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Autonomous learning is one of the most important factors in the field of language learning. Leaning a language demands a considerable amount of time and learners have to work inside and outside the classroom to develop their language skills. The present study explored ways of promoting autonomous learning skills in mixed-level of students of English at a Japanese university. The course syllabus, which employed various methods was developed in order to increase students' autonomous learning skills and incorporate a self-study period during the semester. The students set their own goals, then planned, developed and followed strategies to achieve them. Learners also kept a weekly learning-log, culminating in a presentation and a written report about what they had done to achieve their goals, including self-evaluation. The results showed that the students recognized some improvements in their English learning skills, motivation and learning habits, including an increase in learning hours. In addition, the students gained confidence in their English learning. Further practical improvements are suggested for supporting students to become autonomous language learners.

Objectives: The deterioration of oral function to a state of oral hypofunction (OHF) has been associated with malnutrition and frailty. This cross-sectional pilot study investigated for differences in OHF prevalence and its category measures across age groups and sex, as well as their associations with physical function. Methods: A total of 155 healthy adults (median age: 55 years, range: 22–89 years) participated in this study after providing informed consent. The cohort was age and sex matched. Seven oral function measures based on the concept of OHF were assessed: oral hygiene (Hygiene), oral dryness, maximum occlusal force (MOF), lip-tongue motor function (LTMF), maximum tongue pressure (MTP), masticatory function, and swallowing function. Hand grip strength (HGS) was also measured. The participants were divided into the young (20–39 years), middle (40–64 years), and old (≥ 65 years) age groups for linear regression analysis of differences in oral and physical function. Differences in OHF prevalence were tested by the chi-square test. Results: The prevalence of OHF was significantly higher in the old group than in the young and middle groups. Such OHF measures as Hygiene, MTP, LTMF, and MOF were significantly worse in the old group as well. The measures of Hygiene and LTMF showed a moderate correlation with age in the multiple regression model (standardized partial regression coefficient, β = 0.24 and -0.19, respectively). HGS was significantly associated with MTP (β = 0.58, p < 0.001) and LTMF (β = 0.38, p = 0.002) in both male and female participants. Conclusions: Our findings suggest that OHF prevalence increases with age, especially after 65 years old. However, the pathological route may vary among OHF categories. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to modify the Japanese version of the Justice Sensitivity Inventory for married couples raising children to help them become more aware of their partner's sensitivity to fairness. Background: In Japan, couples with children tend to have prejudice about the division of roles, perceiving each other based on the fairness of child care, housework, and work. Method: Our participants comprised married couples who lived together with a child aged between 1 month and 3 years. A Web company commissioned a survey, with 1,200 and 500 participants included in the first and second rounds of testing, respectively, conducted 1 week apart. We examined the correlation between each subscale of the Japanese version of the Equity Sensitivity Inventory Adapted for Married Couples (J‐ESIA), the Japanese version of the Quality Marriage Index (J‐QMI), the Japanese version of the Interpersonal Reactivity Index (J‐IRI), and the short form of the Japanese Big‐Five Scale (S‐JBFS). Exploratory and confirmatory factor analyses were conducted. Results: Three factors were identified: ES‐Perpetrator, ES‐Victim, and ES‐Beneficiary. Cronbach's α for each subscale ranged from.95 to.96. Conclusion: A couple‐specific correlation was confirmed for comorbid validity. Implications: Couples can recognize each other's sensitivity to fairness and bring about behavioral change in their relationship. [ABSTRACT FROM AUTHOR]

Emotion plays important roles in learning, memory, and other cognitive processes; it does so not only in the form of "macro-level emotion" (e.g., salient affective states and self-reportable motivational currents) but also in the form of "micro-level emotion" (e.g., subtle feelings and linguistic attributes that are usually processed subconsciously without special attention). According to the Emotion-Involved Processing Hypothesis (EIPH), processing that draws attention to emotional aspects (EmInvProc+) is postulated as a deeper version of semantic processing which has cognitive advantage to facilitate linguistic processing and retention more than non-emotional semantic processing (EmInvProc-). This study empirically investigated whether the EIPH can be experimentally corroborated for learners of a distant foreign language (viz., Japanese learners of English). In the experiment, participants processed visually presented English words that were either positively or negatively valenced under different conditions, followed by the test session in which they engaged in memory tests. Two processing modes were compared (EmInvProc+ vs. EmInvProc-). The dependent variables were correct recall frequency, correct recognition frequency, and correct recognition reaction time. It was revealed that EmInvProc+ was more cognitively facilitatory in making stronger foreign language lexical memory traces than EmInvProc- for all the measures employed in the experiment, regarding both accuracy (correct response frequency) and fluency (correct response reaction time). Therefore, it is implied that EmInvProc+ can be regarded as a sui generis deeper level of processing that is qualitatively distinguishable from mere semantic processing, supporting the Emotion-Involved Processing Hypothesis.

Simple Summary: This study was proposed to address the poor prognosis of primary lung cancer, particularly lung adenocarcinoma, which remains a leading cause of cancer-related mortality. The authors aim to explore the prognostic impact of lipid peroxidation markers and regulators involved in ferroptosis, an emerging form of cell death, to identify potential therapeutic targets. By analyzing the expression levels of glutathione peroxidase 4 (GPX4), ferroptosis suppressor protein 1 (FSP1), and 4-Hydroxy-2-nonenal (4-HNE) in resected lung adenocarcinoma tissues, the study seeks to establish a relationship with clinicopathological factors and patient outcomes. The findings revealed that low 4-HNE and low GPX4 expression are associated with worse prognosis, while low FSP1 expression correlates with unfavorable relapse-free survival. These insights suggest that lipid peroxidation markers and ferroptosis regulators could serve as valuable prognostic biomarkers and therapeutic targets. This research has the potential to significantly impact the scientific community by guiding the development of novel, targeted therapies for lung adenocarcinoma, ultimately improving patient outcomes. Background: Primary lung cancer is among the cancers with the poorest prognosis, having the highest mortality rate among men and the second highest among women in Japan. While surgery is the primary treatment, advanced stages often require pharmacotherapy. Recently, ferroptosis, an iron-dependent form of cell death caused by lipid peroxidation, has gained attention as a potential therapeutic strategy. This study investigated the prognostic impact of lipid peroxidation marker and regulators involved in ferroptosis in lung adenocarcinoma. Methods: We analyzed 207 patients who underwent resection surgery for lung adenocarcinoma at Tokyo Medical and Dental University Hospital. Immunohistochemistry was used to evaluate the expression levels of glutathione peroxidase 4 (GPX4), ferroptosis suppressor protein 1 (FSP1), and 4-hydroxy-2-nonenal (4-HNE). The association between these markers and clinicopathological factors was assessed, and in vitro experiments were conducted to examine the effects of these markers on cell death. Results: Low cytoplasmic accumulation of 4-HNE and low expression of GPX4 were associated with a worse prognosis, and low FSP1 expression was associated with unfavorable relapse-free survival. In vitro experiments demonstrated that 4-HNE inhibited cell proliferation, and combined inhibition of GPX4 and FSP1 induced ferroptosis. Conclusions: These findings suggest that lipid peroxidation markers and regulators can serve as prognostic biomarkers and therapeutic targets in lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: Mapping of atypical atrial arrythmias arising in the left atrium is often challenging. The Local Activation Time (LAT) Histogram, a new function of the 3D color mapping system CARTO version 7, may help improve identification of atrial tachycardia circuits. We aimed to assess the effectiveness of the LAT Histogram for identification of left atrial tachycardia circuits. Methods: This retrospective study compared 25 consecutive cases of left atrial tachycardia that were treated before use of LAT Histogram (unused group) and 25 consecutive cases that were treated after introduction of LAT Histogram (used group) at Nagano Chuo Hospital. We evaluated whether we could identify the circuit of left atrial tachycardia from the electrophysiology lab data during ablation and the CARTO system data and whether we could perform effective ablation. Results: Door‐to‐door time, skin‐to‐skin time, and fluoroscopy time (p ≤.011) were all shorter in the LAT Histogram used group versus unused group, while mapping analysis times were longer in the used group (p ≤.019). A significantly greater number of cases in the LAT Histogram used compared with the unused group had ablation for entrance or exit points (19 vs. 10 cases; p =.001 for first map). Ablation resulted in a return to sinus rhythm and changed cycle length at the first mapping in 20 cases (80%) in the LAT Histogram unused group and in 24 cases (96%) in the used group. Conclusions: LAT Histogram may provide a simple and effective method to identify entrance and exit locations in left atrial tachycardia. [ABSTRACT FROM AUTHOR]

Background An analysis was conducted in Japan to determine the most cost-effective neuraminidase inhibitor for the treatment of influenza virus infections from the healthcare payer's standpoint. Objective This study reanalysed the findings of a previous study that had some limitations (no probabilistic sensitivity analysis and quality of life scores measured by the EQ-5D-3L instead of the EQ-5D-5L) and used a decision tree model with only three health conditions. Methods This study incorporated new data from a network meta-analysis study into the first examination. The second examination involved constructing a new decision tree model encompassing seven health conditions and identifying costs, which consisted of medical costs and drug prices based on the 2020 version of the Japanese medical fee index. Effectiveness outcomes were measured using EQ-5D-5L questionnaires for adult patients with a history of influenza virus infections within a 14-day time horizon. Deterministic and probabilistic sensitivity analyses were performed to examine the uncertainty. Results In the first examination, the base-case cost-effectiveness analysis confirmed that oseltamivir outperformed laninamivir, zanamivir and peramivir, making it the most cost-effective neuraminidase inhibitor. The second examination revealed that oseltamivir dominated the other agents. Both deterministic and probabilistic sensitivity analyses showed robust results that validated oseltamivir as the most cost effective among the four neuraminidase inhibitors. Conclusions This study thus reaffirms oseltamivir's position as the most cost-effective neuraminidase inhibitor for the treatment of influenza virus infections in Japan from the perspective of healthcare payment. These findings can help decision makers and healthcare providers in Japan. [ABSTRACT FROM AUTHOR]

This study stems in part from a desire to correct the misapprehension that Japanese students are somehow less autonomous than learners from other cultural backgrounds. The view that Japanese learners tend to be passive, obedient, and quiet is commonly accepted. Much of this "evidence" is anecdotal and comes from teacher observation of student behavior, not interviews with students themselves. Language teaching in Japan is, indisputably, still teacher-centered, and students have been led to rely upon memorization and mechanical approaches to language learning. Given these facts, it is not surprising that Japanese students do not typically demonstrate much learner autonomy or use a wide variety of learning strategies. It is asserted that Japanese students are not any more or less autonomous than learners from different cultural backgrounds; rather, the environment in which they have studied a foreign language, characterized by a formal, teacher-centered, grammar-translation approach that discourages experimentation with language and the development of a set of personalized learning strategies is responsible for the students' classroom behavior. Six groups of four to five Japanese college students were asked to respond individually to 13 questions, the answers to which had been used in several earlier studies and had been shown to be valid indicators of the level of learner autonomy. Results indicate that it is not the learners who are innately passive, but it is an educational system that has created an environment that discourages learner autonomy. Seven references and an appendix with the questionnaire are included. (KFT)

Background and aims: Conversion to laparotomy is among the serious intraoperative complications and carries an increased risk of postoperative complications. In this cohort study, we investigated whether or not the Endoscopic Surgical Skill Qualification System (ESSQS) affects the conversion rate among patients undergoing laparoscopic surgery for rectal cancer. Methods: We performed a retrospective secondary analysis of data collected from patients undergoing laparoscopic surgery for cStage II and III rectal cancer from 2014 to 2016 across 56 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery. Data from the original EnSSURE study were analyzed to investigate risk factors for conversion to laparotomy by performing univariate and multivariate analyses based on the reason for conversion. Results: Data were collected for 3,168 cases, including 65 (2.1%) involving conversion to laparotomy. Indicated conversion accounted for 27 cases (0.9%), while technical conversion accounted for 35 cases (1.1%). The multivariate analysis identified the following independent risk factors for indicated conversion to laparotomy: tumor diameter [mm] (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01–1.05, p = 0.0002), combined resection of adjacent organs [+/−] (OR 7.92, 95% CI 3.14–19.97, p < 0.0001), and surgical participation of an ESSQS-certified physician [−/+] (OR 4.46, 95% CI 2.01–9.90, p = 0.0002). The multivariate analysis identified the following risk factors for technical conversion to laparotomy: registered case number of institution (OR 0.99, 95% CI 0.99–1.00, p = 0.0029), institution type [non-university/university hospital] (OR 3.52, 95% CI 1.54–8.04, p = 0.0028), combined resection of adjacent organs [+/−] (OR 5.96, 95% CI 2.15–16.53, p = 0.0006), and surgical participation of an ESSQS-certified physician [−/+] (OR 6.26, 95% CI 3.01–13.05, p < 0.0001). Conclusions: Participation of ESSQS-certified physicians may reduce the risk of both indicated and technical conversion. Referral to specialized institutions, such as high-volume centers and university hospitals, especially for patients exhibiting relevant background risk factors, may reduce the risk of conversion to laparotomy and lead to better outcomes for patients. Trial Registration: This study was registered with the Japanese Clinical Trials Registry as UMIN000040645. [ABSTRACT FROM AUTHOR]

Risk factors for severe COVID-19 associated with people living with HIV (PLWH) have not been well studied in Japan. In this study, we aim to reveal how having AIDS and comorbidities affect adverse COVID-19 outcomes. This observational, retrospective study examined the clinical outcomes for PLWH hospitalized as COVID-19 inpatients in Japan, using data extracted from hospitals with the Diagnosis Procedure Combination (DPC) system between January 2020 and December 2021. From 4672 records of HIV patients receiving antiretroviral therapy, 85 adult PLWH became hospitalized with COVID-19. The associations between patients' AIDS diagnosis, comorbidities, and their adverse COVID-19 outcomes (mild/moderate and severe/death) were analyzed. Among 85 studied patients, 78 were male (91.8%) with mean (SD) age of 48 (14.4) years. 75 (88.2%) were found to be COVID-19 mild/moderate; 9 (10.6%) were severe; 1 (1.2%) died. Older age (p = 0.002) and hypertension (p = 0.032) were significantly associated with progressing to severe COVID-19 or death. AIDS and other AIDS-defining illnesses were not found to be significant risk factors in this study. While interpretation of the results from this hospital claim database study warrants caution, we found that among PLWH hospitalized as COVID-19 inpatients in Japan, those who are older or with hypertension have a higher risk for progression to severe COVID-19 outcomes, suggesting a careful monitoring of clinical course for these patients. [ABSTRACT FROM AUTHOR]

Background: A bridge to surgery (BTS) using self-expandable metallic stents (SEMSs) is becoming the primary treatment for obstructive colorectal cancer (OCRC). In Japan, intestinal decompression was usually performed using decompression tubes (DTs). However, few reports have compared the outcomes of SEMS and DTs as BTS. Therefore, we compared the treatment outcomes of SEMS and DTs for OCRC. Methods: Data of 80 patients who underwent radical resection after endoscopic decompression for stage II or III OCRC between 2007 and 2021 were retrospectively analyzed. Patients were divided into two groups based on whether they received SEMS (n = 53) or DTs (n = 27). Results: The clinical success rate of decompression was 96.2% and 88.9% in the SEMS and DT groups, respectively. Additionally, 96.2% of patients who received SEMS were able to resume their routine diet without stricture symptoms. The rate of stoma construction and incidence of postoperative complications were lower in the SEMS group (p < 0.005 and p < 0.01, respectively). The 3-year relapse-free survival rates were 71.9% and 51.2% in the SEMS and DT groups, respectively, which were not significantly different (p = 0.10). Conclusion: BTS using SEMS might be an adequate treatment for stage II or III OCRC regardless of tumor location owing to the comparable oncological outcomes with DT and low perioperative complication rate. [ABSTRACT FROM AUTHOR]

Background: The present retrospective study was carried out to determine the incidence of unrecognized cardiac surgery-associated acute kidney injury (CSA-AKI) due to infrequency of serum creatinine (SCr) measurements in pediatric cardiac patients and to assess the association between unrecognized CSA-AKI and clinical outcomes. Methods: This study was a single-center, retrospective study of pediatric patients who underwent cardiac surgery. Patients were diagnosed with CSA-AKI based on SCr measurements, and unrecognized CSA-AKI was defined under the assumptions that there had been only one or two SCr measurements within 48 h after surgery: CSA-AKI unrecognized by one SCr measurement (AKI-URone), CSA-AKI unrecognized by two SCr measurements (AKI-URtwo), and CSA-AKI recognized by one and two SCr measurements (AKI-R). The change of SCr from baseline to postoperative day 30 (delta SCr30d) was assessed as a surrogate of kidney recovery. Results: In a total of 557 cases, 313 patients (56.2%) were diagnosed with CSA-AKI, 188 (33.8%) of whom had unrecognized CSA-AKI. Delta SCr30d in the AKI-URtwo group and delta SCr30d in the AKI-URone group was not significantly different from delta SCr30d in the non-AKI group (p = 0.67 and p = 0.79, respectively). There were significant differences in the durations of mechanical ventilation, serum B-type natriuretic peptide levels, and lengths of stay in hospital between the non-AKI group and the AKI-URtwo group and between the non-AKI group and the AKI-URtwo group. Conclusions: Unrecognized CSA-AKI due to infrequent SCr measurements is not rare and is associated with prolonged mechanical ventilation, high postoperative BNP level, and prolonged length of stay in hospital. [ABSTRACT FROM AUTHOR]

Mild cognitive impairment (MCI), including memory loss, has been attracting attention in Japan. This study assessed the effect of new complete dentures provision alone and with dietary intervention on cognitive functions assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). A randomized controlled trial was conducted with 70 older adults who required new complete dentures. The participants had new complete dentures fabricated and were randomly classified into the intervention or control group. The intervention group received simple dietary advice, and the control group only received denture care advice. Cognitive function was assessed using the MoCA-J before and at 3 and 6 months after treatment. The between-group comparison and within-group comparison were analyzed. No significant differences were reported for comparisons between the intervention and control groups. A significant increase was revealed in the within-group comparisons for the total scores between the 3- and 6-month assessments (p = 0.002) and between the baseline and 6-month assessments (p = 0.012) in the intervention group. In the control group, a significant increase in the total scores was not revealed between any of evaluation period. Complete denture replacement combined with simple dietary intervention may help improve MoCA-J scores in edentulous older adults. [ABSTRACT FROM AUTHOR]

Background: The aims were to use Japanese data from the Rome Foundation Global Epidemiological Study (RFGES) to test the hypotheses that severity of gastrointestinal (GI) symptoms and psychosocial disturbance are ordered as Rome IV irritable bowel syndrome (IBS) > Rome III IBS > DGBI, not IBS > others. Methods: Subjects were 2504 Japanese in the RFGES. We assessed DGBI/IBS diagnoses with Rome IV/III, IBS Symptom Severity Scale (IBS‐SSS), Patient Health Questionnaire (PHQ) for anxiety/depression and non‐GI somatic symptoms, PROMIS‐10 for quality of life (QOL), Work Productivity and Activity Impairment (WPAI) Questionnaire, parts of Self‐reported IBS Questionnaire (SIBSQ) for meal effect and stress effect, Food Frequency Questionnaire, and medication questions. Key Results: The prevalence of Rome IV DGBI was as follows; IBS‐C 0.5%, IBS‐D 0.8%, IBS‐M 0.8%, IBS‐U 0.1%, unspecified functional bowel disorder 10.7%, postprandial distress syndrome 2.2%, and epigastric pain syndrome 0.3%. Rome III IBS prevalence; IBS‐C 3.0%, IBS‐D 3.1%, IBS‐M 2.7%, and IBS‐U 0.6%. Comparison among Rome IV IBS (n = 54), Rome III IBS (n = 197), other DGBI (n = 746), others (n = 1389) revealed significant order as Rome IV IBS > Rome III IBS > other DGBI > others in IBS‐SSS, anxiety/depression, activity impairment, non‐GI symptoms, physical QOL, mental QOL, exacerbated symptoms by meals and perceived stress (all p < 0.001). Conclusions & Inferences: These findings support the study hypotheses. Data from Japan as a culturally homogenous country suggest Rome IV IBS is more severe and hence has more gut–brain psychobehavioral involvement than Rome III IBS. [ABSTRACT FROM AUTHOR]

Background: Knee is the most commonly injured part of the body in young athletes. Knee pain in several studies have been seen to be more prevalent in active adolescents compared to inactive, although common in both groups. Nevertheless, few studies with large sample size have been published reporting the difference of the prevalence of knee pain for each sport among young sports players. This study investigated the point prevalence of knee pain among young sports players aged 6–15 years old according to age, sex, and sports discipline. Furthermore, this study investigated the association between knee pain and sports discipline among young sports players. Methods: A cross-sectional study was conducted using a self-reported questionnaire on young sports players aged 6–15 years from the Miyagi Amateur Sports Association. Multivariable logistic regression models were used to examine the association between knee pain and sports discipline and were adjusted for age, sex, body mass index (BMI), training days per week, and training hours per weekday and weekend. Results: A total of 7234 young sports players were included. The point prevalence of knee pain was 10.9%. Females (13.3%) had more knee pain than males (9.8%). Young, 13-year-old sports players had the highest prevalence of knee pain (19.1%). The multivariable analysis showed that the highest odds ratio [95% confidence interval] was observed for handball players (2.42 [1.01–5.81]). In addition, hand ball, mini-basketball (odds ratio 1.85; 95% CI 1.38–2.47), and basketball (odds ratio 1.66; 95% CI 1.23–2.26) were significantly associated with knee pain, compared with football. The lowest odds ratio was observed for swimming (0.34 [0.05–2.54]), followed by karate (odds ratio 0.38; 95% CI 0.16–0.89) and baseball (odds ratio 0.47; 95% CI 0.35–0.64). Conclusion: The prevalence of knee pain among young athletes differed according to age, sex, and sports discipline. Their parents and clinicians should recognize this information to manage knee pain among young sports players. [ABSTRACT FROM AUTHOR]

The common grass yellow butterfly, Eurema mandarina is a Fabaceae-feeding species, the females of which readily oviposit on Albizia julibrissin and Lespedeza cuneata in mainland Japan. We previously demonstrated that the methanolic leaf extracts of these plants, and their highly polar aqueous fractions strongly elicit female oviposition. Furthermore, the three subfractions obtained by ion-exchange chromatographic separation of the aqueous fraction have been found to be less effective alone, but synergistically stimulate female oviposition when combined. This indicates that female butterflies respond to multiple compounds with different acidity. We have previously identified d-pinitol from the neutral/amphoteric subfractions and glycine betaine from the basic subfractions as oviposition stimulants of E. mandarina. The present study aimed to identify active compounds in the remaining acidic subfractions of A. julibrissin and L. cuneata leaf extracts. GC-MS analyses of trimethylsilyl-derivatized samples revealed the presence of six compounds in the acidic subfractions. In bioassays using these authentic chemicals, erythronic acid (EA) and threonic acid (TA) were moderately active in eliciting oviposition responses in E. mandarina, with their d-isomers showing slightly higher activity than their l-isomers. Female responsiveness differed between d-EA and l-TA, the major isomers of these compounds in plants, with the response to d-EA reaching a plateau at concentrations above 0.005% and that to l-TA peaking at a concentration of 0.01%. The natural concentrations of d-EA and l-TA in fresh A. julibrissin and L. cuneata leaves were sufficient to stimulate oviposition. Furthermore, mixing 0.001% d-EA or 0.001% l-TA, to which females are mostly unresponsive, with 0.1% d-pinitol resulted in a synergistic enhancement of the oviposition response. These findings demonstrate that E. mandarina females utilize both polyhydroxy acids, EA and TA, as chemical cues for oviposition. [ABSTRACT FROM AUTHOR]

: Development and acquisition of communication, logical thinking, team-building, critical appraisal, critical thinking and person-centred multi-disciplinary care planning must be considered as skill sets and global core competencies for a dental professional. Therefore, an international online study course to foster undergraduate dental students' skill sets in these areas was established and this study aimed to report the perceptions of participants. An international online course consisting of three levels pertaining to the school year was delivered to dental undergraduates of Japan and Thailand from September to December in 2021. An online questionnaire survey was conducted to obtain feedback from the participants and assess the implementation of the course. In total, 64 responses were obtained from students who participated in all the assigned online sessions and completed the questionnaire (a response rate of 88%). More than 95% of students from each level felt that the programme increased their motivation to study clinical dentistry, and was beneficial for their future and made them appreciate the importance of participating in international exchange. The ratio of favourable respondents was more than 90% with a 95% confidence interval. Fostering globally competent dental students is important and the acquisition of necessary skill sets could be enhanced through international virtual team-working, problem-solving and person-centred multi-disciplinary care planning activities. These are beneficial for undergraduate dental student training so that they graduate with a broader global perspective and an appreciation of the importance of delivering person-centred culturally sensitive dental care. [ABSTRACT FROM AUTHOR]

Aspiration prevention surgeries, such as laryngotracheal separation and total laryngectomy are performed to prevent aspiration pneumonia. We aimed to investigate the outcomes of surgery for intractable aspiration and relevant factors. This retrospective cohort study used a nationwide insurance claims database that included company employees and their family members aged < 75 years in Japan. We extracted the data of patients who underwent aspiration prevention surgeries between January 2005 and March 2019. We identified 127 patients (males, 55.9%), of whom 59.8% were aged < 18 years at the surgery. The most common comorbidity was neurological disease (99.2%). The frequency of pneumonia episodes decreased by 1.5 per year after surgery compared with before surgery (p < 0.001). Among patients who received parenteral and enteral nutrition before surgery (n = 92), the adjusted hazard ratio (aHR) for oral intake without parenteral and enteral nutrition was lower in the longer preoperative duration (≥ 14.7 months) for the parenteral and enteral nutrition. However, the difference was not statistically significant (aHR 0.55; 95% confidence interval: 0.15-2.08, p = 0.38). The aHR for oral intake was higher in the ≥ 30 years group than in the < 30 years group (aHR 13.76; 95% confidence intervals: 4.18-42.24; p < 0.001). This study demonstrated that postoperative oral intake was achieved more frequently in patients aged ≤ 30 years than in those aged > 30 years, and supported the effectiveness of aspiration prevention surgery for reducing aspiration pneumonia. Further research is necessary to investigate factors related to postoperative oral intake. [ABSTRACT FROM AUTHOR]

The collaboration between public libraries and school libraries is required for elementary, junior high, and high school students, as well as teachers and staff of schools, from the viewpoints of learning support, reading support, improving their own information literacy, and teaching support. The development, presentation and upkeep of such school support services by public libraries are practically necessary to fulfill such collaboration. It is thought that web pages for school support services are essential to public library websites, not only in Japan but also in the U.S.A., in order to inform people, who are especially involved in education, about the existence of school support services and how to utilize them for school support. Also, it is essential for public libraries to provide users with web pages for school support services, children's web pages, YA web pages, and web pages for promotion of reading on their own websites, in order to improve school education and social education in local community. Furthermore, a contents model of web pages for school support services is proposed through the results of our recent investigation into the contents of web pages for school support services. This contents model is composed of five kinds of material: (I) information on school support services, (II) information on resource sharing, (III) information on cooperative library programs, (IV) information resources on teaching support and the study of teaching materials for school teachers and staff of schools, (V) information resources on provisions for reading and improvements in student information literacy. [ABSTRACT FROM AUTHOR]

Background Prehospital stroke triage scales help with the decision to transport patients with suspected stroke to suitable hospitals. Objective To explore the effect of the region-wide use of the Japan Urgent Stroke Triage (JUST) score, which can predict several types of stroke: large vessel occlusion (LVO), intracranial hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral infarction other than LVO (CI). Methods We implemented the JUST score and conducted a retrospective and prospective multicenter cohort study at 13 centers in Hiroshima from April 1, 2018, to March 31, 2020. We investigated the success rate of the first request to the hospital, on-scene time, and transport time to hospital. We evaluated the door-to-puncture time, puncture-to-reperfusion time, and 90-day outcome among patients with final diagnoses of LVO. Results The cohort included 5141 patients (2735 before and 2406 after JUST score implementation). Before JUST score implementation, 1269 strokes (46.4%) occurred, including 140 LVO (5.1%), 394 ICH (14.4%), 120 SAH (4.4%), and 615 CI (22.5%). The JUST score was used in 1484 (61.7%) of the 2406 patients after implementation, which included 1267 (52.7%) cases of stroke (186 LVO (7.7%), 405 ICH (16.8%), 109 SAH (4.5%), and 567 CI (23.6%)). Success rate of the first request to the hospital significantly increased after JUST score implementation (76.3% vs 79.7%, p=0.004). JUST score implementation significantly shortened the door-to-puncture time (84 vs 73 min, p=0.03), but the prognosis remained unaltered among patients with acute LVO. Conclusions Use of prehospital stroke triage scales improved prehospital management and preparation time of intervention among patients with acute stroke. [ABSTRACT FROM AUTHOR]

Owing to the large number of power distribution equipment, the supply voltage is managed independently in 6.6‐kV medium‐voltage (MV) and 100‐V low‐voltage (LV) systems in Japanese distribution systems. Both systems have their respective independent allowable voltage range. We have studied the optimum allowable voltage range for MV and LV systems in order to reduce the equipment cost. In this study, we analyze the relationship between the maximum voltage drop and system configuration in an LV systems from the viewpoint of investment costs. © 2022 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Aims It has been reported that a staging system combining N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T (hs-cTnT) or estimated glomerular filtration rate (eGFR) is useful in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). However, these studies were mainly conducted in Western countries, and their usefulness for the Japanese population is unclear. We examined and validated the staging system using hs-cTnT, eGFR, and B-type natriuretic peptide (BNP) in Japanese patients with ATTRwt-CM. Methods and results We retrospectively evaluated 176 patients with ATTRwt-CM. The cut-off values of hs-cTnT and eGFR were selected as 0.05 ng/mL and 45 mL/min/1.73 m², respectively, based on a previous report. The optimal cut-off value of BNP was 255.6 pg/mL to predict all-cause mortality (sensitivity, 75%; specificity, 58%; area under the curve, 0.69; 95% confidence interval [CI], 0.61–0.78; P < 0.001) based on a receiver operating characteristic curve. We defined the cut-off value of BNP as 250 pg/mL. Increased hs-cTnT (>0.05 ng/mL) and BNP (>250 pg/mL) and decreased eGFR (<45 mL/min/1.73 m2 ) were significant predictors of poor prognosis (P < 0.05). We calculated the score by adding 1 point if hs-cTnT and BNP levels increased or eGFR decreased by more than the cut-off value. The hazard ratio of all-cause death adjusted by age and sex, using score 0 as a reference, was 0.44 (95% CI 0.08–2.49, P = 0.44) for score 1, 3.69 (95% CI 1.21–11.21, P = 0.02) for score 2, and 5.40 (95% CI 1.57–18.54, P = 0.007) for score 3. We divided patients into a low score group (0–1 point) and high score group (2–3 points). Kaplan–Meier analyses revealed significant differences in all-cause death and rehospitalization for heart failure (log rank test; P < 0.001), and after adjusting for sex and age, the hazard ratio of all-cause death was 6.96 (95% Cl 2.88–16.83, P < 0.001) and that for rehospitalization for heart failure was 4.27 (95% Cl 2.26–8.07, P < 0.001) in the high-risk group, compared with those in the low-risk group. The median survival period was 32.0 months in the high-risk group. Conclusions This simple staging system, which combines hs-cTnT, BNP, and eGFR, was useful for predicting prognosis in Japanese patients with ATTRwt-CM. This system can objectively evaluate the disease progression of ATTRwt-CM and may be useful for patient selection for disease-modifying therapy. [ABSTRACT FROM AUTHOR]

This review introduces the National Hospital Organization (NHO) database in Japan. The NHO has maintained two databases through a system of data collection from 140 hospitals in the NHO. National Hospital Organization Clinical Data Archives (NCDA) is collecting clinical information in real time from the electronic medical records since January 2016, and Medical Information Analysis (MIA) databank is collecting daily insurance claims data since April 2010. The NHO database covers more than 8 million patients in 140 hospitals throughout Japan. The database consists of the information of patient profiles, hospital admission and discharge, diagnosis with ICD-10 codes, text data from medical chart, daily health insurance claims such as medical procedures, medications or surgeries, vital signs and laboratory data, and so on. The NHO database includes a wide variety of diseases and settings, including acute, chronic and intractable diseases, emergency medical services, disaster medicine, response to emerging infectious disease outbreaks, medical care according to health policies such as psychiatry, tuberculosis, or muscular dystrophy, and health systems in sparsely populated non-urban areas. Among several common diseases, the database has representativeness in terms of age distribution compared with the Patient Survey 2017 by the Ministry of Health, Labour and Welfare. Interested researchers can contact ([email protected]) the NHO database division to obtain more information about the NHO database for utilization. [ABSTRACT FROM AUTHOR]

Introduction: Data on the clinical outcomes of patients receiving adjuvant chemotherapy for surgically resected high-grade pulmonary neuroendocrine carcinoma (HGNEC) (large-cell neuroendocrine carcinoma and small-cell lung cancer) are limited. This study aimed to evaluate the prognostic significance of adjuvant chemotherapy in patients with HGNEC. Methods: We retrospectively analyzed patients with surgically resected HGNEC at five institutions in Japan between January 2006 and May 2016. Results: A total of 143 patients were enrolled. Among them, 65 received adjuvant chemotherapy. Four patients who participated in clinical trials were excluded; the remaining 61 patients were included in the study. Fifty-six patients received adjuvant small-cell lung cancer-based chemotherapy. Twenty-five of 29 patients who relapsed after postoperative adjuvant chemotherapy received chemotherapy. The most commonly administered chemotherapy agent was amrubicin. The 3-year relapse-free and overall survival rates were 55.2% and 66.8%, respectively. The median relapse-free and overall survival times for the 25 patients who received chemotherapy after relapse were 12.9 and 27.5 months, respectively. Among them, 22 relapsed within 2 years. Patients who received platinum-doublet chemotherapy after relapse tended to have better time to progression disease and overall survival than those who received single-agent chemotherapy. Conclusions: Most patients with HGNEC received small-cell lung cancer-based regimens as postoperative adjuvant chemotherapy. Those who relapsed after adjuvant chemotherapy were mainly treated with amrubicin. Our findings suggest that platinum-doublet chemotherapy tends to improve the time to progression disease and overall survival in patients who relapse after postoperative adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

In recent years, a local downpour occurs frequently in various parts of Japan and there is an embankment destroyed by the downpour. River embankments are important structures to protect residents from floods and other disasters. Many long embankments are historical products of flood control that have been reinforced by raising them with age. However, the structure of the river embankment was developed based on the experience of the disaster that occurred, and the design and analysis of the destruction of the structure were not analyzed. Furthermore, up to now, the mechanism of the levee collapse has been discussed, and it has not been fully elucidated. In this study, we perform a numerical analysis considering the infiltration boundary of the slope of the embankment and express the difference in stress behavior in the embankment before and after considering the infiltration boundary. We analyzed the stress behavior of the embankment when the river water level rises by analysis and tried to analyze the collapse mechanism of the river embankment by analyzing the effect. In addition, we observed the stress behavior when precipitation was applied and performed a detailed analysis closer to the actual problem. Also, it was analytically confirmed that the fracture mode of the embankment differs depending on the presence or absence of the infiltration boundary. At that time, it was analytically confirmed that the failure mode of the embankment was different depending on the difference in the water level rising speed. [ABSTRACT FROM AUTHOR]

Despite its potential use for population control, the winter ecology of nonnative fishes is still poorly understood due to the difficulty of conducting field surveys. In this study, we investigated the winter habitat use of invasive rainbow trout Oncorhynchus mykiss at the cannel unit scale (i.e., pool, riffle). Twenty-four reaches were surveyed in late December 2013 along the Obicha River, a tributary of the Otofuke River, Tokachi River basin, Hokkaido, Japan. A total of 532 fish were captured, of which 96% were rainbow trout, whereas native salmonid was only a single southern Asian Dolly Varden Salvelinus curilus. Smaller rainbow trout (< 250 mm) used reaches with low velocity, whereas larger trout (250–520 mm) aggregated in specific reaches with deep pools with abundant cover and coarse substrate. A previous tributary-scale study in the same river system showed the importance of velocity and temperature, but not depth and substrate. Therefore, habitat selection would be scale-, as well as size-, dependent. This study provides useful information on capturing large mature adults in winter for effective control of nonnative salmonids. [ABSTRACT FROM AUTHOR]

Purpose In postpartum mental health, postpartum depression is a serious disorder. In Japan, the Japanese version of Edinburgh Postnatal Depression Scale (EPDS) has been used to screen for postpartum depression, but it has not screened all mothers at risk. Therefore, we examined objective indicators that reflect the psychological state of the mother, which can be used in conjunction with the EPDS to accurately screen mothers at risk. This study examined the relationship between maternal psychological status and urinary catecholamines and serotonin at 1-month postpartum. Methods We used the EPDS and Profile of Mood States Second Edition (POMS-2) to measure mothers' postpartum psychological state. Analysis was conducted on 94 women at their 1-month postpartum checkup in Ibaraki Prefecture, Japan. Psychological state and biological state and background factors were analyzed using logistic regression analysis and multiple regression analysis. Urinary catecholamines and serotonin were measured as stress response and depression indicators. Background factors were age, parity, delivery method, support, and lactation status. Results Higher urinary noradrenaline levels were associated with an EPDS score. Lack of husband support was associated with higher POMS-2 Total Mood Disturbance, Confusion-Bewilderment, and Depression-Dejection scores. In addition, first-time mothers had higher Tension-Anxiety scores on POMS-2, and mothers using formula milk or mixed feeding scored higher on Confusion-Bewilderment. Conclusion These results suggest that urinary noradrenaline reflects postpartum maternal depression. In addition, the husband's support, being primipara, and breastfeeding were associated with better mental health for mothers. [ABSTRACT FROM AUTHOR]

Background: Among patients with non-small cell lung cancer (NSCLC), the impact of first-line treatment on overall survival (OS) may be influenced by subsequent therapies. Thus, using patient-level data, we assessed the relationships of progression-free survival (PFS) and post-progression survival (PPS) with OS among patients with high-programmed death-ligand 1 (PD-L1) expression undergoing first-line pembrolizumab monotherapy for NSCLC. Methods: We reviewed data from 133 patients with high PD-L1 expression undergoing first-line pembrolizumab monotherapy for NSCLC at 6 Japanese centers between February 2017 and December 2018. The correlations of PFS and PPS with OS were evaluated at the patient level. Results: Linear regression analyses and Spearman's rank correlation coefficient revealed that PPS was strongly correlated with OS (r = 0.76, p < 0.05, R2 = 0.65), while PFS was only moderately correlated with OS (r = 0.71, p < 0.05, and R2 = 0.4). Furthermore, PPS was significantly associated with performance status at the end of pembrolizumab monotherapy, as well as the use of platinum-based combination chemotherapy after pembrolizumab monotherapy (both p < 0.05). Conclusions: Among patients with high PD-L1 expression undergoing first-line pembrolizumab monotherapy for NSCLC, PPS was more strongly correlated with OS, relative to the relationship between PFS and OS. Therefore, subsequent treatment appears to significantly influence OS in patients with disease progression following first-line pembrolizumab monotherapy. [ABSTRACT FROM AUTHOR]

Background: Although low birth weight in Japan has slightly increased over the past several decades, the association between maternal birth weight and pregnancy outcomes remains poorly understood. Methods: In this hospital-based, prospective cohort study conducted at the National Center for Child Health and Development, we obtained information on pregnant women's birth weight via their maternal and child health handbook. We analyzed 944 women born at term after dividing them into five categories according to their birth weight: <2500 g, 2500–2999 g, 3000–3499 g, 3500–3999 g, and ≥4000 g. Multivariate logistic regression analysis and trend analysis were used to elucidate the extent to which maternal birth weight was associated with small-for-gestational-age and low birth weight in offspring, as well as with hypertensive disorders of pregnancy. Results: Compared with women with a birth weight of 3000–3499 g, those born with a birth weight <2500 g had a significantly higher risk of low birth weight (adjusted odds ratio: 5.39, 95% confidence interval: 2.06–14.1) and small-for-gestational-age (adjusted odds ratio: 9.11, 95% confidence interval: 3.14–26.4) infants. No significant association was found between the incidence of hypertensive disorders of pregnancy and preterm birth. A linear relationship was observed between the lower birth weight categories and a higher risk of low birth weight and small-for-gestational-age (p-values for trends: 0.009 and <0.001, respectively), but no linear relationship was observed for the risk of preterm birth and hypertensive disorders of pregnancy (p-value for trends: 0.317 and 0.157, respectively). Conclusions: Our findings suggest that lower maternal birth weight is associated with small-for-gestational-age and low birth weight in offspring of women born at term. [ABSTRACT FROM AUTHOR]

In recent years, it has been discovered that the magnitude of the connection node voltage is affected by the output power from a photovoltaic (PV) generator and the line impedance when the PV generator, in an increasing trend, is introduced into the distribution system. In this paper, power flow is qualitatively discussed using basic circuit theory comprising the voltage and current vector diagram. A magnitude and its operation point of the maximum allowable output power from the PV generator were successfully derived in the vector diagram where the power conditioning system was operated with a constant output power and constant power factor controls. Furthermore, an optimum capacity of the PV generator was also clarified in the vector diagram to effectively utilize the output power of the PV generator. © 2021 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Managing irritable bowel syndrome (IBS) has attracted international attention because single-agent therapy rarely relieves bothersome symptoms for all patients. The Japanese Society of Gastroenterology (JSGE) published the first edition of evidence-based clinical practice guidelines for IBS in 2015. Much more evidence has accumulated since then, and new pharmacological agents and non-pharmacological methods have been developed. Here, we report the second edition of the JSGE-IBS guidelines comprising 41 questions including 12 background questions on epidemiology, pathophysiology, and diagnostic criteria, 26 clinical questions on diagnosis and treatment, and 3 questions on future research. For each question, statements with or without recommendations and/or evidence level are given and updated diagnostic and therapeutic algorithms are provided based on new evidence. Algorithms for diagnosis are requisite for patients with chronic abdominal pain or associated symptoms and/or abnormal bowel movement. Colonoscopy is indicated for patients with one or more alarm symptoms/signs, risk factors, and/or abnormal routine examination results. The diagnosis is based on the Rome IV criteria. Step 1 therapy consists of diet therapy, behavioral modification, and gut-targeted pharmacotherapy for 4 weeks. For non-responders, management proceeds to step 2 therapy, which includes a combination of different mechanistic gut-targeted agents and/or psychopharmacological agents and basic psychotherapy for 4 weeks. Step 3 therapy is for non-responders to step 2 and comprises a combination of gut-targeted pharmacotherapy, psychopharmacological treatments, and/or specific psychotherapy. These updated JSGE-IBS guidelines present best practice strategies for IBS patients in Japan and we believe these core strategies can be useful for IBS diagnosis and treatment globally. [ABSTRACT FROM AUTHOR]

Cabled seafloor seismic and tsunami observation systems are ideal for marine geophysical monitoring because the data can be obtained in real time. We have developed a new compact seafloor‐cable seismic and tsunami observation system using Information and Communication Technology (ICT). Our system achieves reliability through redundancy using ICT. A software‐based system using up‐to‐date electronics technology contributes to cost reduction and production sustainability. The system named the Ocean Bottom Cable Seismic and Tsunami (OBCST) observation system was installed on the Pacific Ocean floor off Sanriku, northeast Japan, in September 2015, in the source area of the 2011 Tohoku‐oki earthquake. The purpose of the installation is to monitor seismic activity better and to observe tsunami activity through spatially dense observation. The system has been continuously collecting the seismic and pressure data since the deployment. For the seismic data, ambient seismic noise is comparable to that from a previous cable observation system. One observation node is buried 1 m below the seafloor and has a lower noise level compared to nodes on the seafloor. Because the noise levels are stable, many local earthquakes and teleseismic events have been recorded by the system. The data obtained by high‐precision pressure gauges have a resolution of <1 hPa which is limited to environmental noise. The effectiveness of the buried pressure gauge is demonstrated by a recording of a tsunami. The system also continuously monitors its operating environment. The operating temperature is reasonably low and stable, which is optimal for long‐term operation. Plain Language Summary: Large magnitude earthquakes and tsunamis are significant hazards in marine subduction zones. A cable seafloor observation system is essential for research on and the mitigation of such hazards because it can provide observations in real time. We have developed a new compact cable seismic and tsunami observation system to increase the number of observation stations. The system uses Information and Communication Technology which also provides the flexibility to monitor the system and change observational parameters after deployment. In 2015, our system was deployed in the source region of the 2011 Tohoku‐oki earthquake, and data have been gathered continuously since then. Long‐term observational data show that the system consistently records high‐quality seismic and pressure data. The system operates at a low and stable temperature which is ideal for reliable long‐term observations. Key Points: We developed a seafloor‐cable seismic and tsunami observation system using Internet technology. Reliability is ensured by redundancyThe practical system with three stations and a total length of 105 km was deployed, and observation began in 2015The seismic data have a low‐noise level, and the pressure data from the buried observation node are comparable to those on the seafloor [ABSTRACT FROM AUTHOR]

Objective: Tracheal reconstruction is a rare surgical procedure and the actual incidence of or indications for this procedure have not been thoroughly elucidated. We performed the nationwide database analysis to clarify the real-world situation of laryngotracheal surgery requiring cervical tracheal reconstruction.Methods: Patients who underwent surgical treatment for laryngotracheal stenosis or defect from 2008 to 2016 were identified from the Diagnosis Procedure Combination inpatient database, collected from 270 acute care hospitals in Japan. Patients were divided into two groups based on presence/absence of malignancy, and T-tube or tracheotomy dependence at 6 months after surgery was compared between the two groups.Results: One hundred and thirty-four patients (75 males) were identified. The median age at surgery was 65.5 years. The most common indication for surgery was malignancy (n = 60, 44.8%), followed by iatrogenic (n = 25, 18.6%), trauma (n = 6, 4.5%), malformation of the larynx and trachea (n = 6, 4.5%), and chronic inflammatory disease (n = 4, 2.8%). Thyroid cancer was the most common malignancy (n = 38). Thirty patients (22.4%) failed to decannulate within 6 months and malignancy was associated with a lower dependence on T-tube or tracheotomy at 6 months after surgery (adjusted odds ratio: 0.25, 95% confidence interval: 0.08-0.79).Conclusion: A Japanese health insurance claims database provided a useful overview of the clinical features and outcomes of patients who underwent cervical tracheal reconstruction surgery for laryngotracheal stenosis or defect. [ABSTRACT FROM AUTHOR]

In recent years, local downpours frequently occur in various parts of Japan, and embankments are destroyed by these downpours. Many embankments are historical products of flood control that have been reinforced as they age by raising their height. However, the structure of the river embankment was developed based on information from disasters that actually occurred, and analysis of the destruction of the structure was not considered in design. Furthermore, until now, mechanisms of levee collapse have been discussed, but they have not been fully elucidated. Therefore, in this study, embankment analysis considering difference of layer thickness was performed by using the unsaturated soil / water / air coupled element finite method analysis program (DACSAR-MP). Stress behavior in the embankment during the rise of the river water level due to rainfall was analytically expressed, and the effect of the stress was considered to analytically investigate the collapse mechanism of the river embankment. From this work, it was analytically confirmed that embankment failure mode differed depending on differences in the speed of water level rise. [ABSTRACT FROM AUTHOR]

In this study, we propose a new optimization method to determine the control parameters of a step voltage regulator (SVR) to maximize its voltage control characteristic in distribution networks (DNs) with photovoltaic systems. Considering the service life of an SVR, the proposed method evaluates the expected number of tap operations and the voltage control performance based on the past voltage measurements obtained with sensors in the DN. Subsequently, the time series of two control parameters, that is, the reference voltage and the dead bandwidth, are determined for the most improved voltage control characteristic of the SVR, maintaining the number of tap operations within the upper limit. Voltage control simulation using a realistic 6.6‐kV DN model is conducted to show that the proposed method significantly reduces the voltage violation compared with the conventional SVR control using fixed parameters, as well as the alternative SVR operation developed in our previous study, in which the reference voltage was temporally updated. In addition, the simulation results demonstrate that the proposed method realizes efficient tap operations to mitigate the voltage violation, whereas the conventional method requires a much larger number of tap operations to mitigate the voltage violation to the same degree. © 2020 Institute of Electrical Engineers of Japan. Published by Wiley Periodicals LLC. [ABSTRACT FROM AUTHOR]

Objectives: To collect clinical information and NOD2 mutation data on patients with Blau syndrome and to evaluate their prognosis.Methods: Fifty patients with NOD2 mutations were analysed. The activity of each NOD2 mutant was evaluated in HEK293 cells by reporter assay. Clinical information was collected from medical records through the attending physicians.Results: The study population comprised 26 males and 24 females aged 0-61 years. Thirty-two cases were sporadic, and 18 were familial from 9 unrelated families. Fifteen different mutations in NOD2 were identified, including 2 novel mutations (p.W490S and D512V); all showed spontaneous nuclear factor kappa B activation, and the most common mutation was p.R334W. Twenty-six patients had fever at relatively early timepoints in the disease course. Forty-three of 47 patients had a skin rash. The onset of disease in 9 patients was recognised after BCG vaccination. Forty-five of 49 patients had joint lesions. Thirty-eight of 50 patients had ocular symptoms, 7 of which resulted in blindness. After the diagnosis of Blau syndrome, 26 patients were treated with biologics; all were antitumour necrosis factor agents. Only 3 patients were treated with biologics alone; the others received a biologic in combination with methotrexate and/or prednisolone. None of the patients who became blind received biologic treatment.Conclusions: In patients with Blau syndrome, severe joint contractures and blindness may occur if diagnosis and appropriate treatment are delayed. Early treatment with a biologic agent may improve the prognosis. [ABSTRACT FROM AUTHOR]

Background/Aim: A sufficiently open papilla is needed to remove common bile duct stones (CBDS) but endoscopic sphincterotomy (EST) requires a high level of skill and is difficult with endoscopic papillary balloon dilation (EPBD). The main adverse event of EST is bleeding and perforation and that of EPBD is post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. To reduce these adverse events we employed minimal EST followed by papillary dilation (ESBD), and retrospectively evaluated its efficacy and safety compared with EST. Patients and Methods: CBDS patients who underwent EST (n = 114) or ESBD (n = 321) at Juntendo University Hospital from January 2009 to December 2018 were consecutively enrolled, retrospectively. The exclusion criteria were large-balloon dilation (≥ 12 mm), large CBDS (>12 mm), and previous EST/EPBD. We compared the overall stone removal rate, incidence of adverse event, procedure time, number of ERCP procedures, and rate of mechanical lithotripsy (ML) between the two groups. Results: Complete stone removal was successful in both ESBD and EST group. However, the rate of multiple ERCP sessions was significantly lower (35.1% vs. 12.8%, P < 0.001), procedure time was shorter (31.6 vs. 25.8 min, P = 0.01), and rate of ML was lower (16.7% vs. 7.8%, P = 0.01) in ESBD group. Bleeding was significantly more frequent in the EST group (9.6% vs. 1.2%, P < 0.001), particularly acute bleeding (7.9% vs. 0.9%, P < 0.001). Conclusions: ESBD is more efficient and safer in the management of CBD stones than EST. A prospective randomized study comparing ESBD with EST is needed to establish this combination technique. [ABSTRACT FROM AUTHOR]

Background: S‐1 monotherapy is effective and feasible for previously treated patients with advanced non‐small cell lung cancer (NSCLC). However, it is not clear whether its effectiveness and tolerability in elderly patients are equivalent to those in younger patients. Hence, this study aimed to evaluate the efficacy and feasibility of S‐1 monotherapy in elderly patients with NSCLC who had previously received other treatments. Methods: We included 96 elderly patients (aged ≥75 years) with advanced NSCLC treated with S‐1 alone as a subsequent‐line treatment at 12 medical facilities between January 2005 and March 2018 in this study. The baseline characteristics of the patients, response to S‐1 monotherapy, and adverse events (AEs) were investigated, retrospectively. Results: A total of 68 male and 28 female patients (median age, 78 [range: 75–86] years) were analyzed. In elderly patients who were treated with S‐1 monotherapy as a subsequent‐line treatment, the objective response rate, disease control rate, median progression‐free survival (PFS), and overall survival (OS) were 8.3%, 43.8%, 3.4 months, and 9.6 months, respectively. Observed AEs included anorexia, anemia, nausea, fatigue, reduced platelet count, and skin hyperpigmentation. Treatment‐related death was observed in one patient because of pneumonitis. In patients who experienced no progressive disease, subsequent‐line S‐1 alone was associated with longer PFS and OS. Conclusions: S‐1 monotherapy is effective and feasible as a subsequent‐line treatment in elderly patients who were previously treated for NSCLC, and it produces results. S‐1 monotherapy could be one of the treatment choices for elderly patients with previously treated NSCLC. [ABSTRACT FROM AUTHOR]

The current study aimed to describe the use of antipsychotics to clarify the gap between clinical guidelines and health care practice in Japan. We used data from the JMDC Claims Database (JMDC Inc., Tokyo, Japan), a nationwide claims database, from 2005 to 2016. Antipsychotics were defined as drugs coded as N05A with the Anatomical Therapeutic and Chemical (ATC) codes. We described the annual changes in proportions based on the number of patients prescribed any antipsychotics. From the database of 4,081,102 people, the data of 12,382 patients was extracted by applying the following exclusion criteria: no use of antipsychotics, missing the prescription date or dose, inpatients, prescribed antipsychotics only for use as needed, prescribed only injectable antipsychotics except for long-acting injections (LAIs), without schizophrenia as the primary disease, not exceeding 75 mg/day chlorpromazine equivalent, and less than 18 years old. The use of second-generation antipsychotics (SGA) has been expanding, while the use of first-generation antipsychotics has been decreasing. Aripiprazole accounted for the highest proportion of prescribed antipsychotics (31.9%) in 2016. Even though clozapine is categorized as a SGA, it accounted for a paltry 0.2%. The proportion of prescribed antipsychotics accounted for by LAIs was less than 5%. Although the use of antipsychotics for schizophrenia in Japan mostly corresponds to various clinical guidelines, limited use of clozapine and LAIs was identified. Further research focusing on the factors affecting the prescription of these underused antipsychotics may help advance the pharmacological therapy of schizophrenia. [ABSTRACT FROM AUTHOR]

In this paper, we propose a semicentralized voltage control method utilizing past voltage measurements obtained with sensors in a distribution network (DN) to improve the voltage control performance of a single‐step voltage regulator (SVR). In this method, the SVR basically performs autonomous voltage control referring to the control parameter, the reference voltage, but the parameter is updated with a specific interval via communication. To determine a time series of the reference voltage using the past voltage measurements, the simple averaging method and the probabilistic weighting method are considered. The effect of these methods on the voltage control performance is evaluated with a power flow simulation using a realistic 6.6 kV DN model with photovoltaic systems. The results show that the proposed semicentralized SVR control with these advanced parameter‐updating methods dramatically mitigate voltage violation compared to the conventional SVR operation in which the constant reference voltage is used for 1 year. © 2020 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc. [ABSTRACT FROM AUTHOR]

Background: Recombinant human soluble thrombomodulin (rhTM) was approved in 2008 and has been used for treatment of disseminated intravascular coagulation in Japan. The antifibrotic effects of rhTM in acute exacerbation of idiopathic pulmonary fibrosis are well established, but the therapeutic potential of rhTM in renal fibrosis remains poorly understood. Methods: Nephrotoxic serum nephritis (NTS-N) was induced in 22 female Wistar-Kyoto (WKY) rats on day 0. Rats were administered either rhTM or vehicle intraperitoneally, every day from day 4 to day 55. Rats were sacrificed on day 56 when renal fibrosis was established and renal morphological investigations were performed. In vitro, rat renal fibroblasts (NRK-49F) were pretreated with rhTM or saline, and expression levels of profibrogenic gene induced by thrombin were analyzed by real-time reverse transcription polymerase chain reaction. Results: Compared to WKY-GN-vehicle rats, the body weights of WKY-GN-rhTM rats were significantly greater on day 55. By day 56, rhTM had significantly reduced serum creatinine levels in NTS-N. On the other hand, urinary protein excretion was comparable between the two treatment groups throughout the study. The percentage of Masson trichrome-positive areas in WKY-GN-rhTM rats was significantly lower compared to that in WKY-GN-vehicle rats. Glomerular fibrin deposition was significantly reduced in WKY-GN-rhTM rats. In addition, rhTM significantly reduced the renal cortical mRNA expression levels of TNF-α, Toll-like receptor 4, MYD88, TGF-β, αSMA, collagen I, collagen III, fibronectin, and protease-activated receptor 1 (PAR1), a thrombin receptor. In vitro, thrombin stimulation of NRK-49F cells significantly enhanced the mRNA expression levels of αSMA and PAR1, and these upregulations were significantly reduced by pretreatment with rhTM. Conclusions: Administration of rhTM after establishment of crescentic glomerulonephritis (GN) attenuated the subsequent development of renal fibrosis in NTS-N, possibly in part by inhibiting thrombin-mediated fibrogenesis. Our results suggest that rhTM may offer a therapeutic option for limiting the progression of chronic kidney disease in crescentic GN. [ABSTRACT FROM AUTHOR]

Aims: Pulmonary vein (PV) isolation (PVI) utilizing a cryoballoon (CB) has become one of the standard therapeutic options for atrial fibrillation (AF). However, it connotes a potential risk of cerebral ischaemic events (CIEs). This study aimed to clarify the prevalence of CIEs after PVI using second-generation CBs assessed by magnetic resonance imaging (MRI) of the brain.Methods and Results: This prospective observational study consisted of 160 patients that underwent PVI with second-generation CBs for drug-refractory AF. Irrigated radiofrequency (RF) ablation for 'touch-up' procedures was utilized when conduction gaps between the left atrium (LA) and PVs were found after the CB application. Radiofrequency linear ablation was added in select patients. Cerebral MRI and neurological examinations were performed on the day following the ablation procedure. The MRI depicted micro-cerebral infarctions in 43 patients (26.9%, 1.49 lesions per case). All patients were free from symptomatic focal neurological deficits. Touch up ablation was required for the PVI establishment in 35 patients (21.9%). Linear ablation was performed in 59 patients (36.9%). Additional RF ablation within the LA was an independent risk of CIEs in the uni- and multivariate analyses. When the analyses were limited to patients who had undergone only CB ablation, CIEs were found in 12 of 66 patients (18.2%).Conclusion: Pulmonary vein isolation utilizing second-generation CBs carries a negligible risk of symptomatic CIEs; however, it includes a comparable risk of asymptomatic CIEs as in the previous similar reports using the first-generation CB. Radiofrequency applications in addition to the CB within the LA were the only predictor of this adverse effect. [ABSTRACT FROM AUTHOR]

The seed germination characteristics of Maianthemum dilatatum were investigated in a laboratory experiment and the results compared with those of other species in the subfamily Asparagoideae, LILIACEAE (Engler's system). M. dilatatum seeds mature in late September to October in montane to subalpine areas across Japan. Germination percentages and rates were low for fresh seeds at 10 to 30°C. Seeds cold stratified for 4 months or longer showed increased germination percentages and rates. The seeds lost germinability with decreasing moisture content. The seeds germinated well in dark conditions. The process of germination from the cotyledonary sheath/petiole breaking through the seed coat to the appearance of the first and second leaves was examined. After emergence of the cotyledonary sheath/petiole, a root emerged from it, and additional roots appeared after 1–2 months. The plumule emerged from the cotyledonary sheath/petiole after the seedling had three roots. Seeds dispersed in autumn, and germinate slowly in the next spring after exposure to low temperature even though dark condition as buried seed. We compared the seed germination characteristics among species in the Asparagoideae or with other recent taxonomy, and found that seedlings of Paris verticillate and Trillium apetalon, which belong to Melanthiaceae, and Streptopus streptopoides Var. japonica and Clintonia udensis, which belong to Liliaceae (linear cotyledon), were different from Asparagaceae, showing a globose cotyledon in the APG II. [ABSTRACT FROM AUTHOR]

Background: As the number of internet users increases, problems related to internet overuse are becoming more and more serious. Adolescents and youth may be particularly attracted to and preoccupied with various online activities. In this study, we investigated the relationship of internet addiction, smartphone addiction, and the risk of hikikomori, severe social withdrawal, in Japanese young adult. Methods: The subjects were 478 college/university students in Japan. They were requested to complete the study questionnaire, which consisted of questions about demographics, internet use, the Internet Addiction Test (IAT), the Smartphone Addiction Scale (SAS)–Short Version (SV), the 25-item Hikikomori Questionnaire (HQ-25), etc. We investigated the difference and correlation of the results between two groups based on the purpose of internet use or the total score of each self-rating scale, such as screened positive or negative for the risk of internet addiction, smartphone addiction, or hikikomori. Results: There was a trend that males favored gaming in their internet use while females used the internet mainly for social networking via smartphone, and the mean SAS-SV score was higher in females. Two-group comparisons between gamers and social media users, according to the main purpose of internet use, showed that gamers used the internet longer and had significantly higher mean IAT and HQ-25 scores. Regarding hikikomori trait, the subjects at high risk for hikikomori on HQ-25 had longer internet usage time and higher scores on both IAT and SAS-SV. Correlation analyses revealed that HQ-25 and IAT scores had a relatively strong relationship, although HQ-25 and SAS-SV had a moderately weak one. Discussion: Internet technology has changed our daily lives dramatically and altered the way we communicate as well. As social media applications are becoming more popular, users are connected more tightly to the internet and their time spent with others in the real world continues to decrease. Males often isolate themselves from the social community in order to engage in online gaming while females use the internet as to not be excluded from their communications online. Mental health providers should be aware of the seriousness of internet addictions and hikikomori. [ABSTRACT FROM AUTHOR]

Purpose: Considerable research has focused on shoulder and elbow injuries among baseball players; however, although lumbar spine and knee injuries are commonly experienced, they are less frequently studied. During common motions in baseball, such as throwing, hitting, and running, energy is transferred from the lower extremities through the lower back to the upper body. Lower extremity pain, as well as lower back pain (LBP), can disrupt the kinematic chain, and it is important to understand the association between lower extremity complaints and LBP. The purpose of this study was to elucidate the association between knee pain and LBP among young baseball players.Methods: A cross-sectional study was conducted with young baseball players (aged 6-15 years, n = 1,609) using a self-reported questionnaire. Multivariate logistic regression models were used for analyses. Variables considered in the models were sex, age, body mass index, team levels, number of days of training per week, number of hours in practice per day on weekdays and weekend, frequency of participation in games, practice intensity, and player position.Results: The point prevalence of LBP and knee pain was 8.4% and 13.1%, respectively. Knee pain was significantly associated with LBP. Using the absence of knee pain as a reference, the adjusted odds ratio (95% confidence interval) for LBP was 5.83 (3.93-8.65) (p < 0.001) in the presence of knee pain.Conclusions: Knee pain was associated with LBP among young baseball players. Clinicians should pay attention to knee complaints to prevent and treat LBP among young baseball players.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

After a radiation-release incident, intake of radionuclides in the initial stage immediately following the incident may be the major contributor to total internal radiation exposure for individuals in affected areas. However, evaluation of early internal contamination risk is greatly lacking. This study assessed the relationship between initial stage evacuation/indoor sheltering and internal radiation contamination levels 4 months after the 2011 Fukushima nuclear incident in Japan and estimated potential pathways of the contamination. The study population comprised 525 participants in the internal radiation screening program at Minamisoma Municipal General Hospital, 23 km north of the Fukushima nuclear plant. The analysed dataset included the results of a screening performed in July 2011, 4 months after the incident, and of a questionnaire on early-incident response behaviours, such as sheltering indoors and evacuations, completed by participants. Association between such early countermeasures and internal contamination levels of cesium-134 were assessed using Tobit multiple regression analyses. Our study shows that individuals who evacuated to areas outside Fukushima Prefecture had similar contamination levels of cesium-134 to individuals who stayed in Fukushima (relative risk: 0.86; 95% confidence interval: 0.74-0.99). Time spent outdoors had no significant relationship with contamination levels. The effects of inhalation from radiological plumes released from the nuclear plant on total internal radiation contamination might be so low as to be undetectable by the whole-body counting unit used to examine participants. Given the apparent limited effectiveness of evacuation and indoor sheltering on internal contamination, the decision to implement such early responses to a radiation-release incident should be made by carefully balancing their potential benefits and health risks. [ABSTRACT FROM AUTHOR]

Here, we investigated the prevalence of Salmonella enterica, with and without resistance to 17 common antimicrobial agents, in 706 green anoles (Anolis carolinensis) that were collected in Naha and Tomigusuku Cities, Okinawa Main Island, Japan, between 2009 and 2014. Salmonella strains, including S. enterica Weltevreden and Enteritidis serovars, were identified in the large intestinal content samples extracted from 15 (2.1%) of the analyzed green anoles. No antimicrobial resistance was detected. Thus, the present study demonstrates that although the prevalence of Salmonella and the risk of its transmission from the green anoles to humans or other animals on Okinawa Main Island are relatively low, the green anole population nevertheless represents a potential source of Salmonella infection that could affect human health in this region. [ABSTRACT FROM AUTHOR]

Background: Little is known about the outcomes of in-hospital cardiopulmonary resuscitation (CPR) in Asian populations including elderly patients in Japan.Objective: To determine the survival outcome of in-hospital CPR among elderly patients in Japan, and to identify predictors associated with survival.Design: Retrospective cohort study in 81 Japanese hospitals from April 1, 2010 to March 31, 2016.Patients: We included elderly patients (age ≥ 65 years) who received CPR after 2 days of hospitalization.Main Measures: The primary outcome was survival at hospital discharge and the secondary outcomes were the discharge disposition and consciousness level of patients who survived to hospital discharge. To determine predictors associated with survival after in-hospital CPR, we fit multivariable models for patient-level and institutional-level factors.Key Results: Among the 5365 patients who received CPR, 595 (11%) survived to discharge. Of those who survived to discharge, 46% of patients were discharged home, and 10% of patients were comatose at discharge. Older age and higher burden of comorbidities were associated with reduced survival. The adjusted OR was 0.35 (95% CI, 0.22-0.55) for age ≥ 90 years compared to age 65-69 years, and 0.68 (95% CI, 0.48-0.97) for Charlson Comorbidity Index score of ≥ 4 compared with score of 0. Other predictors of reduced survival included receiving CPR on weekends compared to weekdays (AOR, 0.63; 95% CI, 0.51-0.77) and in small hospitals compared to large hospitals (AOR, 0.58; 95% CI, 0.40-0.83).Conclusions: Among elderly patients in Japan, the survival rate of in-hospital CPR was approximately one in ten, and less than half of these patients were discharged home. In addition to older age and higher illness burden, receiving CPR on weekends and/or in small hospitals were significant predictors of reduced survival. These findings should be considered in advanced care planning discussions with elderly patients to avoid subjecting patients to CPR that are likely futile. [ABSTRACT FROM AUTHOR]

Youth athletes are known to be at high risk of musculoskeletal (MSK) injuries. Children in developed countries are increasingly adopting a sedentary lifestyle. Although some risk factors related to sports activities have been reported, the effect of lifestyle (i.e. screen time behaviour) on MSK pain in youth athletes is not well known. This study aimed to examine the association of game playing and TV viewing with MSK pain among youth athletes. A self-administered questionnaire was mailed to youth athletes belonging to the Miyagi Amateur Sports Association. The final study population included 6,143 youth athletes (male, 71.1%; age range, 6-15 years). Multiple logistic regression analysis was used to examine the association of game playing and TV viewing behaviour with MSK pain. The point prevalence of MSK pain was 25.5%. The longest category of game playing time (≥3 h) was significantly associated with MSK pain as compared with the shortest category (<1 h) (odds ratio, 1.39; 95% confidence interval, 1.12-1.73, p = 0.003). There was no significant association between TV viewing time and MSK pain. These results suggest that game playing time might be an associated factor for MSK pain among youth athletes. [ABSTRACT FROM AUTHOR]