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BACKGROUND: Internet-cognitive behavioural therapy (iCBT) for depression can include multiple components. This study explored depressive symptom improvement prognostic factors (PFs) and effect modifiers (EMs) for five common iCBT components including behavioural activation, cognitive restructuring, problem solving, self-monitoring, and assertion training. METHODS: We used data from a factorial trial of iCBT for subthreshold depression among Japanese university students (N=1093). The primary outcome was the change in PHQ-9 scores at 8weeks from baseline. Interactions between each component and various baseline characteristics were estimated using a mixed-effects model for repeated measures. We calculated multiplicity-adjusted p-values at 5% false discovery rate using the Benjamini-Hochberg procedure. RESULTS: After multiplicity adjustment, the baseline PHQ-9 total score emerged as a PF and exercise habits as an EM for self-monitoring (adjusted p-values

Despite being one of the bilaterians, the body plan of echinoderms shifts from bilateral symmetry to five-fold radial, or pentaradial symmetry during embryogenesis or their metamorphosis. While the clarification of the developmental mechanism behind this transition will be a basis for understanding their unique body plan evolution, it is still poorly understood. With this regard, the hydrocoel, a mesodermal coelom formed on the left side of bilateral larva, would be a clue for understanding the mechanism as it is the first pentaradial structure that appears before metamorphosis and develops into the water vascular system of adults. By analyzing the development of a sea cucumber, Apostichopus japonicus, we found that the hydrocoel expresses genes related in muscle and neural formation such as myosin heavy chain, tropomyosin, soxC, and elav, implying that cells of the hydrocoel contributes to muscle and neural structures in the adult. Furthermore, ablation of one of the hydrocoel lobes led to incomplete development of adult pentameral structures. The ablation of primary hydrocoel lobes resulted in the reduction in tentacles and the ablation of secondary hydrocoel lobes resulted in the reduction in water vascular canals and nerve cords. Our findings suggest that the hydrocoel lobes may serve as a potential organizing center for establishing the pentaradial body plan in echinoderms.

[Objectives] This study aims to describe the distribution of anchor-based minimal important change (MIC) estimates in standard deviation (SD) units and examine if the robustness of such estimates depends on the specific SD used or on the methodological credibility of the anchor-based estimates. [Design and Setting] We included all anchor-based MIC estimates from studies published in MEDLINE and relevant literature databases upto October 2018. Each MIC was converted to SD units using baseline, endpoint, and change from baseline SDs. We performed a descriptive analysis of MICs in SD units and checked how the distribution would change if MICs with low methodological credibility were excluded from the analysis. [Results] We included 1, 009 MIC estimates from 182 studies. The medians and interquartile ranges of MICs in SD units were 0.43 (0.25 to 0.69), 0.42 (0.22 to 0.70), and 0.51 (0.28 to 0.78) for baseline, endpoint, and change SD units, respectively. Some MICs were extremely large or small. The distribution did not change significantly after excluding MICs estimated by less credible methods. [Conclusions] The size of the universally applicable MIC in SD units could not be determined. Anchor-based MICs in SD units were widely distributed, with more than half in the range of 0.2 to 0.8.

Endoscopic resection (ER) for early gastric cancer (EGC) can preserve the stomach; however, the remaining stomach can develop second gastric cancer. Few reports have prospectively investigated the incidence and treatment outcomes of second gastric cancer.This post-hoc analysis used the dataset of the single-arm confirmatory trial, JCOG0607. The key inclusion criteria for JCOG0607 were solitary differentiated-type EGC and no previous gastrectomy or endoscopic treatment for EGC. Three hundred seventeen patients who underwent curative ER were included in this study. Surveillance endoscopy was performed 1 to 3 months after the initial ER and subsequently annually for at least 5 years. A lesion detected ≤1 year and1 year after the initial ER was defined as overlooked gastric cancer (OGC) and metachronous gastric cancer (MGC), respectively.During a median follow-up period of 6.0 years (interquartile range, 5.1-7.0), 30 OGCs and 61 MGCs were detected in 24 and 48 patients, respectively. The cumulative incidence of OGC at 1 year and MGC at 5 years was 7.6% and 12.7%, respectively. ER and gastrectomy were performed in 85 lesions and 6 lesions, respectively. Pathologic evaluation showed 78 mucosal cancers, 12 submucosal cancers, and 1 advanced cancer. Eventually, 28 OGCs and 52 MGCs fulfilled the pathologic criteria for curative ER.Our study was the first to reveal the actual incidence of second gastric cancer after curative ER for differentiated-type gastric cancer. Most lesions could be treated with ER. Continuous endoscopic surveillance after curative ER is important to detect second gastric cancer.

The m.14453G A mutation in MT-ND6 has been described in a few patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes or Leigh syndrome.However, the clinical spectrum and molecular characteristics are unclear.Here, we present four infantile-onset patients with m.14453G A-associated Leigh syndrome. All four patients had brainstem lesions with basal ganglia lesions, and two patients had cardiac manifestations. Decreased ND6 protein expression and immunoreactivity were observed in patient-derived samples. There was no clear correlation between heteroplasmy levels and onset age or between heteroplasmy levels and phenotype; however, infantile onset was associated with Leigh syndrome.

Hypothesis and Background The relationship between baseball pitchers' satisfaction with their performance and the incidence of shoulder and elbow injuries is unclear. We hypothesized that self-evaluated satisfaction with pitching performance before an injury and incidence of shoulder and elbow injuries are related. Methods Baseline data on baseball experience, height, weight, elbow and shoulder range of motion, and shoulder muscle strength of high-school baseball pitchers were collected. During the season, all participants completed a self-recorded questionnaire regarding satisfaction scores, presence of shoulder and/or elbow pain, and pitching limitations due to shoulder and/or elbow pain experienced daily to determine when injuries occurred and record the satisfaction scores. The optimal satisfaction score cutoff value was determined through receiver operating characteristic (ROC) curve analysis; participants were categorized into satisfied and unsatisfied groups. Statistical tests were performed to evaluate the differences between the groups, obtain the time-to-event curves, and calculate the hazard ratios for the incidence of injury. Results Overall, 108 participants aged 15–17 years were enrolled and divided into satisfied (88) and unsatisfied (20) groups. The injury incidence rate was 10.2% and 50.0% in the satisfied and unsatisfied groups, respectively. High-school baseball pitchers with low satisfaction had a significantly increased risk of shoulder and elbow injuries; these players had a 7.3-times greater risk of injuries and 1.9-times earlier occurrence of injuries than pitchers who were satisfied with their performance. Conclusion Daily evaluation of players' self-satisfaction could predict shoulder and elbow injuries in high-school baseball pitchers.

BACKGROUND Cardiomyopathy is a risk factor for poor prognosis in pediatric patients with mitochondrial disease. However, other risk factors including genetic factors related to poor prognosis in mitochondrial disease has yet to be fully elucidated. METHODS AND RESULTS Between January 2004 and September 2019, we enrolled 223 consecutive pediatric mitochondrial disease patients aged

Background We investigated the differences in the prevalence of ulnar nerve instability (UNI) by hand dominance and evaluated the relationship between UNI and morphologic changes in the ulnar nerve and the clinical findings and upper limb function. Methods This study examined 153 healthy participants (n = 306 elbows; 44 men, 112 women; mean age 65.4 years) who underwent ultrasonography to assess the ulnar nerve cross-sectional area (UNCSA) at three points of the bilateral cubital tunnel at 30° of elbow flexion. Participants were divided into three groups based on the ultrasonography findings of UNI: no instability (type N), subluxation (type S), and dislocation (type D). For the dominant and nondominant sides, we assessed the relationship between the UNCSA and clinical factors, including the age, gender, height, weight, body mass index, fat mass, grip strength, key pinch strength, UNCSA, and Patient-Rated Elbow Evaluation score. Results We identified 75 cases without instability in both elbows and 78 cases with some instability. The prevalence of UNI was 51%. No significant difference was found between hand dominance and the prevalence of UNI. The UNCSA at 1 cm proximal to the medial epicondyle on the bilateral sides in type S was the most increased among three types. Conclusion UNI was identified in almost half of the participants, with no marked difference found in the hand dominance. The UNCSA at 1 cm proximal to the medial epicondyle was significantly increased the most in type S. UNI does not appear to be associated with elbow symptoms in the general population.

Calcite-core/Mg-calcite (MgxCa1−xCO3)-shell nanorods were synthesized by bubbling CO2 gas into Ca(OH)2 aqueous slurry with Mg2+ doping. The thermal stability of the resulting particles in the forms of aqueous slurry and dry powder was investigated, and the nanorods doped with higher Mg2+ concentrations were found to have excellent thermal stability both in water and air. The microscopic structures of the nanorods were characterized in detail by XRD and TEM, and the Mg-calcite nanoclusters that almost fully covered the particle surface were deduced to be responsible for the improvement of particle morphology stability. Facile fabrication of 1D anisotropic nanoparticles with better thermal stability can widen the industrial application of calcite.

Pisiform and hamate coalition, a rare congenital anomaly, is most often identified as an asymptomatic incidental finding on radiographs. Some patients have symptomatic coalition with ulnar-sided wrist pain or ulnar nerve neuropathy from ulnar nerve compression. Sports activities such as cycling and weight lifting can cause compression of the ulnar nerve in the hand. This report describes a case of a pisiform and hamate coalition in a 36-year-old man who reported decreased right-hand dexterity and right ulnar-sided wrist pain. The patient, an amateur weight lifter, developed right claw hand through repeated bench press training. Intraoperative findings revealed compression of the deep palmar branch of the ulnar nerve between the tendinous arch of the hypothenar muscles and pisiform and hamate coalition. Surgical resection of the tendinous arch and the enlarged hook of hamate relieved the claw hand deformity.

Dynamic public good contribution games in the literature allow players to contribute in multiple periods. These games typically have inefficient and, sometimes, (approximately) efficient subgame perfect equilibria. Inefficiency can take the form of either delayed provision or nonprovision of the public good. In contrast, this paper studies a game that differs primarily in that each player can contribute only once. Each player thus chooses the period at which they contribute, and the size of the contribution. The main result is that if the number of periods is finite but larger than the number of players, then every subgame perfect equilibrium in which each player's contribution amount is strictly less than that player's valuation for the good is efficient: the public good is provided without delay.

Background Elbow injuries are common in young baseball players and evaluating the characteristics of young baseball players in a large-scale population is necessary. However, few studies have compared playing position, length of baseball experience, physical findings, and elbow pain in young baseball players. This retrospective multi-regional cohort study sought to document the physical findings at the elbow in Japanese elementary school baseball players and to examine the relationship between playing position, length of baseball experience, physical findings at the elbow, and elbow pain. Methods In 2014, 720 fifth-grade baseball players from four regions in Japan were invited to participate in a questionnaire survey and undergo physical examination to obtain data on position played, length of baseball experience, presence of elbow pain, and physical findings at the elbow, including range of motion, tenderness, and valgus stress test results. Potential risk factors associated with elbow pain and correlations between physical findings and playing position, length of baseball experience, and elbow pain were investigated. Results The 720 subjects had a mean age of 10.4 years and 29.4% reported having experienced elbow pain for ≥1 week. Risk factors for elbow pain included playing pitcher and catcher, playing pitcher and fielder, and length of baseball experience. The most frequent finding was limitation of flexion (21.1%) followed by tenderness of the medial epicondyle (18.3%) and a positive valgus stress test (14.3%). These three findings were also significantly associated with elbow pain. Elbow extension was limited in 14.9% of subjects but there was no correlation with length of baseball experience or elbow pain. Conclusions Our data show that elementary school baseball players who experienced elbow pain are likely to have valgus stress overload. Elbow pain might be prevented by not playing pitcher and catcher.