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Bacillus cereus (B. cereus) is commonly found in the environment and is often considered a blood culture contaminant. However, in patients with specific risk factors such as intravenous drug use, central venous access catheters, immunosuppression, or prosthetic valves, B. cereus can cause severe infections. Herein, we present a case of prosthetic valve endocarditis (PVE) caused by B. cereus in an 84-year-old woman with a history of aortic valve replacement for aortic stenosis five years earlier. She presented with anorexia, and her physical examination revealed tenderness in the left upper quadrant of the abdomen. Blood culture grew B. cereus, and a CT scan showed splenic infarction, raising suspicion of PVE. Transesophageal echocardiogram (TEE) revealed an abscess around the left coronary cusp of the aortic valve and a 15 mm vegetation. Due to the patients high risk for post-operative complications and her unwillingness to undergo surgery, the surgery was deferred. Instead, she was successfully treated with six weeks of intravenous vancomycin and discharged home. Follow-up TEE demonstrated resolution of the vegetation and valvular abscess. At her six-month post-discharge evaluation, no signs of active infection were noted including fever or worsening heart failure. Although surgery is typically recommended for most cases of PVE, conservative treatment can be considered as an alternative option for selected patients.

ABSTRACT Aims/Introduction The study aim was to investigate sulfonylurea prescription patterns in elderly patients (age ≥65 years) with type 2 diabetes mellitus in Japan. Sulfonylurea use among older adults has been insufficiently examined, despite the associated risks of hypoglycemia. Materials and Methods This retrospective cross‐sectional survey entailed analysis of Japanese pharmacy data, extracted from the Musubi database, for patients (age 20–100 years) prescribed sulfonylureas between November 2022 and October 2023. Dose distribution, adherence to the Diabetes Treatment Guidelines for the Elderly 2023 and coprescription of other diabetes medications were investigated. Results Of the total 91,229 patients, 80.1% were prescribed glimepiride, 16.3% gliclazide and 3.6% glibenclamide. In patients aged ≥65 years, exceeding the recommended dose (>1 mg/day for glimepiride, >40 mg/day for gliclazide) was numerically higher for glimepiride (25.0%) than for gliclazide (7.8%). The most common prescribing patterns were quadruple therapy with a sulfonylurea, a dipeptidyl peptidase‐4 inhibitor, an sodium–glucose transporter 2 inhibitor and a biguanide in patients aged 65 to

We previously reported that a high HbA1c level 3 months before vitrectomy for vitreous hemorrhage or a large preoperative decrease in the HbA1c level over 3 months tended to increase the risk of rebleeding in diabetic retinopathy patients evaluated between 2010 and 2014. Here, we aimed to confirm these results with an extended study period and an increased number of operated eyes. This study included 121 diabetic patients who were admitted to Osaka University Hospital between 2010 and 2019 and who underwent vitrectomy for vitreous hemorrhage. Binomial logistic regression analysis was performed with the presence of postoperative bleeding as the outcome. The present study showed that the duration of the operation was associated with rebleeding (odds ratio = 1.02, p = 0.0016). A high HbA1c level just before vitrectomy tended to be associated with the bleeding (odds ratio = 1.27, p = 0.05), while preoperative HbA1c changes were not associated with rebleeding. The results of this study suggest that a high preoperative HbA1c level just before vitrectomy, not a decrease in HbA1c levels, in addition to the duration of the operation may increase the risk of postoperative bleeding after vitrectomy in diabetic retinopathy patients.

The effectiveness of a hybrid closed-loop (HCL) system in improving glycemic control is unclear in Japanese individuals. Therefore, we assessed the effect impact of the MiniMed 770G HCL system on glycemic control in this population. This prospective, single-center, 24-week observational study (registration number: UMIN000047394) enrolled 23 individuals with type 1 diabetes mellitus using the Medtronic MiniMed 640G system. The primary endpoint was the improvement in time in the range of 70–180 mg/dL after transitioning to the MiniMed 770G HCL system. We observed an increase in time in range (from 64.1 [55.8–69.5] to 70.9 [67.1–74.4] %, interquartile range 25–75%, p < 0.001) and a decrease in glycated hemoglobin level (from 7.4 [7.0–7.9] to 7.1 [6.8–7.4] %, p = 0.003). There was a significant reduction in time above the range (181–250 mg/dL: 25.8 [20.9–28.6] to 19.5 [17.1–22.1] %, p < 0.001; >251 mg/dL: 8.7 [4.0–13.0] to 4.7 [3.6–9.1] %, p < 0.001). Time below the range remained unchanged (54–69 mg/dL: 1.8 [0.4–2.4] to 2.1 [0.4–3.9] %, p = 0.24;

Objective: The purpose of this study is to investigate the effect of visual obstruction when a head-up display (HUD) is presented in front of a driver's field of view. Background: The use of HUDs is expected to increase due to advances in augmented reality (AR) technology. A conventional HUD is displayed at a relatively low position in relation to the driver's viewpoint and has little effect on their front view. However, while an HUD, such as the AR-HUD, is presented in front of the driver's field of vision and helps them in presenting ADAS information, there is a concern that this display may obscure visual objects on the road from the driver's field of vision. Method: An experiment using a mockup consisting of a HUD and a driver's seat was conducted with 28 participants. A passenger car, motorcycle, and crossing pedestrian were presented as visual objects on a 65-in monitor behind the image of the HUD. Participants were asked questions under different conditions with changes in the HUD luminance and asked to correctly answer questions regarding changes in the inter-vehicle distance and the existence of visual objects on the road. The number of correct answers provided by the participants was recorded. Results: The experimental results revealed that the HUD had an effect under the twilight condition wherein the background luminance was low. Furthermore, analyzing the number of correct answers for each visual target revealed that the HUD had an effect under conditions wherein the size of the visual object was small. Conclusion: It was experimentally derived that the luminance ratio Rluminance = 1.1 was the threshold value that affected the recognition of the visual object in the background when the HUD was presented in front of the driver's field of view. Implication: The threshold value of the luminance ratio Rluminance obtained in this study can be considered when deciding how to properly display the HUD in front of the driver's field of view.

Background: Insomnia is common in patients with psychiatric disorders. However, patients’ awareness of sleep has seldom been examined in detail. In this study, we investigated sleep awareness in outpatients at the psychiatry department of a university hospital. Methods: The participants (n = 241) were recruited at the psychiatry department of Ehime University Hospital between 11 October and 5 November 2021. The following questionnaires were used: Clinical Global Impression Scale of Severity (CGI-S), Global Assessment of Functioning (GAF), General Health Questionnaire (GHQ-30), Athens Insomnia Scale (AIS), and Epworth Sleepiness Scale (ESS). Psychiatric disorders were diagnosed by certified psychiatrists using the International Statistical Classification of Diseases and Related Health Problems 10. Participants with an AIS score of ≥6 were allocated to the insomnia group for statistical analysis. A logistic regression analysis was conducted to identify which items of sleep hygiene the patients with insomnia practiced using the Sleep Guidelines for Health Promotion. Results: Of 241 participants, 133 (55.2%) were allocated to the insomnia group. The mean scores for the CGI were significantly higher and the GAF scores were significantly lower in the insomnia group than in the healthy sleep group (p < 0.01). Of the 12 sleep guidelines proposed by the Japanese Government, “Do not go to bed until you are sleepful, do not delay getting up”, was the item that maximally influenced insomnia. Conclusions: The insomnia group had worse scores on various medical assessment scales compared to the healthy sleep group. Based on a survey of outpatients at the psychiatry department of the university hospital, appropriate stimulus control techniques may help clinicians to treat outpatients with insomnia.

Abstract Background A decline in cognitive function is associated with inflammatory processes. However, the association between high-sensitivity C-reactive protein (hs-CRP) levels and cognitive decline in the Japanese population remains inconclusive. Thus, this study aimed to determine whether hs-CRP is associated with low cognitive function in 70- and 80-year-old community-dwelling Japanese individuals. Methods The participants in this cross-sectional study were 872 Japanese residents aged 70 and 80 years who voluntarily participated in the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study between 2010 and 2011. Blood sample collection, cognitive assessment, and other measurements were performed at the venue. Low cognitive function was defined as a score of 25 points or lower on the Japanese version of the Montreal Cognitive Assessment. The odds ratio (OR) and 95% confidence interval (95% CI) for each hs-CRP quartile were calculated using logistic regression analysis. Results A total of 288 (69.9%) parsons in the 70-year-old group and 372 (80.9%) in the 80-year-old group exhibited low cognitive function. The association between hs-CRP levels and low cognitive function was significant among 70- and 80-year-old Japanese community-dwelling adults. In particular, the fourth quartile of hs-CRP (0.727–7.420 mg/L) in the 70-year-old group and the second and fourth quartiles (0.214–0.404 and 0.911–9.890 mg/L) in the 80-year-old group were associated with low cognitive function. Furthermore, the third quartile (0.409–0.892 mg/L) in the 80-year-old group was closely associated with low cognitive function. Conclusions High hs-CRP levels were associated with lower cognitive function in 70- and 80-year-old Japanese community-dwelling individuals, suggesting that high hs-CRP levels may influence cognitive function.

Background/Aims Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement. Methods Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included. Results Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p

Collagen is the most abundant protein in the extracellular matrix of animals, and 28 types of collagen have been reported in humans. We previously analyzed the endoplasmic reticulum (ER)-to-Golgi transport of fibril-forming type III collagen (Hirata et al., 2022) and network-forming type IV collagen (Matsui et al., 2020), both of which have long collagenous triple-helical regions. To understand the ER-to-Golgi trafficking of various types of collagens, we analyzed the transport of short-chain type X collagen in this study. We fused cysteine-free GFP to the N-telopeptide region of procollagen X (GFP-COL10A1), as employed in our previous analysis of procollagens III and IV, and analyzed its transport by live-cell imaging. Procollagen X was transported to the Golgi apparatus via vesicular and tubular carriers containing ERGIC53 and RAB1B, similar to those used for procollagen III. Carriers containing procollagen X probably used the same transport processes as those containing conventional cargoes such as α1-antitrypsin. SAR1, TANGO1, SLY1/SCFD1, and BET3/TRAPPC3 were required for trafficking of procollagen X, which are different from the factors required for trafficking of procollagens III (SAR1, TANGO1, and CUL3) and IV (SAR1 and SLY1/SCFD1). These findings reveal that accommodation of various types of collagens with different shapes into carriers may require fine-tuning of the ER-to-Golgi transport machinery. Key words: collagen, GFP-procollagen X, ER-to-Golgi trafficking, export from ER, TANGO1

Public health nurses (PHNs) play a central role in community health in Japan, and the number of certified PHNs has decreased since 2011. However, thus far, no study has estimated the supply and demand of PHNs in the coming years. The present study aimed to estimate the future balance between supply and demand for PHNs in Japan. This simulation study adopted a stock-flow approach using data from a survey of local governments, log data from a recruitment information website, and government statistics. The supply was estimated by adding up the numbers of newly hired PHNs and job changers to that of PHNs from the human resource pool. The demand was estimated from the number of PHNs needed in the future calculated by demographics assumed to affect the demand for PHNs. At the current job change rate to PHNs, the gaps between future supply and demand of PHNs were expected to be -494 to -50 in 2025, -1,007 to -435 in 2030, and -772 to -330 in 2035. If the job change rate would be 1.5 times, the gaps were estimated to be 285 to 729 in 2025, -431 to 141 in 2030, and -182 to 260 in 2035. If the job change rate would be 2.0 times, the supply was sufficient for all estimated years. The number of PHNs working in Japanese local governments is estimated to decline until 2035, resulting in a shortage. Policy makers should consider early measures to adjust the future number of PHNs.

Remimazolam, a short-acting benzodiazepine approved for use in general anesthesia in Japan in 2020, has cardiovascular stability superior to conventional anesthetics. Anesthesia management using remimazolam of a patient with impaired cardiac function and several complications is reported. A man in his 50s with hypertension, diabetes mellitus, and chronic kidney disease (G 5) on dialysis came to our hospital with a chief complaint of exertional dyspnea and chest tightness, and a close examination showed stenoses of three coronary arteries. The patient was managed under anesthesia using remimazolam as a sedative because anesthetics could easily induce circulatory failure. Cardiopulmonary bypass was initiated without causing any circulatory failure, and coronary artery bypass grafting and aortic valve replacement were performed. The patient was successfully weaned with a small dose of catecholamine. Remimazolam was selected for this patient because of its minimal effect on cardiac rhythm, and the anesthesia was safely administered.

Objectives Inhaled nitric oxide (iNO) is a known treatment for pulmonary hypertension (PH) associated with bronchopulmonary dysplasia in preterm infants after 7 days of age (postacute phase). However, a consensus regarding the optimal criteria for initiating iNO therapy in this population in the postacute phase is currently lacking. This study, therefore, aimed to identify the criteria for initiating iNO therapy, alongside the associated clinical and echocardiographic findings, in this population.Design We performed a scoping review using the population-concept-context framework following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.Data sources PubMed, Embase and the Japanese database ‘Ichushi’ were systematically searched for relevant articles published between January 2003 and August 2023.Eligibility criteria This study included randomised controlled trials, prospective and retrospective cohort studies, case–control studies and case series on iNO therapy in the postacute phase for preterm infants born before 34 gestational weeks, written in English or Japanese.Data extraction and synthesis Data screening, extraction and charting were performed independently, with the characteristics and findings of the included studies subsequently summarised.Results We included 10 reports that analysed the data from 10 separate studies. The use of iNO therapy was categorised as prophylactic and rescue purposes. While randomised controlled trials (RCTs) and retrospective analyses indicated the safety of iNO during the postacute phase, the latter highlighted poor prognoses associated with severe cases requiring rescue iNO therapy. Additionally, although echocardiography is currently the primary diagnostic tool for identifying PH in preterm infants, standardised diagnostic criteria are lacking. Further, reports of complications and side effects associated with iNO are rare.Conclusion Our exploration of the initiation criteria for iNO revealed that definitive guidelines have not been established. Nonetheless, iNO administration during the postacute phase appeared to be safe and devoid of complications.Trial registration number UMIN000051498.

Nano-fibrillated bacterial cellulose (NFBC) can be prepared by cultivating a cellulose-producing bacterium in a medium containing a dispersant under agitating and aerobic conditions. Although NFBCs have various applications, their detailed structure and physical properties have not been clarified. Therefore, in this study, we performed detailed structural and physical property analyses of NFBCs to advance their potential applications. Atomic force microscopy and image analysis showed that the average fiber length of NFBCs was approximately 17 µm and fiber widths were 10–15 nm; the aspect ratios of NFBCs were > 1000, which are >10-fold higher than that of 2,2,6,6-tetramethylpioeridine-1-oxyl-oxidized cellulose nanofiber. Shear viscosity measurements showed that the NFBCs exhibited shear-thinning flow behavior even at low concentrations (0.01 wt%). Frequency sweep measurements showed that the storage modulus values were greater than the loss modulus values in the measured frequency range, indicating that the NFBCs were in a stable gel state. Thus, the NFBCs exhibited significantly longer fiber lengths, larger aspect ratios, and excellent viscoelastic properties based on these unique structural features. Our findings will help develop novel applications utilizing the ultrahigh aspect ratio unique to NFBC and its viscoelastic properties.

Abstract Efficiently solving combinatorial optimization problems (COPs) such as Max‐Cut is challenging because the resources required increase exponentially with the problem size. This study proposes a hardware‐friendly method for solving the Max‐Cut problem by implementing a spiking neural network (SNN)‐based Boltzmann machine (BM) in neuromorphic hardware systems. To implement the hardware‐oriented version of the spiking Boltzmann machine (sBM), the stochastic dynamics of leaky integrate‐and‐fire (LIF) neurons with random walk noise are analyzed, and an innovative algorithm based on overlapping time windows is proposed. The simulation results demonstrate the effective convergence and high accuracy of the proposed method for large‐scale Max‐Cut problems. The proposed method is validated through successful hardware implementation on a 6‐transistor/2‐resistor (6T2R) neuromorphic chip with phase change memory (PCM) synapses. In addition, as an expansion of the algorithm, several annealing techniques and bias split methods are proposed to improve convergence, along with circuit design ideas for efficient evaluation of sampling convergence using cell arrays and spiking systems. Overall, the results of the proposed methods demonstrate the potential of energy‐efficient and hardware‐implementable approaches using SNNs to solve COPs. To the best of the author's knowledge, this is the first study to solve the Max‐Cut problem using an SNN neuromorphic hardware chip.

A 39-year-old woman with type I osteogenesis imperfecta reported experiencing back pain at 35 weeks of gestation. Two days following an elective cesarean section, the patient developed a Th12 vertebral compression fracture; 3 weeks postoperatively, she sustained an L3 vertebral compression fracture. The patient displayed a lumbar spine Z-score of −1.7; she subsequently discontinued breastfeeding, and treatment with active vitamin D was initiated. Genetic testing confirmed a diagnosis of osteogenesis imperfecta.

Purpose: This study aimed to assess the diagnostic performance of dynamic chest radiography (DCR) and investigate its added value to chest radiography (CR) in detecting pulmonary embolism (PE). Methods: Of 775 patients who underwent CR and DCR in our hospital between June 2020 and August 2022, individuals who also underwent contrast-enhanced CT (CECT) of the chest within 72 h were included in this study. PE or non-PE diagnosis was confirmed by CECT and the subsequent clinical course. The enrolled patients were randomized into two groups. Six observers, including two thoracic radiologists, two cardiologists, and two radiology residents, interpreted each chest radiograph with and without DCR using a crossover design with a washout period. Diagnostic performance was compared between CR with and without DCR in the standing and supine positions. Results: Sixty patients (15 PE, 45 non-PE) were retrospectively enrolled. The addition of DCR to CR significantly improved the sensitivity, specificity, accuracy, and area under the curve (AUC) in the standing (35.6–70.0 % [P < 0.0001], 84.8–93.3 % [P = 0.0010], 72.5–87.5 % [P < 0.0001], and 0.66–0.85 [P < 0.0001], respectively) and supine (33.3–65.6 % [P < 0.0001], 78.5–92.2 % [P < 0.0001], 67.2–85.6 % [P < 0.0001], and 0.62–0.80 [P = 0.0002], respectively) positions for PE detection. No significant differences were found between the AUC values of DCR with CR in the standing and supine positions (P = 0.11) or among radiologists, cardiologists, and radiology residents (P = 0.14–0.68). Conclusions: Incorporating DCR with CR demonstrated moderate sensitivity, high specificity, and high accuracy in detecting PE, all of which were significantly higher than those achieved with CR alone, regardless of scan position, observer expertise, or experience.

Introduction: Enfortumab vedotin (EV) is an antibody-drug conjugate combining a monoclonal antibody targeting nectin-4 with a highly potent microtubule disrupting agent. EV is expected to be a candidate for the third-line treatment for urothelial carcinoma previously treated with platinum-based chemotherapy and PD-1/PD-L1 inhibitors. Very few cases of patients experienced hyperglycemia of unknown cause. Case Presentation: We describe a 72-year-old Asian man with mild obesity, type 2 diabetes, hyperlipidemia, hypertension, and chemo-resistant metastatic urothelial carcinoma. He developed hyperglycemia and febrile neutropenia after 3 doses of EV. He had hyperglycemia of 489 mg/dL and was started on continuous intravenous insulin infusion (CVII). The patient’s intravenous insulin requirements peaked at 316 units per day. He also developed febrile neutropenia and consequent sepsis caused acute kidney injury. Continuous hemodialysis filtration (CHDF) together with antibiotics were started to treat the septic condition. The blood glucose level gradually decreased after CHDF treatment and CHDF was continued for 14 days. The timing of liberation from CHDF correlated with the elimination half-life of EV of 3.4 days. CVII was treated for 26 days and the patient was finally released from the intensive care unit. Conclusion: This case indicates that the uncontrollable hyperglycemia induced by EV during metastatic urothelial carcinoma treatment is effectively managed with CVII and CHDF until the elimination of the adverse effect of EV.

Abstract The ALICE experiment was proposed in 1993, to study strongly-interacting matter at extreme energy densities and temperatures. This proposal entailed a comprehensive investigation of nuclear collisions at the LHC. Its physics programme initially focused on the determination of the properties of the quark–gluon plasma (QGP), a deconfined state of quarks and gluons, created in such collisions. The ALICE physics programme has been extended to cover a broader ensemble of observables related to Quantum Chromodynamics (QCD), the theory of strong interactions. The experiment has studied Pb–Pb, Xe–Xe, p–Pb and pp collisions in the multi-TeV centre of mass energy range, during the Run 1–2 data-taking periods at the LHC (2009–2018). The aim of this review is to summarise the key ALICE physics results in this endeavor, and to discuss their implications on the current understanding of the macroscopic and microscopic properties of strongly-interacting matter at the highest temperatures reached in the laboratory. It will review the latest findings on the properties of the QGP created by heavy-ion collisions at LHC energies, and describe the surprising QGP-like effects in pp and p–Pb collisions. Measurements of few-body QCD interactions, and their impact in unraveling the structure of hadrons and hadronic interactions, will be discussed. ALICE results relevant for physics topics outside the realm of QCD will also be touched upon. Finally, prospects for future measurements with the ALICE detector in the context of its planned upgrades will also be briefly described.