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An 89-year-old woman underwent examinations for leg edema. Blood tests indicated low nutrition and low pancreatic enzymes, and a stool examination indicated fatty stool. Computed tomography showed pleural effusion, ascites, and cystic lesions in the pancreatic head and mural nodules within the cysts. Pancreatic juice cytology revealed adenocarcinoma. The diagnosis was pancreatic exocrine insufficiency caused by intraductal papillary mucinous carcinoma. The patient did not wish to undergo surgery. Therefore, diuretics, component nutrients, and pancreatic exocrine replacement therapy using pancrelipase were initiated. After starting treatment, her leg edema, pleural effusion, and ascites disappeared, and her activities of daily living improved markedly.

An 80-year-old man underwent follow-up examinations after endoscopic submucosal dissection (ESD) for esophageal cancer. Computed tomography (CT) showed enlarged lymph nodes of the right recurrent nerve. The patient had esophageal stenosis due to repeated ESD for multiple esophageal tumors. The stenosis made the passage of an endoscopic ultrasound (EUS) scope through the esophagus difficult. Thus, an endobronchial ultrasound bronchoscope, which had a thinner diameter than that of the EUS scope, was used for transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration. This technique led to the diagnosis of mediastinal lymph node metastasis of esophageal cancer.

Background: Japan’s historically low immigration rate and monolingual culture makes it a particularly interesting setting for clarifying non-national medical care. Our study objective was to examine disease patterns and outcome differences between Japanese and non-Japanese patients in a rapidly globalizing nation. Methods: A secondary data analysis of 325 non-Japanese and 13,370 Japanese patients requiring tertiary care or intensive-care unit or high-care unit admission to the emergency department at the Tokyo Medical and Dental University medical hospital from 2010 through 2019 was conducted. Multivariable linear and logistic regressions models were applied to examine differences in percentage of diagnosis, mortality rates, and length of stay, stratified by Glasgow Coma Scale (GCS) scores to consider the impact of language barriers. Sex and age were adjusted. Results: Non-Japanese patients had more anaphylaxis, burns, and infectious disease, but less cardiovascular diagnoses prior to adjustment. After adjustment, there were significantly more anaphylaxis (adjusted odds ratio [aOR] 2.7; 95% confidence interval [CI], 1.7–4.4) and infectious disease diagnoses (aOR 2.2; 95% CI, 1.3–3.7), and marginally more burn diagnoses (aOR 2.3; 95% CI, 0.96–5.3) than Japanese patients. Regardless of GCS scores, there were no significant differences between non-Japanese and Japanese patient length of stay for anaphylaxis, burn, and infectious disease after covariate adjustment. Conclusion: There were more non-Japanese patients diagnosed with anaphylaxis, burns, and infectious disease, but no notable patient care differences for length of stay. Further prevention efforts are needed against anaphylaxis, burns, and infectious disease for non-Japanese tourists or residents.

Objectives Despite relatively poor health outcomes of migrants in Japan, little is known about their access to reproductive healthcare. We conducted qualitative research to explore perceived barriers to access, with a specific focus on contraceptive services, and their consequences among Myanmar migrants in Japan. Study design From January to April 2020, we conducted 17 in-depth interviews with Myanmar migrant women and 4 key informant interviews with Myanmar interpreters working in health services in Tokyo, Saitama, and Chiba prefectures. We transcribed interviews and coded them in ATLAS.ti primarily using a deductive approach based on the 5 components of Levesque et al.'s conceptual framework of healthcare access. We also used inductive coding to allow for other themes outside of the framework to emerge. Results Among the 17 women, almost half stated that they were using periodic abstinence based on the presumed fertility window or the withdrawal method. Furthermore, slightly over half of the women had a history of unintended pregnancy. Language barriers, limited health information sources, cultural and health beliefs and financial factors played important roles in access to contraceptives among Myanmar migrant women. Women described how these barriers resulted in feeling lack of control over family planning and unintended pregnancies. Conclusions Findings suggested that Myanmar migrants in Japan are faced with limited contraceptive access. Language barriers, limited information sources, health beliefs, and cultural and financial factors affected access. Implications Results suggest that to increase public awareness and contraceptive access of Myanmar women in Japan nonprofit support programs would benefit from the help of existing social networks of Myanmar migrants, interpreters, and Japanese doctors and researchers in reproductive health.

The coronavirus disease 2019 (COVID-19) pandemic necessitated down-scaling of in-hospital care to prohibit the spread of severe acute respiratory syndrome-coronavirus-2. We (1) assessed patient perceptions on quality of care by telesurvey (cohort 1) and written questionnaire (cohort 2), and (2) analyzed trends in elective and nonelective admissions before (December 2019 to February 2020) and during (March to May 2020) the COVID-19 pandemic in Austria. A total of 279 outpatients were recruited into cohort 1 and 138 patients into cohort 2. All admissions from December 2019 to May 2020 to the Division of Gastroenterology/Hepatology at the Vienna General Hospital were analyzed. A total of 32.6% (n = 91 of 279) of cohort 1 and 72.5% (n = 95 of 131) of cohort 2 had telemedical contact, whereas 59.5% (n = 166 of 279) and 68.2% (n = 90 of 132) had face-to-face visits. A total of 24.1% (n = 32 of 133) needed acute medical help during health care restrictions; however, 57.3% (n = 51 of 89) reported that contacting their physician during COVID-19 was difficult or impossible. Patient-reported satisfaction with treatment decreased significantly during restrictions in cohort 1 (visual analog scale [VAS] 0-10: 9.0 ± 1.6 to 8.6 ± 2.2; P

Background Joubert syndrome is an autosomal recessive or X-linked genetic disease with a cerebellar vermis defect or hypoplasia, hypotonia, ocular dyskinesia, and mental retardation. In neonates, respiratory problems such as apnea and tachypnea are notable. Case report We report a patient Joubert syndrome with a homozygous NPHP1 variant, who had head titubation with irritability, including exaggerated jitteriness and a marked Morrow reflex appeared soon after birth without neonatal respiratory problems. These symptoms decreased gradually and disappeared until 1 year. Conclusion Irritability with head titubation may be an early clinical clue for the clinician to suspect Joubert syndrome.

A multiple access (MA) soft-decision (SD) decoder based on the cost rankings of the channel output matrix, is proposed and applied in an optical wireless communication system in which permutation-based optical codes (POCs) are used. The proposed decoder determines the possible transmitted MA codewords by implementing the Hungarian and Murty’s algorithms to solve and rank the costs of all the possible codewords of the received signal. The performance of the proposed Hungarian-Murty (HM) decoder is evaluated in comparison with two decoders based on the Exhaustive Search (ES) technique, in terms of computational complexity and block error rate (BER). It is found that when POCs are employed, the proposed HM decoder achieves better BER performance with a low decoding complexity in comparison to the ES based decoders.

Background and Aim: Listeria monocytogenes in ready-to-eat (RTE) foods remains consistently under-reported globally. Nevertheless, several independent studies conducted to investigate have elucidated the prevalence and antibiotic resistance profiles of L. monocytogenes in RTE-associated foods and their antibiotic resistance profiles. Given the rapid increase in consumption of RTE foods of both animal and plant origin, it is imperative to know the prevalence deductive data focusing on how much of L. monocytogenes is present in RTE foods, which is critical for food safety managers and retailers to assess the possible risk posed to end-users. In addition, valuable insight and another angle to the depth of the problem, we conducted a systematic review and meta-analysis to synthesize available data regarding the prevalence of L. monocytogenes in RTE foods and antibiotic resistance profiles. Materials and Methods: We conducted a meta-analysis study of L. monocytogenes and antibiotic resistance to clinically relevant antibiotics to determine the extent of L. monocytogenes contamination in RTE foods and antibiotic resistance profiles. The primary search terms, also known as keywords used, were restricted to peer-reviewed and review articles, and databases, including Google Scholars, Science-Direct, and Scopus, were searched. The inclusion of articles meeting eligibility criteria published between 2010 and 2020 after title, abstract, and full article screening. Data analysis was performed at multiple stages using quantitative meta-analysis reviews. Results: L. monocytogenes pooled proportion/prevalence was highest in chicken products determined at (22%) followed by various but uncategorized RTE foods at 21%. Regarding antibiotic resistance, profiling's highest pooled prevalence resistance was observed in penicillin at 80% resistance, followed by cephalosporin at 47%. Conclusion: Within its limitations, this study has attempted to provide insight into the pooled proportion/prevalence of L. monocytogenes in RTE foods and the antibiotic resistance profile at the global level. Determining the proportion/ prevalence of L. monocytogenes in RTE foods across the globe and antibiotic resistance profile is essential for providing quality food and reducing public health problems due to unsuccessful treatment of foodborne illness. This study provides insight into the pooled prevalence of L. monocytogenes in RTE foods and the antibiotic resistance profile. The results of this study partly endeavored to help appropriate authorities strengthen their preventive measures on specific RTE foods that are most likely to be contaminated with L. monocytogenes and antibiotic resistance profiles.

Near-term decarbonization of aviation requires energy-dense, renewable liquid fuels. Biomass- derived 1,4-dimethylcyclooctane (DMCO), a cyclic alkane with a volumetric net heat of combustion up to 9.2% higher than Jet-A, has the potential to serve as a low-carbon, high- performance jet fuel blendstock that may enable paraffinic bio-jet fuels to operate without aromatic compounds. DMCO can be produced from bio-derived isoprenol (3-methyl-3-buten-1- ol) through a multi-step upgrading process. This study presents detailed process configurations for DMCO production to estimate the minimum selling price and life-cycle greenhouse gas (GHG) footprint considering three different hydrogenation catalysts and two bioconversion pathways. The platinum-based catalyst offers the lowest production cost and GHG footprint of $9.0/L-Jet-Aeq and 61.4 gCO2e/MJ, given the current state of technology. However, when the conversion process is optimized, hydrogenation with a Raney nickel catalyst is preferable, resulting in a $1.5/L-Jet-Aeq cost and 18.3 gCO2e/MJ GHG footprint if biomass sorghum is the feedstock. This price point requires dramatic improvements, including 28 metric-ton/ha sorghum yield and 95-98% of the theoretical maximum conversion of biomass-to-sugars, sugars-to-isoprenol, isoprenol-to-isoprene, and isoprene-to-DMCO. Because increased gravimetric energy density of jet fuels translates to reduced aircraft weight, DMCO also has the potential to improve aircraft efficiency, particularly on long-haul flights.

Aim A reduced mismatch negativity (MMN) response is a promising electrophysiological endophenotype of schizophrenia that reflects neurocognitive impairment. Dopamine dysfunction is associated with symptoms of schizophrenia. However, whether the dopamine system is involved in MMN impairment remains controversial. In this study, we investigated the effects of the dopamine D2‐like receptor agonist quinpirole on mismatch responses to sound frequency changes in an animal model. Methods Event‐related potentials were recorded from electrocorticogram electrodes placed on the auditory and frontal cortices of freely moving rats using a frequency oddball paradigm consisting of ascending and equiprobable (ie, many standards) control sequences before and after the subcutaneous administration of quinpirole. To detect mismatch responses, difference waveforms were obtained by subtracting nondeviant control waveforms from deviant waveforms. Results Here, we show the significant effects of quinpirole on frontal mismatch responses to sound frequency deviations in rats. Quinpirole delayed the frontal N18 and P30 mismatch responses and reduced the frontal N55 MMN‐like response, which resulted from the reduction in the N55 amplitude to deviant stimuli. Importantly, the magnitude of the N55 amplitude was negatively correlated with the time of the P30 latency in the difference waveforms. In contrast, quinpirole administration did not clearly affect the temporal mismatch responses recorded from the auditory cortex. Conclusion These results suggest that the disruption of dopamine D2‐like receptor signaling by quinpirole reduces frontal MMN to sound frequency deviations and that delays in early mismatch responses are involved in this MMN impairment., The subcutaneous administration of quinpirole delayed early mismatch response latencies and reduced a late MMN‐like response amplitude recorded from the frontal cortex but had no effect on those recorded from the auditory cortex. These observations suggest that increased dopamine D2‐like receptor signaling impairs MMN generation to sound frequency changes in the frontal cortex and that the neurochemical mechanisms of MMN vary according to the cortical area. As MMN is associated with cognitive function, these new findings may help develop treatment modalities for cognitive dysfunctions in schizophrenia.

Neutrophil extracellular traps (NETs) have been implicated in the pathogenesis of abdominal aortic aneurysms (AAAs). This study has addressed the notion that NET components might serve as AAA biomarkers or novel targets of AAA therapy. Thus, parameters of neutrophil activation and NET formation were measured in plasma. Their diagnostic marker value was explored in 41 AAA patients and 38 healthy controls. The NET parameter citrullinated histone H3 (citH3) was then validated in 63 AAA patients and 63 controls matched for cardiovascular disease. The prognostic marker potential was investigated in 54 observation periods of AAA growth over 6 months. NETs were further assessed in conditioned medium and sections of aortic tissue. CitH3 was found to be increased in blood (median 362 vs 304 ng/mL, P = 0.004) and aortic tissue (50 vs 1.5 ng/mg, P0.001) of AAA patients compared to healthy controls and accumulated in the intraluminal thrombus (629 ng/mg). The diagnostic potential of citH3 ranged at 0.705 area under the ROC curve (AUROC) and was validated with the independent sample set. Furthermore, plasma citH3 predicted AAA growth over the next 6 months (AUROC: 0.707, P = 0.015) and dropped significantly after surgical aneurysm repair. In an angiotensin II - based mouse model of experimental AAA, an inhibitor of histone citrullination was applied to block NET formation and AAA progression. Of note, further growth of an established aneurysm was prevented in mice treated with the NET inhibitor (P = 0.040). In conclusion, histone citrullination represents a promising AAA biomarker and potential therapeutic target to control disease progression.

Introduction Delayed onset of immune-related adverse events following immune-checkpoint inhibitor discontinuation is underrecognized because of little available evidence. Case presentation A 50-year-old man with metastatic renal cell carcinoma (Case 1) and 58-year-old woman with renal cell carcinoma and retroperitoneal lymph node metastasis (Case 2) underwent nivolumab therapy. Case 1: Progressive disease forced nivolumab discontinuance after 18 months, and he underwent two courses of tyrosine kinase inhibitor therapy. immune-related adverse events of pneumonitis, hepatitis, and renal dysfunction were diagnosed 142 days after nivolumab discontinuation, and he recovered with immunosuppressive treatment. Case 2: The immune-related adverse event of pneumonitis forced nivolumab discontinuance after 14 months, and two courses of tyrosine kinase inhibitor therapy were administered. The immune-related adverse event of hepatitis was diagnosed 436 days after nivolumab discontinuation, and she recovered with immunosuppressive treatment. Conclusion Two patients with delayed onset of immune-related adverse events after nivolumab discontinuation were recovered with immunosuppressive treatment.

Context Passive smoking in childhood has been reported to be associated with dyslipidemia in Western countries. However, this association in Asian countries remains unclear. Further, no study has investigated the sex difference of the association. Objective This study aimed to elucidate the association between passive smoking and dyslipidemia in adolescent boys and girls in Japan. Methods We used a cross-sectional data of junior high school students in the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in Adachi City, Tokyo, Japan in 2016 and 2018. Of the 1431 available students, 1166 students and their parents responded to the survey, including frequency of passive smoking (response rate 81.5%). We assessed dyslipidemia using total cholesterol (TC) levels, low-density lipoprotein cholesterol (LDL-C) levels and high-density lipoprotein cholesterol (HDL-C) levels. The association between passive smoking and dyslipidemia was evaluated by using multivariate regression analyses adjusted for socioeconomic status and lifestyle factors stratified by boys (N = 564) and girls (N = 602). Results Among boys, HDL-C levels were significantly lower if exposed to passive smoking frequently, compared with those not exposed (β = −3.19; 95% CI, −5.84 to −0.55). However, this trend does not hold true among girls. Passive smoking was not associated with TC levels and LDL-C levels in either boys or girls. Conclusion We found that exposure to passive smoking was associated with HDL-C level among boys in Japan, but not in girls. Further longitudinal study is needed to confirm the association between passive smoking and dyslipidemia among boys in Japan.

Background: This study aimed to determine the relationship between exercise performance and spinal function based on clenching strength. Hypothesis: Low-intensity clenching contributes to joint movement, whereas high-intensity clenching contributes to joint fixation. Study Design: Randomized crossover trial. Level of Evidence: Level 3. Methods: Two experiments were conducted using 2 groups of 20 healthy adults. The 4 clenching conditions in experiment 1 were 0%, 12.5%, 25%, and 50% of the maximum voluntary contraction (MVC) of the masseter muscle. Experiment 2 consisted of 3 conditions: no-bite condition, moderate effort, and maximum effort (max condition). In experiment 1, spinal function and ankle dorsiflexion tasks were measured for each clenching condition, and the ankle dorsiflexion task was measured in experiment 2. Regarding spinal function, we measured spinal reciprocal inhibition (RI) and excitability of spinal anterior horn cells. For the ankle dorsiflexion task, ankle dorsiflexion MVC was performed for 3 seconds under each clenching condition. The items analyzed were reaction time, peak ankle dorsiflexion torque, and soleus (Sol)/tibialis anterior (TA) electromyography (EMG) ratio. Results: The results of experiment 1 illustrated that RI was significantly attenuated or eliminated with increasing clenching strength (>25% MVC). Spinal anterior horn cell excitability increased significantly with increasing clenching strength. The peak torque was significantly higher at 50% MVC than that at 0% MVC. In experiment 2, the peak torque was significantly higher under moderate and max conditions than no-bite condition, and the Sol/TA EMG ratio was significantly higher under max condition than that under moderate condition. Conclusion/Clinical Relevance: The results illustrated that during high-strength clenching (≥50% MVC), antagonist muscles are activated simultaneously to increase muscle strength. High-strength clenching improved kinetic performance (joint fixation), whereas low-strength clenching (

Purpose Total skin electron beam therapy (TSEBT) is useful for primary cutaneous lymphoma. However, helical skin radiation therapy (HSRT) using tomotherapy may avoid the complexity and uncertainty of TSEBT. Methods and Materials All patients with primary cutaneous lymphoma who underwent HSRT at our hospital between June 2015 and July 2019 were investigated, including 7 patients registered in a clinical trial approved by an institutional review board (ID UMIN000022142). HSRT was performed in 3 partitioned skin areas: head and neck, trunk and arms, and legs. Results A total of 24 patients with 53 skin areas (including 8 patients with 24 skin areas who had undergone sequential total skin irradiation), with a median follow-up time of 13 months (range, 2-50), were investigated. Twenty patients (83.3%) had mycosis fungoides (MF). For 41 of 53 (77.4%) cases, a dose of 20 Gy in 10 fractions was used. The overall response rate in the treated fields of each HSRT in patients with MF was 100%, including 38 (80.9%) complete response, 4 (8.5%) good partial response, and 5 (10.6%) partial response. Eight patients with MF who underwent sequential total skin irradiation showed a 100% complete response. For patients with MF, the median survival time after a first round of HSRT was 22 months (95% confidence interval [CI], 13.6-30.4 months), the median response duration of each HSRT was 5 months (95% CI, 3.67-6.32 months), and the median time to in-field reirradiation for each HSRT was 15 months (95% CI, 9.76-20.24 months). Bone marrow suppression (grade ≥3) often occurred (94.1%) with HSRT on trunk and arm skin. An early patient died of HSRT-caused grade 5 leukopenia. Conclusions HSRT targeting trunk and arm skin induced severe bone marrow suppression that led to a temporary palliative effect. TSEBT should still be considered standard treatment for primary cutaneous lymphoma covering the total body surface area.

Background: Temperature screening checkpoints have become widely distributed during the COVID-19 pandemic, using various contactless methods of temperature measurement, including wrist and forehead measurement. Aim: In this study we aim to investigate the sensitivity and specificity of these two temperature measurement methods – wrist and forehead – compared with the standards of sublingual or axillary measurement. We also aim to investigate the influence of age, gender, device brand and diurnal effect on the temperature reading. Methods: Participants were randomly assigned to one of two groups, each group using a different temperature measurement device. All participants had their forehead and wrist temperature measured, and this was compared to their axillary or sublingual readings. Results: The area under the curve for wrist measurement was 0.49 (95% CI 0.34 and 0.64), p>0.05, with a sensitivity of 46.2% and specificity of 53.3%, while the area under the curve for forehead measurement was 0.70 (95% CI 0.51, 0.89), p

This study aims to assess risks and carry out risk mapping in reallocating and refocusing the East Nusa Tenggara Provincial regional revenue and expenditure budgeting during the Covid-19 Pandemic. Qualitative research methods are carried out through literature studies, normative studies and prospective studies. Assessment of the scale of likelihood and impact risk for government management was carried out by 32 government internal supervisory in Provincial and District Inspectors in East Nusa Tenggara. Respondents assess, prospectively, the likelihood and impact scales of the identified risks. The results showed 25 risks of reallocating and refocusing the regional revenue and expenditure when Pademi Covid-19 was identified and analyzed. At the high-risk level, when reallocating and refocusing the budget during the Covid 19 pandemic, the PPK Region Unit Works has the task of preparing Region Unit Works financial reports. The risk of such activities is being late in preparing Region Unit Works financial reports; risk of being late in compiling budget implementation documents from the activities of Budget user officials; and the risk of an orderly general cash book made by the treasurer of receipt/expenditure. There is one risk involved at the very low level, namely inappropriate cash due to incorrectly inputting the transaction nominal; there are transactions that have not been inputted so that there is a difference; there is an advance payment which is not recorded; money used for non-operational needs.

BACKGROUND Epidural tunneling could help with prolonged catheterization and be effective in preventing infection and dislodgement. However, epidural tunneling techniques carry a risk of catheter shear or needlestick injuries. AIMS This study aimed to examine the safety of our epidural tunneling technique in terms of catheter shear. METHODS This study was designed as a double-blinded, single-crossover, in vitro study. Each of the operators performed two techniques to create a subcutaneous tunnel. We compared outcomes between the control tunneling technique (group C) and our improved technique (group I). Microscopic findings of catheter shear were assessed as the primary outcome. Secondary outcomes included the tension and displacement required to break the epidural catheter and the frequency of catheter breakage due to catheter shear. Data were analyzed using the Fisher's exact test and Mann-Whitney U test. A p-value of

A 72-year-old man with stage IV hypopharyngeal cancer, who had been treated for three months with combination chemotherapy, was referred to our cardiology department for evaluation of transient palpitation. Combination therapy with cetuximab, cisplatin, and 5-fluorouracil per cycle had been administered intravenously for five cycles every three weeks for three months. After the admission due to slight palpitation and severe hypomagnesemia (Mg = 0.6 mmol/L), monitor ECG showed supraventricular tachycardia (SVT), which was incessantly sustained and ceased every few minutes. 12-lead ECG obtained during tachycardia demonstrated long RP’ narrow QRS tachycardia. SVT was initially considered to be related to severe hypomagnesemia. However, it still occurred even after normalization of serum magnesium level. As the SVT was refractory to landiolol and verapamil, catheter ablation was performed a few days after the admission, revealing non-reentrant focal atrial tachycardia (AT) originating from the posterolateral region of the right atrium. Homogenization of the origin of the AT was then performed with radiofrequency, resulting in complete suppression of the AT. In the present case, the patient receiving the combination therapy of cetuximab, cisplatin, and 5-FU developed focal atrial tachycardia after chemotherapy, which was successfully treated with the radiofrequency catheter ablation.

Compressed sensing magnetic resonance imaging (CS-MRI) uses random undersampling and nonlinear iterative reconstruction. This study was conducted to clarify the noise power spectrum (NPS) characteristics of CS-MRI. We measured two-dimensional (2D) NPS of CS-MRI with various acceleration factors (AF) and denoising factors (DF) and compared their appearance to those of conventional parallel MR images. Results showed that the 2D NPS of CS-MRI exhibited the following characteristics: (1) local decrease in the low-frequency region, (2) gradual decrease in the high-frequency region, and (3) a stripe pattern aligned at unequal intervals in the phase-encoding direction. Specifically, the 2D NPS of CS-MRI reflects the random undersampling pattern of k-space data. Additionally, 2D NPS allowed visualization of AF-dependent noise characteristics of CS-MRI. Furthermore, 1D NPS graph shapes clarified the CS-MRI noise characteristic dependence on AF and DF.

Globally, unintentional injuries are one of the leading causes of infant death. Established risk factors for injuries during infancy include single parent households, socioeconomic disadvantage and maternal postpartum depression. We sought to examine whether maternal working status is associated with unintentional injury among infants in Japan. We used data from an original questionnaire targeting mothers who participated in a 3 or 4-month health check-up program in Aichi prefecture, Japan. Experience of any type of unintentional injury was used as the primary outcome, and we also examined the experience of “falls” and “near-drowning” as secondary outcomes. We conducted multivariable logistic regression analysis, adjusting for covariates. We also performed propensity score matching in order to balance covariates between paid employment and unpaid employment groups. Among 6,465 valid responses (response rate, 67%), 9.8% of infants experienced unintentional injuries. After matching on propensity for maternal employment (based on 26 covariates), we found that infants of mothers in paid employment were 1.35 times (95% CI: 1.04–1.74) more likely to experience injures, including 1.60 times higher likelihood of falls (95% CI: 1.14–2.24). Near-drowning was not significantly associated with maternal employment. We also found that father’s employment status was positively associated with risk of falls. Both multivariable logistic analysis and propensity score matching analysis revealed that maternal paid employment status was associated with unintentional injuries among Japanese infants. To prevent infant injuries, comprehensive support for working families should be considered.

Using a plane‐parallel advanced Markus ionization chamber and a stack of water‐equivalent solid phantom blocks, percentage surface and build‐up doses of Elekta 6 MV flattening filter (FF) and flattening‐filter‐free (FFF) beams were measured as a function of the phantom depth for field sizes ranging from 2 × 2 to 10 × 10 cm2. It was found that the dose difference between the FF and the FFF beams was relatively small. The maximum dose difference between the FF and the FFF beams was 4.4% at a depth of 1 mm for a field size of 2 × 2 cm2. The dose difference was gradually decreased while the field size was increased up to 10 × 10 cm2. The measured data were also compared to published Varian FF and FFF data, suggesting that the percentage surface and build‐up doses as well as the percentage dose difference between FF and FFF beams by our Elekta linac were smaller than those by the Varian linac.

We show that fMRI analysis using machine learning tools are sufficient to distinguish valence (i.e., positive or negative) of freely retrieved autobiographical memories in a cross-participant setting. Our methodology uses feature selection (ReliefF) in combination with boosting methods, both applied directly to data represented in voxel space. In previous work using the same data set, Nawa and Ando showed that whole-brain based classification could achieve above-chance classification accuracy only when both training and testing data came from the same individual. In a cross-participant setting, classification results were not statistically significant. Additionally, on average the classification accuracy obtained when using ReliefF is substantially higher than previous results - 81% for the within-participant classification, and 62% for the cross-participant classification. Furthermore, since features are defined in voxel space, it is possible to show brain maps indicating the regions of that are most relevant in determining the results of the classification. Interestingly, the voxels that were selected using the proposed computational pipeline seem to be consistent with current neurophysiological theories regarding the brain regions actively involved in autobiographical memory processes.

This study aimed to reconstruct the dose distribution of single fraction of stereotactic body radiotherapy for patients with prostate cancer using cone-beam computed tomography (CBCT) and a log file during volumetric-modulated arc therapy (VMAT) delivery with flattening-filter-free (FFF) mode. Twenty patients with clinically localized prostate cancer were treated with FFF-VMAT, and projection images for in-treatment CBCT (iCBCT) imaging were concomitantly acquired with a log file. A D95 dose of 36.25 Gy in five fractions was prescribed to each planning target volume (PTV) on each treatment planning CT (pCT). Deformed pCT (dCT) was obtained from the iCBCT using a hybrid deformable image registration algorithm. Dose distributions on the dCT were calculated using Pinnacle3 v9.10 by converting the log file data to Pinnacle3 data format using an in-house software. Dose warping was performed by referring to deformation vector fields calculated from pCT and dCT. Reconstructed dose distribution was compared with that of the original plan. Dose differences between the original and reconstructed dose distributions were within 3% at the isocenter and observed in PTV and organ-at-risk (OAR) regions. Differences in OAR regions were relatively larger than those in the PTV, presumably because OARs were more deformed than the PTV. Therefore, our method can be used successfully to reconstruct the dose distributions of one fraction using iCBCT and a log file during FFF-VMAT delivery.

With increasing focus on the importance of long-term survivorship care after allogeneic hematopoietic cell transplantation (allo-HCT), more institutions have been establishing long-term follow-up (LTFU) clinics. Currently, however, with varying volumes of HCT procedures and resources, there is no standardized operation of these clinics in HCT centers. We conducted a nationwide questionnaire survey to characterize the current operation of LTFU clinics in Japan. We targeted 271 HCT centers (189 adult and 82 pediatric) that registered allo-HCT cases to the national transplant registry database. The response rate was 69%, and 117 of the 188 participating centers (62%) had an established LTFU clinic. The most frequent reason cited for not operating an LTFU clinic was a "lack of human resources," especially nurses. Most centers with an LTFU clinic targeted allo-HCT recipients, although autologous HCT survivors were followed up at 18% of adult centers and 48% of pediatric centers. Ninety-two percent of centers did not terminate LTFU at a specific time point, and 56% recommended that patients visit the LTFU clinic beyond 5 years after HCT. Fifteen of 20 pediatric centers indicated that they did not routinely refer survivors who underwent HCT at a young age to an adult HCT center for their adulthood LTFU. We found that staffing and standard practices varied widely among centers, and that most centers continued to see long-term HCT survivors at their own outpatient clinics. The development of common LTFU tools may help standardize LTFU practices and facilitate efficient transitions.

Reports of crizotinib‐induced pleural effusion in non‐small cell lung cancer (NSCLC) are limited. A 35‐year‐old Japanese woman was diagnosed with ROS1‐rearranged lung adenocarcinoma (primary left lower lobe, cT4N3M1c). Crizotinib was administered as first‐line therapy, and the primary and mediastinal hilar lymph node metastases rapidly shrank. On the fourth day of treatment, chest X‐ray demonstrated contralateral pleural effusion. On the 41st day of treatment, crizotinib was discontinued because of grade 3 neutropenia. Examination including surgical thoracoscopy did not reveal causative findings, and the continued cessation of drug administration enabled the right pleural effusion to decrease gradually and disappear, suggesting that this event was a side effect of crizotinib. The disease did not progress even though the drug was withdrawn for more than one year. In conclusion, crizotinib was considered to cause pleural effusion as an adverse event in a case of ROS1‐rearranged lung adenocarcinoma with a complete response.

Objective The opioid epidemic in the United States increasingly affects women of reproductive age and has resulted in a rise in concurrent polydrug use. The objective of this study was to investigate the effect of this polydrug use on preterm birth in a multiethnic birth cohort. Methods We analyzed data from 8261 mothers enrolled in the Boston Birth Cohort from 1998 to 2018 in Boston, Massachusetts. We grouped substances used during pregnancy based on their primary effects (stimulant or depressant) and assessed independent and combined associations with smoking on preterm birth. Results Of 8261 mothers, 131 used stimulant drugs and 193 used depressant drugs during pregnancy. The preterm birth rate was 27.5% (2271 of 8261) in the sample. Mothers who smoked had 35% increased odds of preterm birth across adjusted models. Mothers who used stimulant drugs without smoking were not at increased risk of preterm delivery compared with mothers who used neither (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.19-1.98), whereas mothers who used depressant drugs without smoking had more than twice the odds of having preterm delivery (OR = 2.31; 95% CI, 1.19-4.44), and infants were at risk of a 1-week reduction in gestational age (OR = −1.05; 95% CI, −2.07 to −0.03). Concurrently smoking and using depressant drugs was associated with increased odds of preterm birth (OR = 1.83; 95% CI, 1.28-2.61), as was concurrently smoking and using stimulant drugs (OR = 1.73; 95% CI, 1.14-2.59). Conclusions Using stimulant drugs and depressant drugs during pregnancy is a risk factor for preterm birth. The individual and combined effects of using these drugs with smoking must be considered together to reduce the risk of preterm birth in the United States.

Purpose The purpose of this study was to estimate the prevalence of subjects with chronic cough and phlegm and describe their characteristics including the presence or absence of airflow limitation among the general population in Japan. Subjects and methods This was an observational cross-sectional survey targeting multiple regions of Japan. Subjects aged 40 years or above who were undergoing comprehensive health examination were recruited. The existence of chronic cough and phlegm, airflow limitation, and treatment for respiratory diseases were examined. Chronic cough and phlegm were defined as having both symptoms for at least 3 months of the year and for at least 2 consecutive years, or as receiving any treatment for chronic bronchitis at the time of recruitment. Airflow limitation was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) less than 0.7. Results In a total of 22,293 subjects, 380 subjects (1.7%) had chronic cough and phlegm. Among these 380 subjects, 21.8% received treatment for a respiratory disease, and 11.6% had airflow limitation. Compared to subjects without both chronic cough and phlegm but with airflow limitation, subjects with chronic cough and phlegm without airflow limitation were younger, more likely to be current smokers (39.6%), and had higher total scores on a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Scores of CAT questions 1-4 (cough, phlegm, chest tightness, breathlessness, respectively) were higher in subjects with chronic cough and phlegm regardless of airflow limitation. Conclusion This study demonstrated that subjects identified to have chronic cough and phlegm in comprehensive health examination settings were symptomatic, while most of them did not receive any treatment for respiratory diseases and did not have airflow limitation. Screening subjects for chronic cough and phlegm in a comprehensive health examination followed by a detailed examination of screened subjects could be an effective approach for better management of chronic cough and phlegm. Smoking cessation should be included in the management, in consideration that around 40% of subjects with chronic cough and phlegm were current smokers.

Aims Although distinct DNA methylation patterns have been reported, its localization and roles remain to be defined in heart failure. We investigated the cellular and subcellular localization of DNA methylation and its pathophysiological significance in human failing hearts. Methods and results Using left ventricular (LV) endomyocardial biopsy specimens from 75 patients with dilated cardiomyopathy (DCM; age: 58 ± 14 years old, %female: 32%) and 20 patients without heart failure (controls; age: 56 ± 17 years old, %female: 45%), we performed immunohistochemistry and immunoelectron microscopy for methylated DNA, 5‐methylcytosine (5‐mC). We next investigated possible relations of the incidence of 5‐mC‐positive (%5‐mC+) cardiomyocytes with clinicopathological parameters. Immunopositivity for 5‐mC was detected in the cardiomyocytes and other cell types. The %5‐mC+ cardiomyocytes was significantly greater in DCM hearts than in controls (57 ± 13% in DCM vs. 25 ± 12% in controls, P < 0.0001). The localization of 5‐mC immunopositivity in cardiomyocyte nuclei coincided well with that of heterochromatin, as confirmed by immunoelectron microscopy. Substantial DNA methylation was also observed in interstitial non‐cardiomyocytes, but the incidences did not differ between control and DCM hearts (39 ± 7.9% in DCM vs. 41 ± 10% in controls, P = 0.4099). In DCM patients, the %5‐mC+ cardiomyocytes showed a significant inverse correlation with LV functional parameters such as heart rate (r = 0.2391, P = 0.0388), end‐diastolic pressure (r = 0.2397, P = 0.0397), and ejection fraction (r = −0.2917, P = 0.0111) and a positive correlation with LV dilatation (volume index at diastole; r = 0.2442, P = 0.0347; and volume index at systole; r = 0.3136, P = 0.0062) and LV hypertrophy (mass index; r = 0.2287, P = 0.0484)—that is, LV remodelling parameters. No significant correlations between DNA methylation and the histological parameters of the biopsies, including cardiomyocyte hypertrophy, fibrosis, and inflammatory cell infiltration, were noted. Conclusions The present study revealed increased nuclear DNA methylation in cardiomyocytes, but not other cell types, from DCM hearts, with predominant localization in the heterochromatin. Its significant relations with LV functional and remodelling parameters imply a pathophysiological significance of DNA methylation in heart failure.

A prospectively registered observational study was conducted to assess the significance of allogeneic hematopoietic stem cell transplantation from highly HLA-matched unrelated donors (UD) and cord blood (CB) on outcomes in adult acute leukemia (AL) and myelodysplastic syndrome (MDS). Between 2007 and 2015, 231 transplant-eligible patients were registered for a phase 2 study of alternative donor transplantation. After registration, a sufficient time period was given to find appropriate UD. Patients received CB transplantation (CBT) if an appropriate UD was unavailable. In total, 119 patients received CBT (106 AL and 13 MDS) and 91 patients received UD transplantation (UDT) (86 AL and 5 MDS). The median age was 39 years in both groups. The primary objective was overall survival (OS); secondary objectives included cumulative incidences of non-relapse mortality (NRM) and relapse, and disease-free survival. Diagnosis, disease status at transplantation, refined disease risk index, and hematopoietic cell transplant-specific comorbidity index did not differ between UDT and CBT. In multivariate analyses, graft source was not a significant risk factor for all objectives. In adjusted analyses, UDT and CBT showed similar OS, NRM, and relapse in this prospective study. CB can be a comparable alternative stem cell source to UD by achieving a timely transplant.

During the mobile clinic activities in Tak Province, Thailand, Paragonimus sp. eggs were found in a fecal sample of a 72-year-old Karen resident. Paragonimus DNA was amplified from the stool sample and identified to P. heterotremus. The patient did not have any symptoms. Apparent pulmonary lesion was not found on the chest X-ray. The patient admitted habitual consumption of semi-cooked or roasted waterfall crabs for several years. The waterfall crabs collected from stream near the village were found negative for Paragonimus metacercariae. In northern Thailand, paragonimiasis remains as one of the public health concerns and should be ruled out for asymptomatic pulmonary patients.

Background: Postoperative irradiation for brain tumor in pregnant women is a matter of concern. Aim: We aimed to assess the safety of radiotherapy for brain tumors in pregnancy. We here report a successful treatment for anaplastic astrocytoma during pregnancy: surgery + postoperative irradiation. We wish to emphasize how we devised irradiation procedure to achieve both therapeutic effectiveness and safety to the fetus/infant. Case Presentation: A 34-year-old pregnant woman suffered with brain anaplastic astrocytoma. Tumor resection under craniotomy was performed with success. We decided to conduct postoperative radiotherapy at 25 weeks of gestation to reduce the risk of recurrence. We used a flattening filter-free volumetric arc therapy (FFF-VMAT) technique, which can achieve lower out-of-field dose than VMAT with a flattening filter or helical tomotherapy. We prescribed 60 Gy over 30 fractions. During actual beam delivery, surface and rectal dose to the patient (mother) were measured. The total fetal dose was estimated at 0.006 - 0.018 Gy, which is under the threshold set by the ICRP. A male healthy infant was born vaginally at the 37th week of pregnancy. The patient (mother) and the infant are healthy at the time of writing. Conclusion: FFF-VMAT is a good choice for brain tumors during pregnancy.

Little is known about stem cell transplantation in solid organ transplantation (SOT) recipients. We conducted a nationwide retrospective survey of Japan Society for Hematopoietic Stem Cell Transplantation centers. A total of 19 patients who underwent 22 hematopoietic stem cell transplantations (HSCTs) after SOT were identified: 5 autologous HSCTs and 17 allogeneic HSCTs were performed. Patients who underwent autologous HSCT received a liver (n = 4) or kidney (n = 1) transplant. All 5 patients achieved neutrophil engraftment, and 2 of 3 patients with hepatoblastoma were alive at 1 year after HSCT. Allogeneic HSCT was performed in 16 patients (7 liver transplant recipients and 9 kidney transplant recipients). Among these, 2 donors were identical for both transplantations. All but 1 patient achieved neutrophil engraftment. The 5-year overall survival rate was 41.7%, but that in patients with malignant disease (n = 13) was much lower than the overall rate (23.1%). Only 1 patient with malignant disease underwent allogeneic HSCT in nonremission. In allogeneic HSCT after kidney transplantation, post-transplantation (1 year) kidney function in 5 evaluable patients was significantly lower than that before allogeneic HSCT, and 3 patients experienced renal rejection. However, no severe hepatic rejection was noted. In SOT recipients, HSCT is a potentially curable treatment for hematologic disorders, but it must be performed with caution, especially in patients with malignancy.

Purpose Volumetric modulated arc therapy (VMAT) can acquire projection images during rotational irradiation, and cone-beam computed tomography (CBCT) images during VMAT delivery can be reconstructed. The poor quality of CBCT images prevents accurate recognition of organ position during the treatment. The purpose of this study was to improve the image quality of CBCT during the treatment by cycle generative adversarial network (CycleGAN). Method Twenty patients with clinically localized prostate cancer were treated with VMAT, and projection images for intra-treatment CBCT (iCBCT) were acquired. Synthesis of PCT (SynPCT) with improved image quality by CycleGAN requires only unpaired and unaligned iCBCT and planning CT (PCT) images for training. We performed visual and quantitative evaluation to compare iCBCT, SynPCT and PCT deformable image registration (DIR) to confirm the clinical usefulness. Result We demonstrated suitable CycleGAN networks and hyperparameters for SynPCT. The image quality of SynPCT improved visually and quantitatively while preserving anatomical structures of the original iCBCT. The undesirable deformation of PCT was reduced when SynPCT was used as its reference instead of iCBCT. Conclusion We have performed image synthesis with preservation of organ position by CycleGAN for iCBCT and confirmed the clinical usefulness.

Highlights • An optimal and safe irradiation method for pregnant woman remains controversial. • Flattening-filter free VMAT could reduce the fetal exposure significantly. • As adjuvant CCRT, 66 Gy to the involved nodes was delivered over 33 fractions. • Without any shielding device, the fetal dose of 0.03 Gy in total was estimated. • A vigorous liveborn girl was born vaginally and she had no complications until now., Optimizing irradiation protocols for pregnant women is challenging, because there are few cases and a dearth of fetal dosimetry data. We cared for a 36-year-old pregnant woman with tongue cancer. Prior to treatment, we compared three intensity-modulated radiation therapy (IMRT) techniques, including helical tomotherapy, volumetric arc therapy (VMAT), and flattening-filter free VMAT (FFF-VMAT) using treatment planning software. FFF-VMAT achieved the minimum fetal exposure and was selected as the optimal modality. We prescribed 66 Gy to the involved nodes, 60 Gy to the tumor bed and ipsilateral neck, and 54 Gy to the contralateral neck over 33 fractions. To confirm the out-of-field exposure per fraction, surface doses and the rectal dose were measured during FFF-VMAT delivery. Postoperative chemoradiotherapy was delivered using IMRT and a cisplatin regimen. Without any shielding, the total fetal dose was 0.03 Gy, within the limits established by the ICRP. A healthy girl was born vaginally at 37 weeks’ gestation.

Bifidobacterium breve is widely used as a probiotic in preterm infants and children with congenital surgical conditions, however, some cases of probiotics-induced bacteremia have been reported recently.To examine the clinical and bacteriologic features of Bifidobacterium breve bacteremia caused by a probiotic (BBG-01) in term and preterm infants.We included 298 patients who were admitted to the neonatal intensive care unit of Miyagi Children's Hospital and were given BBG-01 as a probiotic within the period June 2014 to February 2019. We experienced six cases of B. breve bacteremia and assessed their features retrospectively.The incidence rate of B. breve bacteremia in our hospital was 2% (6/298), higher than reported previously. The median age at onset, corrected age, and weight of the patients was 8 days (range: 5-27 days), 35 weeks (range: 26-39 weeks), and 1,940 g (range: 369-2734 g), respectively. The bacteremia triggers were gastrointestinal perforations in two cases, food protein-induced enterocolitis syndrome in two cases, adhesive ileus in one case, ileal volvulus in one case, and aspiration pneumonia following esophageal atresia repair in one case. B. breve was detected on blood cultures after a median of 5 days 13 hours (range: 4 days 18 hours-9 days 13 hours). No patient demonstrated serious symptoms, such as septic shock. All patients received antibiotics and recovered without any sequelae.Ileus and intestinal mucosal damage, such as enteritis, can cause B. breve bacteremia. The incidence of B. breve bacteremia may be higher than reported previously and detection via culture may require a longer time than typically needed for more common bacteria. It is associated with a good prognosis.

The aim of this study was to examine the relationship between parental anxiety (father-only, mother-only, or both) and infant weight change. We performed a secondary data analysis among 551 children in the Avon Longitudinal Study of Parents and Children, a birth cohort with weight measurements collected prospectively at 4, 8, and 12 months of age. Paternal and maternal anxiety symptoms were based on the eight-item anxiety subscale of the Crown-Crisp Experiential Index. Scores in the top 15% at 8 weeks postpartum were classified as high anxiety. Generalized Estimating Equations were employed to estimate the joint association between parental anxiety and change in child weight-for-age z-score. Children who had fathers, but not mothers, with anxiety showed a 0.15 (95% CI: 0.01, 0.29) greater increase in weight-for-age z-score than children with neither parent anxious. This result suggests that paternal anxiety, not maternal anxiety, was associated with increases in child weight gain in the first year of life. Public health practitioners and clinicians should consider the use of robust measures of both maternal and paternal anxiety in the postpartum period, in addition to the suggested screening for postpartum depression. Given the limitations of the study, this study should be considered preliminary and hypothesis generating.

Introduction The epidemic of coronavirus disease 2019 (COVID-19) rapidly spread worldwide, and the various infection control measures have a significant influence on the spread of many infectious diseases. However, there have been no multicenter studies on how the number of hospitalized children with various infectious diseases changed before and after the outbreak of COVID-19 in Japan. Methods We conducted a multicenter, prospective survey for hospitalized pediatric patients in 18 hospitals in Hokkaido Prefecture, Japan, from July 2019 to February 2021. We defined July 2019 to February 2020 as pre-COVID-19, and July 2020 to February 2021 as post-COVID-19. We surveyed various infectious diseases by sex and age. Results In total, 5300 patients were hospitalized during the study period. The number of patients decreased from 4266 in the pre-COVID-19 period to 701 (16.4%) post-COVID-19. Patients with influenza and RSV decreased from 308 to 795 pre-COVID-19 to zero and three (0.4%) post-COVID-19. However, patients with adenovirus (respiratory infection) only decreased to 60.9% (46–28) of pre-COVID levels. Patients with rotavirus, norovirus, and adenovirus gastroenteritis decreased markedly post-COVID-19 to 2.6% (38–1), 27.8% (97–27) and 13.5% (37–5). The number of patients with UTIs was similar across the two periods (109 and 90). KD patients decreased to 31.7% (161–51) post-COVID-19. Conclusions We suggest that current infection control measures for COVID-19 such as wearing masks, washing hands, and disinfecting hands with alcohol are effective against various infectious diseases. However, these effects vary by disease.

Background Hands of healthcare workers (HCWs) and family caregivers are a potential source of bacterial pathogens that may be transferred to susceptible individuals. However, there is a paucity of data regarding the effect of hand rubs used in Zambian hospitals. Therefore, we determined the effect of locally made alcohol-based hand rubs in three selected wards of the Children Hospital at the University Teaching Hospital in Zambia. Methods This was a cross-sectional study involving 31 participants (12 family caregivers, 5 doctors and 14 nurses). The samples were collected before and after the use of the alcohol-based hand rub by direct fingerprints. They were then cultured and identified using conventional microbiological methods. The Kirby-Bauer Disc Diffusion method was used for antimicrobial susceptibility testing. Results All samples collected from the participants yielded bacterial growth with a total of 7 species isolated. These included coagulase-negative staphylococcus (33.3%), Bacillus species (28.9%), Staphylococcus aureus (22.2%), Enterobacter agglomerans (6.7%), Corynebacterium species (4.4%), Escherichia coli (2.2%) and Burkholderia pseudomallei (2.2%). Notably, all study participants hands were not only contaminated but with drug-resistant organisms as most of the bacterial isolates were resistant to routine antibiotics used at the hospital including ciprofloxacin. S. aureus was also resistant to oxacillin thus suggesting the presence of Methicillin-Resistant S. aureus. The use of alcohol-based hand rubs reduced the bacterial load by 92.6% on doctors and nurses’ hands and by 84.5% on the hands of family caregivers. Conclusion This study confirms that the hands of HCWs and family caregivers may play a role in the transmission of drug-resistant bacteria and that alcohol-based hand rubs can be an effective way of reducing bacterial hand contamination among healthcare workers and family caregivers. Therefore, we recommend that measures be put in place by the hospital to ensure the availability of hand rubs to HCWs as well as caregivers.

Background A seroepidemiological study was conducted on a random sample of households in Utsunomiya City, Tochigi Prefecture, Greater Tokyo, Japan, to assess the seroprevalence of SARS‐CoV‐2. Methods The level of IgG antibodies in the blood of the recruited subjects was assessed using chemiluminescence immunoassay analysis. In addition, the population‐based prevalence of SARS‐CoV‐2 was estimated. Results Three positive afebrile cases were confirmed. The estimated unweighted prevalence and weighted prevalence of SARS‐CoV‐2 infection were 0.40% and 1.23%, respectively. Conclusions This study suggests that the prevalence of SARS‐CoV‐2 may have been underestimated. Wider testing strategies may lead to revealing more SARS‐CoV‐2 cases., We conducted a seroepidemiological study in a random sample in the Greater Tokyo area. IgG antibody level for SARS‐CoV‐2 in the blood was quantitatively assessed. We estimated the population‐based prevalence using data from basic resident registry. The unweighted prevalence and weighted prevalence of COVID‐19 were 0.40% and 1.23%, respectively.

Background Ubiquitin-associated protein 2-like (UBAP2L) has been demonstrated to be associated with the progression of multiple types of cancer. However, the function of UBAP2L in uterine cervical cancer remains unclear. Materials and methods Between 2005 and 2015, 84 patients who underwent surgery were included in this study. The patients were stratified into two groups on the basis of immunohistochemical staining for UBAP2L, and survival analysis was performed. Moreover, loss-of-function analysis was performed using the cervical cancer cell lines CaSki and SiHa. Results Based on immunohistochemistry, the overall survival in patients with low UBAP2L expression was significantly longer than that of those with high UBAP2L expression (p=0.045). The in vitro experiment revealed that knockdown of UBAP2L remarkably inhibited cell proliferation in both live cell imaging and the MTS assay. Conclusion Patients with high UBAP2L expression had unfavorable prognosis and UBAP2L appears to play an important role in proliferation.

Fintech began to grow rapidly in Indonesia, there were 216 institutions that joined the Indonesian fintech organization. One of the fast growing finteches is lending based crowdfunding or P2P lending. At present 127 registered lending based crowdfunding institutions are registered. Unfortunately, crowdfunding growth is still not maximized, found crowdfunding that collapsed in Indonesia, one of which is indves. To avoid failure, a discussion about risk and risk mitigation from crowdfunding is needed. The purpose of this study is to explain the risks arising from various crowdfunding institutions in Indonesia, along with their mitigation strategies. The results of this study are the risk mitigation strategies carried out by crowdfunding institutions in Indonesia by providing super lenders and raising funds again. Suggested implication from this paper is the application of risk mitigation strategy by other crowd funding.

The fight against malaria is currently ongoing in many countries where the disease is still endemic. The overall target is to eliminate malaria in all nations, regardless of their malaria burden, by 2030. Currently, the disease has been eliminated mainly in low-burden and unstable malaria areas globally. However, in high-burden countries, particularly in Africa, the disease is still not eliminated; some countries are even recording increases in incidence. This paper discusses why the disease is currently being eliminated in some countries and not in others using a historical and geo-economic perspective. It identifies gaps in the primary contemporary interventions in high endemic areas, particularly in rural constituencies where incidence of the disease is even higher. The key discussion point is that poor housing and behavioral patterns predispose rural dwellers to more malaria. Other risk factors include agricultural occupations, livestock keeping, and the fact that mosquito vectors in Africa thrive more in rural than urban areas. Combating malaria in rural African areas, therefore, requires radical transformative action to address the unique situations that currently enable the persistence of malaria beyond the contemporary, mainly indoor, and health facility-based interventions. Improving housing structures in rural Africa, which are mainly mud and thatched huts, to at least insect-proof standards is the recommended transformative action. Moreover, behavioral patterns, such as cooking outdoors in the evenings, must be modified to cooking in improvised insect-proof kitchens.

The purpose of this study was to predict the survival time of patients with malignant glioma after radiotherapy with high accuracy by considering additional clinical factors and optimize the prescription dose and treatment duration for individual patient by using a machine learning model. A total of 35 patients with malignant glioma were included in this study. The candidate features included 12 clinical features and 192 dose–volume histogram (DVH) features. The appropriate input features and parameters of the support vector machine (SVM) were selected using the genetic algorithm based on Akaike’s information criterion, i.e. clinical, DVH, and both clinical and DVH features. The prediction accuracy of the SVM models was evaluated through a leave-one-out cross-validation test with residual error, which was defined as the absolute difference between the actual and predicted survival times after radiotherapy. Moreover, the influences of various values of prescription dose and treatment duration on the predicted survival time were evaluated. The prediction accuracy was significantly improved with the combined use of clinical and DVH features compared with the separate use of both features (P

Background While maternal depression has been linked to impaired child growth, the relationship between anxiety and child weight gain is unknown. The study objective was to investigate maternal pre- and post-natal anxiety in relation to child weight gain. Methods Data included 1168 children in the Avon Longitudinal Study of Parents and Children. Child height and weight were measured at the median ages of 25 and 31 months postnatally and used to calculate body mass index (BMI). Maternal anxiety was measured with the Crown-Crisp Experiential Index at 18 and 32 gestational weeks, and two and 21 months postpartum. Mothers scoring in the top 15% at one or more of the four time points were considered to have anxiety. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale-7 (EPDS-7) at these same time points. Maternal depression was defined as EPDS-7 scores of >10. We used Generalized Estimating Equations to assess whether child BMI trajectories varied by the presence of maternal anxiety. Parallel analyses were conducted for maternal depression. Results Among children of mothers who had anxiety at least at one timepoint, the BMI changes associated with a three-month increase in child age increased by 0.06 (95% CI:0.004-0.12) compared to BMI changes in children of mothers without anxiety. Maternal depressive symptoms were not associated with child BMI trajectories. Limitations Maternal anxiety and depressive symptoms were based on maternal self-report. Conclusion Maternal anxiety around childbirth was associated with modest increases in child BMI gain during the child's second year of life