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Yukinori Kamata,1,2 Osamu Takashio,1,2 Ryotaro Sato,1,2 Hideaki Kawai,1,2 Hiroki Ishii,1,2 Keisuke Aoyagi,1,2 Akisa Tomita,1,2 Shigenobu Toda,1,2 Akira Iwanami1– 3 1Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan; 2Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan; 3Showa University Karasuyama Hospital, Tokyo, JapanCorrespondence: Yukinori Kamata, Department of Psychiatry, Showa University School of Medicine, 2-14-9, Nishi-nakanobu, Shinagawa, Tokyo, Japan, Tel +81 337848000, Fax +81 337848302, Email ykamata3211@gmail.comPurpose: Sleep plays an essential role in maintaining both physical and mental well-being. Many patients in psychiatric outpatient settings complain of insomnia. However, the causal relationship between insomnia and depressive symptoms in all mental illnesses remains unclear. Moreover, research on insomnia and the continuation of outpatient treatment is lacking. We hypothesize a high correlation between depression and insomnia among patients with diverse mental illnesses. Additionally, we posit that insomnia significantly influences the continuity of outpatient visits. To this end, we evaluated insomnia and depression symptoms in psychiatric patients both at their initial visit and one year later. We also examined factors related to insomnia at the outset and factors associated with the ongoing utilization of outpatient treatment.Patients and Methods: The participants of the study consisted of patients who made their first visit to the outpatient department of psychiatry and neurology at Showa University East Hospital between June 1, 2021, and March 31, 2023, and who continued attending the outpatient clinic for one year. Clinical characteristics were assessed using the Self-rating Depression Scale (SDS) and the Athens Insomnia Scale (AIS).Results: The study’s findings were collected from a cohort of 1106 patients and revealed that more than 70% experienced insomnia at the time of their initial visit. In total 137 patients continued to receive outpatient treatment for one year, and their AIS scores improved from 9 points to 5 points. A multivariate analysis revealed that the SDS items of depressed mood and insomnia were confounding factors influencing AIS improvement.Conclusion: Given that 70% of patients complained of insomnia at the time of their first visit and that sleep improved in many of the 12.4% of patients who continued to receive outpatient treatment for at least one year, the results suggest that sleep status is an important determinant of whether a patient continues to attend outpatient clinics.Keywords: insomnia, sleep disorder, depression, continuation rate of outpatient treatment

Hironobu Uzawa,1 Hideaki Ishii,1 Takeki Ishida,1 Takashi Shida,2,3 Hiroto Furuyama,4 Yusuke Nishida1 1Department of Physical Therapy, International University of Health and Welfare, Narita, Chiba, Japan; 2Department of Medical Technology and Science, International University of Health and Welfare, Narita, Chiba, Japan; 3Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; 4Department of Rehabilitation, International University of Health and Welfare Narita Hospital, Narita, Chiba, JapanCorrespondence: Hironobu Uzawa, Department of Physical Therapy, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba, 286-8686, Japan, Tel/Fax +81-746-20-7716, Email h.uzawa@iuhw.ac.jpPurpose: Conditioned pain modulation (CPM) is a measurement of the descending pain pathways that inhibit or facilitate afferent noxious stimuli. The reliability of CPM in older individuals with or without chronic musculoskeletal pain has not been sufficiently reported. This study aimed to examine the inter-session reliability of CPM in these cohorts and the factors in CPM reliability.Patients and Methods: Individuals aged 65 or older were recruited in Narita, Japan. The measurements were performed on separate days 2 weeks apart (sessions 1 and 2). Each participant’s hand was immersed in cold water, and we measured pressure pain threshold (PPT) before and after the immersion. The ratio before and after PPT measurements was presented as CPM index. The autonomic activities (heart rate variability, heart rate, and blood pressure) were simultaneously measured. An absolute reliability of CPM index was analyzed by the adjusted two-way analysis of variance (ANOVA) and the Bland Altman plot, and relative reliability was analyzed by intraclass correlation coefficient (ICC). Spearman’s rho correlation and the adjusted multivariate regression analysis were utilized for examining the CPM reliability factors.Results: Thirty-two participants were divided into two groups: chronic pain (n=19) and non-chronic pain (n=13) groups. The mean difference between session 1 and 2 in CPM index showed a systematic error in the chronic pain group at 17.3 (confidence interval, CI: 15.0 to 19.7), but none in the non-chronic pain group at 3.7 (CI: − 0.02 to 7.4). The adjusted two-way ANOVA for CPM index did not identify any differences. ICC was not significant at p=− 0.247 in the non-chronic and 0.167 in chronic pain. Multivariate regression analysis revealed total power and low/high frequencies as significant factors for CPM index.Conclusion: This study identified low inter-session reliability in older adults with chronic musculoskeletal pain and autonomic nervous system activities as factors in CPM reliability.Keywords: inter-session reliability, conditioned pain modulation, older people, autonomic nervous system, chronic musculoskeletal pain

Yuji Yoshikawa, Takuhei Shoji, Junji Kanno, Hisashi Ibuki, Kimitake Ozaki, Hirokazu Ishii, Hiromi Inami, Kei Shinoda Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, JapanCorrespondence: Kei ShinodaDepartment of Ophthalmology, Saitama Medical University, 350-0495 Morohogo 38, Iruma, Saitama, JapanTel +81 49-276-1250Fax +81 49-295-8002Email shinodak@med.teikyo-u.ac.jpPurpose: Optical coherence tomography angiography (OCTA) allows noninvasive observation of the retinal vasculature, and image analysis can be used to calculate the retinal vessel density and foveal avascular zone (FAZ) area. A previous study showed that macular vessel density and the signal strength index (SSI) of OCTA images increased significantly after cataract surgery. However, the effect of aging on OCTA analysis remains unclear. This study aimed to investigate age-related changes in macular vascularization while excluding the effects of cataracts.Patients and Methods: OCTA imaging of the macula was performed in adult patients who had undergone cataract surgery between February 2018 and May 2019 and in young healthy participants between April 2017 and April 2018.Results: The median (quartiles) age of the overall study population was 59.0 (27.0, 69.0) years, and no severe refractive error was observed (axial length: 24.2 ± 1.3 [mean ± SD] mm; spherical equivalent: 0.75 [− 2.25, 0.00] diopter). When we investigated the relationship between macular vessel density and age after excluding the effects of cataracts, we found that the macular vessel density showed age-related changes even in the absence of the effects of the SSI. However, the FAZ area was not affected by age.Conclusion: Macular vessel density decreased with age, even when the effects of cataracts were excluded. The effects of age and cataracts should be considered when designing studies and interpreting OCTA findings of the retinal vasculature.Keywords: optical coherence tomography angiography, macular vessel density, foveal avascular zone, aging, cataract surgery

Aya Kimura,1 Hiroyuki Yamasaki,1 Haruka Ishii,2 Hisako Yoshida,2 Motoko Shimizu,3 Takashi Mori1 1Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan; 2Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan; 3Department of Anesthesiology, Sumitomo Hospital, Osaka City, Osaka, JapanCorrespondence: Aya KimuraDepartment of Anesthesiology, Osaka City University Graduate School of Medicine, 1-5-7 Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8586, JapanTel +81-6-6645-2186Fax +81-6-6645-2489Email aya1226kimura@gmail.comPurpose: Serotonin (5-HT) is highly associated with pain modulation. The human 5-HT transporter (5-HTT) gene (SLC6A4) features several polymorphisms in its promoter region (5-HTTLPR) that affect the 5-HTT expression. The S allele of 5-HTTLPR induces low 5-HT tone, and it may influence the modulation of chronic pain. Meanwhile, pain occurs in 40– 50% of patients after thoracic surgery, and its mechanism remains under investigation. This study assessed the role of 5-HTTLPR polymorphisms in postthoracotomy pain severity.Patients and Methods: A total of 178 patients undergoing pneumonectomy were enrolled. The genotypes of 5-HTTLPR were divided into two groups: S/S group and S/L or L/L group. Linear mixed-effects models were used to assess the association between 5-HTTLPR genotypes and the numerical rating scale (NRS) score change over time.Results: Among the participants, data were obtained for 162 patients. The genotype distribution was as follows: S/S, 67.3%; S/L or L/L, 32.7%. No significant difference in patient characteristics was found between the genotype groups. There was no significant interaction between the 5-HTTLPR genotypes and the NRS score change over time (p = 0.842).Conclusion: Polymorphisms in 5-HTTLPR were not associated with postthoracotomy pain severity.Keywords: 5-HTTLPR, pain modulation, numerical rating scale

Keiji Hirai, Junki Morino, Saori Minato, Shohei Kaneko, Katsunori Yanai, Yuko Mutsuyoshi, Hiroki Ishii, Momoko Matsuyama, Taisuke Kitano, Akinori Aomatsu, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Susumu Ookawara, Yoshiyuki Morishita Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JapanCorrespondence: Keiji HiraiDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken 330-8503, JapanTel +81-48-647-2111Fax +81-48-647-6831Email keijihirai@kfy.biglobe.ne.jpPurpose: The objective of this study was to determine factors associated with the change in carotid maximum intima-media thickness (IMT), an established surrogate marker of atherosclerosis, in moderate-to-advanced stage chronic kidney disease (CKD) patients.Methods: In total, 130 moderate-to-advanced stage CKD patients (mean age: 67.6 ± 11.0 years old; 91 men and 39 women) were included in this retrospective, single-center, observational study. Relationships between the change in carotid maximum IMT and clinical and laboratory data were analyzed by using multivariate linear regression analyses.Results: Mean observation period was 2.9 ± 1.6 years. Mean carotid maximum IMT at baseline was 2.2 ± 1.0 mm, and the annual change in carotid maximum IMT was 0.06 ± 0.22 mm/year. Low-density lipoprotein (LDL)-cholesterol (β = 0.173, p < 0.05) and annual change in triglyceride (β = 0.175, p < 0.05) independently correlated with the annual change in carotid maximum IMT.Conclusion: Increases in LDL-cholesterol and triglyceride were associated with the rate of progression of carotid maximum IMT in moderate-to-advanced stage CKD patients.Keywords: atherosclerosis, carotid maximum intima-media thickness, chronic kidney disease

Keiji Hirai, Junki Morino, Saori Minato, Shohei Kaneko, Katsunori Yanai, Yuko Mutsuyoshi, Hiroki Ishii, Momoko Matsuyama, Taisuke Kitano, Mitsutoshi Shindo, Akinori Aomatsu, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Susumu Ookawara, Yoshiyuki Morishita Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JapanCorrespondence: Keiji HiraiDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama City, Saitama 330-8503, JapanTel +81-48-647-2111Fax +81-48-647-6831Email keijihirai@kfy.biglobe.ne.jpIntroduction and Objectives: We investigated the efficacy and safety of sodium-glucose cotransporter-2 (SGLT-2) inhibitors as an add-on therapy in patients with advanced-stage diabetic kidney disease taking renin-angiotensin system (RAS) blockers.Materials and Methods: Changes in glycated hemoglobin (HbA1c), urine protein-to-creatinine ratio (UACR), body weight, systolic blood pressure, and annual change in estimated glomerular filtration rate (eGFR) were retrospectively analyzed in 20 patients after 12 months of SGLT-2 inhibitor administration (mean eGFR: 22.8 ± 9.7 mL/min/1.73 m2). All patients had advanced-stage diabetic kidney disease and were taking RAS blockers. Twenty patients matched with similar propensity scores who were not taking SGLT-2 inhibitors served as the control group.Results: The annual change in eGFR improved significantly from − 8.6 ± 12.5 mL/min/1.73 m2/year to − 2.6 ± 5.0 mL/min/1.73 m2/year after 12 months by SGLT-2 inhibitor administration (p < 0.05), but did not change in the control group. Other clinical parameters, such as HbA1c, UACR, body weight, blood pressure, serum lipids, and electrolytes did not change in either group. No adverse effects were observed by taking SGLT-2 inhibitors.Conclusion: Using SGLT-2 inhibitors as an add-on therapy may have beneficial effects on renal function in patients with advanced-stage diabetic kidney disease taking RAS blockers without any adverse effects.Keywords: advanced-stage diabetic kidney disease, renin-angiotensin system blocker, sodium-glucose cotransporter-2 inhibitor

Saori Minato, Keiji Hirai, Junki Morino, Shohei Kaneko, Katsunori Yanai, Yuko Mutsuyoshi, Hiroki Ishii, Momoko Matsuyama, Taisuke Kitano, Mitsutoshi Shindo, Akinori Aomatsu, Haruhisa Miyazawa, Kiyonori Ito, Yuichiro Ueda, Taro Hoshino, Susumu Ookawara, Yoshiyuki Morishita Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, JapanCorrespondence: Keiji HiraiDivision of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama 330-8503, JapanTel +81-48-647-2111Fax +81-48-647-6831Email keijihirai@kfy.biglobe.ne.jpAim: The aim of this study was to investigate different intensities of uremic pruritus in the daytime and nighttime, as well as contributing factors, in patients undergoing peritoneal dialysis (PD).Methods: A total of 46 patients (31 males, 15 females) with a mean age of 59.4± 14.7 years and mean PD vintage of 29.2± 25.2 months were enrolled in this single-center, prospective, cross-sectional study. The intensity of uremic pruritus in the daytime and nighttime was assessed using a visual analog scale (VAS). The relationships between intensity and various clinical and laboratory parameters were analyzed using multiple linear regression analyses.Results: The most common site of uremic pruritus was on the back (70%), followed by lower limbs (67%), chest and abdomen (59%), upper limbs (28%), and head and neck (22%). Mean VAS scores were higher in the nighttime compared with the daytime (4.5± 3.3 vs. 3.5± 2.7, P=0.02). Only male sex was correlated with higher uremic pruritus intensity in the daytime (standard coefficient [β]=0.310, P=0.036). PD vintage (β=0.415, P=0.004) and topical medicines, including moisturizer and topical corticosteroid use (β=0.345, P=0.019), were independently correlated with higher uremic pruritus intensity in the nighttime.Conclusion: Uremic pruritus intensity was greater in the nighttime than in the daytime in PD patients. Male sex was associated with higher uremic pruritus intensity in the daytime, whereas PD vintage and topical medicine use were associated with higher uremic pruritus intensity in the nighttime.Keywords: uremic pruritus, peritoneal dialysis

Yuji Yoshikawa, Takuhei Shoji, Junji Kanno, Hisashi Ibuki, Kimitake Ozaki, Hirokazu Ishii, Yoshikazu Ichikawa, Itaru Kimura, Kei Shinoda Department of Ophthalmology, Saitama Medical University, Saitama, Japan Purpose: To evaluate microvascular changes in the macular area of eyes with rhegmatogenous retinal detachment (RRD) without macular involvement (macula-on RRD) using swept-source optical coherence tomography angiography (SS-OCTA). Patients and methods: Five patients with macula-on RRD were eligible for analysis. All patients underwent SS-OCTA examination (Triton) for the macular area. The healthy fellow eyes were included as controls. The vessel density (VD) was calculated using binarization, and the foveal avascular zone (FAZ) was measured. The VD and FAZ area were compared between the eyes with RRD and the fellow eyes using the Wilcoxon signed rank test. Results: The patients’ clinical characteristics were as follows: age, 49.0 years (21.0, 54.0) (median [25, 75th percentile]); preoperative best-corrected visual acuity, -0.08 (-0.08, 0.11) for RRD and -0.08 (-0.08, -0.03) for the fellow eye (P=0.50); and axial length, 27.0 (25.1, 28.7) mm for RRD and 27.4 (25.6, 28.5) mm for the fellow eye (P=0.31). The parafoveal VD was not significantly different between the eyes with RRD and the fellow eyes (P=1.00 for the superficial retina and P=0.44 for the whole retina). The FAZ area was also similar for the eyes with RRD and the fellow eyes (P=0.31 for the superficial retina and P=0.13 for the whole retina). Conclusion: The findings of this study suggest that the macular microvasculature remains intact in eyes with macula-on RRD. Keywords: rhegmatogenous retinal detachment, macula, optical coherence tomography angiography, vessel density

Purpose: Environment-friendly pest management techniques are safer, sustainable over the years, better for ecosystem services, and more convenient with lower risks. Netting and or bagging is one of the most suitable tools for pest management. To develop environmentally friendly management techniques against the common cutworm (Spodoptera litura Fab.), we compared the cost-effectiveness of netting and bagging for the production of bell peppers in Bangladesh. Research Method: The study was undertaken in the field of Entomology, at Sylhet Agricultural University, Bangladesh, from October 2018 to April 2019. Netting and bagging significantly improved plant morphology, fruit quality, and yield and managed the insect pests. Findings: In this paper, we tried to bring forth different prospects of netting and bagging in bell peppers to manage the common cutworm. Superior-quality fruits were harvested from the netting/bagging treatment compared to the control. Netting and bagging treatment increased yield by more than 10-fold over control and decreased fruit infestation to 10.67%. The maximum marginal benefit-cost ratio (MBCR = 18.06) was achieved from the netting/bagging treatment, while the lowest MBCR (7.29) was obtained from bagging only. Superior-quality fruits were obtained using white paper bags compared to brown paper bags. The common cutworm first appeared in February and gradually increased with the progress of the season, indicating that netting and bagging need to be applied at the early fruiting stage of bell pepper. Research Limitations: The study focused on the environment-friendly management of common cutworms in bell peppers, revealing impressive results, but these need to be validated across the locations. Originality/Value: Albeit labor-intensive, combining nylon netting with fruit bagging is a cost-effective, eco-friendly management technique against the common cutworm of bell pepper. [ABSTRACT FROM AUTHOR]

In Japan, secondary forests associated with agriculture (satoyama) had been maintained traditionally by small-scale clearcutting and short-rotation coppice forestry. After forest management was discontinued due to modernization, shade-intolerant, deciduous trees such as Q. serrata and Q. variabilis have become dominant in many secondary forests of southwestern Japan. In recent years, however, tree death from Japanese oak wilt has become wide-spread. To identify forest communities that will be most affected by oak wilt, we investigated stand structure and species composition in a 64-ha unmanaged secondary forest in Kobe, Japan. We identified three forest communities using cluster analysis of 27 survey plots. We then analyzed and visualized vegetation similarity among the communities using non-metric multidimensional scaling (nMDS). In secondary forests, Pinus densiflora–Rhododendron macrosepalum and Quercus serrata–Quercus variabilis communities, which established after pine wilt were identified. We also found communities dominated by Cryptomeria japonica, a plantation species. We predicted that Quercus serrata–Quercus variabilis communities will experience significant vegetation change after oak wilt and become low-statured, evergreen-deciduous forests. These communities, therefore, should be prioritized for active management by small-scale clear cutting to prevent further spread of oak wilt and subsequent biodiversity decline. [ABSTRACT FROM AUTHOR]