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Background: In 2019, coronavirus disease 2019 (COVID-19) emerged in China, spreading globally with significant impacts in Japan, including the Delta and Omicron variants. The research identified risk factors such as age, chronic diseases, and lifestyle choices, emphasizing the need for further study on the association between underlying health conditions, treatments, and COVID-19 severity in Japan. Methods: This study used a nationwide medical database to analyze the association between COVID-19 underlying conditions and pharmacological interventions to identify risk factors for disease severity. We examined the Japanese COVID-19 dataset from Medical Data Vision, selecting patients diagnosed with COVID-19 between January 2020 and December 2022. Logistic regression was used to calculate the odds ratios (ORs) for intensive care unit treatment- or ventilator use-related risk factors. Results: Among 650,317 patients (mean age: 52.1 ± 20.9 years; male individuals: 324,127; female individuals: 326,190), factors that significantly increased the severe disease risk (OR [95% confidence interval]) included age > 65 years (1.31 [1.27–1.36]), hypertension (1.34 [1.28–1.41]), cardiovascular disease (1.74 [1.67–1.81]), and use of beta-blockers (2.09 [2.00–2.17]), calcium blockers (1.97 [1.89–2.06]), angiotensin-converting enzyme inhibitors (1.41 [1.33–1.49]), low-dose aspirin (1.38 [1.32–1.45]), and insulin (7.14 [6.87–7.43]). Conversely, factors that reduced the severe disease risk included female sex and the use of sulfonylureas, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide-1 receptor agonists, and alpha-glucosidase inhibitors. Conclusions: Patients using cardiovascular medications faced a higher risk, whereas those receiving diabetes treatment had a lower risk. Appropriate pharmacotherapy and risk factor identification can aid in the prevention of severe COVID-19. [ABSTRACT FROM AUTHOR]

Summary: Background and Aims: While filgotinib, an oral Janus kinase (JAK) 1 preferential inhibitor, is approved for moderately to severely active ulcerative colitis (UC), real‐world studies assessing its short‐ and long‐term efficacy and safety are limited. Methods: This is a multicenter, retrospective study of UC patients who started filgotinib between March 2022 and September 2023. The primary outcome was clinical remission, defined as a partial Mayo score ≤1 with a rectal bleeding score of 0, or Simple Clinical Colitis Activity Index (SCCAI) ≤2 with a blood‐in‐stool score of 0. Secondary outcomes included clinical response, corticosteroid‐free remission, and endoscopic improvement. Outcomes were assessed at 10, 26, and 58 weeks based on patients with available follow‐up. Adverse events were evaluated. Results: We identified 238 UC patients and 54% had prior exposure to biologics/JAK inhibitors. The median baseline partial Mayo score and SCCAI were 5 (IQR 3–6) and 4 (IQR 2–7). Clinical remission rates based on per‐protocol analysis at 10, 26, and 58 weeks were 47% (70/149), 55.8% (48/86), and 64.6% (31/48), respectively. At a median follow‐up of 28 weeks (IQR 10–54) with a discontinuation rate of 39%, the rates of clinical remission, clinical response, corticosteroid‐free remission, and endoscopic improvement were 39.9% (81/203), 54.7% (111/203), and 36.5% (74/203), and 43.5% (10/23), respectively. These rates were comparable between biologic/JAK inhibitor‐naïve and ‐experienced patients. While three patients (1.3%) developed herpes zoster infection, no cases of thrombosis or death were reported. Conclusions: Real‐world data demonstrate favourable clinical and safety outcomes of filgotinib for UC. [ABSTRACT FROM AUTHOR]

Background: Improving diets requires an awareness of the need to limit foods for which excessive consumption is a health problem. Since there are limited reports on the link between this awareness and mortality risk, we examined the association between awareness of limiting food intake (energy, fat, and sweets) and all-cause mortality in a Japanese cohort study. Methods: Participants comprised 58,772 residents (27,294 men; 31,478 women) aged 35-69 years who completed baseline surveys of the Japan Multi-Institutional Collaborative Cohort Study from 2004 to 2014. Hazard ratios (HRs) for all-cause mortality and 95% confidence intervals (CIs) were estimated by sex using a Cox proportional hazard model, with adjustment for related factors. Mediation analysis with fat intake as a mediator was also conducted. Results: The mean follow-up period was 11 years, and 2,516 people died. Estimated energy and fat intakes according to the Food Frequency Questionnaire were lower in those with awareness of limiting food intake than in those without this awareness. Women with awareness of limiting fat intake showed a significant decrease in mortality risk (HR 0.73; 95% CI, 0.55-0.94). Mediation analysis revealed that this association was due to the direct effect of the awareness of limiting fat intake and that the total effect was not mediated by actual fat intake. Awareness of limiting energy or sweets intake was not related to mortality risk reduction. Conclusion: Awareness of limiting food intake had a limited effect on reducing all-cause mortality risk. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, people often modified their behaviors and performed individual infection control practices despite the uncertain effectiveness of these in preventing COVID-19. A cross-sectional study using a nationwide internet survey (Japan COVID-19 Society Internet Survey) was conducted from September 2022 through October 2022. The questionnaire consisted of individual-level social distancing behaviors and infection prevention measures, and COVID-19 vaccination status. A multivariate logistic regression was performed to determine factors associated with the diagnosis of COVID-19 in the last two months of the survey date. In total, 19,296 respondents were selected for the primary analysis. Of 19,296 respondents, those with COVID-19 diagnosed in the last two months were 1,909 (9.9%). Factors independently associated with a recent history of COVID-19 were meeting colleagues in person ≧ 1 per week (adjusted odds ratio [aOR] 1.72). The response of "never or rarely" to the question of taking out (i.e., dining in) foods was marginally associated with a recent history of COVID-19 (aOR 1.27). Most individual, infection prevention practices and behavioral modifications during the omicron variant phase of the pandemic did not substantially impact COVID-19 prevention in the community. [ABSTRACT FROM AUTHOR]

Ustekinumab (UST) is an anti–IL-12/23p40 monoclonal antibody used to treat inflammatory bowel disease. The aim of this retrospective, multicenter study was to investigate the effectiveness of UST administration in achieving remission in patients with ulcerative colitis (UC) and to determine patient characteristics that influence its effectiveness. Of 88 UC patients who received UST from March 2020 to August 2023, 47 with traceable data and for whom 56 weeks had elapsed since the start of treatment received UST to induce remission. The remission rates at 8 weeks were 66% overall, 73.7% for Bio Naïve (never used biologics/JAK inhibitors), and 60.7% for Bio Failure (used biologics/JAK inhibitors) groups. Remission rates at 56 weeks were 70.2% overall, 73.7% for Bio Naïve, and 67.9% for Bio Failure groups. Ustekinumab showed good mid-to-long-term results in the induction of remission of UC in both Bio Naïve and Bio Failure groups. The group showing remission at 8 weeks had a significantly higher non-relapse or continuation rate (proportion of patients with no worsened symptoms necessitating surgery/drug change) at 56 weeks. Predictive factors for achieving remission after UST in UC were female gender, low body mass index, and low lymphocyte-to-monocyte ratio. Thus, UST is effective for moderate-to-severe UC. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim of this study was to determine the prevalence of anti‐myelin‐associated glycoprotein (MAG) neuropathy and the current status of such patients in Japan. Methods: We conducted a nationwide survey in 2021 using established epidemiological methods. Questionnaires were sent to all neurology and pediatric neurology departments throughout Japan to identify patients with anti‐MAG neuropathy. An initial questionnaire was used to determine the number of patients, with a second one used to collect detailed clinical information. Results: The estimated number of patients with anti‐MAG neuropathy was 353, with a prevalence of 0.28 per 100,000 and an incidence of 0.05 per 100,000. The detailed clinical profiles of 133 patients were available. The median (range) age of onset was 67 (30–87) years, with a prominent peak in the age range 66–70 years, and the male‐to‐female ratio was 3.6. Most patients had distal sensory‐predominant polyneuropathy, and neuropathic pain (50%), or sensory ataxia (42%), while 18% had Waldenström's macroglobulinemia or multiple myeloma. Intravenous immunoglobulin was the most frequently used treatment (65%), but the response rate was <50%, whereas rituximab was given in 32% of patients, and 64% of these showed improvement. At the last visit, 27% of patients could not walk independently. Conclusions: This study on anti‐MAG neuropathy provides updated insights into the epidemiology of this disease, clinical profiles, and treatment approaches in Japan. Rituximab therapy, used for only one‐third of the patients, demonstrated efficacy. During the final visit, a quarter of the patients were unable to walk independently. Further studies are warranted to determine the optimal management of this rare and intractable disorder. [ABSTRACT FROM AUTHOR]

Aim: Subjective age is an emerging concept in the aging literature that predicts various aspects of quality of life, but its nature is not fully understood. This study aimed to explore whether subjective age is a unidimensional or a multidimensional construct and its relationship with quality of life through a multi‐aspects approach. Methods: We examined subjective age for 2896 Japanese adults aged 20–89 by using five subjective age measures and questions with regard to their quality of life and analyzed the results with four indexes. Results: Factor analyses found one factor for the measures, indicating a unidimensional construct. Yet, the multi‐aspect analyses revealed unique features of the measures, especially in relation to variables on the quality of life. Among the five measures, Perceived physical age is the best predictor of life satisfaction and perception of cognitive function (i.e., memory), such that the more satisfied individuals are with their life, the younger they feel. Ideal age is another best predictor in the opposite direction, such that the less satisfied individuals are with their life, the younger they want to be. Conclusion: Although the factor analyses revealed subjective age to be a unidimensional construct, the present results also suggest the possibility that it is multidimensional in nature. In future studies, a more systematic approach is essential for a thorough exploration of scales designed to measure the multiple aspects of subjective age. This is particularly crucial in the context of predicting our well‐being. Such scales could also enable us to compare the universality and individuality of subjective age across different cultures. Geriatr Gerontol Int 2024; 24: 253–258. [ABSTRACT FROM AUTHOR]

Introduction: Intrahepatic cholangiocarcinoma (ICC) can be treated with chemotherapy in unresectable cases, but outcomes are poor. Proton beam therapy (PBT) may provide an alternative treatment and has good dose concentration that may improve local control. Methods: Fifty-nine patients who received initial PBT for ICC from May 2016 to June 2018 at nine centers were included in the study. The treatment protocol was based on the policy of the Japanese Society for Radiation Oncology. Forty patients received 72.6–76 Gy (RBE) in 20–22 fr, 13 received 74.0–76.0 Gy (RBE) in 37–38 fr, and 6 received 60–70.2 Gy (RBE) in 20–30 fr. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. Results: The 59 patients (35 men, 24 women; median age: 71 years; range: 41–91 years) had PS of 0 (n = 47), 1 (n = 10), and 2 (n = 2). Nine patients had hepatitis and all 59 cases were considered inoperable. The Child-Pugh class was A (n = 46), B (n = 7), and unknown (n = 6); the median maximum tumor diameter was 5.0 cm (range 2.0–15.2 cm); and the clinical stage was I (n = 12), II (n = 19), III (n = 10), and IV (n = 18). At the last follow-up, 17 patients were alive (median follow-up: 36.7 months; range: 24.1–49.9 months) and 42 had died. The median OS was 21.7 months (95% CI: 14.8–34.4 months). At the last follow-up, 37 cases had recurrence, including 10 with local recurrence. The median PFS was 7.5 months (95% CI: 6.1–11.3 months). In multivariable analyses, Child-Pugh class was significantly associated with OS and PFS, and Child-Pugh class and hepatitis were significantly associated with local recurrence. Four patients (6.8%) had late adverse events of grade 3 or higher. Conclusion: PBT gives favorable treatment outcomes for unresectable ICC without distant metastasis and may be particularly effective in cases with large tumors. [ABSTRACT FROM AUTHOR]

Background: Endometrial cancer (EMC) is the most common female genital tract malignancy with an increasing prevalence in many countries including Japan, a fact that renders early detection and treatment necessary to protect health and fertility. Although early detection and treatment are necessary to further improve the prognosis of women with endometrial cancer, biomarkers that accurately reflect the pathophysiology of EMC patients are still unclear. Therefore, it is clinically critical to identify biomarkers to assess diagnosis and treatment efficacy to facilitate appropriate treatment and development of new therapies for EMC. Methods: In this study, wide-targeted plasma metabolome analysis was performed to identify biomarkers for EMC diagnosis and the prediction of treatment responses. The absolute quantification of 628 metabolites in plasma samples from 142 patients with EMC was performed using ultra-high-performance liquid chromatography with tandem mass spectrometry. Results: The concentrations of 111 metabolites increased significantly, while the concentrations of 148 metabolites decreased significantly in patients with EMC compared to healthy controls. Specifically, LysoPC and TGs, including unsaturated fatty acids, were reduced in patients with stage IA EMC compared to healthy controls, indicating that these metabolic profiles could be used as early diagnostic markers of EMC. In contrast, blood levels of amino acids such as histidine and tryptophan decreased as the risk of recurrence increased and the stages of EMC advanced. Furthermore, a marked increase in total TG and a decrease in specific TGs and free fatty acids including polyunsaturated fatty acids levels were observed in patients with EMC. These results suggest that the polyunsaturated fatty acids in patients with EMC are crucial for disease progression. Conclusions: Our data identified specific metabolite profiles that reflect the pathogenesis of EMC and showed that these metabolites correlate with the risk of recurrence and disease stage. Analysis of changes in plasma metabolite profiles could be applied for the early diagnosis and monitoring of the course of treatment of EMC patients. [ABSTRACT FROM AUTHOR]

Background Mucormycosis is a potentially fatal fungal infection, and there is limited information on its precise epidemiology and treatment practices, including the optimal dosage of liposomal amphotericin B. Methods A retrospective, multicenter, nationwide analysis of 82 proven and probable cases of mucormycosis was performed. Cases between 2015 and 2022 were collected from 51 hospitals in Japan by hematologists and infectious disease specialists. The study included the epidemiology, treatment details, and association between the dose of liposomal amphotericin B and the outcome. Results The lungs were the most commonly involved organ (70.7% of cases), and 35.4% of patients had disseminated disease. Rhizopus spp. Cunninghamella spp. and Mucor spp. were the most common organisms. Mortality at 4 weeks was 41.5%. The survivors had a shorter duration of neutropenia (P =.006) and less persistent hyperglycemia (P =.023). The site of infection and species of Mucorales had no detectable effect on survival. Survival did not differ between patients receiving liposomal amphotericin B at 5 mg/kg/d relative to those receiving >5 mg/kg/d (P =.625). Using Cox proportional hazards models and adjusting for confounders, the hazard ratio for the influence of >5 mg/kg/d liposomal amphotericin B on 4-week survival was 0.86 (95% CI, 0.28–2.68; P =.796) compared with 5 mg/kg/d. Conclusions This study provides important insights into the precise epidemiology and treatment practices of mucormycosis. Treatment with liposomal amphotericin B at doses higher than 5 mg/kg/d did not improve outcomes relative to 5 mg/kg/d. [ABSTRACT FROM AUTHOR]

In Japan, additional potassium fertilization is used as a countermeasure for radiocesium-contaminated grasslands in the Tohoku and North Kanto regions. A 2-year pot experiment was conducted to assess the efficacy of using tall fescue (Festuca arundinacea Schreb.), a low-cesium-absorption grass species, to replace orchardgrass (Dactylis glomerata L.), the most common forage grass species in these regions, to reduce potassium fertilization and improve the forage mineral balance. The treatments were a combination of two grass species (tall fescue and orchardgrass) and two potassium application rates (0 [K0] and three times the conventional amount [K3]) with four replications. The grass species and potassium application rate had significant (p < .001) effects on plant cesium-137 concentrations. The results of the generalized linear mixed-model analysis indicated that when tall fescue replaced orchardgrass, cesium-137 in the forage grass was reduced to 34% and that the K3 treatment reduced cesium-137 to 46% relative to the K0 treatment. The difference in cesium-137 concentration between the two grass species increased as the soil exchangeable K2O content decreased. The equations for estimating the cesium-137 concentration (y [g/kg]) from the exchangeable K2O content (x [g/kg]) were obtained as y = 63.7e-2.095x for tall fescue and y = 185.5e-3.327x for orchardgrass. These equations indicate that tall fescue cultivation can reduce the risk of elevated radioactive Cs in the grass by reducing potassium fertilizer to approximately half that of orchardgrass. There were no differences in the response of plant potassium concentrations or the potassium/(calcium + magnesium) equivalent ratio to soil exchangeable K2O content among the grass species. However, the mineral balance of forage can be improved by reducing potassium fertilizer applications for cesium-137 remediation. Tall fescue has good potential to remediate contaminated grasslands as it reduces additional potassium fertilization and improves the mineral balance of forage. [ABSTRACT FROM AUTHOR]

Continued receipt of Renin–Angiotensin–Aldosterone inhibitors in patients with COVID-19 has shown potential in producing better clinical outcomes. However, superiority between ACEi (angiotensin-converting enzyme inhibitors) and ARB (angiotensin II receptor blockers) regarding clinical outcomes in this setting remains unknown. We retrospectively collected data on patients hospitalized for acute COVID-19 using the nationwide administrative database (Diagnosis and Procedure Combinations, DPC). The DPC data covered around 25% of all acute care hospitals in Japan. Patient outcomes, with focus on inpatient mortality, were compared between patients previously prescribed ACEi and those prescribed ARB. Comparisons based on crude, multivariate and propensity-score adjusted analysis were conducted. We examined a total of 7613 patients (ARB group, 6903; ACEi group 710). The ARB group showed lower crude in-hospital mortality, compared to the ACEi group (5% vs 8%; odds ratio, 0.65; 95% CI 0.48–0.87), however not in the multivariate-adjusted model (odds ratio, 0.95; 95% CI 0.69–1.3) or propensity-score adjusted models (odds ratio, 0.86; 95% CI 0.63–1.2). ARB shows potential in reducing hospital stay duration over ACEi in patients admitted for COVID-19, but does not significantly reduce in-hospital mortality. Further prospective studies are needed to draw a definitive conclusion, but continuation of either of these medications is warranted to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Species diversity encompasses both richness and evenness, but the interrelationship between these two aspects remains poorly understood. The long‐term dynamics of species diversity were examined in three natural secondary forests in Hokkaido, northern Japan, using permanent plot data gathered over 65–66 years after severe windthrow damage. The relationships among species diversity, species richness, and evenness were analyzed in the context of stand dynamics. Temporal trends in species diversity were unimodal‐shaped in three permanent plots, consistent with the pattern predicted by the intermediate disturbance hypothesis. Species richness and evenness increased following the windthrow, but decreased 27–37 years later in all three plots. In two plots, species diversity was closely associated with species richness and evenness at the early and late successional stages, respectively; in the other plot, species diversity was significantly related to both species richness and evenness in the later stage. The former two plots and the latter one plots differed markedly in terms of the extents of fatal tree damage caused by windthrow. Thus, windthrow severity affected the relationships among diversity, richness, and evenness as succession proceeded in these secondary forests. The tree density, species richness, evenness, and species diversity in all three plots decreased when the basal areas exceeded 18–24 m2/ha, indicating that increased competition among trees affected the temporal trends in these metrics. In conclusion, after a severe disturbance, the relationships among species diversity, richness, and evenness in secondary forests change with succession. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined the effects of glucagon-like peptide-1 receptor agonist switching, particularly in Japanese patients. Therefore, we aimed to investigate the effects of switching from liraglutide to semaglutide or dulaglutide on blood glucose, body weight, and the occurrence of adverse effects in clinical practice. Materials and Methods: This was an open-label, prospective, randomized, parallelgroup controlled trial. Patients with type 2 diabetes treated with liraglutide (0.6 or 0.9 mg) at Yokosuka Kyosai Hospital in Japan were recruited from September 2020 to March 2022 and, after obtaining informed consent, randomly assigned to the semaglutide or dulaglutide group (1:1). Changes in the glycated hemoglobin level from baseline to weeks 8, 16, and 26 were evaluated post-treatment. Results: Initially, 32 participants were enrolled, of whom 30 completed the study. Glycemic control was significantly better in the semaglutide group than in the dulaglutide group (-0.42 - 0.49% vs -0.00 - 0.34%, P = 0.0120). Body weight significantly decreased in the semaglutide group (-2.6 - 3.6 kg, P = 0.0153), whereas no change was observed in the dulaglutide group (-0.1 - 2.7 kg, P = 0.8432). We found a significant difference in body weight between the groups (P = 0.0469). The proportion of participants who reported adverse events was 75.0% and 18.8% in the semaglutide and dulaglutide groups, respectively. One patient in the semaglutide group had difficulty continuing treatment due to severe vomiting and weight loss. Conclusions: Switching from once-daily liraglutide to once-weekly semaglutide 0.5 mg significantly improved glycemic control and body weight compared with switching to once-weekly dulaglutide 0.75 mg. [ABSTRACT FROM AUTHOR]

A dynamic vegetation model was adapted to a mixed forest of deciduous broad‐leaved trees and evergreen conifers in Hokkaido, the northernmost main island of Japan, located within a transition zone between cool‐temperate and sub‐boreal forest ecosystems. In this forest, elevation and a terrestrial‐wetness index affect tree biomass and the percentage of conifers. We maximized agreement between this observed pattern and model output by calibrating parameters that control drought and excessive soil‐moisture tolerance, establishment rate, and background mortality rate. In the simulation, biomass increased as a single peak curve with simulation year, while the percentage of conifers increased until the end of 200 simulation years. The 75‐year simulated forest was most comparable to the adapted forest, consistent with the average frequency of catastrophic storm disturbances in Hokkaido. The model also reconstructed a reasonable succession pattern based on temperature and soil moisture. Therefore, the model mechanistically reconstructed the mixed forest via spatial niche segregation and succession after catastrophic disturbances. However, the model did not reconstruct the percentages of broad‐leaved trees and conifers of forests prior to the disturbance in independent validation plots, demonstrating that additional processes should be considered in future models. [ABSTRACT FROM AUTHOR]

Meta-analytic procedures were used to test the effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, empathy/desensitization, and prosocial behavior. Unique features of this meta-analytic review include (a) more restrictive methodological quality inclusion criteria than in past meta-analyses; (b) cross-cultural comparisons; (c) longitudinal studies for all outcomes except physiological arousal; (d) conservative statistical controls; (e) multiple moderator analyses; and (f) sensitivity analyses. Social-cognitive models and cultural differences between Japan and Western countries were used to generate theory-based predictions. Meta-analyses yielded significant effects for all 6 outcome variables. The pattern of results for different outcomes and research designs (experimental, cross-sectional, longitudinal) fit theoretical predictions well. The evidence strongly suggests that exposure to violent video games is a causal risk factor for increased aggressive behavior, aggressive cognition, and aggressive affect and for decreased empathy and prosocial behavior. Moderator analyses revealed significant research design effects, weak evidence of cultural differences in susceptibility and type of measurement effects, and no evidence of sex differences in susceptibility. Results of various sensitivity analyses revealed these effects to be robust, with little evidence of selection (publication) bias. (Contains 12 footnotes, 10 tables, and 1 figure.)

A 1-year panel study of 591 children in fifth grade explored the accumulative effects of the presence and contexts of video game violence on aggression and the antiviolence norm in Japan, on the basis of a comprehensive content analysis of video game violence. The results suggest that contextual effects of violent video games are quite complex, differing with gender, and that contexts are more important than the quantity of violence. Although attractive perpetrators and justification of violence increase aggression for boys, they decrease aggression and strengthen the antiviolence norm for girls, indicating that the direction of effects depend on the players' interpretation of violence. (Contains 4 tables.)

Purpose: In this study we evaluate outcomes of a community-based program to prevent suicide among elderly individuals aged 65 and older. Design and Methods: We used a quasi-experimental design with intervention and referent municipalities. The program included a 7-year implementation of depression screening with follow-up by general practitioners and a 10-year implementation of public education conducted in Yasuzuka (population 4,940; elderly suicide rate for women, 275/100,000; for men, 323/100,000). We estimated changes in the risk of completing suicide before and after the 10-year implementation by the incidence-rate ratio (IRR). Results: The risk for women in the intervention area was reduced by 64% (age-adjusted IRR = 0.36; 95% confidence interval = 0.14-0.93), whereas there was no significant change in the risk for men in the intervention area and either men or women in the referent municipalities. A ratio of the IRR for women aged 65 to 74 in the intervention area to that in its prefecture was estimated at 0.23 (90% confidence interval = 0.05-0.99), showing that the risk reduction was greater than the secular trend. Implications: The management of depression by use of community resources involving public health and primary care physicians is effective in the prevention of suicide for elderly women but uncertain for men.

Background: Evidence has demonstrated that excess sodium intake is associated with development of several non-communicable diseases. The main source of sodium is salt. Therefore, reducing salt intake in foods is an important global public health effort to achieve sodium reduction and improve health. This study aimed to model salt intake reduction with 'umami' substances among Japanese adults. The umami substances considered in this study include glutamate or monosodium glutamates (MSG), calcium diglutamate (CDG), inosinate, and guanylate. Methods: A total of 21,805 participants aged 57.8 years on average from the National Health and Nutrition Survey was used in the analysis. First, we employed a multivariable linear regression approach with overall salt intake (g/day) as a dependent variable, adjusting for food items and other covariates to estimate the contribution of salt intake from each food item that was selected through an extensive literature review. Assuming the participants already consume low-sodium products, we considered three scenarios in which salt intake could be reduced with the additional umami substances up to 30%, 60% and 100%. We estimated the total amount of population-level salt reduction for each scenario by age and gender. Under the 100% scenario, the Japan's achievement rates against the national and global salt intake reduction goals were also calculated. Results: Without compromising the taste, the 100% or universal incorporation of umami substances into food items reduced the salt intake of Japanese adults by 12.8–22.3% at the population-level average, which is equivalent to 1.27–2.22 g of salt reduction. The universal incorporation of umami substances into food items changed daily mean salt intake of the total population from 9.95 g to 7.73 g: 10.83 g to 8.40 g for men and 9.21 g to 7.17 g for women, respectively. This study suggested that approximately 60% of Japanese adults could achieve the national dietary goal of 8 g/day, while only 7.6% would meet the global recommendation of 5.0 g/day. Conclusions: Our study provides essential information on the potential salt reduction with umami substances. The universal incorporation of umami substances into food items would enable the Japanese to achieve the national dietary goal. However, the reduced salt intake level still falls short of the global dietary recommendation. [ABSTRACT FROM AUTHOR]

Background: Hospital physician workforce in Japan is the lowest among developed countries. Many patients with novel coronavirus disease 2019 (COVID-19) with high risk of mortality could not be hospitalized during case surges in Japan and only about 5% of total acute care beds were used as COVID-19 beds nationwide. However, the relationship between the number of hospital physicians and patient admissions remains unclear. Thus, we aimed to evaluate this relationship in areas with the highest incidences during the surges. Methods: Data collection was performed for teaching hospitals accredited with the specialty of internal medicine in three prefectures which experienced the highest COVID-19 incidences in Japan (Tokyo, Osaka, Okinawa). Association was examined between the number of full-time physicians (internal medicine staff physicians and residents) and admissions of internal medicine patients through ambulance transport from April 2020 to March 2021. Analysis was conducted separately for community hospitals and university hospitals because the latter have roles as research institutions in Japan. Community hospitals included private, public, and semi-public hospitals. Results: Of 117 teaching hospitals in three prefectures, data from 108 teaching hospitals (83 community hospitals and 25 university hospitals) were available. A total of 102,400 internal medicine patients were admitted to these hospitals during the one-year period. Private hospitals received the greatest mean number of patient admissions (290 per 100 beds), followed by public hospitals (227) and semi-public hospitals (201), and university hospitals (94). Among community hospitals, a higher number of resident physicians per 100 beds was significantly associated with a greater number of patient admissions per 100 beds with beta coefficient of 11.6 (95% CI, 1.5 to 21.2, p = 0.025) admissions by one physician increase per 100 beds. There was no such association among university hospitals. Conclusions: Community hospitals with many resident physicians accepted more internal medicine admissions through ambulance transport during the COVID-19 pandemic. An effective policy to counter physician shortage in hospitals in Japan may be to increase internal medicine resident physicians among community hospitals to save more lives. [ABSTRACT FROM AUTHOR]

COVID-19 is a viral infection and does not require antibiotics. The study aimed to elucidate a prescribing pattern of antibiotics for COVID-19. A nationwide cross-sectional study was conducted in Japan. The Diagnosis and Procedure Combinations (DPC) data was used to collect information, covering 25% of all acute care hospitals in the country. In 140,439 COVID-19 patients, 18,550 (13.21%) patients received antibiotics. Antibiotics were prescribed more often in inpatients (10,809 out of 66,912, 16.15%) than outpatients (7741 out of 73,527, 10.53%) (p < 0.001). Outpatient prescription was significantly associated with older patients (odds ratio [OR], 4.66; 95% confidence interval [CI] 4.41–4.93) and a greater Charlson index (OR with one-point index increase, 1.22; 95% CI 1.21–1.23). Inpatient prescription was significantly associated with older patients (OR 2.10; 95% CI 2.01–2.21), male gender (OR 1.12, 95% CI 1.07–1.18), a greater Charlson index (OR with one-point increase, 1.06; 95% CI 1.05–1.07), requirement of oxygen therapy (OR 3.44; 95% CI 3.28–3.60) and mechanical ventilation (OR 15.09; 95% CI 13.60–16.74). The most frequently prescribed antibiotic among outpatients was cefazolin, while that among inpatients was ceftriaxone. Antibiotic prescription is relatively low for acute COVID-19 in Japan. Antibiotic prescription was associated with older age, multi-morbidity, severe disease, and winter season. [ABSTRACT FROM AUTHOR]

Objectives: To clarify Japanese real‐world clinical data on the use of desmopressin 25 and 50 μg orally disintegrating tablets (ODT) for male patients with nocturia and evaluate the predictive factors to improve nighttime frequency. Methods: We retrospectively accumulated real‐world clinical data from 27 institutions in Japan. Male patients with two or more episodes of nocturia who received desmopressin ODT for nocturnal polyuria (NP) from 2019 through 2021 were included. The primary endpoint was the change of nighttime frequency until 3 months after desmopressin administration. The secondary endpoints were to clarify the persistence rate, adverse events, and predictive factors of decreasing nighttime frequency. Results: A total of 118 patients were eligible to participate in this study. The persistence rate of desmopressin on the Kaplan‐Meier curve at week 12 was 51.3. The reason for discontinuation was mainly the occurrence of adverse events in 67 patients (56.8%), particularly hyponatremia in 7 patients (5.9%). Nighttime frequencies at baseline, ‐ 1 month and 1 ‐ 3 months after desmopressin administration were 4.1 ± 1.3, 2.9 ± 1.4 (P <.01), and 2.6 ± 1.3 (P <.01), respectively. The mean nighttime urine volume voided at baseline was significantly larger in patients whose nighttime frequency decreased by two or more times than in those with a decrease of less than two times. Conclusions: Desmopressin 25 and 50 μg ODT treatments are feasible for male patients with NP in Japanese real‐world clinical practice. Patients with higher voided volumes, particularly in the nighttime, may have great benefit from desmopressin. [ABSTRACT FROM AUTHOR]

Japan's compact-city policy addresses rapid population decline and aging to ensure sustainable development. However, its implementation requires significant time, financial resources, and complex stakeholder collaborations. Faced with these challenges, we asked: How can the cost-and-effect of planning be simply and automatically recognized by stakeholders? To address this, a simulation model was developed for evaluating urban planning strategies within the compact-city framework. Our model integrates pseudo-people-flow data and includes three fundamental modules and five sub-models to simulate and predict urban metrics, including population, administrative costs, visitors, and traffic volume from 2015 to 2040. Four scenarios-baseline, location optimization, new road and new station installation-were analyzed. Findings suggest that 1) new station project could mitigate population decline, 2) both location optimization and new station projects improve public services efficiency and sustainability, 3) urban vitality could be enhanced by new station construction, generating a new urban core, and 4) compact city policy may also reduce and concentrate traffic volume, shortening car trips. The model's efficiency and uncertainty were examined, and user experiments highlighted the potential of digital tools to democratize urban planning, making it accessible for non-expert stakeholders and fostering informed participation. This research advances the use of technology in participatory urban planning. • A cost-and-effect simulation model is developed for compact city approaches, integrating multiple modules and sub-models. • The model predicts future administrative cost, population, number of visitors, and traffic volume from 2015 to 2040. • Conducted a comparative analysis of four development scenarios under compact city policy framework in Japan. • Demonstrated the model's computational efficiency, integrating into a web application for participatory urban planning. • Highlighted digital tools' role in urban planning, advocating accessible technology for informed decisions for non-experts. [ABSTRACT FROM AUTHOR]

In such cases, the present model, which treats both types of natural infection in the same way, might overestimate the herd immunity acquired from natural infection, making improvement of the vaccination rate more important. Estimating COVID-19 herd immunity in Japan at the beginning of the seventh wave: Transitioning from a pandemic to an endemic Natural infections and vaccinations are leading to the acquisition of immunity among the general population in Japan; given current trends, it is unlikely that infections will continue to expand over the long term, and there is little need to impose strict behavioral restrictions. [Extracted from the article]

The first magnetic resonance (MR)-guided radiotherapy system in Japan was installed in May 2017. Implementation of online MR-guided adaptive radiotherapy (MRgART) began in February 2018. Online MRgART offers greater treatment accuracy owing to the high soft-tissue contrast in MR-images (MRI), compared to that in X-ray imaging. The Japanese Society for Magnetic Resonance in Medicine (JSMRM), Japan Society of Medical Physics (JSMP), Japan Radiological Society (JRS), Japanese Society of Radiological Technology (JSRT), and Japanese Society for Radiation Oncology (JASTRO) jointly established the comprehensive practical guidelines for online MRgART. These guidelines propose the essential requirements for clinical implementation of online MRgART with respect to equipment, personnel, institutional environment, practice guidance, and quality assurance/quality control (QA/QC). The minimum requirements for related equipment and QA/QC tools, recommendations for safe operation of MRI system, and the implementation system are described. The accuracy of monitor chamber and detector in dose measurements should be confirmed because of the presence of magnetic field. The ionization chamber should be MR-compatible. Non-MR-compatible devices should be used in an area that is not affected by the static magnetic field (outside the five Gauss line), and their operation should be checked to ensure that they do not affect the MR image quality. Dose verification should be performed using an independent dose verification system that has been confirmed to be reliable through commissioning. This guideline proposes the checklists to ensure the safety of online MRgART. Successful clinical implementation of online MRgART requires close collaboration between physician, radiological technologist, nurse, and medical physicist. [ABSTRACT FROM AUTHOR]

Purpose: The association between metabolic syndrome (MetS) and the risk of death from cancer is still a controversial issue. The purpose of this study was to examine the associations of MetS and metabolically unhealthy obesity (MUHO) with cancer mortality in a Japanese population. Methods: We used data from the Japan Multi-Institutional Collaborative Cohort Study. The study population consisted of 28,554 eligible subjects (14,103 men and 14,451 women) aged 35–69 years. MetS was diagnosed based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the Japan Society for the Study of Obesity (JASSO), using the body mass index instead of waist circumference. The Cox proportional hazards analysis was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for total cancer mortality in relation to MetS and its components. Additionally, the associations of obesity and the metabolic health status with cancer mortality were examined. Results: During an average 6.9-year follow-up, there were 192 deaths from cancer. The presence of MetS was significantly correlated with increased total cancer mortality when the JASSO criteria were used (HR = 1.51, 95% CI 1.04–2.21), but not when the NCEP-ATP III criteria were used (HR = 1.09, 95% CI 0.78–1.53). Metabolic risk factors, elevated fasting blood glucose, and MUHO were positively associated with cancer mortality (P <0.05). Conclusion: MetS diagnosed using the JASSO criteria and MUHO were associated with an increased risk of total cancer mortality in the Japanese population. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the management and outcome of idiopathic retroperitoneal fibrosis (iRPF) in Japan, and to identify its clinical biomarker. Methods: We retrospectively analyzed 129 patients with iRPF treated between January 2008 and May 2018 at 12 university and related hospitals. Patients treated with glucocorticoid were analyzed to identify a predictive biomarker. These patients were classified into three groups according to overall effectiveness (no change: NC, complete response: CR, and partial response groups: PR), and each parameter was compared statistically. Results: Male–female ratio was 5:1, and median age at diagnosis was 69 (33–86) years. Smoking history was reported in 59.6% of the patients. As treatment, 95 patients received glucocorticoid therapy with an overall response rate of 84%. As a result, serum concentration of IgG4 was significantly decreased in NC group compared with the other two groups (56.6 mg/dL vs. 255 mg/dL, 206 mg/dL, p = 0.0059 and 0.0078). ROC analysis was performed between the nonresponder (NC) and responder groups (CR + PR) to identify the cut-off value of serum IgG4 as a predictive marker. As a result, AUC of 0.793 was confirmed. Conclusions: Pre-treatment serum IgG4 concentration may have potential as a predictive biomarker of steroid treatment. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, the prevalence of inflammatory bowel diseases has been increasing in Japan due to the westernization of lifestyles. Many patients have been reported to have extra‐intestinal manifestations (EIMs) at least once. Skin lesions occur with a high degree of frequency among EIMs, with erythema nodosum (EN) and pyoderma gangrenosum (PG) the main complications. Cytapheresis is again attracting attention as a treatment with few side effects. Methods: We investigated the therapeutic effect of cytapheresis on ulcerative colitis (UC) and cutaneous EIMs. Between 2008 and 2021, 240 patients with active UC had induction therapy by cytapheresis at our hospital. Results: Remission and response rates were 50.0% and 67.5%, respectively. Apheresis was performed on seven patients with PG and five patients with EN with a good response. Serious adverse events were not observed. Conclusion: This retrospective assessment of efficacy showed that EN and PG responded favorably to cytapheresis. [ABSTRACT FROM AUTHOR]

Background: While fertility rates have decreased during the second half of the 20th century in Japan, little is known regarding trends in the number of children that men and women have across birth cohorts and whether these differ by education and income. Methods: We used data from four rounds of the National Fertility Survey (1992, 2005, 2010 and 2015) and included men and women aged 40–49 years (16728 men and 17628 women). By 5-year birth cohorts, we assessed the distribution of number of children (0, 1, 2 and 3 or more) and total fertility (the mean number of children) at completed fertility (age 45–49 or 40–44 years depending on birth cohort). We assessed trends in these fertility outcomes in men and women separately, and by education (no university education; university education) for men and women and by reported annual income (0 to <3 000 000 JPY; 3 000 000 to <6 000 000 JPY; ≥6 000 000 JPY) for men. Results: When comparing those born in 1943–1948 with those born in 1971–1975, the proportion with no children had increased from 14.3 to 39.9% for men and from 11.6 to 27.6% for women. This increase coincided with a decrease in the proportions of individuals with 2 or more children. Total fertility had decreased from 1.92 to 1.17 among men and from 1.96 to 1.42 among women. For men, those with a university degree were more likely to have children than those without a university degree in all birth cohorts except 1943–1947. Men with higher income were more likely to have children across birth cohorts. While the proportion who had children had decreased in all income groups, the decrease was steeper among those in the lowest income group. Among women born 1956–1970, those with a university degree were less likely to have children than those without a university degree; this difference was no longer seen among those born 1971–1975. For both men and women, trends in having children and total fertility across birth cohorts did not differ by educational status. Conclusions: The decline in the total fertility rate in Japan can be attributed to both an increasing proportion of the population who have no children and a lower number of children among those who have children. Men with lower education and income were less likely to have children and the disparity in the number of children that men have by income had increased in more recent birth cohorts. Among women, higher education was associated with lower fertility, although this pattern was no longer observed among those born in 1971–1975. [ABSTRACT FROM AUTHOR]

In Japan, there is concern that concrete blocks due to demolition will increase with the renewal of concrete structures. Although it has been used for roadbed materials as recycling, in recent years, aggregates are removed from the concrete mass by crushing and grinding and used again as concrete aggregates. In concrete using recycled aggregates, it is necessary to take account of insufficient strength, drying shrinkage, freeze-thaw resistance. In previous study, the quality of recycled aggregates was improved by adsorbing carbon dioxide to recycled aggregates, and recycled concrete used the modified aggregates has been confirmed to increase strength and reduce drying shrinkage. In this study, we focused on the aggregate interface of concrete such as the interfacial transition zone for the purpose of clearing the quality improvement method of recycled concrete. We attempted to modify the aggregate interface using a C-S-H hardening accelerator using two recycled aggregates of different quality and concrete using ordinary aggregates. We will also compare which is more effective, concrete that tried to modify the aggregate interface and recycled concrete that uses carbonated modified recycled aggregate. We try include strength test, drying shrinkage test, and freeze-thaw test. We clarify the matters concerned about recycled concrete. [ABSTRACT FROM AUTHOR]

Background: A large proportion of adults in Japan remain unmarried even though they intend to marry during their lifetime. To provide data for policy makers and those searching for partners in the Japanese marriage market, we estimated the number and characteristics of unmarried women and men with marriage intention and assessed their partner preferences. Based on the findings, we hypothesized regarding potential mismatches between the individuals available in the marriage market and the type of partners they are looking for. Methods: We used data from the National Fertility Survey (2015), a nationally representative survey in Japan, and included 20,344 participants aged 18–49 years, of which 6,568 were unmarried with marriage intention. We estimated the total number of unmarried women and men who intend to marry, extrapolated their characteristics to the Japanese population, and assessed their partner preferences, as well as their ideal age of marriage and the ideal age of their partner. Results: In 2015, there were 8.48 million unmarried women and 9.83 million unmarried men aged 18–49 years with marriage intention in Japan. Surpluses of around 600,000 men were observed in non-densely inhabited areas (men-to-women ratio: 1.31) and in the Kanto region (1.23). Most of the women and men in the marriage market had annual incomes lower than 3,000,000 JPY (28,000 USD) and only 263,000 women (3%) and 883,000 men (9%) had an income of 5,000,000 JPY (47,000 USD) or more; 167,000 men (2%) had an income of 7,000,000 JPY (66,000 USD) or more, with roughly three-quarters of them having a university degree. When asked about eight items that one may consider in a potential partner, the proportion of women listing an item as "important" tended to be larger than those of men across all items (education, occupation, finances, personality, mutual hobbies, cooperation/understanding regarding one's work, and attitude towards/skills in housework and childrearing) except appearance. The largest differences were observed for finances (proportion of women vs. men listing the item as "important" or "would consider:" 94.0% vs. 40.5%, p<0.001), occupation (84.9% vs. 43.9%, p<0.001), and education (53.9% vs. 28.7%, p<0.001). While women, on average, preferred men who were around 1–3 years older than themselves, men preferred women around their own age until the age of 26 years, at which point men preferred women who were younger than themselves, with the preferred age difference increasing substantially with age. As such, the number of men preferring a younger partner was larger than the number of women who preferred an older partner. Conclusions: By providing data on the number, characteristics and partner preferences of individuals in the marriage market, our study could inform decisions for those searching for marriage partners in Japan. Moreover, we hypothesize that mismatches in geographical location, the supply-demand disparity for partners with higher income, and age preferences could partly explain the large number of Japanese women and men who remain unmarried despite intending to get married. Further studies are needed to assess if, and to what extent, the identified mismatches may affect marriage rates. [ABSTRACT FROM AUTHOR]

Twenty-four specimens (184.6–243.6mm in standard length) of Monotaxis Anonymous [Bennett], 1830, collected from the Ryukyu Islands, southern Japan, were identified as M. heterodon (Bleeker, 1854) (Perciformes: Lethrinidae). Although a widely distributed Indo-West Pacific species, all previous records from Japanese waters have been based solely on photographs, the present specimens therefore representing the first specimen-based records of M. heterodon from Japan. A detailed comparison between M. heterodon and its only congener, M. grandoculis (Forsskål, 1775), from which it has previously been distinguished primarily by scale rows below the lateral line and fresh or live coloration, revealed new diagnostic characters, most of which are applicable to preserved specimens. In addition to previously recognized characters, the two species can be distinguished by mid-dorsal snout profile in adults (concave vs. straight), snout length (excluding lips) [8.9–11.1 (mean 9.9) % of SL vs. 10.3–12.1 (11.2) % SL], spinous anal-fin base length [4.6–5.9 (5.0) % of SL vs. 3.9–4.9 (4.4) % SL], a distinct black blotch above the pupil (absent vs. present), a dark brown stripe across the post interorbital region in preserved specimens (present vs. absent), and preserved coloration of the pectoral-fin base inner surface (blackish brown vs. light brown). [ABSTRACT FROM AUTHOR]

We monitored the abundance of a non-native (Rhinogobius sp. OR) and two native stream gobies (R. fluviatilis and R. nagoyae) over a decade, from 1995 to 2004, in a fixed reach of a tributary of the Kamo River, southwestern Japan. The non-native Rhinogobius sp. OR appeared and reproduced in 1997, when an increased deposition of fine sediments occurred. However, after a severe spate in 1999, the non-native goby almost completely disappeared from the study reach, while the density of the native R. fluviatilis increased. The severe spate is likely to have prevented the establishment of the non-native goby. Our results provide an example of abiotic barriers to invasion. [ABSTRACT FROM AUTHOR]

This study examines disastrous historical precipitation cases that generate extreme precipitation simultaneously over a wide area in Japan (as in July 2018), defined as widespread extreme precipitation events. A statistically significant large-scale environment conducive for widespread extreme precipitation events over western Japan is investigated based on composite analysis. During a widespread precipitation event, a zonally elongated positive anomaly of the column-integrated water vapor extends from East China to western Japan. In the lower troposphere, a dipole of a geopotential height anomaly exists with positive and negative values at the east and west of the precipitation area, respectively. It is found that the negative geopotential anomaly is enhanced over East China at 2 days before the event and moves toward the precipitating area mainly due to the potential vorticity (PV) production term by diabatic heating, analogous to a diabatic Rossby wave. The temporal evolution of the dynamical forced vertical velocity is well in phase with that the PV production term, suggesting the importance of the coupling between the dynamical forced motion and diabatic heating. This result provides a physical understanding of the reason why both the background moisture and the baroclinicity are essential in the composited atmospheric fields and another view to the importance of the feedback parameter between the dynamical motion and diabatic heating. [ABSTRACT FROM AUTHOR]

We tracked the spawning habitat use of two native stream gobies (Rhinogobius fluviatilis and Rhinogobius nagoyae) before and during the invasion of a non-native goby (Rhinogobius sp. OR) and after its disappearance in the Tani River, Japan. Throughout the three phases, the majority of the two native gobies showed high preference and use for the habitat with medium-fast current velocity and coarse substrates as spawning sites. When the non-native Rhinogobius sp. OR invaded, the majority of them also preferred and used the same habitat as spawning sites, and the spawning habitat use of the three Rhinogobius species substantially overlapped. These results suggest that the invasion by the non-native goby did not significantly change the spawning habitat use of the two native gobies. However, the similar habitat requirement among the three Rhinogobius species may cause competition for the spawning habitat when the availability of their favorite habitat is greatly restricted. The non-native Rhinogobius sp. OR could utilize the spawning space on the undersurface of nest stones more efficiently than the two native gobies. Therefore, in the non-native Rhinogobius sp. OR, the size of nest stones is unlikely to be a limiting factor for reproductive success. Such ecological characteristics on nest stone use may enable Rhinogobius sp. OR to easily acquire nest stones with less competition in the spawning habitat where they coexist, which have also helped Rhinogobius sp. OR to extend its distribution area. [ABSTRACT FROM AUTHOR]

The role of vertically integrated water vapor flux convergence (IVFC) in heavy rainfall events in western Japan is investigated by dividing the atmosphere into a boundary layer and free troposphere using the Japan Meteorological Agency's mesoscale gridded analysis product and reanalysis product. Rainfall events are defined by peaks of area‐averaged precipitation. The results show an increase in the free‐tropospheric IVFC more than 15 h before rainfall events, contributing to atmosphere moistening. This preceding moistening is favorable for mesoscale convective systems (MCSs) with slantwise ascending deep inflow layers (layer lifting) that produce large precipitation amounts. Appearance frequency of the moist absolutely unstable layer (MAUL) increases around the precipitation peak times, which is especially notable for larger peaks. These results indicate that the free‐tropospheric IVFC contributes to heavy rainfall in western Japan by providing environments favorable for producing and maintaining MAUL, enhancing the organization of MCSs. Plain Language Summary: The role of moisture convergence for heavy rainfall events in western Japan is investigated by dividing the atmosphere into its lowest part (boundary layer) and layers above it (free troposphere). Our results indicate that free‐tropospheric moisture increases earlier than 15 h before peak rainfall, contributing to atmospheric moistening. This moistening in the free troposphere is favorable for developing MCSs with slantwise ascending deep inflow layers, which produce large amounts of precipitation. These results indicate the significance of free‐tropospheric moisture convergence to rainfall events over western Japan. Key Points: Significant increases in the free‐tropospheric moisture convergence precede heavy rainfall events over western JapanMoist absolutely unstable layers in the mid‐troposphere are produced and maintained by the deep moist inflow in the prepared environmentSuch conditions are favorable for the development of mesoscale convective systems, bringing large amounts of precipitation [ABSTRACT FROM AUTHOR]

Background: Yeasts are a type of fungi thought to have probiotic functions. In this study, we isolated a novel probiotic yeast (Zygosaccharomyces sapae strain I-6) from Miso (a traditional Japanese fermented food). We examined its effects on phenotypic changes in intestinal dendritic cells (DCs), and evaluated its anti-inflammatory effects in dextran sulfate sodium (DSS)-induced colitis.Methods: A single colony was selected from homogenized Miso, based on its ability to produce interleukin (IL)-10 in CD11c+ bone marrow DCs (BMDCs) in vitro. The anti-inflammatory effects of strain I-6 on CD11c+ BMDCs and CD11c+ CD103+ DCs were analyzed in mouse mesenteric lymph nodes in vitro and in a DSS mouse model.Results: The IL-10 concentrations in the co-culture BMDC supernatants treated with I-6 were dramatically higher than in those treated with Saccharomyces cerevisiae (Sc). IL-10 production is mediated by both TLR2 and Dectin-1. β-Glucan extracted from I-6 also induced higher levels of IL-10 production in BMDCs than β-glucan from Sc. The number of mesenteric lymph node CD11c+ CD103+ DCs was significantly increased by I-6 administration, compared with Sc administration. Strain I-6 showed strong anti-inflammatory effects on DSS-induced colitis compared to Sc. Moreover, the adoptive transfer of I-6-treated BMDCs showed anti-inflammatory effects on DSS-induced colitis in mice without oral administration of I-6 cells.Conclusions: Strain I-6 induced phenotypic changes in intestinal CD11c+ DCs characterized by high IL-10 production and exerted strong anti-inflammatory effects on DSS-induced colitis. Traditional Japanese fermented foods may be a valuable source of probiotic yeasts for effective IBD therapy and treatment. [ABSTRACT FROM AUTHOR]

Background: Sessile serrated lesion (SSL) is a colorectal polyp that has malignant potential. However, the dysplastic components within an SSL can be difficult to diagnose with conventional endoscopy, because most SSLs with dysplasia/carcinoma have subtle mucosal features. Many studies have indicated that narrow-band imaging (NBI) observations of colorectal polyps are very useful, accurate predictors of histology. We aimed to verify the usefulness of the Japan NBI Expert Team (JNET) classification system for the diagnosis of SSLs with dysplasia/carcinoma. Methods: We examined 709 endoscopically or surgically resected lesions that were pathologically diagnosed as SSL, including 647 with no dysplasia, 37 with low-grade dysplasia, 15 with high-grade dysplasia, and 10 with submucosal invasive carcinoma. We retrospectively evaluated their clinicopathologic characteristics and conventional endoscopic and magnifying NBI endoscopic findings using the JNET system. Results: Cases in all groups were more frequently located in the proximal colon. Submucosal invasive carcinomas were significantly larger than no dysplasia and low-grade dysplasia lesions. Almost all studied lesions (96.3%) were covered with a mucus cap. Five hundred and eighty (81.8%) lesions exhibited dark spots inside the crypts, which are NBI findings' characteristic of SSL. As for the JNET classification of magnifying NBI endoscopic findings, all 709 lesions showed Type 1. Six hundred and eighteen (95.5%) SSLs with no dysplasia lesions exhibited Type 1 only, whereas 52 (83.9%) SSLs with dysplasia/carcinoma had a combination of Type 1 and Type 2A, 2B, or 3, corresponding to SSL and dysplasia/carcinoma, respectively. The JNET classification had high sensitivity (83.9%), specificity (95.5%), and overall diagnostic accuracy (94.5%) for diagnosing SSLs with dysplasia/carcinoma. Conclusions: Use of magnifying NBI endoscopy with the JNET classification might be useful for diagnosing SSLs with dysplasia/carcinoma. This increased awareness may also improve the recognition of SSLs with dysplasia/carcinoma. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to predict disability-adjusted life years (DALY) rate in Japan through 2040 with plausible future scenarios of fruit intake for neoplasms, cardiovascular diseases (CVD) and diabetes and kidney diseases (DKD).Design: Data from National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017 were used. We developed an autoregressive integrated moving average model with four future scenarios. Reference scenario maintains the current trend. Best scenario assumes that the goal defined in Health Japan 21 is achieved in 2023 and is kept constant afterwards. Moderate scenario assumes that the goal is achieved in 2040. Constant scenario applies the same proportion of 2016 for the period between 2017 and 2040.Setting: DALY rates in Japan were predicted for the period between 2017 and 2040.Participants: Population aged more than than 20 years old.Results: In our reference forecast, the DALY rates in all-ages group were projected to be stable for CVD and continue increasing for neoplasms and DKD. Age group-specific DALY rates for these three disease groups were forecasted to decrease, with some exceptions. Among men aged 20-49 years, DALY attributable to CVD differed substantially between the scenarios, implying that there is a significant potential for reducing the burden of CVD by increasing fruit intake at the population level.Conclusions: Our scenario analysis shows that higher fruit intake is associated with lower disease burden in Japan. Further research is required to assess which policies and interventions can be used to achieve an increase in fruit intake as modelled in the scenarios of the current study. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the 5-year natural course of frailty status assessed with the Kihon Checklist (KCL) and the risk factors of transition towards frailty in community-dwelling older adults. We used the data from the postal KCL survey conducted by the municipal government between 2011 and 2016. The sample of the current study consisted of 551 older adults (265 men and 286 women) aged 65–70 years in 2011. The median KCL score increased from 2 (interquartile range 1–3) in 2011 to 3 (1–5) in 2016 (p < 0.001). Hence, the prevalence of frailty increased from 8.0 to 12.3% (p < 0.001). Regarding the 5-year transitions in frailty status, 68.3% of participants remained unchanged, while 21.4% transitioned towards a worse frailty status, and 10.3% towards an improved status. Of the 507 respondents who were robust or prefrail at the baseline, 44 experienced a transition towards frailty, indicating that the 5-year incidence of frailty was 8.7%. These 44 individuals had higher body mass indexes (BMI) and lower physical activity scores on the KCL than others (p < 0.05), the latter of which was an independent predictor of transition toward frailty in the multivariate analysis. This study was the first to evaluate the 5-year natural course of frailty status assessed using the KCL in community-dwelling elderly adults, in which the prevalence of frailty increased by 4.3%. To prevent transition towards frailty, maintaining optimal physical activity is recommended. [ABSTRACT FROM AUTHOR]

Background: Disability weights (DWs) are weight factors that reflect the severity of health states for estimates of disability-adjusted life years. A new set of global DWs was published for the Global Burden of Diseases and Injuries (GBD) 2013 study, which relied on sampling from various world regions, but included little data for countries in East Asia. This study aimed to measure DWs in Japan using comparable methods, and compare the results with previous estimates from the GBD 2013 DW study. Methods: We conducted a web-based survey in 2019 to estimate DWs for 231 health states for the Japanese population. The survey included five new health states but otherwise followed the method of the GBD DW measurement study. The survey consisted of 15 paired comparison (PC) questions and 3 population health equivalence questions (PHE) per respondent. We analyzed PC data using probit regression and rescaled results to DW units between 0 (equivalent to full health) and 1 (equivalent to death). Findings: We considered 37,318 nationally representative respondents. The values of the resulting DWs ranged from 0.707 (95% uncertainty interval (UI) 0.527–0.842) for spinal cord injury at neck level (untreated) to 0.004 (UI 0.001–0.009) for mild anemia. High correlation between Japanese DW and GBD 2013 DW was observed, but there was considerable disagreement. Out of 226 comparable health states, 55 (24.3%) showed more than a factor-of-two difference, of which 41 (74.6%) had a higher value in Japanese DW. Many of the health states with higher DW in the Japan study were injuries, including amputation and fracture, and hearing and vision loss, while mental, behavioral, and substance use disorders generally tended to be lower. Conclusions: This study has created an empirical basis for assessment of Japanese DWs of health status. The findings from this study based on the Japanese population suggest that there might be contextual differences in rating the severity of health states compared to previous surveys conducted elsewhere. [ABSTRACT FROM AUTHOR]

Background: Low vegetable intake is one of the key dietary risk factors known to be associated with a range of health problems, including cardiovascular diseases (CVDs), cancer, and diabetes and kidney diseases (DKDs). Using data from Japan's National Health and Nutrition Surveys and the Global Burden of Diseases study in 2017, this study aimed to forecast the impact of change in vegetable intake on disability-adjusted life years (DALYs) between 2017 and 2040 for three diseases.Methods: We generated a three-component model of cause-specific DALYs, including changes in major behavioural and metabolic risk predictors, the socio-demographic index and an autoregressive integrated moving average model to project future DALY rates for 2017-2040 using the data between 1990 and 2016. Data on Vegetable consumption and risk predictors, and DALY rate were obtained from Japan's National Health and Nutrition Surveys and the Global Burden of Diseases Study in 2017. We also modelled three scenarios of better, moderate and worse cases to evaluate the impact of change in vegetable consumption on the DALY rates for three diseases (CVDs, cancer, and DKDs).Results: Projected mean vegetable intake in the total population showed a decreasing trend through 2040 to 237.7 g/day. A significant difference between the reference scenario and the better case scenario was observed with un-overlapped 95% prediction intervals of DALY rates in females aged 20-49 years (- 8.0%) for CVDs, the total population for cancer (- 5.6%), and in males (- 8.2%) and females (- 13.7%) for DKDs.Conclusions: Our analysis indicates that increased vegetable consumption would have a significant reduction in the burdens of CVDs, cancer and DKDs in Japan. By estimating the disease burden attributable to low vegetable intake under different scenarios of future vegetable consumption, our study can inform the design of targeted interventions for public health challenges. [ABSTRACT FROM AUTHOR]

Objective: Recently, screening for Helicobacter pylori infection has been performed among children in Japan as a prevention strategy for gastric cancer. However, the diagnostic accuracy of the serum antibody test, using the ELISA-kit, for screening in children has not been confirmed, and it is unknown whether the cutoff value used for adults is appropriate for children. The aim of this study was to evaluate the accuracy of the serum antibody test for H. pylori infection for the mass screening of junior high school students in Japan. Subjects and Methods:H. pylori infection testing and eradication therapy in junior high schools began in the 2015 fiscal year for students in Yurihonjo and Nikaho cities, located in the Akita prefecture. The data of 410 students who underwent both stool antigen tests (SATs) and serum antibody test, between 2016 and 2018, were used for analysis. Students who had positive results on the SATs test were diagnosed with H. pylori infection. Results: The rate of H. pylori infection was 3.7% (15/410). The optimal cutoff of serum antibody for children was identified to be 5.4 U/mL, with this cutoff having an area under the curve of 0.94 (95% CI 0.83–1.00), specificity of 99.5% (95% CI 98.2–99.9) and sensitivity of 93.3% (95% CI 68.1–99.8), which was wide because of the small sample size. Conclusion: The accuracy of the serum antibody test may be enough for practical use in children 13–14 years old [ABSTRACT FROM AUTHOR]

Background: The Oral Care BC-trial reported that professional oral care (POC) reduces the incidence and severity of oral mucositis in patients receiving everolimus (EVE) and exemestane (EXE). However, the effect of POC on clinical response among patients receiving EVE and EXE was not established. We compared outcomes for estrogen receptor-positive metastatic breast cancer patients who received POC to those who had not, and evaluated clinical prognostic factors. All patients simultaneously received EVE and EXE.Methods: Between May 2015 and Dec 2017, 174 eligible patients were enrolled in the Oral Care-BC trial. The primary endpoint was the comparative incidence of grade 1 or worse oral mucositis, as evaluated for both the groups over 8 weeks by an oncologist. The secondary endpoints were progression-free survival (PFS) and overall survival (OS). Data were collected after a follow-up period of 13.9 months.Results: There were no significant differences in PFS between the POC and Control Groups (P = 0.801). A BMI <  25 mg/m2 and non-visceral metastasis were associated with longer PFS (P = 0.018 and P = 0.003, respectively) and the use of bone modifying agents (BMA) was associated with shorter PFS (P = 0.028). The PFS and OS between the POC and control groups were not significantly different in the Oral-Care BC trial.Conclusions: POC did not influence the prognosis of estrogen receptor-positive metastatic breast cancer patients. Patients with non-visceral metastasis, a BMI <  25 mg/m2, and who did not receive BMA while receiving EVE and EXE may have better prognoses.Trial Registration: The study protocol was registered online at the University Hospital Medical Information Network (UMIN), Japan (protocol ID 000016109), on January 5, 2015 and at ClinicalTrials.gov ( NCT02376985 ). [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

Parasites of the genus Haemoproteus are vector-borne avian haemosporidia commonly found in bird species of the world. Haemoproteus infections are typically considered relatively benign in birds. However, some Haemoproteus species cause severe disease and mortality, especially for captive birds removed from their original habitat. In September 2018, a captive 15-year-old snowy owl (Bubo scandiacus), kept in a zoological garden of Japan, died subacutely after presenting leg dysfunction. This case showed significantly low PCV and elevated AST, ALT, CK, and LDH values. Many megalomeronts with prominent morphological characteristics of Haemoproteus were observed in the left leg muscles. Those megalomeronts exhibited multilocular structures and were internally filled with merozoites. A new lineage of Haemoproteus was detected by subsequent PCR for the cytochrome b (cytb) gene of avian haemosporidia from DNA extracted from several organ tissues. The detected lineage was classified in the subgenus Parahaemoproteus and was similar to those from the wild birds inhabiting the region including the study area, suggesting that this snowy owl likely acquired its infection from wild birds. This is the first report of a fatal case of a captive bird with a locally transmitted Haemoproteus infection in Japan. We considered the pathogenicity of this infection in conjunction with the clinical course and hematology results. We surmise that snowy owls may be particularly susceptible to infection with Haemoproteus parasites, and warming northern temperatures may exacerbate the overall health of these and other high latitude birds. Further research into the prevalence of Haemoproteus in wild birds near zoological gardens and potential biting midge vectors is necessary for the ex situ conservation of introduced birds. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that an increasing proportion of young adults in Japan have lost interest in romantic relationships, a phenomenon termed "herbivorization". We assessed trends in heterosexual relationship status and self-reported interest in heterosexual romantic relationships in nationally representative data. Methods: We used data from seven rounds of the National Fertility Survey (1987–2015) and included adults aged 18–39 years (18–34 years in the 1987 survey; sample size 11,683–17,675). Current heterosexual relationship status (married; unmarried but in a relationship; single) was estimated by sex, age group and survey year, with singles further categorized into those reporting interest vs. no interest in heterosexual romantic relationships. Information about same-sex relationships were not available. Results: Between 1992 and 2015, the age-standardized proportion of 18-39-year-old Japanese adults who were single had increased steadily, from 27.4 to 40.7% among women and from 40.3 to 50.8% among men. This increase was largely driven by decreases in the proportion of married women aged 25–39 years and men aged 30–39 years, while those in a relationship had increased only slightly for women and remained stable for men. By 2015, the proportion of single women was 30.2% in those aged 30–34 years and 24.4% in those aged 35–39 years. The corresponding numbers for men were 39.3% and 32.4%. Around half of the singles (21.4% of all women and 25.1% of all men aged 18–39 years) reported that they had no interest in heterosexual romantic relationships. Single women and men who reported no interest in romantic relationships had lower income and educational levels and were less likely to have regular employment compared to those who reported such an interest. Conclusions: In this analysis of heterosexual relationships in nationally representative data from Japan, singlehood among young adults had steadily increased over the last three decades. In 2015 around one in four women and one in three men in their thirties were unmarried and not in a heterosexual relationship. Half of the singles reported no interest in romantic relationships and these women and men had lower income and educational levels and were less likely to have regular employment. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae is a commensal bacterium of the human nasopharynx and a major causative pathogen of bacterial diseases worldwide. Pilus of S. pneumoniae is one of the virulence factors which enhance the adhesion to the host epitherial cells in the upper respiratory tract. We analyzed the serotype distribution and presence of pilus genes, rrgC and sipA , among 785 S. pneumoniae isolates from specimens of patients with invasive or non-invasive disease in a regional Japanese hospital between October 2014 and August 2018. We next performed multilocus sequence typing and penicillin-resistant genotyping for 86 isolates of serotype 35B. Serotype 35B was the most frequent serotype which accounted for 11.0% of total isolates and had pilus genes at high rate (80.2%). Clonal complex (CC) 558 isolates accounted for 77.9% of serotype 35B and were highly positive for rrgC and gPRSP (98.5%). In contrast, all CC2755 isolates (19.8%) were rrgC -negative and gPISP. Our results suggest that CC558 may assist the prevalence of serotype 35B after the introduction of vaccines, as that clone has pili as adhesins in addition to non-susceptibility against penicillin. These results may be useful information for development of optimal preventive strategies. Continuous studies on serotype distribution and virulence factors of S. pneumoniae are necessary. [ABSTRACT FROM AUTHOR]