Search

We present two results of a search for MeV-scale neutrino and anti-neutrino events correlated with gravitational wave events/candidates and large solar flares with KamLAND. The KamLAND detector is a large-volume neutrino detector using liquid scintillator, which is located at 1 km underground under the top of Mt. Ikenoyama in Kamioka, Japan. KamLAND has multiple reaction channels to detect neutrinos. Electron antineutrino can be detected via inverse-beta decay with 1.8 MeV neutrino energy threshold. All flavors of neutrinos can be detected via neutrino-electron scattering without neutrino energy threshold. KamLAND has continued the neutrino observation since 2002 March. We use the data set of 60 gravitational waves provided by the LIGO/Virgo collaboration during their second and third observing runs and search for coincident electron antineutrino events in KamLAND. We find no significant coincident signals within a ±500 s timing window from each gravitational wave and present 90% C.L. upper limits on the electron antineutrino fluence between 108–1013 cm−2 for neutrino energies of 1.8–111 MeV. For a solar-flare neutrino search at KamLAND, we determine the timing window using the solar X-ray data set provided by the GOES satellite series from 2002 to 2019 and search for the excess of coincident event rate on the all-flavor neutrinos. We find no significant event rate excess in the flare time windows and get 90% C.L. upper limits on the fluence of neutrinos of all flavors (electron anti-neutrinos) between 1010–1013 cm−2 (108–1013 cm−2) for neutrino energies in the energy range of 0.4–35 MeV.

We report on a search for electron antineutrinos ( ) from astrophysical sources in the neutrino energy range 8.3-30.8 MeV with the KamLAND detector. In an exposure of 6.72 kton-year of the liquid scintillator, we observe 18 candidate events via the inverse beta decay reaction. Although there is a large background uncertainty from neutral current atmospheric neutrino interactions, we find no significant excess over background model predictions. Assuming several supernova relic neutrino spectra, we give upper flux limits of 60-110 cm-2 s-1 (90% confidence level, CL) in the analysis range and present a model-independent flux. We also set limits on the annihilation rates for light dark matter pairs to neutrino pairs. These data improve on the upper probability limit of 8B solar neutrinos converting into , (90% CL) assuming an undistorted shape. This corresponds to a solar flux of 60 cm-2 s-1 (90% CL) in the analysis energy range.

We report the result of a search for neutrinos in coincidence with solar flares from the GOES flare database. The search was performed on a 10.8 kton-year exposure of KamLAND collected from 2002 to 2019. This large exposure allows us to explore previously unconstrained parameter space for solar flare neutrinos. We found no statistical excess of neutrinos and established 90% confidence level upper limits of 8.4 × 107 cm-2 (3.0 × 109 cm-2) on the electron antineutrino (electron neutrino) fluence at 20 MeV normalized to the X12 flare, assuming that the neutrino fluence is proportional to the X-ray intensity.

Atsushi Kimura,1 Kohei Yamaguchi,2 Haruka Tohara,2 Yusuke Sato,3 Naoko Sawada,3 Yasuhide Nakagawa,3 Yukako Matsuda,4,5 Motoharu Inoue,5 Yuji Wada,6 Kazuhiro Tamaki3,4 1College of Risk Management, Nihon University, Tokyo, Japan; 2Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan; 3Geriatric Health Services Facility Nanohana, Medical Corporation Kanjinkai, Tokyo, Japan; 4Nanohana Dentistry Clinic, Medical Corporation Kanjinkai, Tokyo, Japan; 5Department of Dysphagia Rehabilitation, Nihon University of Dentistry, Tokyo, Japan; 6College of Gastronomy Management, Ritsumeikan University, Shiga, JapanCorrespondence: Atsushi Kimura, College of Risk Management, Nihon University, Setagaya-ku, Tokyo, 1548513, Japan, Tel +81 3 6453 1600, Fax +81 3 6453 1630, Email kimura.atsushi@nihon-u.ac.jp Kazuhiro Tamaki, Geriatric Health Services Facility Nanohana, Medical Corporation Kanjinkai, Nishitama-Gun, Tokyo, 1901212, Japan, Tel +81 42 568 5111, Fax +81 42 568 5127, Email tamakikazuhiro@g.kanjinkai.netPurpose: Past research has shown that exposure to the image of a slim person reduces food consumption among young adults. However, it remains unknown whether this paradigm could be adapted and applied to increase food intake among older adults with dementia by exposing them to the image of a higher-weight person to mitigate weight loss and malnutrition. The present study explored whether weight-related visual cues affect the amount of food consumed by older adults with dementia.Participants and Methods: In the experiment, twenty-one elderly people with dementia living in a nursing home were visually exposed to one of four conditions (a cartoon image of a normal-weight chef, a higher-weight chef, a flower or no image) during real-life daily lunch situations over the course of four weeks, during which each condition was presented for one week.Results: Results demonstrate that participants finished their meals more frequently when they were exposed to the image of the higher-weight chef than when they were not exposed to any images.Conclusion: These results suggest that exposure to a cartoon chef character representing a stereotyped social group related to body weight activates the stereotype and increases stereotype-consistent behavior in older adults with dementia. The present findings will contribute to understanding the effect of visual information on eating behavior and to designing eating environments which facilitate sufficient nutrition intake among older adults with dementia.Keywords: nudge, body weight, dementia, food consumption, dining environment

Yosuke Wada,1,2 Kensaku Shojima,1 Kayoko Tamaki,1 Takara Mori,1,3 Hiroshi Kusunoki,1,4 Masaaki Onishi,5 Shotaro Tsuji,5,6 Ryota Matsuzawa,7 Koutatsu Nagai,7 Kyoko Sano,8 Kana Hashimoto,9 Masashi Goto,10 Yasuyuki Nagasawa,1 Ken Shinmura1,10 1Department of General Internal Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, Japan; 2Roppou Clinic, Toyooka, Hyogo, Japan; 3Amagasaki Medical COOP Honden Clinic, Amagasaki, Hyogo, Japan; 4Department of Internal Medicine, Osaka Dental University, Hirakata, Japan; 5Department of Orthopedic Surgery, School of Medicine, Hyogo Medical University, Nishinomiya, Japan; 6Department of Orthopedic Surgery, Tatsuno City Hospital, Tatsuno, Japan; 7Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan; 8Takarazuka Rehabilitation Hospital, Takarazuka, Japan; 9School of Pharmacy, Hyogo Medical University, Kobe, Japan; 10Department of General Medicine and Community Health Science, Hyogo Medical University, Sasayama Medical Center, Tambasasayama, JapanCorrespondence: Ken Shinmura, Department of General Internal Medicine, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan, Tel +81-798-45-6865, Fax +81-798-45-6977, Email ke-shimmura@hyo-med.ac.jpPurpose: This study aimed to evaluate the relationship between timed up-and-go (TUG) test time and changes in frailty status in a longitudinal cohort study of rural Japanese older adults.Patients and Methods: This prospective cohort study included 545 community-dwelling older adults. Initial and 2-year follow-up surveys were conducted. We compared the number of the Japanese version of the Cardiovascular Health Study components during the follow-up period and classified the participants into three groups: the favorable change, unchanged as prefrail, and unfavorable change groups. Associations between changes in frailty status and TUG time in the first survey were examined. The predictive ability of the TUG test was determined using the receiver operating characteristic (ROC) curve.Results: The favorable change group comprised 315 individuals (57.8%), the unchanged as prefrail group 105 (19.2%), and the unfavorable change group 125 (22.9%). TUG time was associated with the favorable and unfavorable changes after adjustment for covariates (OR 0.79, 95% CI 0.68– 0.92, P=0.001 and OR 1.27, 95% CI 1.09– 1.49, P=0.002). The ROC curve of TUG time as a predictor of unfavorable changes showed an area under the curve of 0.59. A cut-off point of TUG was calculated as 6.3 s with 49.6% sensitivity and 66.0% specificity.Conclusion: TUG time in the first survey was significantly associated with changes in frailty status 2 years later. However, its predictive value as a stand-alone test is limited and has the potential to predict future changes in the frailty status in older adults in combination with other tests.Keywords: frailty, cardiovascular health study, older adults, physical function, timed up-and-go test

The KamLAND-Zen 800 experiment is searching for the neutrinoless double-beta decay of 136Xe by using 136Xe-loaded liquid scintillator. The liquid scintillator is enclosed inside a balloon made of thin, transparent, low-radioactivity film that we call Inner Balloon (IB). The IB, apart from guaranteeing the liquid containment, also allows to minimize the background from cosmogenic muon-spallation products and 8B solar neutrinos. Indeed these events could contribute to the total counts in the region of interest around the Q-value of the double-beta decay of 136Xe. In this paper, we present an overview of the IB and describe the various steps of its commissioning minimizing the radioactive contaminations, from the material selection, to the fabrication of the balloon and its installation inside the KamLAND detector. Finally, we show the impact of the IB on the KamLAND background as measured by the KamLAND detector itself.

We report the result of a search for neutrinos in coincidence with solarflares from the GOES flare database. The search was performed on a 10.8kton-year exposure of KamLAND collected from 2002 to 2019. This large exposureallows us to explore previously unconstrained parameter space for solar flareneutrinos. We found no statistical excess of neutrinos and established 90%confidence level upper limits of $8.4 \times 10^7$ cm$^{-2}$ ($3.0 \times10^{9}$ cm$^{-2}$) on electron anti-neutrino (electron neutrino) fluence at 20MeV normalized to the X12 flare, assuming that the neutrino fluence isproportional to the X-ray intensity.

We present the results of a search for MeV-scale electron antineutrino events in KamLAND coincident with the 60 gravitational wave events/candidates reported by the LIGO/Virgo collaboration during their second and third observing runs. We find no significant coincident signals within a 500 s timing window from each gravitational wave and present 90% C.L. upper limits on the electron antineutrino fluence between 108 and 1013 cm-2 for neutrino energies in the energy range of 1.8-111 MeV.

There are many theories where a dark matter particle is part of a multipletwith an electrically charged state. If WIMP dark matter ($\chi^{0}$) isaccompanied by a charged excited state ($\chi^{-}$) separated by a small massdifference, it can form a stable bound state with a nucleus. In supersymmetricmodels, the $\chi^{0}$ and the $\chi^{-}$ could be the neutralino and a chargedslepton, such as the neutralino-stau degenerate model. The formation bindingprocess is expected to result in an energy deposition of {\it O}(1--10 MeV),making it suitable for detection in large liquid scintillator detectors. Wedescribe new constraints on the bound state formation with a xenon nucleususing the KamLAND-Zen 400 Phase-II dataset. In order to enlarge the searchableparameter space, all xenon isotopes in the detector were used. For a benchmarkparameter set of $m_{\chi^{0}} = 100$ GeV and $\Delta m = 10$ MeV, this studysets the most stringent upper limits on the recombination cross section$\langle\sigma v\rangle$ and the decay-width of $\chi^{-}$ of $2.0 \times10^{-31}$ ${\rm cm^3/s}$ and $1.1 \times 10^{-18}$ GeV, respectively (90\%confidence level).

Nobuki Furubayashi,1 Akinori Minato,2 Takahito Negishi,1 Naotaka Sakamoto,3 Yoohyun Song,4 Yoshifumi Hori,5 Toshihisa Tomoda,6 Mirii Harada,2 Shingo Tamura,7 Hiroki Kobayashi,1 Yamato Wada,1 Kentaro Kuroiwa,5 Narihito Seki,4 Naohiro Fujimoto,2 Motonobu Nakamura1 1Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan; 2Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan; 3Department of Urology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan; 4Department of Urology, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan; 5Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan; 6Department of Urology, Oita Prefectural Hospital, Oita, Japan; 7Department of Medical Oncology, National Hospital Organization Kyushu Medical Center, Fukuoka, JapanCorrespondence: Nobuki Furubayashi, Department of Urology, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan, Tel +81-92-541-3231, Fax +81-92-551-4585, Email nobumduro@gmail.comBackground: To evaluate the eosinophil changes, efficacy and safety of pembrolizumab treatment in advanced urothelial carcinoma patients of older age and those with a poor performance status (PS).Materials and Methods: Consecutive patients with advanced UC who received pembrolizumab after the failure of platinum-based chemotherapy between January 2018 and June 2021 were retrospectively examined.Results: 105 patients (median age, 72 years), 71.4% of whom were men, were enrolled. Patients of ≥ 75 years of age were considered to be older patients (n=40), and patients with PS ≥ 2 were considered to have a poor PS (n=10). The objective response and disease control rates were 42.5% and 52.5%, respectively, in older patients and 0% and 10.0%, respectively, in patients with a poor PS. Overall survival (OS) in the older and younger groups did not differ to a statistically significant extent. However, a poor PS was significantly associated with poor survival. Safety analyses demonstrated no significant difference in the occurrence of any immune-related adverse events (irAEs), including grade ≥ 3, between the older and younger groups. However, a poor PS was significantly associated with the low occurrence of any irAEs. The change of the eosinophil count, the increase of the relative eosinophil count (REC) and the decrease of the neutrophil-to-eosinophil ratio (NER) did not differ to a statistically significant extent between the older and younger groups, but showed significant differences between the poor and good PS (PS 0– 1) groups.Conclusion: Pembrolizumab for advanced UC demonstrated similar changes in the eosinophil count, efficacy and toxicity in both older and younger patients. In patients with a poor PS, although toxicity was significantly lower, survival was significantly worse, and neither an increase in REC nor a decrease in NER were observed, but these values showed significant changes in patients with a good PS.Keywords: urothelial carcinoma, pembrolizumab, age, performance status, immune-related adverse events, relative eosinophil count, neutrophil-to-eosinophil ratio

Yusuke Suzuki,1 Yoshiaki Kitaguchi,1 Fumika Ueno,1 Yunden Droma,1 Norihiko Goto,1 Takumi Kinjo,1 Yosuke Wada,1 Masanori Yasuo,2 Masayuki Hanaoka1 1First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan; 2Departments of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Nagano, JapanCorrespondence: Yoshiaki Kitaguchi, First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan, Tel +81-263-37-2631, Email kitaguti@shinshu-u.ac.jpPurpose: The associations between morphological phenotypes of COPD based on the chest computed tomography (CT) findings and clinical characteristics in surgically resected patients with COPD and concomitant lung cancer are unclear. The purpose of this study was to clarify the differences in clinical characteristics and prognosis among morphological phenotypes based on the chest CT findings in these patients.Patients and Methods: We retrospectively reviewed the medical records of 132 patients with COPD and concomitant lung cancer who had undergone pulmonary resection for primary lung cancer. According to the presence of emphysema and bronchial wall thickness on chest CT, patients were classified into three phenotypes: non-emphysema phenotype, emphysema phenotype, or mixed phenotype.Results: The mixed phenotype was associated with poorer performance status, higher score on the modified British Medical Research Council (mMRC) dyspnea scale, higher residual volume in pulmonary function, and higher proportion of squamous cell carcinoma than the other phenotypes. Univariate and multivariate Cox proportional hazards regression analyses showed that the extent of emphysema on chest CT, presented as a low attenuation area (LAA) score, was an independent determinant that predicted prognosis. In the Kaplan-Meier analysis, the Log rank test showed significant differences in survival between the non-emphysema and mixed phenotypes, and between the emphysema and mixed phenotypes.Conclusion: The cross-sectional pre-operative LAA score can predict the prognosis in surgically resected patients with COPD and concomitant lung cancer. The COPD phenotype with both emphysema and bronchial wall thickness on chest CT was associated with poorer performance status, greater extent of dyspnea, greater impairment of pulmonary function, and worse prognosis.Keywords: LAA, emphysema, CT, prognosis, mortality, surgery

Masahiro Takeshima,1 Hiroyasu Ishikawa,1 Masaya Ogasawara,1 Munehiro Komatsu,2 Dai Fujiwara,1 Yu Itoh,2 Yuki Wada,3 Yuki Omori,4 Hidenobu Ohta,1 Kazuo Mishima1 1Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; 2Department of Neuropsychiatry, Akita City Hospital, Akita, Japan; 3Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan; 4Department of Neuropsychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, JapanCorrespondence: Masahiro TakeshimaDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita, 010-8543, JapanTel +81-18-884-6122Fax +81-18-884-6445Email m.takeshima@med.akita-u.ac.jpPurpose: D-dimer has the advantage of excluding venous thromboembolism (VTE) due to its high sensitivity but is disadvantageous for diagnosing VTE due to its low specificity. A method to increase the usefulness of D-dimer in the diagnosis of VTE is warranted. This study aimed to investigate the usefulness of the combination of D-dimer and soluble fibrin monomer complex (SFMC), which has been suggested as a new candidate marker for VTE, in VTE diagnosis.Patients and Methods: This prospective study in 109 subjects was performed at a psychiatric department between August 1, 2017 and December 31, 2019. Subjects’ levels of D-dimer and SFMC were measured simultaneously. Plasma levels of D-dimer and SFMC were measured using NANOPIA® D-dimer and NANOPIA® SF. Subjects with positive D-dimer (≥ 1.0 μg/mL) results underwent contrast computed tomography for confirmation of VTE within 12 hours of D-dimer measurement. A receiver operating characteristic curve analysis was performed to examine the usefulness of SFMC for the diagnosis of VTE.Results: Only 109 of the 783 subjects without symptoms suggestive of VTE participated in the study. Out of 41 subjects with positive D-dimer results, 17 subjects were diagnosed with VTE. A receiver operating characteristic curve analysis was performed to determine cutoff values. The area under the curves was 0.848 for SFMC (p< 0.001, 95% CI 0.722 to 0.974), and the optimal cutoff value was 10.0 μg/mL (sensitivity 58.8%, specificity 100%, positive predictive value 100%, negative predictive value 77.4%).Conclusion: SFMC was useful for diagnosing VTE in the psychiatric patients with positive D-dimer results.Keywords: computed tomography, D-dimer, psychiatric patients, soluble fibrin monomer complex, venous thromboembolism

Hideki Shibata, Takeshi Aoki, Tomotake Koizumi, Tomokazu Kusano, Tatsuya Yamazaki, Kazuhiko Saito, Takahito Hirai, Kodai Tomioka, Yusuke Wada, Tomoki Hakozaki, Yoshihiko Tashiro, Koji Nogaki, Kosuke Yamada, Kazuhiro Matsuda, Akira Fujimori, Yuta Enami, Masahiko Murakami Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, JapanCorrespondence: Takeshi AokiDivision of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, 1-5-8, Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, JapanTel +81-3-3784-8000Fax +81-3-3784-5835Email takejp@med.showa-u.ac.jpPurpose: Bile duct injury is one of the most serious complications of laparoscopic cholecystectomy. Intraoperative indocyanine green (ICG) cholangiography is a safe and useful navigation modality for confirming the biliary anatomy. ICG cholangiography is expected to be a routine method for helping avoid bile duct injuries.Patients and Methods: We examined 25 patients who underwent intraoperative cholangiography using ICG fluorescence. Two methods of ICG injection are used: intrabiliary injection (percutaneous transhepatic gallbladder drainage [PTGBD], gallbladder [GB] puncture and endoscopic nasobiliary drainage [ENBD]) at a dosage of 0.025 mg during the operation or intravenous injection with 2.5 mg ICG preoperatively.Results: There were 24 patients who underwent laparoscopic cholecystectomy and 1 patient who underwent hepatectomy. For laparoscopic cholecystectomy, the average operation time was 127 (50– 197) minutes, and estimated blood loss was 43.2 (0– 400) g. The ICG administration route was intravenous injections in 12 cases and intrabiliary injection in 12 cases (GB injection: 3 cases, PTGBD: 8 cases, ENBD:1 case). The course of the biliary tree was able to be confirmed in all cases that received direct injection into the biliary tract, whereas bile structures were recognizable in only 10 cases (83.3%) with intravenous injection. The postoperative hospital stay was 4.6 (3– 9) days, and no postoperative complications (Clavien–Dindo ≧IIIa) were observed. For hepatectomy, a tumor located near the left Glissonian pedicle was resected using a fluorescence image guide. Biliary structures were fluorescent without injury after resecting the tumor. No adverse events due to ICG administration were observed, and the procedure was able to be performed safely.Conclusion: ICG fluorescence imaging allows surgeons to visualize the course of the biliary tree in real time during cholecystectomy and hepatectomy. This is considered essential for hepatobiliary surgery to prevent biliary tree injury and ensure safe surgery.Keywords: indocyanine green fluorescent imaging, navigation surgery, near-infrared fluorescent cholangiography

Masanori Yasuo,* Yoshiaki Kitaguchi,* Yayoi Tokoro, Makoto Kosaka, Yosuke Wada, Takumi Kinjo, Atsuhito Ushiki, Hiroshi Yamamoto, Masayuki Hanaoka The First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan*These authors contributed equally to this workCorrespondence: Masanori YasuoThe First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, JapanTel +81 263 37 2631Fax +81 263 36 3722Email yasumasa@shinshu-u.ac.jpBackground: Obstructive ventilatory disturbances occur in both chronic obstructive pulmonary disease (COPD), a typical disease representative of peripheral airway obstruction, and central airway obstruction (CAO). Pulmonary function tests (PFTs), which depend on patient effort, are traditionally used to evaluate lung function. The forced oscillation technique (FOT) is an effort-independent method for examining lung function during tidal breathing. The FOT is used universally to assess respiratory function in patients with COPD. Several studies have measured FOT to assess ventilatory disturbances in CAO. The results showed that FOT measurements in patients with CAO were similar to those reported in patients with COPD. However, no studies have compared FOT measurements directly between CAO and COPD. The aim of this study was to identify differences in ventilatory disturbances between peripheral and central airway obstructions in COPD and CAO, before patients received pharmacological therapy or bronchoscopic interventions, respectively.Patients and Methods: We retrospectively included 16 patients with CAO (10 cases of tracheal obstruction and 6 cases of bronchial obstruction) and 75 treatment-naïve patients with COPD (60 cases in Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II and 15 cases in GOLD stage III) that were admitted from December 2013 to May 2017. Prior to treatment, patients were examined with the FOT and PFTs.Results: All parameters measured with the FOT in the inspiratory phase were significantly worse in patients with CAO than in patients with COPD. The PFTs showed that the CAO group had a significantly lower peak expiratory flow rate. In the airway wall thickening phenotype of COPD, a difference between the inspiratory and expiratory phases of the resonance frequency (ΔFres) was the best indicator for distinguishing between peripheral and central airway obstructions.Conclusion: This study compared differences between CAO and COPD (mainly GOLD stage II). We found that the FOT measurement, ΔFres, was the optimal indicator of the difference between the airway wall thickening COPD phenotype and CAO. Thus, the difference might be due to mechanical changes that occur in COPD with airway wall thickening.Keywords: forced oscillation technique, pulmonary function test, quality of life, central airway obstruction, COPD

Naoko Iida,1,2 Yoshihisa Wada,1,3 Tatsuhisa Yamashita,1,2,4 Michiko Aoyama,5,6 Kiyoshi Hirai,5,6 Jin Narumoto1 1Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Child Psychiatry, Kyoto Prefectural Child Development Support Center, Kyoto, Japan; 3Fuchu-mikumari Hospital, Hiroshima, Japan; 4Department of Child and Adolescent Psychiatry, Yamashita Mental Health Clinic, Kyoto, Japan; 5Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; 6Department of Pediatrics, Kyoto Prefectural Child Development Support Center, Kyoto, Japan Purpose: Raising a child with autism spectrum disorder (ASD) can be a stressor, and mothers of ASD children often present with high levels of stress and depression. Interventional steps to enhance parental coping skills and resiliency are more important for parental mental health and the family-centered care of children with ASD than merely reducing parental stress. Although the importance of stress-coping skills is well established, only a few studies have investigated interventional steps to improve parental coping or resiliency. Parent training (PT) is known to improve a mother’s mental health. Here, we aimed to assess the effectiveness of PT in improving the stress-coping style of mothers raising children with ASD.Patients and methods: Thirty mothers of children with ASD aged 4–11 years participated in this study. The mothers underwent PT based on the Hizen Parenting Skills Training in Japan, which comprised seven sessions. Each session included education on behavior therapy, individual consultation, and workshops in small groups. Sixteen mothers completed psychological assessment, including the Stress Coping Inventory, the Beck Depression Inventory Second Edition, the State–Trait Anxiety Inventory, and the Child Behavior Checklist conducted before and after 2 months of PT.Results: The outcomes before and after the PT program were compared using the paired t-test and Pearson’s correlation. After the PT program, the mothers’ stress-coping strategy “positive appraisal” significantly increased (P

Koutatsu Nagai,1 Kayoko Tamaki,2 Hiroshi Kusunoki,2 Yosuke Wada,3 Shotaro Tsuji,4 Masako Ito,5 Kyoko Sano,5 Manabu Amano,6 Soji Shimomura,7 Ken Shinmura2 1Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan; 2Department of General Medicine, Hyogo College of Medicine, Nishinomiya, Japan; 3Department of Rehabilitation, Hyogo College of Medicine Sasayama Medical Center, Sasayama, Japan; 4Department of Orthopaedic Surgery, Hyogo College of Medicine Sasayama Medical Center, Sasayama, Japan; 5Department of Occupational Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan; 6School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan; 7Department of General Medicine and Community Health Science, Hyogo College of Medicine Sasayama Medical Center, Sasayama, Japan Objectives: Recently, isotemporal substitution has been developed to substitute activity time for an equivalent amount of another activity. This study employed this method to demonstrate the effects of replacing sedentary behavior (SB) time with an equivalent amount of light-intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) on the risk for different severities of frailty.Methods: A total of 886 older adults (average age 73.6 years, female 70%) participated in this cross-sectional study. Frailty status was assessed according to the cardiovascular health study criteria.Main outcome measures: Wrist-worn accelerometers were used to measure SB, LPA, and MVPA. Isotemporal substitution models were applied to show the estimated effects of substituting 30 min of SB with an equal amount of time spent in LPA or MVPA on the risk for pre-frailty and frailty.Results: The physical activity level and SB were not associated with the incidence of pre-frailty. However, a 16% (OR: 0.84; 95% CI: 0.78–0.90) and 42% (OR: 0.58; 95% CI: 0.37–0.92) decrease in frailty risk was noted when SB was substituted with LPA and MVPA, respectively, in the crude model. In the adjusted model, the significant effect was sustained for LPA (OR: 0.86; 95% CI: 0.80–0.92) but not for MVPA (OR: 0.74; 95% CI: 0.47–1.17).Conclusions: This study indicates that replacing 30 min of SB with an equivalent amount of LPA decreases the risk for frailty in older adults. Moreover, increasing LPA seems more feasible than increasing MVPA in older adults, with substantial benefit. Keywords: isotemporal substitution, frailty, physical activity, sedentary behavior

Yosuke Wada,1 Yoshiaki Kitaguchi,1 Masanori Yasuo,1 Fumika Ueno,1 Satoshi Kawakami,2 Kiyoyasu Fukushima,3 Keisaku Fujimoto,4 Masayuki Hanaoka1 1First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan; 2Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan; 3Department of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Isahaya, Nagasaki, Japan; 4Departments of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Nagano, Japan Introduction: This study was conducted in order to investigate the diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative computed tomography (CT) in patients with COPD. Patients and methods: Medical records of 174 stable COPD patients were retrospectively reviewed to obtain the patients’ clinical data, including the pulmonary function and imaging data. According to the software-based quantification of the degree of emphysema and airway wall thickness, the patients were classified into the “normal by CT” phenotype, the airway-dominant phenotype, the emphysema-dominant phenotype, and the mixed phenotype. The pulmonary function, including the respiratory impedance evaluated by using the forced oscillation technique (FOT) and the reversibility of airway obstruction in response to inhaled short-acting β2-agonists, was then compared among the four phenotypes. Results: The respiratory system resistance at 5 and 20 Hz (R5 and R20) was significantly higher, and the respiratory system reactance at 5 Hz (X5) was significantly more negative in the airway-dominant and mixed phenotypes than in the other phenotypes. The within-breath changes of X5 (ΔX5) were significantly greater in the mixed phenotype than in the “normal by CT” and emphysema-dominant phenotypes. The FOT parameters (R5, R20, and X5) were significantly correlated with indices of the degree of airway wall thickness and significantly but weakly correlated with the reversibility of airway obstruction. There was no significant correlation between the FOT parameters (R5, R20, and X5) and the degree of emphysema. Conclusion: There is a diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative CT in patients with COPD. The FOT measurements may reflect the degree of airway disease and aid in detecting airway remodeling in patients with COPD. Keywords: FOT, respiratory impedance, MostGraph, AWT-Pi10

Yoshiyuki Wada, Yuko Takami, Masaki Tateishi, Tomoki Ryu, Kazuhiro Mikagi, Hideki SaitsuDepartment of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, JapanBackground: Five or more colorectal liver metastases (CRLM) are considered marginally resectable and cannot be treated solely by hepatic resection (Hr). This study investigated the long-term effectiveness of surgical treatment using microwave coagulo-necrotic therapy (MCN) and/or Hr for marginally resectable or unresectable multiple CRLM.Methods: This study retrospectively analyzed 82 consecutive CRLM patients with ≥5 CRLM who underwent MCN, Hr, or both, at our institution from 1994 to 2012. Presuming all CRLM were resected curatively, virtual remnant liver volume was calculated using preoperative computed tomography or magnetic resonance imaging. Virtual remnant liver volume