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Her medical history included pulmonary embolism (PE) due to remaining in the same position for a long time at the age of 42 years. Learning points for clinicians Pulmonary embolism is an important complication of coronavirus disease 2019 (COVID-19). [Extracted from the article]

Objective The long-term impact of personalized diet and exercise programs for steatotic liver disease (SLD) remains unclear. Materials The subjects of this retrospective cohort study included 104 consecutive Japanese patients with SLD. The long-term treatment efficacy of personalized diet and exercise treatment was evaluated two years after the start of observation. Regular and repeated hospitalizations every 6 months (RRH group, n=23) indicated the 4 times of the number of hospitalizations, and irregular hospitalizations (IH group, n=56) showed the 1 to three times. The group without hospitalization was defined as the no hospitalization group (NH group, n=25). To balance confounding biases, the difference in treatment efficacy between the RRH and IH groups was evaluated using propensity score (PS)-matched analysis. A diet of 25 to 30 kcal/kg multiplied by ideal body weight (BW) daily, and aerobic and resistance exercise (exercise intensity of 4 to 5 metabolic equivalents daily, respectively) was performed for 6 days. Results At 2 years compared to baseline, the decrease rates of liver function tests, HbA1c, and physical findings in the RRH group were significantly higher than those in the NH or IH groups by multiple comparisons. According to the liver function tests and physical findings, the rate of decrease in the RRH group (17 cases) was significantly higher than that in the IH group (17 cases) using a PS-matched analysis. Conclusion The present study indicated the long-term favorable efficacy of personalized diet and exercise programs for SLD. In particular, this RRH program was effective in improving the findings of liver function tests and might help to sustain diet and exercise.

Background: The increasing number of women physicians is in contrast to their underrepresentation in academic positions and professional associations. This study aimed to evaluate the status of women physicians in the Japanese Society of Hospital General Medicine (JHGM) based on society membership, board membership, and annual meeting authorship., Methods: A cross-sectional analysis was conducted. Information on women physicians, society and board membership, and annual meeting authorship was collected. Data from the Japanese Primary Care Association (JPCA) served as the control. The gender of authors with accepted abstracts in the JHGM and JPCA annual meetings was determined by name or Internet search., Results: In the JHGM, 14.2% of members were women physicians, compared to 19.1% in the JPCA ( p  < 0.001). None of the 21 JHGM board members were women, compared to 20.5% in the JPCA ( p  < 0.001). The average number of years of experience was significantly higher for the JHGM board members than for the JPCA board members (37.0 vs. 28.1 years, p  < 0.001). Women first authors in the 2022-2023 JHGM meeting comprised 17.9%, significantly lower than the 28.4% in the 2023 JPCA meeting ( p  = 0.002). Similar patterns were seen for women last authors (6.0% in the JHGM vs. 18.8% in the JPCA, p  < 0.001) and women chairpersons (17.9% in the JHGM vs. 40.3% in the JPCA, p  = 0.036)., Conclusions: The JHGM has low women representation in society and board membership, and annual meeting authorship. Strategies are needed to enhance diversity and inclusion by increasing women's participation and leadership in the JHGM., Competing Interests: The authors have declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this manuscript., (© 2024 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

A 70-year-old man had developed a high fever and arthralgia in his right elbow 6 months prior. Loxoprofen improved the symptoms temporarily, but arthropathy developed in other joints. Long-term recurrent arthropathy and the fever caused activity reduction and progressive debilitation. We performed fluorine-18 fluorodeoxyglucose-positron emission tomography and detected a positive accumulation in multiple joints and lymph nodes. A lymph node biopsy revealed epithelioid cell granulomas, which, along with elevated angiotensin-converting enzyme levels, led to the diagnosis of sarcoid arthropathy. After prednisolone administration, the fever and arthralgia resolved, and his activities of daily living improved. Clinicians should be aware of this type of sarcoid arthropathy.

Aims: The effects of genetic polymorphism on a personalized diet and exercise program for steatotic liver disease (SLD) are still unclear., Methods: Participants of this retrospective cohort study were 203 Japanese patients with SLD diagnosed by abdominal ultrasonography. All of them were introduced the personalized diet and exercise treatment. A diet of 25-30 kcal/kg multiplied by ideal body weight (BW) daily and aerobic and resistance exercise (exercise intensity of 4-5 metabolic equivalents daily, respectively) were performed for 6 days. Treatment efficacy was evaluated in terms of the rate of decrease of liver function tests, glycolipid metabolism markers, physical findings, image findings, and cardiovascular disease (CVD) risk score at 6 months compared with baseline. Furthermore, the impact of genetic polymorphism was also investigated., Results: At 6 months compared with baseline, liver function tests (AST, ALT, γGTP), glycolipid metabolism markers (hemoglobin A1c, triglycerides [TG], low-density lipoprotein cholesterol), physical findings (BW, body mass index), image finding (liver stiffness measurement), and CVD risk score (Suita score) improved significantly. There was no significant difference in treatment efficacy, except for the rates of decrease of TG, according to genotype PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs6834314. The rates of decrease of TG with TM6SF2 CT were significantly higher than those with CC or TT, and the rates of TG with HSD17B13 AA were significantly higher than those with AG by multiple comparisons., Conclusion: Personalized diet and exercise program for SLD improved liver function tests, physical findings, glycolipid metabolism markers, and CVD risk score. Genetic polymorphism might partially affect treatment efficacy. Further studies should be performed to develop an individualized program for SLD, considering genetic polymorphism., (© 2023 Japan Society of Hepatology.)

Aims: Both diet and exercise counseling are recommended for patients with fatty liver, including nonalcoholic fatty liver disease (NAFLD), to achieve weight loss goals. However, data evaluating treatment efficacy are limited., Methods: The subjects of this retrospective cohort study were 186 consecutive Japanese cases with fatty liver diagnosed by abdominal ultrasonography. Treatment efficacy and predictive factors of "Hospitalization Program for Improvement Purpose for Fatty Liver" as a combined diet and aerobic and resistance exercise program were evaluated according to the hospitalization group (153 cases) or the no hospitalization group (33 cases). To balance the confounding biases, treatment efficacy was evaluated using propensity score-matched analysis. In the hospitalization group, a diet of 25-30 kcal/kg multiplied by ideal body weight (BW) daily and aerobic and resistance exercise (exercise intensity of 4-5 metabolic equivalents daily, respectively) were performed for 6 days., Results: In liver function tests and BW at 6 months compared with baseline, the rates of decrease of the hospitalization group (24 cases) were significantly higher than those of the no hospitalization group (24 cases), using propensity score-matched analysis. In markers of glycolipid metabolism and ferritin levels, the rates of the hospitalization group were not different from those of the no hospitalization group. In the hospitalization group (153 cases), multivariate regression analysis identified the etiology of non-NAFLD, the presence of diabetes mellitus, and large waist circumference as independent predictors of decreased rates of hemoglobin A1c levels., Conclusion: The diet and exercise program for fatty liver improved liver function tests and BW. Further study should be performed to develop a feasible and suitable program., (© 2023 Japan Society of Hepatology.)

A fundamental task of a sensory system is to infer information about the environment. It has long been suggested that an important goal of the first stage of this process is to encode the raw sensory signal efficiently by reducing its redundancy in the neural representation. Some redundancy, however, would be expected because it can provide robustness to noise inherent in the system. Encoding the raw sensory signal itself is also problematic, because it contains distortion and noise. The optimal solution would be constrained further by limited biological resources. Here, we analyze a simple theoretical model that incorporates these key aspects of sensory coding, and apply it to conditions in the retina. The model specifies the optimal way to incorporate redundancy in a population of noisy neurons, while also optimally compensating for sensory distortion and noise. Importantly, it allows an arbitrary input-to-output cell ratio between sensory units (photoreceptors) and encoding units (retinal ganglion cells), providing predictions of retinal codes at different eccentricities. Compared to earlier models based on redundancy reduction, the proposed model conveys more information about the original signal. Interestingly, redundancy reduction can be near-optimal when the number of encoding units is limited, such as in the peripheral retina. We show that there exist multiple, equally-optimal solutions whose receptive field structure and organization vary significantly. Among these, the one which maximizes the spatial locality of the computation, but not the sparsity of either synaptic weights or neural responses, is consistent with known basic properties of retinal receptive fields. The model further predicts that receptive field structure changes less with light adaptation at higher input-to-output cell ratios, such as in the periphery.

Background: Assessment of the musical ability of people with schizophrenia has attracted little interest despite the diverse and substantive findings of impairments in sound perception and processing and the therapeutic effect of music in people with the illness. The present study investigated the musical ability of people with schizophrenia and the association with psychiatric symptoms and cognition., Methods: We recruited patients with chronic schizophrenia and healthy controls for participation in our study. To measure musical ability and cognitive function, we used the Montreal Battery of Evaluation of Amusia (MBEA) and the Brief Assessment of Cognition in Schizophrenia (BACS). We carried out a mediation analysis to investigate a possible pathway to a deficit in musical ability., Results: We enrolled 50 patients and 58 controls in the study. The MBEA global score in patients with schizophrenia was significantly lower than that in controls (p < 0.001), and was strongly associated with both the composite cognitive function score (r = 0.645, p < 0.001) and the negative symptom score (r = -0.504, p < 0.001). Further analyses revealed direct and indirect effects of negative symptoms on musical ability. The indirect effects were mediated through cognitive impairment., Limitations: The relatively small sample size did not permit full evaluation of the possible effects of age, sex, education, medication and cultural influences on the results., Conclusion: Examining the associations between musical deficits, negative symptoms and cognitive imapirment in patients with schizophrenia may identify shared biological mechanisms.

Robust coding has been proposed as a solution to the problem of minimizing decoding error in the presence of neural noise. Many real-world problems, however, have degradation in the input signal, not just in neural representations. This generalized problem is more relevant to biological sensory coding where internal noise arises from limited neural precision and external noise from distortion of sensory signal such as blurring and phototransduction noise. In this note, we show that the optimal linear encoder for this problem can be decomposed exactly into two serial processes that can be optimized separately. One is Wiener filtering, which optimally compensates for input degradation. The other is robust coding, which best uses the available representational capacity for signal transmission with a noisy population of linear neurons. We also present spectral analysis of the decomposition that characterizes how the reconstruction error is minimized under different input signal spectra, types and amounts of degradation, degrees of neural precision, and neural population sizes.

To achieve color vision, the brain has to process signals of the cones in the retinal photoreceptor mosaic in a cone-type-specific way. We investigated the possibility that cone-type-specific wiring is an adaptation to the statistics of the cone signals. We analyzed estimates of cone responses to natural scenes and found that there is sufficient information in the higher order statistics of L- and M-cone responses to distinguish between cones of different types, enabling unsupervised learning of cone-type specificity. This was not the case for a fourth cone type with spectral sensitivity between L and M cones, suggesting an explanation for the lack of strong tetrachromacy in heterozygous carriers of color deficiencies.

We address the problem of robust coding in which the signal information should be preserved in spite of intrinsic noise in the representation. We present a theoretical analysis for 1- and 2-D cases and characterize the optimal linear encoder and decoder in the mean-squared error sense. Our analysis allows for an arbitrary number of coding units, thus including both under- and over-complete representations, and provides insights into optimal coding strategies. In particular, we show how the form of the code adapts to the number of coding units and to different data and noise conditions in order to achieve robustness. We also present numerical solutions of robust coding for high-dimensional image data, demonstrating that these codes are substantially more robust than other linear image coding methods such as PCA, ICA, and wavelets.

Objective: The aim of this study was to investigate the outcomes of gemcitabine-treated patients with inoperable biliary tract cancers., Methods: We conducted a retrospective study of consecutively treated 22 inoperable biliary tract cancer patients with gemcitabine (500-1,000 mg/m(2) on days 1, 8, 15 every 4 weeks) as first-line, and 17 patients as second- or third-line treatment., Results: The response rate of patients treated with gemcitabine as first-line and second- or third-line treatment was 5.3 and 28.5%, respectively. The median overall survival time in the first-, and second- or third-line treatment groups was 8.3 and 17.0 months, and the 1-year survival rate was 44.0 and 50.9%, respectively. The present study also suggests the possibility that the prognosis of patients with high levels of C-reactive protein and total bilirubin, or a low level of albumin might be worse., Conclusions: Our results indicate that the treatment of inoperable biliary tract cancers with gemcitabine is feasible. There was no difference in the response rate and overall survival between biliary tract cancer patients in the first- and second- or third-line treatment groups. We also present the systematic review of literature of the recent treatment results of biliary tract cancers treated with gemcitabine., (Copyright 2006 S. Karger AG, Basel.)

Neurons in the early stages of processing in the primate visual system efficiently encode natural scenes. In previous studies of the chromatic properties of natural images, the inputs were sampled on a regular array, with complete color information at every location. However, in the retina cone photoreceptors with different spectral sensitivities are arranged in a mosaic. We used an unsupervised neural network model to analyze the statistical structure of retinal cone mosaic responses to calibrated color natural images. The second-order statistical dependencies derived from the covariance matrix of the sensory signals were removed in the first stage of processing. These decorrelating filters were similar to type I receptive fields in parvo- or konio-cellular LGN in both spatial and chromatic characteristics. In the subsequent stage, the decorrelated signals were linearly transformed to make the output as statistically independent as possible, using independent component analysis. The independent component filters showed luminance selectivity with simple-cell-like receptive fields, or had strong color selectivity with large, often double-opponent, receptive fields, both of which were found in the primary visual cortex (V1). These results show that the "form" and "color" channels of the early visual system can be derived from the statistics of sensory signals.

Hepatitis C virus (HCV) infection is very common among hemodialysis (HD) patients. Transmission of infection in this setting has been related to the number of blood transfusions, the duration of hemodialysis and to nosocomial transmission of virus in the dialysis unit. We conducted a study of 74 HD patients to determine the frequency of HCV at a single point in time (cross-sectional analysis), and to evaluate the association between HCV infection and patients' demographic, clinical and biochemical features. Serum samples were tested for anti-HCV antibodies using a third-generation enzyme-linked immunosorbent assay (ELISA). In the case of a positive result, third-generation recombinant immunoblot and HCV RNA detection by polymerase chain reaction (PCR) tests were performed. Collected data included the patient's age, gender, time on HD, number of blood transfusions and serum alanine aminotransferase (ALT) activity. Twenty-nine patients (29/74.4%) were found to be HCV positive using a third-generation ELISA assay. Of these 29 patients, 27 were also positive by recombinant immunoblot assay and 2 patients had indeterminate results. In the anti-HCV ELISA-positive subgroup, 20 (69%) of the 29 patients had detectable HCV RNA. The HCV RNA-positive patients had received more blood transfusions (15&plusm;3 vs. 5&plusm;1 units of packed red blood cells, p<0.0001) and had been on HD for a longer period of time than the HCV RNA-negative patients (65&plusm;32 vs. 32&plusm;29 months, p<0.0001). Mean serum ALT levels were significantly higher in the HCV RNA positive group (30&plusm;18 vs. 15&plusm;9, p<0.0001). We were unable to determine the most likely mode of transmission in our unit, but these results emphasize the need for strict adherence to blood collecting and handling precautions, careful attention to hygiene in the dialysis units, and sterilization of dialysis machines in order to properly combat this frequent infection.

The central nervous system involvement in chronic graft versus host disease (GVHD) has been suggested. Chronic GVHD resembles auto immune connective tissue disorders. In order to investigate the immunoglobulin intra blood brain barrier (BBB) synthesis during chronic GVHD, and contribute to understanding the pathophysiology of the disease, we studied 33 patients who underwent allogeneic bone marrow transplants (BMT) from HLA identical related donors. Immunoglobulin intra BBB synthesis was investigated quantitative and qualitatively. The samples were collected pre BMT, pos BMT and during chronic GVHD. There were no evidence of immunoglobulin intra BBB synthesis, and no oligoclonal bands were found. Only isolated cases suggested IgO and IgA intra BBB synthesis, and in one case IgM during GVHD.

The blood-brain barrier (BBB) contributes to the central nervous system (CNS) immunological isolation. BBB has never been studied in patients who developed chronic graft-versus-host disease (GVHD) after allogeneic bone marrow transplants (BMT), from HLA identical related donors. BBB disruption was investigated through the cerebrospinal fluid (CSF) proteins, quantitative and graphically, in order to detect the incidence and possible pathophysiology of the CNS involvement in chronic GVHD. Thirty three CSF and matched serum samples from chronic myeloid leukemia patients were collected pre BMT pos BMT and during chronic GVHD. There was no evidence of BBB disruption in any patient studied.

The folding of heat-denatured ovalbumin, a non-inhibitory serpin with a molecular size of 45 kDa, was examined. Ovalbumin was heat-denatured at 80 degrees C under nonreducing conditions at pH 7.5 and then cooled either slowly or rapidly. Slow cooling allowed the heat-denatured ovalbumin to refold to its native structure with subsequent resistance to digestion by trypsin. Upon rapid cooling, by contrast, the heat-denatured molecules assumed the metastable non-native conformations that were susceptible to trypsin. The non-native species were marginally stable for several days at a low temperature, but the molecules were transformed slowly into the native conformation. Considering data from size-exclusion chromatography and from analyses of CD, intrinsic tryptophan fluorescence, and adsorption of the dye 1-anilinonaphthalene-8-sulfonate, we postulated that the non-native species that accumulated upon rapid cooling were compact but structureless globules with disordered side chains collectively as a folding intermediate. Temperature-jumped CD experiments revealed biphasic kinetics for the refolding process of heat-denatured ovalbumin, with the features of increasing and subsequently decreasing amplitude of the rapid and the slow phases, respectively, with the decrease in folding temperature. The temperature dependence of the refolding kinetics indicated that the yield of renaturation was maximal at about 55 degrees C. These findings suggested the kinetic partitioning of heat-denatured ovalbumin between alternative fates, slow renaturation to the native state and rapid collapse to the metastable intermediate state. Analysis of disulfide pairing revealed the formation of a scrambled form with non-native disulfide interactions in both the heat-denatured state and the intermediate state that accumulated upon rapid cooling, suggesting that non-native disulfide pairing is responsible for the kinetic barriers that retard the correct folding of ovalbumin.