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This study examined hydrogen conversion efficiency and operational stability in pilot-scale in-situ bio-methanation during the co-digestion of sewage sludge and lactic acid (partially derived from waste poly-lactic acid). Parallel laboratory-scale experiments were also conducted. In the pilot, hydrogen conversion efficiency decreased from 98.9 % to 84.4 % as the hydrogen feed rate increased from 240 to 1,200 mL/L R /d. Conversely, laboratory experiments maintained efficiencies above 95 % at a feed rate of 3,600 mL/L R /d, suggesting that hydrogen gas-liquid transfer limited hydrogen conversion efficiency in the pilot. Lactic acid degradation was observed both with and without hydrogen injection in the pilot. Methane yields from the acid were 310 ± 30 and 300 ± 30 mL/g (chemical oxygen demand (COD))-added, close to the theoretical methane yield (350 mL/gCOD). These results demonstrate the importance of hydrogen gas-liquid transfer when scaling up bio-methanation processes. Moreover, they showed the potential of waste poly-lactic acid as a methane source., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: This study determined whether the GENECUBE rapid nucleic acid amplification test could directly detect nuc and mecA genes in clinical blood culture samples of Staphylococcus and various other pathogens., Methods: Between September 2020 and December 2021, 537 blood culture samples from 192 patients with suspected bacteremia were tested using conventional assays (MicroScan WalkAway96 or VITEK 2 systems) and GENECUBE nuc and mecA assays. Isolates from samples with discrepant results between the conventional and GENECUBE assays were further evaluated using MALDI-TOF mass spectrometry, disk diffusion testing using cefoxitin, broth microdilution testing using oxacillin, and sequencing for mecA. Bacterial solutions containing a mixture of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus epidermidis (MRSE) were prepared to evaluate the limit of detection (LOD) of mecA., Results: Using conventional assays as the reference, the sensitivity, specificity, and positive and negative predictive values (95 % confidence interval) of GENECUBE were 100 % (96.8-100 %), 100 % (99.1-100 %), 100 % (96.8-100 %), and 100 % (99.1-100 %), respectively, for nuc detection and 100 % (96.1-100 %), 98.9 % (97.4-99.6 %), 94.9 % (88.5-98.3 %), and 100 % (99.2-100 %), respectively, for mecA detection. Sequencing analysis of five samples identified as methicillin-sensitive staphylococci using conventional assays and methicillin-resistant staphylococci using GENECUBE revealed the presence of methicillin-resistant isolates in all samples. The estimated LOD of mecA was 10 4 colony-forming units (CFU)/mL of MRSE with GENECUBE, compared with 10 5  CFU/mL with conventional assays., Conclusion: The GENECUBE assay accurately detected mecA in positive blood culture samples and had higher sensitivity than conventional assays., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yoshihiro Soya is an employee of TOYOBO Co., Ltd., a private company that manufactures the GENECUBE analyzer and related reagents., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The methanation efficiency and operational stability of a 2 m 3 pilot-scale in-situ biomethanation reactor were investigated using on-site sewage sludge as the substrate, at a wastewater treatment plant. In parallel, a laboratory-scale study was conducted. Hydrogen conversion efficiencies of 96.7 and 97.5 %, and average methane contents of 84.2 and 83.2 % were obtained, for the laboratory and pilot experiments, respectively. The pilot-scale digester was operated at various conditions for 137 d, of which the last 30 d were stable with a high biomethanation efficiency and an average pH of 8.2. Gas recirculation increased the hydrogen conversion efficiency. When hydrogen injection and gas recirculation were applied separately, a 96 % lower gas recirculation rate was needed to achieve the same hydrogen conversion efficiency, compared to a mixture of hydrogen injection and gas recirculation in the same line. These findings may facilitate the selection of suitable gas recirculation concepts for practical biomethanation applications., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Shinya Akimoto reports financial support was provided by Ministry of Land, Infrastructure, Transport and Tourism, Japan. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Japan currently has a super-aged society, with a rapid increase in elderly patients in need of medical care. Determining treatment strategies for acute cholecystitis (AC) in very elderly patients with various comorbidities is often difficult. Although percutaneous cholecystostomy (PC) is a less-invasive treatment option, its impact on subsequent surgery remains debatable. This study investigated the validity of PC as a bridge to surgery in very elderly patients with AC., Methods: Of 215 patients who underwent cholecystectomy for AC at our hospital, we retrospectively investigated 83 patients aged ≥80 years-53 and 30 who underwent upfront surgery (US) and PC before surgery, respectively-to assess the treatment strategies and clinical course., Results: The PC group had a significantly worse systemic status at diagnosis than the US group, including age, severity grading, comorbidities, performance status, systemic inflammatory status, and blood coagulation abnormalities, which improved after PC. The elective surgery rate was significantly higher in the PC group than in the US group. Despite the high number of severe cases in the PC group, surgical quality indicators, including the conversion rate to open surgery, operative time, blood loss, and critical view of safety achievement rate, tended to be better in the PC group, without severe perioperative complications., Discussion: PC followed by cholecystectomy improves preoperative conditions, including systemic inflammation status and blood coagulation abnormalities, in very elderly patients, allowing safe elective surgical treatment while securing the quality of surgery and clinical outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Although vascularized bone graft (VBG) transfer is the current standard for mandibular reconstruction, reconstruction with a mandibular reconstruction plate (MRP) and with a soft-tissue flap (STF) alone remain crucial options for patients with poor general conditions. However, objective aesthetic outcome evaluations for these methods are limited., Methods: In a retrospective analysis of 65 patients (VBG, 33; MRP, 19; and STF, 13), mandibular asymmetry value was calculated for each patient's photograph using facial recognition AI, with a higher value indicating worse asymmetry., Results: The MRP group had a value comparable to the VBG group regardless of mandibular defect types. The STF group had a significantly higher value than the VBG group., Conclusions: Regarding cosmesis, STF was inferior to VBG, whereas MRP was comparable to VBG, even for anterior defects for which rigid reconstruction is mandatory. However, MRP's risks of plate-related complications limit its use to cases where VBG is contraindicated or with poor prognosis., (© 2024 Wiley Periodicals LLC.)

Objectives: The Russian-Ukrainian War of 2022 (RUW-2022) was accompanied by the subsequent risk of accidents at a nuclear power plant in Ukraine. This study investigated posttraumatic stress (PTS) symptoms related to media reports of an attack on a Ukrainian nuclear power plant during the RUW-2022 among victims of the Fukushima nuclear disaster and revealed their association with radiation risk perception (RRP) of the accident., Methods: This cross-sectional study targeted 1193 residents of Naraha Town in Fukushima Prefecture. PTS symptoms were measured using the Japanese version of the Impact of Events Scale-Revised (IES-R). Univariate and multivariate analyses explored the association between IES-R scores and background factors, particularly RRP., Results: Participants with higher RRP showed significantly higher IES-R scores; furthermore, the proportion of disruption because of radiation anxiety was significantly larger among higher RRP residents. Radiation anxiety mediated the association between RRP and PTS symptoms (total IES-R score and sub-item of intrusion)., Conclusions: People with higher RRP in Fukushima may continue to be at risk of persistent, unwanted PTS symptoms due to future nuclear crises. Therefore, mental health practitioners need to continue providing support in affected areas for a longer period than anticipated. Moreover, a population-based approach to cope with these stressors from media reports is essential.

Background: T-SPOT.TB ® , one of the screening tests for latent tuberculosis infection (LTBI), yields invalid results in human T-cell leukemia virus type 1 (HTLV-1)-positive patients with rheumatoid arthritis. However, the detailed mechanisms behind this invalidation are unclear. Additionally, it remains unclear whether T-SPOT.TB ® or QuantiFERON-TB (QFT) is more useful in HTLV-1-positive patients with rheumatic disease (RD)., Method: Among all of the HTLV-1-positive RD patients who visited our department between August 2012 and December 2022, 44 patients who were screened using T-SPOT.TB® were included in the analysis. QFT testing was performed in 33 of the 44 patients, and the results were compared with that of T-SPOT.TB®. Furthermore, we performed a culture experiment mimicking T-SPOT.TB® using peripheral blood mononuclear cells (PBMCs) obtained from HTLV-1-positive patients with RD. Additionally, T-cell subsets with autonomous product IFN-γ were analyzed using a flow cytometer., Results: Of the included patients, 13 (29.5%) were invalid for T-SPOT.TB® because of the increased number of negative control spots. The median HTLV-1 proviral load in the invalid group was higher than that in the valid group (2.45 vs. 0.49 copies/100 PBMCs, respectively, p = 0.002). QFT was performed in all 33 patients, including 13 patients who were invalid in T-SPOT.TB®. The main source of IFN-γ production was CD8+ T-cells in the T-SPOT.TB® mimic experiment. Furthermore, Tax-expressing CD4+ T-cells and Tax-specific cytotoxic CD8+ T-cells were more frequently observed in patients with invalid results than in patients with valid results. CD4+ T-cell depletion in the T-SPOT.TB® mimic experiment reduced the population of IFN-γ producing CD8+ T cells., Conclusion: T-SPOT.TB® may be invalidated by the interaction between Tax-expressing CD4+ T-cells and cytotoxic CD8+ T-cells. Moreover, HTLV-1-associated immune reactions due to contact between these cells may be unlikely to occur in QFT using whole blood. Therefore, our results reveal the superiority of QFT over T-SPOT.TB® as a screening test for LTBI in HTLV-1-positive patients with RD., Competing Interests: TH received honoraria for lectures from AbbVie GK, Eli Lilly Japan K.K., Pfizer Japan Inc., Asahi Kasei Pharma Corp., Bristol-Myers K.K., Chugai Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K.,Taisho Pharma Co., Ltdand Eisai Co. K. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kimura, Umekita, Iwao, Kawano, Hashikura, Hashiba, Hidaka, Sugata, Satou and Miyazaki.)

Background and Objectives: Some reports suggest that older patients with traumatic brain injury (TBI) are more likely to experience acute intracranial hemorrhage, resulting in poor outcomes. However, the association between precise chronological age and use of antithrombotic agents with acute intracranial hemorrhage in these patients remains unknown. The aim of this study was to determine factors associated with acute intracranial hemorrhage and poor outcomes in patients with TBI, including chronological age and use of antithrombotic agents., Methods: Patients hospitalized for TBI between January 2006 and December 2021 were included. Patients were categorized by age groups of <65 years, 65 to 74 years, 75 to 84 years, and ≥85 years. Associations between each age group and acute intracranial hemorrhage, a poor outcome at discharge, and in-hospital mortality were evaluated., Results: The cohort included 1086 patients, with 713 (65.7%) in the ≥65 age group. Although chronological age was associated with acute intracranial hemorrhage in patients aged <65 years (odds ratio [OR] 1.02; 95% CI 1.01-1.03), it was not associated with patients aged ≥65 years. None of the antithrombotic agents investigated were associated with acute intracranial hemorrhage in the group aged ≥65 years. Although chronological age was associated with a poor outcome in patients aged <65 years (OR 1.03; 95% CI 1.01-1.07), it was not associated in those aged ≥65 years. The ≥85 year age group (OR 2.30; 95% CI 1.18-4.51) compared with <65 years were significantly associated with a poor outcome. None of the antithrombotic agents investigated were associated with a poor outcome in the group aged ≥65 years., Conclusion: Our findings confirmed the lack of an association of chronological age and antithrombotic agents with acute intracranial hemorrhage in the group of older adults with TBI. Our findings suggest that antithrombotic agents may be safely used, even in older adults., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Precise skin phenotypic data are indispensable in accurately diagnosing atopic dermatitis (AD). Therefore, this study examined the interobserver concordance for AD and non-AD diagnoses between two dermatologists. AD prevalence determined by the self-reported physician diagnoses and the diagnoses determined from the United Kingdom (UK) diagnostic criteria were compared with the diagnoses made by the two dermatologists, using data from a skin health survey., Methods: This study included 1,638 children that participated in the skin health survey, which was part of the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. AD was assessed using dermatologist assessments, self-reported physician diagnoses, and the UK diagnostic criteria. The concordance for diagnoses was evaluated using kappa. The sensitivity and specificity of the self-reported physician diagnoses and the UK diagnostic criteria were calculated by comparing them with the two dermatologists' diagnoses., Results: Among the 1,638 children, 393 (24.0 %), 194 (11.9 %), and 597 (37.2 %) were diagnosed with AD by the two dermatologists, physicians, and the UK diagnostic criteria, respectively. The kappa (95 % CI) of the interobserver concordance for AD or non-AD diagnoses between the two dermatologists was 0.78 (0.75-0.81). The sensitivity and specificity of the self-reported physician diagnoses were 26.7 % and 94.1 %, respectively. The sensitivity and specificity of the UK diagnostic criteria were 85.0 % and 82.4 %, respectively., Conclusions: Interobserver concordance for AD or non-AD diagnoses between the two dermatologists was substantial. Self-reported physician diagnoses exhibited low sensitivity that potentially indicated underdiagnosis of AD, whereas the UK diagnostic criteria might overdiagnose AD., (Copyright © 2024 Japanese Society of Allergology. Published by Elsevier B.V. All rights reserved.)

Objectives: We aimed to evaluate the effects of age on clinical characteristics and outcomes in biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD)-naïve patients with rheumatoid arthritis (RA)., Methods: We analysed the cases of 234 Japanese b/tsDMARD-naïve RA patients who underwent b/tsDMARD treatment in a multicentre ultrasound prospective observational cohort. We compared the clinical characteristics at baseline and outcomes at 12 months between those aged ≥60 years and those <60 years., Results: Compared to the <60-year-old group (n = 78), the ≥60-year-old group (n = 156) had higher inflammatory marker values and ultrasound combined scores, especially wrist joints, at baseline. Age at baseline positively correlated significantly with the ultrasound scores at baseline; however, age was not a significant variable by the multiple regression analysis. The patients treated with different MOAs in the ≥60-year-old group had comparable outcomes and multiple regression analysis revealed that mechanism of action (MOA) was not a significant contributor to the Clinical Disease Activity Index at 12 months., Conclusions: RA patients with advanced age demonstrated distinctive clinical characteristics. The MOAs were not associated with clinical outcomes and ultrasound outcomes in RA patients with advanced age., (© Japan College of Rheumatology 2024. Published by Oxford University Press.)

Objectives: Late-onset rheumatoid arthritis (LORA), which has been increasing in recent years, lacks evidence for initial treatment. Japanese rheumatology experts recognized this gap and addressed it by developing consensus statements on the first clinical application of LORA., Methods: These statements were created following an introductory discussion about treatment fundamentals, which included a review of existing literature and cohort data. The steering committee created a draft, which was refined using a modified Delphi method that involved panel members reaching a consensus. The panel made decisions based on input from geriatric experts, clinical epidemiologists, guideline developers, patient groups, and the LORA Research Subcommittee of the Japan College of Rheumatology., Results: The consensus identified four established facts, three basic approaches, and six expert opinions for managing LORA. Methotrexate was recommended as the primary treatment, with molecular-targeted agents being considered if treatment goals cannot be achieved. An emphasis was placed on assessing the lives of older patients due to challenges in risk management and methotrexate accessibility caused by comorbidities or cognitive decline., Conclusions: The experts substantiated and refined 13 statements for the initial treatment of LORA. To validate these claims, the next is to conduct a registry study focusing on new LORA cases., (© Japan College of Rheumatology 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Objective: This study aimed to elucidate the effects of pre-evacuation family hospital visits on post-evacuation returns to Fukushima Prefecture (hometown) among psychiatric inpatients who mandatorily evacuated to hospitals outside the prefecture because of the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident., Method: Of the inpatients in Fukushima, 44 were admitted to a hospital in the nearby Soso district on March 11, 2011, and were therefore included in the current analysis. We collected information on their discharge after the evacuation and family visits before the evacuation by reviewing the medical records of both the evacuation destination and former hospitals., Results: The average durations from the accident to post-evacuation return among patients with and those without former family visits were 681.8 days (standard error [SE] = 163.3) and 1,027.8 days (SE = 152.0), respectively. The log-rank test showed a tendency of earlier return to Fukushima among inpatients who had received family visits to the hospital before evacuation ( p  = .073)., Conclusions: The results highlight the critical need for close collaboration between psychiatric medical practitioners and families, to not only support patients' community reintegration into daily life but also facilitate a timely return to their hometowns following long-distance evacuation caused by an unforeseen large-scale disaster.

Adult T-cell leukemia/lymphoma (ATLL) is a refractory blood cancer with severe immunodeficiency resulting from retroviral infection. ATLL develops in only 5 % of HTLV-1-infected individuals, but the entire mechanism of ATLL progression remains unknown. Since recent studies have reported that the gut microbiome influences the progression of various diseases, we hypothesized that ATLL is also related to the gut microbiome and aimed to investigate this relationship. We analyzed the taxonomic and functional profiles of the gut microbiota of ATLL patients (n = 28) and HTLV-1-infected individuals (n = 37). We found that the succinic semialdehyde (SSA) synthesis pathway was significantly enriched in the gut microbiome of ATLL patients (P = 0.000682), and Klebsiella , whose abundance was significantly greater in ATLL patients and high-risk HTLV-1-infected individuals (P = 0.0326), was the main contributor to this pathway. Administration of SSAs to ATLL cell lines resulted in significant cell proliferation. Herein, we propose that the gut microbiome can regulate ATLL progression via metabolites., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Takuji Yamada reports a relationship with Metagen Therapeutics Inc that includes: board membership. Takuji Yamada reports a relationship with Metagen Inc that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The clinical ramifications of adaptive servo-ventilation (ASV) therapy have stirred debate within the medical community. Given the potential detrimental effect of elevated expiratory positive airway pressure (EPAP) on cardiac output, we hypothesized that relatively lower EPAP may be recommended for successful ASV therapy. In-hospital patients with congestive heart failure refractory to medical therapy were included in the prospective cohort study of ASV therapy on prognosis in repeatedly hospitalized patients with chronic heart failure: longitudinal observational study of effects on readmission and mortality (SAVIOR-L) study. Assignment to either the ASV treatment group or the medical management group was at the discretion of the attending physicians. For the purposes of this retrospective study, our focus remained solely on the ASV cohort. We conducted an extensive analysis to elucidate the influence of lower EPAP settings on midterm mortality. A total of 108 patients were included. The median age was 74 years, and 83 (77%) patients were male. The median EPAP setting employed was 4 cmH 2 O, with 60 patients subjected to EPAP levels below 5 cmH 2 O. There were no significant differences in the baseline characteristics between the lower and higher EPAP groups, which were divided at the EPAP cutoff of 4.5 cmH 2 O (p > 0.05 for all). A trend toward reduced mortality emerged among patients with EPAP settings below 5 cmH 2 O, exhibiting a hazard ratio of 0.48 (95% confidence interval 0.22-1.07, p = 0.072) after adjusting for potential confounding factors: 2-year mortality 26% vs. 38%; p = 0.095. Heart failure readmission rates were not significantly different between the two groups (p = 0.61). The adoption of relatively lower EPAP settings during ASV therapy may be advisable. Such an approach has the potential to ameliorate mortality rates while concurrently maintaining heart failure recurrence rates at levels commensurate with those with default EPAP settings., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Microbial fuel cells (MFCs) are a promising technology that directly converts organic matter (OM) in wastewater into electricity while simultaneously degrading contaminants. However, MFCs are insufficient for the removal of nitrogenous compounds. Therefore, the post-treatment of MFCs is essential. This study was the first to use natural zeolite adsorption integrated with photosynthesis (ZP) for post-treating MFCs. In this system, no external energy was required; instead, natural light was used to promote the growth of photosynthetic microorganisms, thereby enhancing contaminants removal through the photosynthesis process. To assess the effectiveness of the method, comparisons were conducted under two conditions: dark (no photosynthesis) and light (with photosynthesis). In darkness, extending hydraulic retention time (HRT) enhanced COD and BOD removal by 19.8% and 28.9%, respectively. When exposed to natural light, improvements were even more notable, with COD and BOD removal reaching 32% and 40%, respectively. In both conditions, the method effectively removed NH 4 + , achieving 60% efficiency in darkness and 84.5% in light. This study showed that the adsorption capacity of the zeolite reached saturation when the cumulative liquid volume per unit weight of the zeolite exceeded 0.2 L g -1 . The key functional photosynthetic microbes were investigated using 16S rRNA and 18S rRNA. This revealed the presence of microorganisms such as Chlorobium , Acidovorax , Novosphingobium , and Scenedesmus , which likely play a role in enhancing the efficiency of photosynthesis in removing contaminants. The study findings indicated that the integration of MFCs-ZP represents an eco-friendly approach capable of resource recovery from wastewater while also meeting discharge standards., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

We aimed to examine the support needs of women who migrated to Fukushima Prefecture after the Fukushima Daiichi Nuclear Power Plant accident. In recent years, the presence of migrants has become an important part of the government's reconstruction policy for affected areas. However, there is insufficient research on the status of migrants in these areas, and it is unclear what kind of support the migrants, especially females, require to encourage further migration to the area. We conducted three semi-structured interviews each with four women who had migrated to Fukushima after the accident. The narratives obtained from the interviews were summarized into categories through open coding and were finally presented as support needs in the form of a four-quadrant diagram. Four needs were identified for female migrants in areas affected by the radiation disaster: "soft adaptation needs," "lifestyle constancy needs," "female empowerment needs," and "community participation needs." Female migrants in the affected areas may be marginalized in terms of receiving migrant support. Key strategies for supporting female migrants in radiation disaster areas include providing an environment in which they can relax, interact with Fukushima and its residents, and address intersectionality., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kobayashi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Total pharyngolaryngectomy is sometimes combined with total glossectomy for advanced hypopharyngeal or cervical esophageal cancers involving the tongue base. The optimal reconstruction method for total pharyngolaryngectomy with total glossectomy has not been established due to a considerable diameter mismatch between the floor of mouth and the esophageal stump. This report describes two reconstruction methods using free jejunal transfer., Methods: Five consecutive patients who underwent total pharyngolaryngectomy with total glossectomy were included, with a mean age of 67.0 (range 55-75) years. Primary tumors included tongue, hypopharyngeal, cervical esophagus, and laryngeal cancers. The mean defect size was 17.0 (16-19) × 6.8 (6-7) cm. Surgical techniques involved either a simple incision or a two-segment method to address the size mismatch between the jejunum and the floor of mouth. In the simple incision method, a longitudinal cut was made to the antimesenteric or paramesenteric border of a jejunum wall to expand the orifice. In the two-segment method, a jejunal graft was separated into two segments to reconstruct the floor of mouth and the cervical esophagus, and these segments were connected with a longitudinal incision to the cervical esophageal segment to form a funnel-shaped conduit., Results: Of the five patients, three underwent the simple incision method and two the two-segment method. Postoperative pharyngoesophagography showed a smooth passage for all patients. Postoperative courses were uneventful except for one flap loss due to arterial thrombosis. Four patients achieved oral feeding, while one became gastric-tube dependent. At a mean follow-up of 22.1 (4-39) months, one patient required tube feeding, two tolerated full liquid, and two consumed a soft diet., Conclusions: Both the simple incision and two-segment methods achieved satisfactory swallowing function. The choice between these reconstruction methods may depend on the extent of resection of the posterior pharyngeal wall., (© 2024 Wiley Periodicals LLC.)

Objectives We investigated the current perspectives regarding the management of late-onset rheumatoid arthritis (LORA) among rheumatologists in clinical practice. Methods This study was performed in October 2021, and included 65 rheumatologists certified by the Japan College of Rheumatology, who were administered questionnaires (including multiple choice and descriptive formulae) regarding the management of LORA. We aggregated and analyzed the responses. Results All 65 rheumatologists responded to the survey; 47 (72%) answered that >50% of newly diagnosed patients were aged ≥65 years, 42 (65%) answered that achievement of remission or low disease activity was the treatment goal, and 40 (62%) considered patient safety to be the highest priority. Most rheumatologists are concerned about the management of conditions other than RA, such as comorbidities, financial constraints, and life circumstances that interfere with standard or recommended treatment implementation. Conclusion This preliminary survey highlighted various rheumatologists' perspectives regarding the management of LORA.