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The nonlinear motion of underactuated mechanisms has drawn recent interests of researchers. Underactuated mechanical systems are often subject to so-called nonholonomic constraints which are related to many both theoretical and practical issues. In this paper, we first analyze the nonlinear behavior of a two-joint planar manipulator with the second joint free, from nonlinear dynamics point of view. We then discuss the simultaneous positioning of both joints. We use a time-periodic input and propose an amplitude modulation of the feedback error. The analysis via the Poincare map shows that the behavior becomes chaotic with large amplitude. The effectiveness of the proposed positioning control is verified by experiments. Index Terms - Amplitude modulation, chaos, free-joint manipulator, nonlinear behavior, nonlinear control, periodic perturbation input, second-order nonholonomic systems.

Platinum (Pt) nanosheets were developed by exfoliating layered platinumoxide. Moreover, we succeeded in synthesizing monolayer Pt nanosheets for the first time by adjusting the conditions for reduction. Monolayer Pt nanosheets were highly active in oxygen reduction reaction. [ABSTRACT FROM AUTHOR]

Layered niobate oxide (K4Nb6O17·3H2O) films with high orientation and strong adhesion were fabricated by electrophoretic deposition. The deposited films displayed the behavior of a typical n-type semiconductor in K2SO4 solution. When the films were irradiated with UV light, an anodic photocurrent due to the oxidative reaction of the water between the NbO6 layers could be observed. Consequently, the deposited film was converted by photoelectrochemical oxidation from a hydrated form (K4Nb6O17·3H2O) into an anhydrous form (K4Nb6O17). [Copyright &y& Elsevier]

Graphene oxide (GO) has been attracting intensive attention as a flexible barrier film, however, provides no barrier for proton transfer due to its out-of-plane proton conductivity (10 -6  S cm -1 ) based on nanoscale defects with oxygen functional groups. In this study, it is reported that a pore-free GO (Pf-GO) membrane with controlled oxygen functional groups exhibits unexpected proton blocking behavior (10 -11  S cm -1 ). Proton permeation tests conducted in aqueous solution demonstrate that proton permeation is below the detection limit, and lithium metal foils coated with the Pf-GO show higher chemical stability to water than those coated with previously reported GO. The Pf-GO has periodic honeycomb atomic structure, which is found to impart the Pf-GO membrane with novel performance characteristics distinct from those of conventional GO., (© 2024 Wiley‐VCH GmbH.)

Objectives: This study aimed to examine the impact of prefracture cognitive impairment (CI) severity and postoperative delirium on recovery after hip fracture surgery in older patients., Design: Prospective study with a 1-year follow-up., Setting and Participants: We included 355 patients aged ≥80 years from 2 acute hospitals in Japan., Methods: Barthel Index (BI) ambulation scores were assessed prefracture and at 1, 3, 6, and 12 months postoperatively. The score at each time point minus the prefracture score was used as the ambulation recovery variable. The 21-item Dementia Assessment Sheet for the Community-based Care System (DASC-21) and Confusion Assessment Method were used to assess CI severity and delirium, respectively. The impacts of CI severity and delirium on recovery at 1 month and by 12 months postoperatively were examined. Linear multiple regression and linear mixed effects models were used., Results: BI ambulation scores remained the same or improved from prefracture levels in 26.8%, 34.4%, 33.0%, and 30.4% of patients at 1, 3, 6, and 12 months, respectively. Ten patients (2.8%) had fall-related hip fractures, 20 (5.6%) were rehospitalized, and 43 (12.1%) died during this period. Although DASC-21 CI severity significantly affected the recovery both at 1 month and by 12 months postoperatively [standardized β (Stdβ) = -0.39, P < .0001, and Stdβ = -0.37, P < .0001, respectively], delirium did not. Other variables affecting recovery by 12 months postoperatively included prefracture BI ambulation scores, Mini Mental State Examination scores, age, fracture type, place of residence, and time., Conclusions and Implications: Postoperative ambulation recovery, excluding the effect of death and other poor outcomes, is influenced by prefracture CI severity, and the presence of delirium itself may not be the moderating variable. These results emphasize the importance of treatment planning based on prefracture CI severity and indicate that assessments such as the DASC-21 may be useful in implementing such a plan., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Perioperative management of patients on dialysis is critical for controlling bleeding and thrombotic risk, in addition to infection control. Postoperative anticoagulation is often difficult to control, and different institutions have different policies. Therefore, in this study, we aimed to investigate factors associated with postoperative bleeding events and whether warfarin (WF) therapy affects the incidence of postoperative bleeding events, total mortality, and stroke., Methods: Patients who were admitted to the cardiovascular surgery department and underwent valve replacement or plasty were included, and those who underwent mechanical valve introduction were excluded. Thirty-nine patients were included in the study. The primary endpoint was to identify factors associated with the composite endpoint of postoperative bleeding events, and the secondary endpoint was to determine the effect size of WF therapy on postoperative bleeding events, all-cause mortality, and stroke and the strength of association between the crossed endpoints. The strength of the association between the crossed items was examined., Results: Low body weight (p = 0.038) was identified as a factor associated with the primary endpoint of postoperative bleeding events. The secondary endpoint of whether or not patients received WF therapy was largely unrelated to bleeding events, all-cause mortality, and postoperative stroke up to 90 days after surgery., Conclusions: Preliminary studies suggest that low body weight is a risk factor for postoperative bleeding events in patients on dialysis, although further exploration of other factors will be necessary with the accumulation of similar cases., (© 2024. The Author(s).)

Background and Purpose: Cortical hyperexcitability has been identified as a diagnostic and pathogenic biomarker of amyotrophic lateral sclerosis (ALS). Cortical excitability is assessed by transcranial magnetic stimulation (TMS), a non-invasive neurophysiological technique. The TMS biomarkers exhibiting highest sensitivity for cortical hyperexcitability in ALS remain to be elucidated. A meta-analysis was performed to determine the TMS biomarkers exhibiting the highest sensitivity for cortical hyperexcitability in ALS., Methods: A systematic literature review was conducted of all relevant studies published in the English language by searching PubMed, MEDLINE, Embase and Scopus electronic databases from 1 January 2006 to 28 February 2023. Inclusion criteria included studies reporting the utility of threshold tracking TMS (serial ascending method) in ALS and controls., Results: In total, more than 2500 participants, incorporating 1530 ALS patients and 1102 controls (healthy, 907; neuromuscular, 195) were assessed with threshold tracking TMS across 25 studies. Significant reduction of mean short interval intracortical inhibition (interstimulus interval 1-7 ms) exhibited the highest standardized mean difference with moderate heterogeneity (-0.994, 95% confidence interval -1.12 to -0.873, p < 0.001; Q = 38.61, p < 0.05; I 2  = 40%). The reduction of cortical silent period duration along with an increase in motor evoked potential amplitude and intracortical facilitation also exhibited significant, albeit smaller, standardized mean differences., Conclusion: This large meta-analysis study disclosed that mean short interval intracortical inhibition reduction exhibited the highest sensitivity for cortical hyperexcitability in ALS. Combined findings from this meta-analysis suggest that research strategies aimed at understanding the cause of inhibitory interneuronal circuit dysfunction could enhance understanding of ALS pathogenesis., (© 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Context: Although adding spironolactone to renin-angiotensin system blockers reduces albuminuria in adults with chronic kidney disease and type 2 diabetes, it increases the risk of hyperkalemia., Objective: To assess whether a lower dose of spironolactone (12.5 mg/d) reduces the risk of hyperkalemia while maintaining its effect on reducing albuminemia., Design: Multicenter, open-label, randomized controlled trial., Setting: This study was conducted from July 2016 to November 2020 in ambulatory care at 3 diabetes medical institutions in Japan., Patients: We enrolled 130 Japanese adults with type 2 diabetes and albuminuria (≥30 mg/gCre), estimated glomerular filtration rate ≥30 mL/min/1.73 m2, and serum potassium level <5.0 mEq/L., Interventions: The participants were randomly assigned to the spironolactone-administered and control groups., Main Outcome Measures: Changes in urine albumin-to-creatinine ratio (UACR) from baseline over the 24-week interventional period., Results: The spironolactone group showed a significant reduction in UACR from baseline (mean decrease, 103.47 ± 340.80 mg/gCre) compared with the control group, which showed an increased UACR (mean increase, 63.93 ± 310.14 mg/gCre; P = .0007, Wilcoxon rank-sum test and t test). Although the spironolactone group had a statistically significant increase in serum potassium levels, none of the participants had a potassium level ≥5.5 mEq/L at 24 weeks. Further, participants with a higher initial serum potassium level tended to have a smaller increase (estimate, -0.37, analysis of covariance)., Conclusions: Low-dose spironolactone administration reduced albuminuria without causing hyperkalemia. Spironolactone administration, the oldest known and most cost-effective mineralocorticoid receptor antagonist, at lower doses should be reconsidered., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Humoral and cellular responses are critical in understanding immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Here, we evaluated these responses in hemodialysis (HD) patients after the booster vaccination. SARS-CoV-2 immunoglobulin (IgG) levels, neutralizing antibody titers, and the T-SPOT ® .COVID test (T-SPOT) were measured prior to, three weeks after, and three months after the booster administration. The HD group had significantly higher SARS-CoV-2 IgG levels and neutralizing antibody titers against the original strain at three weeks and three months after the booster vaccination compared to the control group, albeit the HD group had lower SARS-CoV-2 IgG levels and neutralizing antibody titers before the booster administration. Moreover, the HD group had significantly higher T-SPOT levels at all three time points compared to the control group. The HD group also had significantly higher local and systemic adverse reaction rates than the control group. By booster vaccination, HD patients could acquire more effective SARS-CoV-2-specific humoral and cellular immunity than the control group.

Bandgap tunable lanthanum niobium oxynitride [LaNb 2 O 7-x N x ] (1+x)- nanosheet is prepared by the delamination of a Ruddlesden-Popper phase perovskite oxynitride via ion-exchange and two-step intercalation processes. The lanthanum niobium oxynitride nanosheets have a homogeneous thickness of 1.6 nm and exhibit a variety of chromatic colors depending on the nitridation temperature of the parent-layered oxynitride. The bandgap energy of the nanosheets is determined by ultraviolet photoemission spectroscopy, Mott-Schottky, and photoelectrochemical measurements and is found to be tunable in the range of 2.03-2.63 eV. Furthermore, the oxide/oxynitride superlattice structures are fabricated by face-to-face stacking of 2D crystals using oxynitride [LaNb 2 O 7-x N x ] (1+x)- and oxide [Ca 2 Nb 3 O 10 ] - nanosheets as building blocks. Moreover, the superlattices-like restacked oxynitride/oxide nanosheets hybrid exhibits unique proton conductivity and dielectric properties strongly influenced by the oxynitride nanosheets and enhanced photocatalytic activity under visible light irradiation., (© 2023 Wiley-VCH GmbH.)

Background: Consolidation tumor ratio (CTR) calculated as the ratio of the tumor consolidation diameter to the tumor maximum diameter on thin-section computed tomography (CT) of lung cancer has been reported as an important prognostic factor. It has also been used for treatment decision-making. This study aimed to investigate the interobserver variability of CTR measurements on preoperative CT and propose a clinically useful CTR-based classification criterion., Methods: We enrolled 119 patients who underwent surgery for suspected or diagnosed small-sized lung cancer (≤3.0 cm in diameter). Nine doctors reviewed preoperative CT scans to measure CTR. Interobserver variability of CTR measurements was evaluated using the coefficient of variation (CV) and Fleiss' κ. The prognostic effect of the CTR-based classification was assessed using the Kaplan-Meier method., Results: Interobserver variability of CTR measurement was the highest for tumors with the lowest CTR (CTR = 0); it decreased as CTR increased and reached a plateaued level of low variability (CV <0.5) at CTR of 0.5. We proposed a three-group classification based on the findings of CTR interobserver variability (CTR < 0.5, 0.5 ≤ CTR < 1, and CTR = 1). Interobserver agreement of the judgment of the CTR-based classification was excellent (Fleiss' κ = 0.81). The classification significantly stratified patient prognosis (p < 0.001, 5-year overall survival rates with CTR < 0.5, 0.5 ≤ CTR < 1, and CTR = 1 were 100, 88, and 73.8%, respectively)., Conclusions: CTR 0.5 is a clinically relevant and helpful cutoff for treatment decision-making in patients with early-stage lung cancer based on high interobserver agreement and good prognostic stratification., (© 2022 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)

Objective: Analytical studies of risk factor assessment using machine learning have recently been reported. We performed an exploratory detection study of asthma exacerbation-related factors using health insurance claims data and machine learning to explore risk factors that have high generalizability and can be easily obtained in daily practice., Methods: A dataset of asthma patients during May 2014-April 2019 from the Japanese insurance claims database, MediScope® (DB) was used. Patient characteristics and disease information were extracted, and association with occurrence of asthma exacerbation was evaluated to comprehensively search for exacerbation risk factors. Asthma exacerbations were defined as the co-occurrence of emergency medical procedures, such as emergency transport and intravenous steroid injections, with asthma claims, which were recorded in the database., Results: In total, 5,844 (13.7%) subjects had exacerbations in 42,685 eligible cases from the DB. Information on approximately 3,300 diseases was subjected to a machine learning, and 25 variables were extracted as variable importance and targeted for risk assessment. As a result, sex, days without exacerbation from cohort entry date at look-back period, Charlson Comorbidity Index, allergic rhinitis, chronic sinusitis, acute airway disease (upper airway), acute airway disease (lower airways), Chronic obstructive pulmonary disease/chronic bronchitis, gastroesophageal reflux disease, and hypertension were significantly associated with exacerbation. Dyslipidemia and periodontitis were detected as associated factors of reduced exacerbation risk., Conclusions: A comprehensive analysis of claims data using machine learning showed asthma exacerbation risk factors mostly consistent with those in previous studies. Further examination in other fields is warranted.Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.1923740 .

Background: The mortality rate of Coronavirus disease 2019 (COVID-19) is extremely high in hemodialysis patients (HDP). These patients also develop lower antibody titers after vaccination. Therefore, factors associated with antibody titers and vaccine efficacy in HDP with breakthrough infection need to be investigated., Methods: We measured anti-S1 antibody titers in HDP (n = 104) and controls (n = 35), evaluating the influence of background on HDP by multivariable regression analysis. We classified 26 HDP patients admitted with COVID-19 into the unvaccinated (n = 15) and breakthrough infection group (n = 11), performing between-group comparisons of laboratory findings and prognosis. Vaccinated COVID-19 patients were classified into HDP and non-HDP controls, and compared the relationship between antibody titer and severity, and the prognosis of breakthrough infection., Results: The antibody titer was significantly lower in the HDP group than in the control group. Among HDP, age and smoking history were significantly independent factors associated with antibody titer. The breakthrough infection group had significantly better laboratory findings (KL-6 and LDH), severity, and hospitalization period than the unvaccinated group even if antibody titers were lower than the known threshold for neutralization (p < 0.05). There was no significant difference in prognosis between the HDP and non-HDP with breakthrough infection. Severity of COVID-19 tended to be higher with lower antibody titer in non-HDP, but not in HDP., Conclusion: Vaccines improved the severity of COVID-19 and hospitalization period of breakthrough infection in HDP, although HDP, especially in elderly smokers had lower antibody titers than control. There was no significant association between antibody titer and severity in HDP., (© 2022. The Author(s), under exclusive licence to The Japanese Society of Nephrology.)

An all-solid-state supercapacitor with no boundary between the electrode/electrolyte interface is prepared using methanesulfonic acid (MSA)-intercalated graphene oxide (GO)　membranes as a proton-conducting electrolyte. The electrodes (reduced GO) are formed within the surface of the solid GO electrolyte by a combination of self-reduction of the GO under UV-light illumination and electrochemical reduction. In this process, the surface of the GO film is converted to an electrode material with mixed electron/proton conduction, which results in the formation of a seamless capacitor structure. The resultant capacitor shows a large capacitance of 33.8 mF cm -2 , 11.9 F g -1 (g: total weight of device including electrodes, electrolyte, separator and current collector), which is 15 times higher than the capacitance retention of an all-solid-state supercapacitor fabricated using proton-conducting GO film. The seamless structures for the electrode/electrolyte interface suppress the decomposition of the GO electrolyte by the local concentration of applied voltage, resulting in improved cycle stability. The very large capacitance is likely derived not only from the seamless structure but also from the high proton conductivity of the MSA-intercalated GO electrolyte (4.2 × 10 -3  S cm -1 )., (© 2022 Wiley-VCH GmbH.)

Background: Dialysis patients are predisposed to severe disease and have a high mortality rate in coronavirus disease 2019 (COVID-19) due to their comorbidities and immunocompromised conditions. Therefore, dialysis patients should be prioritized for vaccination. This study aimed to examine how long the effects of the vaccine are maintained and what factors affect antibody titers., Methods: Hemodialysis patients (HD group) and age- and sex-matched non-dialysis individuals (Control group), receiving two doses of BNT162b2 vaccine, were recruited through the Japanese Society for Dialysis Therapy (JSDT) Web site in July 2021. Anti-SARS-CoV-2 immunoglobulin (IgG) (SARS-CoV-2 IgG titers) was measured before vaccination, 3 weeks after the first vaccination, 2 weeks after the second vaccination, and 3 months after the second vaccination, and was compared between Control group and HD group. Factors affecting SARS-CoV-2 IgG titers were also examined using multivariable regression analysis and stepwise regression analysis (least AIC). In addition, we compared adverse reactions in Control and HD groups and examined the relationship between adverse reactions and SARS-CoV-2 IgG titers., Results: Our study enrolled 123 participants in the Control group (62.6% men, median age 67.0 years) and 206 patients in the HD group (64.1% men, median age 66.4 years). HD group had significantly lower SARS-CoV-2 IgG titers at 3 weeks after the first vaccination ( p  < 0.0001), 2 weeks after second vaccination ( p  = 0.0002), and 3 months after the second vaccination ( p  = 0.045) than Control group. However, the reduction rate of SARS-CoV-2 IgG titers between 2 weeks and 3 months after the second vaccination was significantly smaller in HD group than in Control ( p  = 0.048). Stepwise regression analysis revealed that dialysis time was identified as the significant independent factors for SARS-CoV-2 IgG titers at 2 weeks after the second vaccination in HD group ( p  = 0.002) and longer dialysis time resulted in higher maximum antibody titers. The incidences of fever and nausea after the second vaccination were significantly higher in the HD group ( p  = 0.039 and p  = 0.020). Antibody titers in those with fever were significantly higher than those without fever in both groups (HD: p  = 0.0383, Control: p  = 0.0096)., Conclusion: HD patients had significantly lower antibody titers than age- and sex-matched non-dialysis individuals over 3 months after vaccination. Dialysis time was identified as a factor affecting SARS-CoV-2 IgG titers in HD group, with longer dialysis time resulting in higher maximum SARS-CoV-2 IgG titers., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2022.)

Antimicrobial resistance is a major health concern. A primary cause is the inappropriate use of antimicrobials, particularly by patients with upper respiratory tract infection. However, baseline information for antibiotic use for common cold before being applied the National Action Plan on Antimicrobial Resistance in Japan is lacking. Here, we analyzed the inappropriate use of antibiotics in the working-age workers. We used large claims data from an annual health check-up for at least 5 consecutive years. Among 201,223 participants, we included 18,659 working-age workers who were diagnosed with common cold at a clinic/hospital. We calculated the proportion of patients with common cold who were prescribed antibiotics and analyzed predictive factors associated with antibiotics prescription. Antibiotics were prescribed to 49.2% (n = 9180) of patients diagnosed with common cold. In the logistic regression analysis, the group taking antibiotics was predominantly younger, male, without chronic diseases, and diagnosed at a small hospital/clinic (where the number of beds was 0-19). Cephems accounted for the highest proportion of prescribed antibiotics, with 40-45% of patients being prescribed antibiotics. Our data may be applied to prioritize resources such as medical staff-intervention or education of working-age people without chronic diseases who visit clinics for common cold to avoid the potential inappropriate use of antibiotics and prevent antimicrobial resistance acceleration., (© 2021. The Author(s).)

Electrocatalysts with metal-nitrogen-carbon (M-N-C) sites have recently attracted much attention as potential catalysts for the oxygen reduction reaction (ORR), and a hybrid of iron phthalocyanine (FePc) and reduced graphene oxide (rGO) is one of the promising candidates. Herein, a FePc/GO nanocomposite was synthesized by electrostatic deposition on the electrode. The electrochemically reduced FePc/GO nanocomposite (ER(FePc/GO)) contained Fe 2+ centers in well reduced graphene sites without agglomeration. The ER(FePc/GO) exhibited high ORR activity with an ORR onset ( E onset ) and half-wave potential ( E 1/2 ) of 0.97 and 0.86 V, respectively. Furthermore, the ORR activity successfully improved by adding an electrolyte such as KCl or KNO 3 . The small H 2 O 2 yield of 2%, superior tolerance to methanol addition and high-durability indicate that the ER(FePc/GO) is a promising electrocatalyst. Theoretical studies, indicating that the presence of Cl - and NO 3 - ions lowered the conversion energy barrier, strongly supported the experimental results., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Elevated serum IgG4 is a useful marker of IgG4-related disease (IgG4-RD) activity. However, there is no uniformity in the cut-off values of IgG4 among the various reagents. The aim of this study was to compare the measured and cut-off values of IgG4 assessed using three different reagents. This study enrolled 466 IgG4-RD and non-IgG4-RD patients who required measurement of serum IgG4 levels to diagnose or treat IgG4-RD. Serum IgG4 was measured using three reagents: N-assay LA IgG4 Nittobo (Nittobo), BS-NIA IgG4 (TBS), and N Latex IgG4 (Siemens). The values obtained using the three reagents were compared, and cut-off values were calculated for each. Although there was good correlation among the results with the three reagents, the measured and cut-off values were all different. The Nittobo values were 1.4 times the TBS values and the TBS values were almost half those of the Siemens values. ROC curve analysis showed cut-off values for the Nittobo, TBS, and Siemens reagents of 1.42, 1.31, and 2.38 g/L, respectively. The measured and cut-off values of serum IgG4 vary depending on the reagents used for the assay, although there is good correlation among the values measured by the three reagents.

[Purpose] The aims of this study were 1) to examine the convergent validity between Lactate pro 2 and a standard JCA-BM 8000 automatic analyzer using salivary lactate and 2) to investigate the relationship between blood and salivary lactate levels after a vertical squat jump. [Participants and Methods] Healthy non-athletes participated in this observational study. The participants performed a vertical squat jump for 1 min 30 s. Blood and salivary lactate levels were measured before and after exercise using Lactate Pro 2. [Results] The intraclass correlation coefficient between Lactate Pro 2 and the JCA-BM 8000 automatic analyzer was 0.773, which can be considered as substantial convergent validity. However, in some samples, the salivary lactate level was out of the measurable range, and numerical values could not be obtained. The cross-correlation function between the blood and salivary lactate levels was 0.535 at lag 0 and 0.750 at lag 1, which indicated a 5-min lag between the salivary and blood lactate values. [Conclusion] Salivary lactate levels can be easily measured using Lactate Pro 2, although its sensitivity needs to be resolved. Further research is required for salivary lactate level, which can be collected non-invasively, to be used as an alternative parameter to blood lactate level., Competing Interests: None., (2021©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Objective: To identify risk factors for bleeding in atrial fibrillation (AF) patients treated with anti-coagulants such as warfarin, apixaban, edoxaban, dabigatran, rivaroxaban using a large claims database., Methods: A claims database for 8926 AF patients from 2004 to 2016 was obtained from JMDC. Inc. We performed a retrospective cohort study in 2796 Japanese AF patients with 4-month screening and 12-month observation periods. Polypharmacy was defined as prescription of over six drugs. Logistic regression analysis was conducted after stratification based on the presence and absence of cerebrovascular diseases to detect the predictive factors for bleeding., Results: Polypharmacy was observed in 815 of 2796 (29.1%) patients. A total of 371 AF patients (13.3%) experienced bleeding in the 12-month observation period. Bleeding risk assessment using multiple logistic regression analysis revealed that the odds ratio for the number of co-administered drugs in the elderly (age for ≥60, ≤74) was not significant in those without and with cerebrovascular diseases (1.05 [0.99-1.12], N.S. and 1.10 [0.96-1.27], N.S.). In contrast, in the young (age for <60), the number of co-administered drugs was a significant predictive factor in those without and with cerebrovascular diseases (1.09 [1.03-1.16], p = 0.0054 and 1.20 [1.05-1.36], p = 0.0059). Other observed predictors were"history of bleeding" in young and elderly, but "polypharmacy" and "start from warfarin" were observed in only young., Conclusion: We determined the bleeding risk in the clinical setting using a large claims database. Physicians and pharmacists need to monitor patients for the initial bleeding signs, particularly in those with these predictive risk factors., Competing Interests: MK and NY are affiliated with JMDC inc. There are no patents, products in development or marketed products to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

We have synthesized solid-solution nanoparticles (Pd : Ru = 1 : 3, 1 : 1 and 3 : 1) in an immiscible Pd-Ru system by the pulsed plasma in liquid method using Pd-Ru mixture bulk electrodes. The particle sizes of the floated and sedimented samples were measured to be <10 and <20 nm, respectively, via high-resolution transmission electron microscopy (HR-TEM). The lattice parameters of nanoparticles followed the Vegard's law, and the energy-dispersive X-ray spectroscopy (EDX) results almost coincided with those obtained for the starting bulk mixtures. The solid-solution structures and local structure were confirmed via HR-TEM, X-ray photoelectron spectroscopy (XPS) and X-ray absorption fine structure spectroscopy (XAFS)., Competing Interests: There are no conflicts of interest to declare., (This journal is © The Royal Society of Chemistry.)

Background: Predicting tolerability and treatment-related risks associated with azacitidine (AZA) in patients with myelodysplastic syndromes (MDS) before the initiation of therapy is required for appropriate treatment. Thus, in this study, the nutritional status of patients with MDS prior to AZA treatment was evaluated using the geriatric nutritional risk index (GNRI). Tolerability and overall survival (OS) after AZA initiation were also investigated., Methods: This was a single-center retrospective observational study. A total of 59 patients with MDS treated with AZA were assessed using GNRI, and a comparison of undernourished (GNRI <92, n = 27) and non-undernourished (GNRI ≥92, n = 32) patients was performed., Results: The undernourished group had a significant reduction in the number of patients that successfully completed 4 cycles of AZA treatment compared with the non-undernourished group (undernourished group, 11/27 patients, 40.7% vs. non-undernourished group, 24/32 patients, 75.0%; p = 0.009). Factors associated with the difference included karyotype and GNRI. There was also a significant increase in the rate of infectious complications in the undernourished group compared with the non-undernourished group (undernourished group, 33/60 cycles, 55.0% vs. non-undernourished group, 31/92 cycles, 33.7%; p = 0.012). Lastly, a significant reduction in OS was observed in the undernourished group compared with the non-undernourished group (undernourished group, 11.5 months; 95% CI, 5.2-16.7 vs. non-undernourished group, 21.9 months; 95% CI, 13.8-24.0; p = 0.026). Factors associated with OS included both the revised International Prognostic Scoring System (IPSS-R) and GNRI., Conclusions: These results indicate that predicting treatment completion and adverse events in patients with MDS prior to AZA treatment is important. This study suggests GNRI may be a valuable nutritional assessment tool for determining tolerability and OS of AZA treatment., (© 2021 S. Karger AG, Basel.)