle and pterygomandibular space. Compressive bone resorption was observed on the buccal side of the maxillary right molar alveolar bone and lingual side of the right mandibular ramus cortical bone. The lesion was enucleated under the clinical diagnosis of cyst or benign tumor in the right masticatory muscle space. Histopathological findings showed that the resected specimen has a cyst wall lined with a layer of squamous epithelium with parakeratosis, but without skin appendages. Thus, this was diagnosed as an epidermoid cyst. Recurrences did not occur 41 months after the surgery. [ABSTRACT FROM AUTHOR]

[Display omitted] • Outpatient cardiac rehabilitation (CR) is a promising tool to stroke survivors. • Outpatient CR improved motor function, but not emotional health after 3-month CR. • Some emotional health concerns may associate with outpatient CR to stroke survivors. Outpatient cardiac rehabilitation (CR) is a promising tool for improving functional outcome in stroke survivors, however, evidence for improving emotional health is limited. We aimed to clarify the effects of outpatient CR following in-hospital stroke rehabilitation on health-related quality of life (HRQOL) and motor function. Patients with acute ischemic stroke or transient ischemic attack discharged directly home were recruited, and 128 patients who fulfilled criteria for insurance coverage of CR were divided into the CR (+) group (n = 46) and CR (-) group (n = 82). All patients underwent in-hospital stroke rehabilitation, and within 2 months after stroke onset, patients in the CR (+) group started a 3-month outpatient CR program of supervised sessions. Changes of motor function and HRQOL assessed by the short form-36 version 2 (SF-36) from discharge to 3 months post-discharge were compared between the two groups. Twenty-six patients in the CR (+) group completed the program and 66 patients in the CR (-) group were followed up at a 3-month examination. Least-square mean changes in 6-minute walk distance and isometric knee extension muscle strength were significantly higher in the CR (+) group than the CR (-) group (52.6 vs. 16.3 m; 10.1 vs. 3.50 kgf/kg). Improvement of HRQOL at 3 months was not observed in the CR (+) group. Outpatient CR following in-hospital stroke rehabilitation within 2 months after stroke onset improved exercise tolerance and functional strength but not HRQOL assessed by the SF-36 after completion of CR in the present cohort. [ABSTRACT FROM AUTHOR]

Factors associated with positive mental health in children with chronic diseases remain unclear. Supporting the development of positive mental health in children with chronic diseases can enhance their mental health throughout childhood and adulthood. This study aimed to identify the factors associated with positive mental health among Japanese young adults with a history of chronic pediatric diseases. Participants aged 18–25 years, with a history of chronic pediatric diseases, were recruited from a population of students at a university. Semi-structured interviews were conducted. The data were analyzed using thematic analysis. After the initial coding of each transcript, the researchers discussed and identified a set of main themes, categories, and subcategories. Ten participants aged 19–22 years were interviewed. Their chronic diseases were diverse and included childhood cancers and allergic diseases. Seven themes (proactive coping, positive coping, negative coping, eudaimonia, hedonia, independence, and awareness) emerged from 21 categories and 70 subcategories identified. A thematic map was applied to two domains (protective factors and well-being factors) and to three inter-related constructs (individual, family, and community/society). The findings indicated that within the well-being factors, meaning in life was prominent, and within the protective factors, stress coping was found to facilitate positive mental health among individuals with a history of chronic pediatric diseases. In children with chronic diseases, support for finding appropriate coping strategies that enhance their optimism and symbiotic relationships in the community/society are important, including valuing little things in their lives, such as play and learning. • Seven themes related to positive mental health were found among Japanese adults. • The thematic map was applied for protective factors and well-being. • There should be appropriate coping strategies to build optimism in children. • Children with chronic diseases need support for valuing the little things in life. [ABSTRACT FROM AUTHOR]

[Display omitted] • Novel sequencing data from 159 Sudanese human mitochondrial genomes. • Combined with 11 published North and East African data sets yields 641 MT genomes. • Analyzed with world-wide sequencing data from 1000 Genomes and the HGDP. • Haplogroup characterization for North and East Africa. • Fifteen potential novel haplogroups. • Differences in haplogroups L0a1 and L2a1. Mitochondria are maternally inherited cell organelles with their own genome, and perform various functions in eukaryotic cells such as energy production and cellular homeostasis. Due to their inheritance and manifold biological roles in health and disease, mitochondrial genetics serves a dual purpose of tracing the history as well as disease susceptibility of human populations across the globe. This work requires a comprehensive catalogue of commonly observed genetic variations in the mitochondrial DNAs for all regions throughout the world. So far, however, certain regions, such as North and East Africa have been understudied. To address this shortcoming, we have created the most comprehensive quality-controlled North and East African mitochondrial data set to date and use it for characterizing mitochondrial genetic variation in this region. We compiled 11 published cohorts with novel data for mitochondrial genomes from 159 Sudanese individuals. We combined these 641 mitochondrial sequences with sequences from the 1000 Genomes (n = 2504) and the Human Genome Diversity Project (n = 828) and used the tool haplocheck for extensive quality control and detection of in-sample contamination, as well as Nanopore long read sequencing for haplogroup validation of 18 samples. Using a subset of high-coverage mitochondrial sequences, we predict 15 potentially novel haplogroups in North and East African subjects and observe likely phylogenetic deviations from the established PhyloTree reference for haplogroups L0a1 and L2a1. Our findings demonstrate common hitherto unexplored variants in mitochondrial genomes of North and East Africa that lead to novel phylogenetic relationships between haplogroups present in these regions. These observations call for further in-depth population genetic studies in that region to enable the prospective use of mitochondrial genetic variation for precision medicine. [ABSTRACT FROM AUTHOR]

• Lay people living in different countries have varying profile preferences. • Sex and racial identity influence profile preferences. • Upturned nose is less desired in all the assessed locations. This study aimed to assess the facial profile preferences of lay people in seven locations from different countries and whether their place of residence, sex, age, race, education, or income influenced the decision. After altering the lip and nose in 1 mm increments in the sagittal and sagittal/vertical directions, 50 profile silhouettes with white-like facial features were rated by evaluators. The soft tissue values were integrated into the profiles, and profile preferences were identified for each location. An ANOVA with post hoc Tukey test was used to compare the differences in mean preference in each location. A multivariable regression model was used to assess the effect of the demographics of the evaluator on preference. Thirteen profiles were ultimately analyzed. The mean for profile preference was significantly different across locations (P < 0.0001). For evaluators in the United States and Lebanon, the most preferred profile had the original lip and original nose. In Switzerland and South Africa, retrusive lips, and a small and less upturned nose was most preferred. In Japan and Saudi Arabia, the most preferred profile had the original lip and a protrusive nose that was less upturned. A protrusive lip with a small, upturned nose was preferred in Turkey. Profile change (P < 0.0001), location (P < 0.0001), sex (P < 0.0001), and race (P = 0.02) were significant confounders; in contrast, age, education, and income were not significant. Profile preference is different among the seven locations. For the most part, lay people prefer profiles within one SD from white norms. Also, an upturned nose is the least favored in most of the locations. Sex and race are also significant confounders. An orthodontic treatment plan decision is affected by an individual's preference for their facial appearance. This study helps clinicians understand how racial and regional differences may affect patients' preferences and, therefore, their expectations for orthodontic treatment results. [ABSTRACT FROM AUTHOR]

The prognosis of oral squamous cell carcinoma (OSCC) with posterior invasion is poor. We examined whether the pterygomandibular raphe (PMR) is useful for the diagnosis of invasion and determination of surgical methods. Of 390 patients with OSCC treated surgically at our hospital between June 2009 and June 2020, 80 patients with posterior invasion were included in the study. Preoperative magnetic resonance imaging was used to classify the lesions into three types: non-contact with PMR (non-contact type), contact with PMR (contact type), and invasion beyond PMR (invasion type). We compared the local control, recurrence, and survival rates of each of the three types. The invasion type showed a significantly higher recurrence rate than the non-contact type (P < 0.001) and contact type (P = 0.018). Overall survival rate comparisons showed that the invasion type had significantly worse prognosis than the non-contact (P = 0.004) and contact types (P = 0.041). OSCCs with posterior invasion beyond the PMR showed a poor treatment outcome and, therefore, should be treated with caution. The initial surgery is especially important and must ensure local control. This study indicates that the PMR is an important criterion for surgical method determination and that invasion beyond the PMR is a predictor of local recurrence and poor prognosis. [ABSTRACT FROM AUTHOR]

The Global Vascular Guidelines (GVGs) recommend initial revascularization (bypass or endovascular therapy) for chronic limb-threatening ischemia (CLTI) based on anatomical complexity and limb severity. This decision is made based on a prediction of the outcomes after endovascular intervention. This study was performed to evaluate outcomes after distal bypass in cases recommended for GVG bypass. A total of 239 distal bypasses for CLTI were evaluated in 195 patients with a GVG bypass recommendation treated between 2009 and 2020 at a single center in Japan. Comparisons were made between crural and pedal bypass cases. The 195 patients (median age, 77 years; 67% male) underwent 133 crural bypasses (106 patients; 54%) and 106 pedal bypasses (89 patients; 46%). Hemodialysis was more common in pedal cases than in crural cases (P =.03). Hospital deaths occurred in two cases (1%) within 30 days. The whole cohort has a follow-up rate of 96% over a mean of 28 ± 26 months, with 3-year limb salvage rates of 87% and 3-year primary, assisted primary, and secondary patency rates of 40%, 65%, and 67%, all without significant differences between crural and pedal cases. The 1-year wound healing rate was 88% and tended to be higher in crural cases than in pedal cases (P =.068). The 3-year survival rate was 52% in the cohort and did not differ significantly between crural and pedal cases. Patients with CLTI with a GVG bypass recommendation had acceptable limb salvage, graft patency, wound healing, and survival after distal bypass, regardless of the bypass method. These findings indicate that a GVG bypass recommendation as an initial revascularization method is valid in the real world. [ABSTRACT FROM AUTHOR]

The use of genetic data for timber species and population assignment is a powerful tool for combating the illegal timber trade, but the challenges of extracting DNA from timber have prevented the routine use of genetics as a supply chain management tool. To overcome these challenges, we explored the feasibility of focused ultrasound extraction (FUSE) for rapid DNA release from timber. Using high-pressure ultrasound pulses, FUSE generates a cavitation bubble cloud that disintegrates samples into acellular debris, resulting in the mechanical release of DNA. In this work, FUSE was applied to white oak (Quercus alba) timber shavings to test the feasibility of using FUSE for timber DNA extraction for the first time. Results showed that FUSE processing disintegrated the tissue samples and released significant quantities of DNA. After five minutes of tissue processing DNA quantities of 0.21 ± 0.02 ng/mg, 0.99 ± 0.32 ng/mg, and 0.14 ± 0.01 ng/mg, were released from medium, coarse, and combination shaving groups, respectively. Amplification and sequencing of regions within the matK and rbcL chloroplast genes confirmed that the quality of DNA prepared with FUSE was suitable for PCR and short-read sequencing applications. Overall, these results show that FUSE can serve as a DNA sample preparation method capable of releasing high-quality DNA from timber in a fraction of the time required by conventional extraction methods. Based on the improved efficiency of DNA release with FUSE, ongoing work aims to develop this technology into portable systems that can be used to rapidly prepare timber samples for genetic species identification. • Extracting DNA from timber tissue is a critical challenge that hinders routing DNA testing in timber supply chains. • Focused ultrasound extraction (FUSE) has recently been developed as a rapid DNA sample preparation technique. • FUSE effectively released DNA from white oak samples, suitable for DNA testing, after 5 minutes of tissue processing. • This technique has the potential to overcome DNA extraction challenges that have prevented the adoption of genetics as a front-line timber identification tool. [ABSTRACT FROM AUTHOR]

Various reports have been published regarding adoption of team-based learning (TBL) in pharmacy education. However, there is insufficient published evidence on the effect of student characteristics on student learning outcomes in a TBL curriculum. The purpose of this research was to evaluate the effects of pre-study examination results and peer evaluation ratings on learning outcomes. The TBL strategy was adopted for a basic chemistry exercise for first-year students at a private pharmacy school in Japan (2012–2019). For the analysis, students were divided into four analytical groups according to quartiles of pre-study examination results. The students were further divided into the high-peer evaluation rating group and low-peer evaluation rating group. We compared the final exam performance results between these groups. In all four groups by quartiles of pre-study examination results, the course final exam performance was higher for the high-peer evaluation rating students than for the low-peer evaluation rating students. Within the TBL framework, students with higher peer evaluation scores performed better on the final exam, regardless of the pre-study examination results. • Team-based learning (TBL) is an active-learning approach. • We evaluated the effect of pre-exam and peer evaluation on final exam using TBL. • High-peer rating group performed better than low-peer rating group. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the influence of pre-operative nutritional status on long term outcomes of patients with chronic limb threatening ischaemia (CLTI) after distal bypass. Patients who underwent distal bypass for CLTI from 2011 to 2020 at a single centre were reviewed retrospectively in Japan. Comparisons were made between patients with malnutrition and normal nutrition, as diagnosed by four nutritional assessments: Controlling Nutritional Status (CONUT), Geriatric Nutritional Risk Index (GNRI), Glasgow Prognostic Score (GPS), and Prognostic Nutritional Index (PNI). The primary endpoint was survival, and the secondary endpoints were graft patency, limb salvage, and wound healing. A total of 314 distal bypasses were performed in 249 patients (169 males; median age, 76 years; diabetes mellitus, 70%; and end stage renal disease with haemodialysis, 40%). Malnutrition was observed in 103 patients (41%) evaluated by CONUT, 129 (52%) by GNRI, 76 (31%) by GPS, and 114 (46%) by PNI. The survival rates in the study cohort were 81% at one year, 55% at three years, and 47% at five years. Malnutrition in all assessments was statistically significantly associated with reduced survival rate (CONUT, p <.001; GNRI, p =.002; GPS, p <.001; PNI, p <.001). In multivariable analysis, CONUT was the best predictor of mortality (p =.014). Malnutrition did not affect graft patency and limb salvage, but malnutrition based on CONUT, GNRI, and GPS was statistically significantly associated with reduced wound healing (CONUT, p =.002; GNRI, p =.006; GPS, p =.011). In multivariable analysis, CONUT tended to be the best predictor of wound healing (p =.061). Malnutrition in patients with CLTI with distal bypass was associated with overall mortality and incomplete wound healing. CONUT assessment was most effective for prediction of survival and wound healing. Distal bypass for CLTI patients with malnutrition may be suboptimal, and endovascular treatment may be recommended as an initial revascularisation method. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate implantation of trophoblast cells is necessary for successful pregnancy outcome. This process requires proper migration and invasion of trophoblast cells into the maternal endometrium and the myometrium. Dysregulation of circulating microRNAs in preeclampsia has been reported in several studies. Furthermore, miR-486-5p was reportedly increased within exosomes derived from maternal circulation in preeclamptic pregnancy. However, the roles of elevated miR-486-5p in preeclampsia has not yet been clarified.Methods: HTR8/SVneo trophoblast cells were transfected with miR-486-5p, and the ARHGAP5 expression was examined by quantitative reverse transcription polymerase chain reaction (RT-qPCR) and Western blotting. A reporter assay using a luciferase construct containing the ARHGAP5 3'-untranslated region (3'UTR) was performed to determine whether or not ARHGAP5 is a direct target of miR-486-5p. Changes in migration and invasion abilities were examined by a wound healing assay and invasion assay, respectively.Results: The ARHGAP5 expression was significantly decreased in miR-486-5p-transfected cells according to RT-qPCR and Western blotting. A dual luciferase reporter gene assay showed that miR-486-5p acts directly on the 3'UTR of ARHGAP5 mRNA. The migration and invasion abilities were suppressed in miR-486-5p-transfected cells. Downregulation of ARHGAP5 by small interfering RNA transfection inhibited trophoblast cell migration and invasion, resembling that of miR-486-5p transfection.Discussion: The migration and invasion abilities of HTR8/SVneo cells were suppressed by miR-486-5p at least partly through inhibiting the ARHGAP5 expression. These data suggest that miR-486-5p is involved in the pathogenesis of preeclampsia and that miR-486-5p is a viable potential biomarker for predicting the onset risk of preeclampsia. [ABSTRACT FROM AUTHOR]

This study created video-based educational materials for pharmacists' disaster response using video recordings of disaster drills to evaluate the feasibility of online education for teaching evacuation shelter management. Video materials were created from an actual disaster drill held at the Hirakata campus of Setsunan University and were provided to second-year pharmacy students as part of their classes. We conducted a questionnaire survey before and after the video intervention to evaluate participants' attitudes toward providing support during disasters, awareness of pharmacists' role in disaster relief, and willingness to participate in disaster drills. A comparison of the pre- and post-intervention questionnaire results showed that the intervention enhanced participants' understanding of pharmacists' role in disaster medicine. The factor analysis, cluster analysis, and the amount of change showed that the video materials vividly conveyed the confusion of a disaster to the participants and helped them imagine experiencing and responding to a disaster. The findings showed the feasibility of using video-based educational materials to vividly convey the chaos that challenges medical personnel during disaster-response efforts. This method provides a safe way to prepare students who might be called upon to work in emergency conditions and stimulate interest in disaster medicine. Ideally, this and similar interventions will become part of an extensive toolbox of empirically-based disaster preparedness educational materials. • Video materials positively influence students' impressions of disaster medicine. • Disaster medical education using video recordings of practical disaster drills builds an image of disaster medicine. • Disaster medical education, including evacuation shelter management, will spark interest in more advanced disaster medicine. • Even if it is not face-to-face and remote, it can introduce disaster medical education. • Our video material will be positioned between mere lectures and practical simulations. [ABSTRACT FROM AUTHOR]

• Patients with atrial fibrillation (AF) and bioprostheses are increasing. • Data of valve position on thrombosis and bleeding in those patients are sparse. • The thrombotic risk in aortic valve (AV) versus mitral valve (MV) was comparable. • The bleeding risk in MV group was significantly higher compared with AV group. • Careful follow up for AF are essential, especially in MV bioprostheses. The impact of valve position on thromboembolic and bleeding events in patients with atrial fibrillation (AF) and bioprosthetic valves is uncertain. We analyzed 159 patients with AF after surgical single-valve replacement from the BPV-AF registry (Retro) (UMIN000034198), which was a multicenter, retrospective, observational registry that enrolled 214 patients with AF and bioprosthetic valves to assess differences in bioprosthetic valve position. Baseline characteristics and clinical outcomes were compared on the basis of the position of aortic or mitral bioprosthetic valves. The primary efficacy endpoint was stroke or systemic embolism, and the primary safety endpoint was major bleeding. There were 85 patients (53.5%) in the aortic valve (AV) group and 74 patients (46.5%) in the mitral valve (MV) group. The MV group had a lower body weight and a higher prevalence of prior major bleeding compared with the AV group. Thromboembolic and bleeding risk scores and the administration of antithrombotic agents were not significantly different between the groups. The primary efficacy endpoint was not significantly different [AV group: 8.2%; 2.25/100 person-years (PY); MV group: 4.1%; 1.01/100 PY] (log-rank, p = 0.23). The primary safety endpoint was significantly higher in the MV group (17.6%; 4.54/100 PY) compared with the AV group (5.9%; 1.59/100 PY) (log-rank, p = 0.049). The adjusted hazard ratio of the primary safety endpoint in the MV group relative to the AV group was 2.71 (95% confidence interval 0.86–8.54, p = 0.09). In Japanese patients with AF and bioprosthetic valves, thromboembolic risk does not differ on the basis of valve position. Bleeding risk is higher in patients with MV bioprostheses, although valve position itself might not be an independent predictor for bleeding. Thromboembolic risk does not differ on the basis of valve position. Bleeding risk is higher with MV bioprostheses, although valve position itself might not be an independent predictor for bleeding. [Display omitted] [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the influence of inframalleolar disease (Global Limb Anatomic Staging System Inframalleolar [GLASS IM] modifier) on long term outcomes of patients with chronic limb threatening ischaemia (CLTI) after distal bypass. Patients who underwent distal bypass for CLTI from January 2012 to December 2019 at a single centre were reviewed retrospectively. Comparisons including baseline characteristics, procedural details, and long term outcomes were made between patients with an intact pedal arch (GLASS IM modifier P0), an absent or severely diseased pedal arch (P1), and no target artery crossing the ankle into the foot (P2), diagnosed by pre- and intra-operative high quality angiography. The primary endpoint was limb salvage. The secondary endpoints were graft patency and wound healing. A total of 254 distal bypasses were performed in 206 patients (139 males; median age, 76 years). The GLASS IM modifier was P0 in 80 (32%) limbs, P1 in 127 (50%), and P2 in 47 (18%). During the follow up period, 22 limbs (9%) required major amputation. The limb salvage rates at three years in P0, P1, and P2 cases were 94%, 89%, and 93%, respectively, with no significant differences among the modifiers. The primary patencies at three years in P0, P1, and P2 cases were 49%, 38% and 24%, respectively. The primary patency in P2 cases was significantly lower than that in P0 cases (p <.050). The respective wound healing rates at 12 months were 97%, 93%, and 79%, and again the wound healing rate in P2 cases was significantly lower than those in other cases (p <.050). Long term outcomes including patency, limb salvage, and wound healing after distal bypass for CLTI patients with an infrapopliteal lesion were acceptable in cases in each GLASS IM modifier. [ABSTRACT FROM AUTHOR]

De-escalation of P2Y12 inhibitor may occur for various clinical reasons in patients with acute myocardial infarction (AMI). We aimed to assess the characteristics and outcomes of patients who underwent a de-escalation strategy in real-world clinical practice. We studied 2604 AMI patients initially treated with prasugrel using the Japan Acute Myocardial Infarction Registry (JAMIR) database. Of these, 110 (4%) were discharged on clopidogrel [de-escalation group; switching 4 days after admission (median)] and the remaining 2494 continued prasugrel at discharge (continuation group). The de-escalation group had higher incidence of heart failure or history of cerebrovascular disease, and were more likely to receive mechanical circulatory support, and oral anticoagulation than the continuation group. During mean follow-up of 309±133 days post-discharge, no significant differences were observed in ischemic events (2.2% vs. 2.8%, p = 0.74) or major bleeding (1.1% vs. 1.6%, p = 0.72) between the de-escalation and continuation groups. Although, patients with de-escalation from prasugrel to clopidogrel had higher bleeding risk profile than those continued on prasugrel, post discharge ischemic and bleeding events were similar between patients with and without de-escalation. De-escalation strategy may be an option for AMI patients with high risk for bleeding. [ABSTRACT FROM AUTHOR]

Background: We sought to examine racial and ethnic disparities in test positivity rate and mortality among emergency department (ED) patients tested for COVID-19 within an integrated public health system in Northern California.Methods: In this retrospective study we analyzed data from patients seen at three EDs and tested for COVID-19 between April 6 through May 4, 2020. The primary outcome was the test positivity rate by race and ethnicity, and the secondary outcome was 30 day in-hospital mortality. We used multivariable logistic regression to examine associations with COVID-19 test positivity.Results: There were 526 patients tested for COVID-19, of whom 95 (18.1%) tested positive. The mean age of patients tested was 54.2 years, 54.7% were male, and 76.1% had at least one medical comorbidity. Black patients accounted for 40.7% of those tested but 16.8% of the positive tests, and Latinx patients accounted for 26.4% of those tested but 58.9% of the positive tests. The test positivity rate among Latinx patients was 40.3% (56/139) compared with 10.1% (39/387) among non-Latinx patients (p < 0.001). Latinx ethnicity was associated with COVID-19 test positivity (adjusted odds ratio 9.6, 95% confidence interval: 3.5-26.0). Mortality among Black patients was higher than non-Black patients (18.7% vs 1.3%, p < 0.001).Conclusion: We report a significant disparity in COVID-19 adjusted test positivity rate and crude mortality rate among Latinx and Black patients, respectively. Results from ED-based testing can identify racial and ethnic disparities in COVID-19 testing, test positivity rates, and mortality associated with COVID-19 infection and can be used by health departments to inform policy. [ABSTRACT FROM AUTHOR]

Objective: The JT interval of the myocardial repolarization time can be divided into Jpoint to T-peak interval (JTp) and T-peak to T-end interval (Tpe). It is well known that the JT interval is dependent on the heart rate, but little is known regarding heart rate dependence for JTp and Tpe. The aim of the present study was to clarify the heart rate dependence of JTp and Tpe and to elucidate the interference of autonomic nervous activity with these parameters.Methods: We evaluated 50 prepubertal children (mean age: 6.4 ± 0.5 years; male:female, 22:28) without heart disease. JTp, Tpe, and the preceding RR intervals were measured using 120 consecutive beats (lead CM5). First, the relationships between the RR interval and JTp and Tpe were evaluated by Pearson's correlation coefficient. Second, to evaluate autonomic interference with JTp and Tpe, the degree of coherence between RR interval variability and JTp or Tpe variability was calculated using spectral analysis.Results: Significant positive correlations were observed between the RR interval and JTp (y = 0.116x + 105.5; r = 0.594, p < 0.001) and between the RR interval and Tpe (y = 0.037x + 44.7; r = 0.432, p < 0.001). Tpe variability had a lower degree of coherence with RR interval variability (range: 0.039-0.5 Hz) than with JTp variability (0.401 [interquartile range, 0.352-0.460] vs. 0.593 [0.503-0.664], respectively; p < 0.001).Conclusions: Tpe had lower heart rate dependence and a lower degree of autonomic nervous interference than did JTp. [ABSTRACT FROM AUTHOR]

Introduction: Maxillary anterior crowding (MxAC) has been considered to be an esthetically favorable characteristic of young women in Japan. It has been hypothesized that laypeople and orthodontists have different esthetic preferences; however, to date, this has not been investigated in detail. Therefore, the present study compared the facial attractiveness of women with MxAC and the interpretation of MxAC among orthodontists and laypeople with and without orthodontic treatment experience in Japan.Methods: Thirty-eight orthodontists, 42 laypeople with orthodontics (patients), and 43 laypeople without orthodontics (laypeople) evaluated the attractiveness of resting and smiling frontal images of 12 women with MxAC (MxAC models; mean age, 21.7 ± 2.6 years) and 12 women with normal occlusion (normal models; mean age, 20.1 ± 0.7 years) using a visual analog scale. In addition, they responded to a questionnaire that asked them to select the terms most closely associated with MxAC. All evaluators and models were Japanese.Results: For all evaluator groups, the facial attractiveness of the MxAC models was significantly lower than that of the normal models for both the resting and smiling images. For MxAC models, orthodontists evaluated resting images more attractive than smiling images, whereas laypeople evaluated smiling images more attractive than resting images. Significantly more patients and laypeople than orthodontists selected "cute" as the term most closely associated with MxAC (P <0.05).Conclusions: The orthodontists, patients, and laypeople showed a different tendency in their facial attractiveness preferences. Regardless of their orthodontic experience, the laypeople showed more positive interpretations of MxAC than orthodontists. This finding seems to be influenced by Japanese culture, which values irregularity in nature as one form of beauty. [ABSTRACT FROM AUTHOR]

Mutations in the fibroblast growth factor receptor 2 (FGFR2) gene are responsible for several severe forms of craniosynostotic disorders, such as Apert and Crouzon syndromes. Patients with craniosynostotic disorders caused by a mutation in Fgfr2 present with several clinical symptoms, including hypersalivation. Here we used a transgenic mouse model of Apert syndrome (Fgfr2 +/S252W mice) to evaluate the morphology of the submandibular glands at embryonic day 15.5 (E15.5), the time point reported to mark the start of lumen formation. Fgfr2 +/S252W mice were generated by crossing ACTB-Cre +/+ and Fgfr2 +/Neo-S252W mice. After measuring body weight, the submandibular glands were collected at E15.5. H&E staining, immunostaining, and RT-qPCR were performed to investigate the development of the submandibular gland. The number of ducts and acini in Fgfr2 +/S252W mice was significantly higher than in control littermates; however, lumen formation was not affected. The mRNA expression of Fgf1 , Fgfr1 , Mmp2 , Bmp4 , Bmp7 , Dusp6 , and Etv5 in Fgfr2 +/S252W mice was significantly higher compared to control littermates. Immunoreactivity for FGF3, FGF1, BMP4, and F4/80 was detected in the parenchyma of Fgfr2 +/S252W mice. The area of apoptotic cells stained with TUNEL in Fgfr2 +/S252W mice was significantly larger than that of the control littermates. These results suggested that increased FGFR1 signaling and apoptosis in the submandibular glands of Fgfr2 +/S252W mice occurred at E15.5, leading to parenchymal hyperplasia. This study demonstrated that a Ser252Trp substitution in mouse FGFR2 resulted in hyperplasia of the submandibular gland parenchyma during development. • An S252W substitution in FGFR2 causes hyperplasia of the salivary gland parenchyma. • An S252W mutation in FGFR2 promotes FGFR1 expression in the salivary gland at E15.5. • An S252W substitution in FGFR2 promotes apoptosis in the salivary gland at E15.5. [ABSTRACT FROM AUTHOR]

Although distal bypass using vein has been established with acceptable outcomes for chronic limb threatening ischaemia (CLTI), the major issue affecting long term outcomes is vein graft disease. This study aimed to analyse the peri-procedural results and long term outcomes of endovascular therapy (EVT) for failing vein grafts after distal bypass. A retrospective analysis of 113 failing vein grafts (94 patients, 113 limbs) after distal bypass between 2009 and 2019 at the study hospital. The mean age was 74 ± 9 years and 72% of the patients were men. Of the 113 grafts, 54 grafts (48%) were detected in asymptomatic patients, 41 grafts (36%) in patients with recurrent ulcer or gangrene, and 18 grafts (16%) in patients with rest pain. The failing grafts were treated by low pressure long inflation balloon angioplasty with a mean balloon size of 3.0 ± 0.8 mm. The mean procedural time was 60 ± 29 min and procedural success was 98% (111 grafts). During the mean follow up period of 34 months, EVT was performed a median frequency of two times (range 1–11 times). The primary and assisted primary patency of the EVT revised grafts were 41% and 80% at one year, 34% and 68% at three years, 31% and 58% at five years, respectively. Of 41 limbs with recurrent ulcer or gangrene, the wound healed in 34 limbs (85%). The complete healing rate was 71% at three months and 84% at 12 months. Eight patients required major amputation, and the freedom from major amputation rate was 96% at one year and 80% at five years. Long term outcomes including patency, wound healing rate, and amputation free survival after EVT for failing vein grafts were acceptable. EVT could be a viable alternative to surgical revascularisation in patients with a failing distal bypass graft for CLTI. [ABSTRACT FROM AUTHOR]

The objective of our study was to examine the direct action of insulin-like growth factor-1(IGF-1) signaling on energy homeostasis in myocytes. We studied the IGF-1 stimulation of mitochondrial uncoupling protein 3 (UCP3) expression in the HEK 293 derived cell line TSA201, murine C2C12 skeletal muscle myoblasts, and rat L6 skeletal myoblasts. We also investigated the direct effect of IGF-1 on the Insulin/IGF-1 receptor (IGF-1R)/phosphatidylinositol 3 (PI3)-Akt/forkhead box O4 (FOXO4) pathway using a combination of a reporter assay, semi-quantitative polymerase chain reaction, western blotting, and animal experiments. We demonstrated that IGF-1 regulates UCP3 expression via phosphorylation of FOXO4, which is a downstream signal transducer of IGF-1. UCP3 expression increased with activated FOXO4 in a dose-dependent manner. We also examined the functional FOXO4 binding site consensus sequences and identified it as the −1922 bp site in the UCP3 promoter region. UCP3 was also found to be concomitantly expressed with IGF-1 during differentiation of C2C12 myoblasts. Our animal experiments showed that high fat diet induced IGF-1 levels which likely influenced UCP3 expression in the skeletal muscle. Our findings demonstrate that that IGF-1 directly stimulates UCP3 expression via the IGF-1/IGF-1R/PI3-Akt/FOXO4 pathway. • FOXO4 acts downstream of PI3K-Akt and is involved in IGF-1-mediated energy metabolism. • IGF-1 regulates the expression of UCP3 and its impact was greater than that of GH. • IGF-1 may play some kind of roles locally in myoblasts differentiation in association with UCP3. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

• The data yielded 34 sustainable dietary behaviors for consumers. • Japanese participants mainly mentioned food waste avoidance behaviors. • German participants mentioned behaviors addressing global environmental issues. This study (1) qualitatively describes sustainable dietary behaviors (SDBs) that Japanese and German adults can implement in their lives, and (2) quantitatively compares similarities and differences in understanding SDBs between the two samples. Data regarding understanding of SDBs from online focus group interviews (16 Japanese, 50.0 % women) and an online open-ended survey (498 Japanese and 197 German, 56.6 % women) in 2021 were analyzed using manifest content analysis and Chi-square and Fisher's exact tests. Consequently, 64 subcategories and 34 categories were identified and grouped into five scenes: food choice, storing and preservation, cooking, eating, and disposal. Of the categories, 16 had significantly different proportions by country (p < 0.05). Many Japanese participants mentioned SDBs related to food waste prevention, while German participants mentioned behaviors related to solving environmental problems more frequently. Our study deepens adults' understanding of SDBs and contributes to strategy development to improve food sustainability among consumers. [ABSTRACT FROM AUTHOR]

Abstract Purpose Most studies of stress in children with chronic diseases have been geared toward parents and caregivers have not considered allergic diseases together. This study aimed to identify the stressors associated with allergic diseases in Japanese school-age children. Design and Methods Stressors associated with allergic diseases of 11 school-age children (seven boys and four girls; age range: 9–12 years) were investigated using semi-structured interviews. Results In the qualitative thematic analysis of stressors about allergic diseases, two themes: allergic disease-specific stressors and common stressors in chronic diseases, and 12 categories were identified. A thematic map was applied to four domains of stressor: physiological factors, psychological factors, social factors, and environmental factors. Conclusions The results showed that school-age children with allergic diseases have a variety of stressors. Future studies should aim to develop an allergic disease-specific stress management program with school-age children. Practice Implications In children with allergic diseases, not only is stress management in daily life important, but also stress management for disease-specific matters to control the symptoms and maintain mental health. Stress management should be supported for school-age children with allergic diseases. Highlights • Stressor types were identified: allergic disease-specific and common in chronic disease. • Map was applied to physiological, psychological, social, and environmental domains. • Awareness of stress management is needed for children with allergic diseases. [ABSTRACT FROM AUTHOR]

Objective We evaluated the direct action of GH signaling in energy homeostasis in myocytes. Design We investigated the GH-induced expression of UCP3 in human embryonic kidney 293 cells, human H-EMC-SS chondrosarcoma cells, murine C2C12 skeletal muscle myoblasts, and rat L6 skeletal muscle cells, as well as its direct effect on the GHR/JAK/STAT5 pathway using a combination of a reporter assay, real-time quantitative polymerase chain reaction, and western blotting. Results We demonstrated that the regulation of energy metabolism by GH involves UCP3 via activated STAT5, a signal transducer downstream of GH. UCP3 expression increased with STAT5 in a dose-dependent manner and was higher than that of UCP2. We confirmed the functional STAT5 binding site consensus sequences at −861 and −507 bp in the UCP3 promoter region. Conclusion The results suggest that GH stimulates UCP3 directly and that UCP2 and that UCP3 participate in the signal transduction pathway that functions downstream of the GHR/JAK/STAT. [ABSTRACT FROM AUTHOR]

Introduction: Placental insufficiency is one of the major risk factors for growth restriction and preeclampsia. The aim of this study is to investigate whether recombinant human Thrombomodulin(r-TM) improves fetal conditions and physiological outcomes.Methods: We used CBA/J × BALB/C mice as a control and CBA/J × DBA/2 mice - a well-studied model of recurrent spontaneous miscarriage. Pregnant mice received daily subcutaneous injections of r-TM or saline from day 0-15. The fetal resorption rate, fetal weight, and litter size were calculated at day 15. Additionally, we analyzed the mRNA expression of angiogenic factors and the concentration of soluble Flt-1 (sFlt-1) using the ELISA kit.Results: The rate of fetal resorption in CBA/J × DBA/2 mice treated with r-TM was significantly lower compared with mice without r-TM treatment. Additionally, fetal weight and litter size were also significantly higher in the r-TM treated mice. Fibrinogen deposition in the labyrinth area of the CBA/J × DBA/2 mice treated with r-TM was significantly lower compared with deposits in the mice untreated with r-TM. As well, r-TM significantly increased the gene expression level of VEGF and Flt-1 mRNA in the placentas of the CBA/J × DBA/2 mice. r-TM treatment also significantly decreased the production of sFlt-1 protein in the placentas of preeclampsia-like diseased mice.Conclusion: r-TM as an anticoagulation therapy has the potential for the medical treatment of recurrent miscarriage and fetal growth restriction due to improved angiogenic factors. Additionally, r-TM treatment has the potential for the recovery of preeclampsia. [ABSTRACT FROM AUTHOR]

Background and Aims Curability is associated with resection width and depth in polypectomy. We evaluated the resection width and depth achieved with hot snare polypectomy (HSP) and cold snare polypectomy (CSP) for small colorectal polyps. Methods In this single-center, prospective, randomized controlled study, patients with rectal or rectosigmoid polyps ≤10 mm in diameter were treated with HSP or CSP. Resection width was evaluated as mucosal defect size, measured immediately postprocedure and 1 day later. Resection depth was histologically evaluated using obtained specimens. Results Fifty-two patients were enrolled. Mean lesion size was 5.6 mm with HSP (n = 27) and 5.8 mm with CSP (n = 25). Mean mucosal defect diameter immediately after HSP and CSP was 5.1 mm and 7.5 mm, respectively ( P < .001). The diameter 1 day after the procedure increased by 29% (95% confidence interval [CI], 17%-41%) with HSP and decreased by 25% (95% CI, 18%-32%) with CSP ( P < .001). Muscularis mucosa was obtained similarly with HSP and CSP (96% [95% CI, 82%-99%] vs 92% [95% CI, 75%-98%]; P = .603). Submucosal tissue was obtained significantly more frequently with HSP than with CSP (81% [95% CI, 63%-92%] vs 24% [95% CI, 11%-43%]; P < .001). Conclusions The resection width immediately after CSP was larger than that after HSP but was significantly smaller at day 1 after resection. Although the resection depth after CSP was more superficial, muscularis mucosa was obtained in most specimens. Thus, CSP has sufficient resection width and depth to enable complete polyp resection and potentially has a superior safety profile than HSP. [ABSTRACT FROM AUTHOR]

Herein, we report the case of a 73-year-old woman with an occupational history of plaster grinding who developed autoimmune pulmonary alveolar proteinosis (PAP) during the treatment of fibrotic hypersensitivity pneumonitis with steroids and immunosuppressive drugs. Based on the changes in computed tomography imaging findings, poor response to steroid therapy, and markedly elevated KL-6 levels, PAP was suspected and diagnosed by bronchoscopy. Repeated segmental bronchoalveolar lavage under high-flow nasal cannula oxygen therapy resulted in slight improvement. Steroids and immunosuppressive treatments for other interstitial lung diseases may cause PAP or exacerbate latent PAP. • PAP is characterized by accumulation of surfactants and phospholipids in the alveoli. • A quarter of autoimmune PAP have a history of dust exposure. • PAP may be revealed or exacerbated by immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to investigate craniofacial morphology in women with Class I occlusion and maxillary anterior crowding (MxAC) with bilateral palatal displacement of the lateral incisors and facial displacement of the canines.Methods: Thirty-three women with normal occlusion (mean age, 20.7 ± 2.3 years) were selected as the control group, and 33 women with severe MxAC (mean age, 23.3 ± 3.8 years) with bilateral palatal and facial displacement of the lateral incisors and canines, respectively, were selected as the MxAC group. Mesiodistal tooth crown diameter, arch length discrepancy, facial-palatal displacement of lateral incisors and canines, and dental arch dimensions were measured. Fourteen skeletal and 10 dental cephalometric measurements were made. Medians, interquartile ranges, means, and standard deviations were calculated for each parameter, and the nonparametric Mann-Whitney U test (P <0.05) was used to compare the 2 groups.Results: Compared with the control group, the MxAC group showed a significantly wider angle (P <0.05) and shorter length (P <0.01) in the cranial base, a smaller sagittal maxillary base (P <0.01), and a hyperdivergent skeletal pattern (P <0.01 and P <0.05).Conclusions: Women with Class I occlusion and severe MxAC exhibited a significantly wider angle and shorter length in the cranial base, a smaller sagittal maxillary base, and a hyperdivergent skeletal pattern. These skeletal and dental characteristics and cranial base dysmorphology may be helpful as potential indicators for orthodontic treatment with extractions. [ABSTRACT FROM AUTHOR]

Background There is no report on correlation between early revascularization and the occurrence of major cardiac events (MCEs) except severe heart failure in Japanese patients with stable coronary artery disease (CAD). This study aimed to determine whether early revascularization affected the incidence of MCEs in Japanese patients with stable CAD. Methods We retrospectively investigated 3581 stable CAD patients who underwent rest 201 Tl and stress 99m Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography (SPECT) and provided three-year-prognostic data. The endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. On the basis of estimated propensity scores, patients who underwent revascularization within the first 60 days after the SPECT and those who did not were matched in a 1:1 ratio ( n = 450 per group). We compared MCE rates in relation to the amount of ischemic myocardium detected with the SPECT between the two groups. Results The overall incidence of MCEs was not significantly different between the early-revascularization and no-early-revascularization groups (6.7% vs. 8.7%, p = 0.2598). Nevertheless, the incidence of MCEs in the patients with ≤5% ischemia was significantly higher in the early-revascularization group than in the no-early-revascularization group (5.8% vs. 0.8%, p = 0.0226). In contrast, the incidence of MCEs in the patients with >10% ischemia was significantly lower in the early-revascularization group than in the no-early-revascularization group (7.0% vs. 16.8%, p = 0.0036). The incidence of MCEs in the patients with 6–10% ischemia, however, was not significantly different between the early-revascularization and no-early-revascularization groups (6.9% vs. 4.1%, p = 0.3235). Conclusions Early revascularization possibly leads to the occurrence of MCEs related to the treatment procedure but may be a therapeutic strategy leading to improvement in prognosis in patients with moderate to severe ischemia. [ABSTRACT FROM AUTHOR]

Objective The transition of white adipocytes to beige cells (a phenomenon referred to as browning or beigeing) during obesity has been previously reported. Our study aimed to examine the mechanisms through which obesity induced by a high fat diet (HFD) affects uncoupling protein 1 (UCP1) expression via signal transduction and activator of transcription 5 (STAT5s). Design Seven-week-old male C57BL/6J mice were fed a normal or HFD for 11 weeks. Body weight, white adipose tissue weight, and blood lipid and glucose levels were measured. To unveil the molecular mechanisms of UCP1 expression in adipose tissue, we performed further studying 3T3-L1 cells using qRT-PCR. We also measured UCP1 promoter activity in the TSA201 cell line using a dual luciferase assay. In addition, we analyzed the predicted consensus sequences for STAT5 binding in the UCP1 promoter region. Results Mice fed an HFD had higher body weight and intra-abdominal adipose tissues weight and a higher expression of UCP1, GH receptor (GHR), STATs, suppressors of cytokine signaling (SOCSs), and cytokine-inducible SH2-containing protein (CISH) compared to control mice. In 3T3-L1 cell studies, GH induced phosphorylation of the STAT5, SOCSs, CISH and UCP1 expressions. UCP1 promoter activity was associated with constitutively active STAT5 in a dose-dependent manner. We confirmed functional STAT5 binding sites at − 425, − 279, and − 178 bp of the UCP1 promoter. Conclusion We suggest that endogenous GH induces UCP1 expression in adipose tissue via STAT5. [ABSTRACT FROM AUTHOR]

Background: Fibroblast growth factor 18 (FGF18) is one of the key factors in human signaling pathways and has been reported to be associated with the formation of various tissues. Additionally, FGF18 has been reported to maintain the telogen stage of the hair cycle, and its over-expression has also been observed in cancer cells.Hypothesis/purpose: We searched for natural compounds that inhibit the expression of FGF18 expression in vitro and evaluated their inhibitory mechanisms.Study Design: Various plant samples were screened using a luciferase assay targeting FGF18. One active compound was selected by the screening, isolated and identified.Methods: The active compound was isolated using chromatographic techniques and identified by specific rotation measurements, LC-MS and NMR. Additionally, its inhibitory mechanism was evaluated using real-time RT-PCR and Western blotting.Results: As a result of screening various plant leaf samples, Macaranga tanarius was identified as the most active plant and a prenylflavonoid nymphaeol-C was isolated as the active compound. Using real-time RT-PCR and Western blotting analysis, this compound was confirmed to strongly suppress the expression of FGF18. The compound lowered the β-catenin level in the Wnt/β-catenin pathway. Thus, it was suggested that nymphaeol-C suppresses the expression of FGF18 by suppressing β-catenin expression. Additionally, the compound lowered the extracellular signal-regulated kinase1/2 (ERK1/2) phosphorylation level in the mitogen-activated protein kinase cascade (MAPK cascade). Therefore, nymphaeol-C suppressed downstream signals of FGF18 by suppressing the expression of FGF18.Conclusion: We isolated and identified prenylflavonoid nymphaeol-C from M. tanarius. The compound suppresses the expression of FGF18 and affects FGF18 related signals. [ABSTRACT FROM AUTHOR]

Introduction: Epidemiological estimate lifetime risk (LTR) is a measure that expresses the probability of disease in the remaining lifetime for individuals of a specific index age. These estimates can be useful for general audience targeted knowledge translation activities against diabetes. There are only a few reports on lifetime of impact of diabetes on coronary heart disease (CHD) events.Methods: The Suita Study, a cohort study of cardiovascular diseases (CVD), was established in 1989. We included all participants who were CVD free at baseline. Age (in years) was used as the time scale. Age-specific incidence rates were calculated with person-year method within ten-year bands. We estimated the sex and index-age specific LTR of first-ever CHD with taking the competing risk of death into account.Results: We followed 5559 participants without CHD history during 1989-2007 for 71,745.4 person-years. At age 40 years the competing risk of death adjusted LTR for all CHD were 16.61% for men without diabetes and 21.06% for men with diabetes. Therefore the LTD for CHD was higher by 4.45% for men with diabetes compared to men without. The competing risk adjusted LTR of CHD at 40 years of aged women was 9.18% for without diabetes and 14.21% for with diabetes. This increased LTR of CHD for diabetic patients were observed among both men and women across all index ages.Conclusion: In this urban community based population we observed that diabetes has significant effect on the residual LTR of CHD among both men and women of middle age. This easy understandable knowledge can be used as important indexes to assist public health education and planning. [ABSTRACT FROM AUTHOR]

This study sought to document the efficiency of DNA bait capture (i.e., “fishing”) methods by two measures: (1) its ability to retain targeted DNA molecules, and (2) its ability to remove non-target DNA molecules from a pool containing both. DNA bait capture uses synthetic biotinylated DNA primers to bind target DNA, which are then immobilized onto streptavidin coated magnetic beads and drawn to a magnet. Bound DNA should, therefore, be isolated from non-target DNA and impurities (e.g., PCR inhibitors) and can be later eluted from the beads for downstream applications. Efficiencies were estimated by comparing the number of “copies in” to “copies out” with quantitative polymerase chain reaction (qPCR). Retention of target DNA molecules, ranging from 109 to 288 base pairs (bps) in length, averaged just 9.06–3.53% (i.e., loss of 90.94–96.47%) using the fishing protocol as originally described. Some improvement was achieved by employing a modified protocol (i.e., with a shortened hybridization time, use of twice the amount of M-270 streptavidin-coated beads, and modified bead washing), resulting in average retention of 31.41–12.08% of the same set of targeted molecules. Noted was the lack of efficacy in removing non-target DNA molecules as opposed to targeted molecules. It was also observed that most of the molecules (61.35–69.49%) are “lost” during the essential hybridization step of the fishing protocol, suggesting its suitability for high copy number samples only. While the bait capture method may be useful in the study of polymerase chain reaction (PCR) inhibited DNA samples as previously suggested, it is necessary to carefully weigh this possible advantage against the degree of expected DNA loss and the non-selectivity of the method for targeted over non-targeted DNA. [ABSTRACT FROM AUTHOR]

• Computer aided Japanese traditional musical instruments learning system. • Visual and vibrational feedback system. • Reducing learning time for Japanese Shamisen. In this study, we focus on shamisen, a traditional Japanese musical instrument. A shamisen expert strikes the shamisen string and body drum with a bachi gripped in the right hand to play the shamisen. However, performing this striking motion of the forearm is difficult for beginners. Therefore, beginners are required to train for the forearm motion. Hence, we developed a forearm motion training system using a visual and vibrational feedback-assist interface for learning the striking motion required for playing a shamisen. In our experiment, a comparison was made between the developed system and a previous visual feedback-only system. The experimental results demonstrated that the users of the developed system can reduce the striking length compared to that in the previous system. In the prestage of practicing musical instructional books, it is thought that there is a certain effect in learning how to move the forearm, which is also a focus of our study, by our proposed feedback. The experimental results show that our proposed system can reciprocatively enhance the learning of various motions, indicating that our system can be used in other musical instruments, such as a drum, guitar, and violin. [ABSTRACT FROM AUTHOR]

The 2019 Global Vascular Guidelines recommend a suitable initial revascularization method with reference to limb severity (wound, ischemia, and foot infection [WIfI] stage) and anatomic complexity (Global Limb Anatomical Staging System [GLASS] stage). However, limb outcomes after revascularization among WIfI and GLASS stages have not been investigated fully after infrapopliteal vein bypass. The purpose of this study was to assess the four Global Vascular Guideline-recommended limb outcomes after infrapopliteal vein bypass in cases with different WIfI and GLASS stages. Patients who underwent infrapopliteal vein bypass for chronic limb-threatening ischemia at a single center were analyzed retrospectively. Medium-term limb outcomes were compared among WIfI and GLASS stages. The primary end points were limb salvage rate and major to minor amputation ratio, and the secondary end points were wound healing rate and wound healing time. A total of 353 infrapopliteal vein bypasses were performed in 284 patients with tissue loss (male, 193 patients; median age, 77 years; diabetes, 71%; hemodialysis, 41%). A total of 111 limbs (31%) required only minor amputation and 38 limbs (11%) required major amputation. The major to minor amputation ratio was 0.34 with no significant differences among WIfI stages or GLASS stages. The 3-year limb salvage rate was 87%. This rate was significantly lower in WIfI stage 4 than in stage 2 (P =.049), but did not differ significantly among GLASS stages. The 12-month wound healing rate was 86%. This rate was also significantly lower in WIfI stage 4 than in stages 2 and 3 (both P <.001), but did not differ significantly among GLASS stages. The median wound healing time was 55 days (range, 32-110 days), and was significantly longer in WIfI stage 4 compared with stages 2 (P =.001) and 3 (P <.001), but showed no significant differences among GLASS stages. The limb salvage rate, wound healing rate, and wound healing time were associated with limb severity (WIfI stage), but not with anatomic complexity (GLASS stage). These findings suggest that an appropriate preoperative strategy and careful perioperative management are important for patients with greater limb severity. [ABSTRACT FROM AUTHOR]

Study Objective: To assess whether a robotic simulation curriculum for novice surgeons can improve performance of a suturing task in a live porcine model.Design: Randomized controlled trial (Canadian Task Force classification I).Setting: Academic medical center.Patients: Thirty-five medical students without robotic surgical experience.Interventions: Participants were enrolled in an online session of training modules followed by an in-person orientation. Baseline performance testing on the Mimic Technologies da Vinci Surgical Simulator (dVSS) was also performed. Participants were then randomly assigned to the completion of 4 dVSS training tasks (camera clutching 1, suture sponge 1 and 2, and tubes) versus no further training. The intervention group performed each dVSS task until proficiency or up to 10 times. A final suturing task was performed on a live porcine model, which was video recorded and blindly assessed by experienced surgeons. The primary outcomes were Global Evaluative Assessment of Robotic Skills (GEARS) scores and task time. The study had 90% power to detect a mean difference of 3 points on the GEARS scale, assuming a standard deviation (SD) of 2.65, and 80% power to detect a mean difference of 3 minutes, assuming an SD of 3 minutes.Measurements and Main Results: There were no differences in demographics and baseline skills between the 2 groups. No significant differences in task time in minutes or GEARS scores were seen for the final suturing task between the intervention and control groups, respectively (9.2 [2.65] vs 9.9 [2.07] minutes, p = .406; and 15.37 [2.51] vs 15.25 [3.38], p = .603). The 95% confidence interval for the difference in mean task times was -2.36 to .96 minutes and for mean GEARS scores -1.91 to 2.15 points.Conclusions: Live suturing task performance was not improved with a proficiency-based virtual reality simulation suturing curriculum compared with standard orientation to the da Vinci robotic console in a group of novice surgeons. [ABSTRACT FROM AUTHOR]

Objectives We have previously reported that tumor endothelial cells (TECs) are chromosomally abnormal. It is generally known that immortalized cells have chromosomal abnormalities. In this study, our objective was to compare chromosomal properties of an immortalized normal endothelial cell (NEC) line, MS1, and those of TECs, to assess the possible usefulness of MS1 cells as a surrogate for TECs, which have some experimental intractability as primary cultured endothelial cells. Methods Primary cultured NECs were isolated from murine dermis tissue. Fluorescence in situ hybridization was performed to analyze aneuploidy in MS1 cells and NECs. DNA damage response (DDR) activation was analyzed by γH2AX staining. We also tested the involvement of reactive oxygen species (ROS) in the chromosomal abnormalities of MS1 cells. Results MS1 cells showed a higher rate of aneuploidy than NECs did (91.6% versus 7.6%). A DDR was activated to a greater extent in MS1 cells than in NECs, judging by H2AX phosphorylation. ROS induced H2AX activation in MS1 cells, suggesting that ROS are involved in their DDR. Conclusion MS1 cells are aneuploid and activate H2AX to a greater extent than NECs do. MS1 cells resemble TECs in terms of the proliferative phenotype and aneuploidy. Thus, MS1 may be a good cell line for studies on the relation between chromosomal instability and a DDR in nonmalignant cells. [ABSTRACT FROM AUTHOR]

Summary Background & aims The accuracy of the visual estimation method is unknown, even though it is commonly used in hospitals to measure the dietary intake of patients. We aimed to compare the difference in the validity of visual estimation according to the raters' job categories and tray divisions, and to demonstrate associations between meal characteristics and validity of visual estimation in a usual clinical setting in a community hospital. Methods We collected patients' dietary intake data in usual clinical settings for each tray in 3 ways: visual estimation by nursing assistants, visual estimation by dietitians, and weighing by researchers (reference method). Dietitians estimated the dietary intake using 2 divisions, namely, whole tray and food items. Then we compared the weights and visual estimation data to evaluate the validity of the visual estimation method. Results Mean nutrient consumption of target trays was significantly different when using the visual estimation of target trays than when using the weighed method (visual estimation by nursing assistants [589 ± 168 kcal, 24.3 ± 7.0 g/tray, p < 0.01], dietitians' whole trays [561 ± 171 kcal, 23.0 ± 6.9 g/tray, p < 0.05], food items [562 ± 171 kcal/tray, p < 0.05], and dietitians' food items [23.4 ± 7.3 g/tray, p = 0.63]). Spearman's correlations for both methods were very high for energy (ρ = 0.91–0.98, p < 0.01) and protein intakes (ρ = 0.88–0.96, p < 0.01), respectively. The limits of agreement in the Bland–Altman plot for both dietary intake categories were −121 kcal to 147 kcal/tray and −6.4 g to 7.0 g/tray (nursing assistants, whole division), −122 kcal–106 kcal/tray and −6.7 g to 5.5 g/tray (dietitians, whole divisions), and −82 kcal to 66 kcal/tray and −4.3 g to 3.9 g/tray (dietitians, food items divisions). High intake rate of grains was significantly associated with decreased odds of a difference between two methods based on the nursing assistant's whole tray evaluation (odds ratio [OR]: 0.85; 95% confidence interval [CI]: 0.76–0.94) and the dietitians' whole tray (OR: 0.80; 95% CI: 0.72–0.89) and food items evaluations (OR: 0.64; 95% CI: 0.56–0.73), respectively. In addition, minced meals were also associated with a difference between two methods, for the nursing assistants' whole tray (OR: 3.53; 95% CI: 1.66–7.51) and dietitians' food items (OR: 2.92; 95% CI: 1.37–6.22). Conclusions Visual estimation by nursing assistants and dietitians correlated highly with the weighing method although the limits of agreement were wide. Nursing assistants and dietitians should pay attention to low consumption and modified texture meals when evaluating dietary intake using the visual estimation method. [ABSTRACT FROM AUTHOR]

Summary Objective Individuals with high impulsivity tend to overeat on impulse. The objective of this study was to examine methods of weight control, focusing on coping with the aftermath of dietary lapses, among those who have high impulsivity. Methods Eight hundred adults aged 20–59 years, who were registered with a research company completed a self-reported cross-sectional questionnaire. They were classified into low and high impulsivity groups using the median impulsivity score measured with the Barratt Impulsiveness Scale. We compared coping strategies in the aftermath of dietary lapses between the two groups. We also examined the correlation between coping methods and body mass index (BMI) using multiple regression analysis in the low and high impulsivity groups. Results The high impulsivity group used more coping strategies, such as self-monitoring, self-reflective thoughts, and positive thoughts. The main finding of this study was that compensation by healthy eating was negatively correlated with BMI in the high impulsivity group. Additionally, positive thoughts were positively correlated with BMI. Conclusions The results suggest that compensation with healthy eating in the aftermath of dietary lapses is important to control weight in those with high impulsivity. [ABSTRACT FROM AUTHOR]

The intestinal microbiota is involved in many physiological processes and it is increasingly recognized that differences in community composition can influence the outcome of a variety of murine models used in biomedical research. In an effort to describe and account for the variation in intestinal microbiota composition across the animal facilities of participating members of the DFG Priority Program 1656 “Intestinal Microbiota”, we performed a survey of C57BL/6J mice from 21 different mouse rooms/facilities located at 13 different institutions across Germany. Fresh feces was sampled from five mice per room/facility using standardized procedures, followed by extraction and 16S rRNA gene profiling (V1–V2 region, Illumina MiSeq) at both the DNA and RNA (reverse transcribed to cDNA) level. In order to determine the variables contributing to bacterial community differences, we collected detailed questionnaires of animal husbandry practices and incorporated this information into our analyses. We identified considerable variation in a number of descriptive aspects including the proportions of major phyla, alpha- and beta diversity, all of which displayed significant associations to specific aspects of husbandry. Salient findings include a reduction in alpha diversity with the use of irradiated chow, an increase in inter-individual variability (beta diversity) with respect to barrier access and open cages and an increase in bacterial community divergence with time since importing from a vendor. We further observe a high degree of facility-level individuality, which is likely due to each facility harboring its own unique combination of multiple varying attributes of animal husbandry. While it is important to account and control for such differences between facilities, the documentation of such diversity may also serve as a valuable future resource for investigating the origins of microbial-driven host phenotypes. [ABSTRACT FROM AUTHOR]

Aims: We compared the effects of heart rate-guided and dose-guided beta-blocker titration strategies on QT variability in patients with chronic heart failure (CHF).Methods: In a prospective study we recorded 5-minute resting high-resolution ECGs (HRECG) in 100 patients with CHF and measured heart rate (HR) and ventricular repolarization by QT variability index (QTVI). In a subgroup of patients not reaching target HR (<70bpm) we uptitrated beta blockers and repeated HRECG measurements 3months thereafter.Results: Target HR was present in 46 patients (group A), and in 54 patients HR was above target (group B). The groups did not differ in age, gender, NYHA class, NT pro-BNP, creatinine, or beta blocker dose. Patients in group A displayed significantly lower QTVI than patients in group B (-1.25±0.55 vs. -1.52±0.42, P=0.013). When uptitrating beta-blockers we found a decrease in HR (from 91±15bpm to 71±15bpm, P<0.001), NTpro BNP levels (from 4474±3878pg/ml to 3042±2566pg/ml, P=0.024), and NYHA class (from 3.0±0.8 to 2.5±0.7, P=0.006). With beta-blocker uptitration QTVI decreased in 10 of 24 patients (42%). In these patients HR decreased more than in the remaining cohort (-25±20bpm vs. -15±17bpm, P=0.017). On multivariate analysis, the presence of target HR was a predictor of QTVI decrease (P=0.017), but beta-blocker dose was not.Conclusions: In patients with CHF treated by beta-blockers, changes in QT variability appear to occur in parallel with changes of heart rate. This suggests that heart rate-guided titration of beta-blockers may be associated with decreased risk of sudden cardiac death. [ABSTRACT FROM AUTHOR]

The actions taken in order to make public administration more efficient within the last few years have been concentrated on optimizing the internal processes within public institutions. In doing so, an emphasis was placed upon the method in which public financial resources are utilized. The accumulated experience in theory as well as in practice has shown however, that optimizing the processes of planning financial resources is just as important. As a result, the emphasis can be placed on the efficiency of budgetary processes. To evaluate the budgetary performance a series of financial-economic indicators can be used in order to quantify the method in which financial resources are used, as well as producing a plan for their application. The use of statistical analysis and the evaluation of official data which is offered by public institutions, on the basis of which financial-economic indicators are calculated manages to distinguish this paper from others. The conclusions of this study focuses on the expressivity and usefulness of these indicators. [ABSTRACT FROM AUTHOR]

Objective Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and is associated with an enhanced risk for liver and cardiovascular diseases and mortality. NAFLD can progress from simple hepatic steatosis to non-alcoholic steatohepatitis (NASH). However, the mechanisms predisposing to this progression remain undefined. Notably, hepatic mitochondrial dysfunction is a common finding in patients with NASH. Due to a lack of appropriate experimental animal models, it has not been evaluated whether this mitochondrial dysfunction plays a causative role for the development of NASH. Methods To determine the effect of a well-defined mitochondrial dysfunction on liver physiology at baseline and during dietary challenge, C57BL/6J-mt FVB/N mice were employed. This conplastic inbred strain has been previously reported to exhibit decreased mitochondrial respiration likely linked to a non-synonymous gene variation (nt7778 G/T) of the mitochondrial ATP synthase protein 8 (mt-ATP8). Results At baseline conditions, C57BL/6J-mt FVB/N mice displayed hepatic mitochondrial dysfunction characterized by decreased ATP production and increased formation of reactive oxygen species (ROS). Moreover, genes affecting lipid metabolism were differentially expressed, hepatic triglyceride and cholesterol levels were changed in these animals, and various acyl-carnitines were altered, pointing towards an impaired mitochondrial carnitine shuttle. However, over a period of twelve months, no spontaneous hepatic steatosis or inflammation was observed. On the other hand, upon dietary challenge with either a methionine and choline deficient diet or a western-style diet, C57BL/6J-mt FVB/N mice developed aggravated steatohepatitis as characterized by lipid accumulation, ballooning of hepatocytes and infiltration of immune cells. Conclusions We observed distinct metabolic alterations in mice with a mitochondrial polymorphism associated hepatic mitochondrial dysfunction. However, a second hit, such as dietary stress, was required to cause hepatic steatosis and inflammation. This study suggests a causative role of hepatic mitochondrial dysfunction in the development of experimental NASH. [ABSTRACT FROM AUTHOR]

The aim of the article was to investigate the effect of site of sampling, size, and sex on the variations of salivary cortisol of healthy dogs. Samples of saliva were collected from dogs of private owners (n = 13), kennels (n = 4), and shelters (n = 2). For each dog, samples were collected at the first interaction of the day with man (T0) before the morning meal (6:00-8:00 am ), 30 minutes after the meal (T1), and 30 minutes after the last interaction of the day with man (T2), when dogs were resting and apparently relaxed. A total of 92 dogs belonging to 17 different pure breeds or crossbred were eligible for the study, being 19 dogs privately owned, 47 recruited in kennels, and 26 hosted in shelters. Salivary cortisol concentrations of the dog population were not normally distributed, and data were transformed to natural logarithm (ln). The mean values ranged from −0.70 to 3.40 ln ng/mL, with an average of 0.90 ± 0.76 ln ng/mL, corresponding to 0.50, 30.00, and 3.48 ± 4.05 ng/mL. Mean salivary cortisol was significantly higher for dogs hosted in shelters than those privately owned or in the kennels ( P < 0.05). Cortisol values from intact dogs did not differ between males and females, whereas for castrated males and spayed females, significantly lower values were found ( P < 0.01 intact vs. castrated males; P < 0.05 intact vs. spayed females). Mean salivary cortisol concentration was significantly lower for giant and large-sized dogs than for small-sized dogs ( P < 0.01), whereas mean cortisol for medium-sized dogs was not significantly different from the other sizes. The interaction of site with time of sampling was significant ( P < 0.05), with the highest cortisol concentration at T2 for dogs privately owned and housed in the kennels and at T0 for dogs hosted in the shelters. This study, focused on healthy dogs, indicated that several factors can affect the concentration of salivary cortisol. Further studies also involving pathological conditions are required to identify critical values that can be used for clinical management settings. [ABSTRACT FROM AUTHOR]

Background We analyzed electromechanical mismatch (EMM) and its relationship to ventricular repolarization in patients with nonischemic dilated cardiomyopathy (DCM). Methods and Results In 39 DCM patients with left ventricular ejection fraction (LVEF) <40% and New York Heart Association functional class ≥III, electroanatomic mapping was used to quantify areas of EMM. High-resolution electrocardiograph was used to measure heart rate variability (HRV) and QT variability index (QTVI). EMM was present in 22 patients (56%, group 1), whereas 17 patients presented no mismatched segments (44%, group 2). The groups did not differ in age (56 ± 10 years in group 1 vs 57 ± 7 years in group 2; P = .82), sex (male: 82% vs 94%; P = .40), LVEF (27 ± 8% vs 25 ± 6%; P = .18), or N-terminal pro–B-type natriuretic peptide (2,350 pg/mL vs 2,831 pg/mL; P = .32). Although heart rate and HRV were similar in both groups (rate: 80 ± 20 beats/min in group 1 vs 74 ± 19 beats/min in group 2 [ P = .47]; standard deviation of normal-to normal RR intervals: 106 ± 79 vs 88 ± 115 [ P = .61]), we found significantly higher QTVI values in patients from group 1 (−1.15 ± 0.46 vs −1.62 ± 0.51 in group 2; P = .005). In patients with implantable cardioverter-defibrillators, ventricular arrhythmias recorded ≤1 year before enrollment were more frequent in group 1 than in group 2 (58% vs 13%; P = .02). Conclusions EMM is present in a majority of patients with DCM and is associated with ventricular repolarization instability. [ABSTRACT FROM AUTHOR]

Study Objective To compare length of hospital stay for minilaparotomy vs laparoscopic hysterectomy. Design Retrospective cohort study (Canadian Task Force classification II-2). Setting Kaiser Permanente Northern California, a large integrated health care delivery system. Patients Women >18 years of age undergoing laparoscopic or minilaparotomy hysterectomy because of benign indications from June 2009 through January 2010. Intervention Hysterectomy via minilaparotomy or laparoscopy. Measurements and Main Results Medical records were reviewed for outcomes of interest including length of stay and surgical and demographic data. Parametric and non-parametric analyses were used to compare the 2 groups. The study was powered to detect a difference of 8 hours in length of stay. Two hundred sixty-three cases were identified as hysterectomy via minilaparotomy (n = 100) or laparoscopy (n = 163). The laparoscopy group demonstrated a significantly shorter mean (SD) length of stay (19 [14] hours vs 42 [20] hours; p < .001) and less blood loss (126 [140] mL vs 241 [238] mL; p < .001). The minilaparotomy group experienced a shorter procedure time (113 [47] minutes vs 197 [124] minutes; p < .001). There was no difference between the groups insofar as patient morbidity including intraoperative and postoperative complications, emergency visits, readmissions, or repeat operations. Conclusion Compared with minilaparotomy, laparoscopic hysterectomy is associated with shorter length of hospital stay, longer operating time, and no increased patient morbidity. [ABSTRACT FROM AUTHOR]