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Abstract The durability of polymer electrolyte fuel cells (PEFCs) in fuel cell electric vehicles is important for the shift from passenger cars to heavy-duty vehicles. The components of a PEFC, namely the proton exchange membrane (PEM), catalyst layer (CL), and gas diffusion layer (GDL), contribute to the degradation of the fuel cell performance. In this paper, we propose a method for simultaneously evaluating the degradation rates of these components by combining electrochemical characterization with operando synchrotron X-ray radiography. The open-circuit voltage, electrochemically active surface area (ECSA), and water saturation were used as the degradation indicators for the PEMs, CLs, and GDLs, respectively. The results of two accelerated stress tests (loading and start-stop cycles) after 10,000 cycles showed that the increase in water saturation owing to the loss of hydrophobicity due to carbon corrosion in the cathode GDL occurred on the same timescale as the degradation in the PEM and cathode CL. Specifically, during the load cycle AST, the cathode CL degraded with a 26% reduction in the ECSA along with the cathode GDL degradation with a 10% increase in water saturation. This suggests that more efforts should be devoted to studies on the durability of GDLs for heavy-duty applications.

ABSTRACT Aims/Introduction The time course of chronic kidney disease in young‐onset type 2 diabetes mellitus remains unclear. We compared the trajectories of proteinuria and estimated glomerular filtration rate (eGFR) decline between young‐onset (aged ≤40 years) and late‐onset (aged >40 years) type 2 diabetes mellitus in a Japanese multicenter cohort. Materials and Methods Participants without diabetic kidney disease were divided into two groups according to age at diagnosis: young‐ and late‐onset. The primary endpoint was eGFR

Abstract Background Having no or few confidants is found to be associated with more severe mental health problems and a higher prevalence of depression in adults, but research examining this association in adolescents is scarce. Social relationships may be particularly critical during adolescence, as it is an important developmental period during which vulnerability to mental health problems increases. The present study examined the relationship between having no or few confidants and anxiety/depressive symptoms in adolescents. Methods Cross-sectional self-report survey targeting 7–12th grade students (age range: 12–18) was conducted in public junior and senior high schools in Mie and Kochi, Japan. Data from 17,829 students (49.7% boys) were analyzed. Associations between anxiety/depressive symptoms (12-item General Health Questionnaire; score range: 0–12) and the number of confidants (None, 1–3, or ≥ 4) were examined using multilevel regression analyses. The analyses were stratified by gender and school level (junior/senior high), and adjusted for experiences of being physically abused and bullied and the interactions of these experiences with the number of confidants. Results Having no or 1–3 confidants was associated with more anxiety/depressive symptoms, compared to having ≥ 4 confidants (p

Musician’s dystonia (MD) is a movement disorder characterized by involuntary muscle contractions specifically triggered by playing an instrument. This condition often leads to a loss of fine motor control, threatening the careers of affected musicians. While MD is commonly associated with the hands, it can also affect the lower limbs, particularly in drummers. Understanding the muscle coordination involved in MD is crucial for comprehending its neurological mechanisms, yet the muscle coordination of lower-limb dystonia has not been thoroughly explored. This study aimed to investigate the differences in lower-limb muscle synergies in a drummer with MD, utilizing non-negative matrix factorization (NMF) to analyze coordinated muscle activity patterns during drumming tasks. A 36-year-old male professional drummer with lower-limb MD was instructed to play a drum set in time with a metronome set at 80 beats per minute. The task involved striking the bass drum pedal in time with the downbeat. Electromyographic (EMG) data were collected from 10 muscles in the right lower limb. The data were analyzed using NMF to extract muscle synergies and compare the number of synergies, spatial modules, and temporal modules between the data with and without dystonia symptoms. The number of muscle synergies did not differ significantly between the data with and without symptoms. Notably, changes were observed in both the spatial and temporal modules of muscle synergies. Spatial modules revealed the appearance of dystonia-specific muscle synergy, which is considered related to compensatory movement. Temporal modules showed significant earlier overactivation in timing, which is considered the direct manifestation of dystonia symptoms. These findings indicate that lower-limb dystonia in drummers affects the spatial and temporal profiles of muscle synergies. This study underscores the importance of considering both spatial and temporal modules of muscle synergy in understanding and treating lower-limb dystonia in drummers. Further research is needed to validate these findings and apply muscle synergy analysis for the clinical assessment of lower-limb dystonia in drummers.

Water management is important for addressing the challenges posed by next‐generation fuel cell electric vehicles. Although X‐ray imaging techniques are useful for probing the mechanism of water transport in the gas diffusion layer of polymer electrolyte fuel cells, they cannot be easily applied to the Pt‐loading catalyst layer because of its low X‐ray transmittance due to the high absorption coefficient of Pt. Herein, a method to realize the high‐resolution X‐ray imaging of a 30 μm‐thick cathode catalyst layer in polymer electrolyte fuel cells using synchrotron X‐ray radiography is proposed, thus bridging the above gap. The results of operando synchrotron X‐ray radiography measurements reveal that water accumulation in the cathode catalyst layer depends on the cell temperature, feed gas humidity, and cell voltage, while time‐slice analysis shows that the water accumulation rate in the cathode catalyst layer immediately after the power generation is faster than that in the cathode gas diffusion layer. The proposed imaging method can be used to evaluate the water storage capacity of the catalyst layer and thus deepen the understanding of flooding phenomena and cold‐start behavior at subzero temperatures.

Abstract Background Vertebral hemangiomas (VHs) are the most common benign tumors of the spinal column and are often encountered incidentally during routine spinal imaging. Methods A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included “vertebral hemangioma,” "back pain,” “weakness,” “radiculopathy,” and “focal neurological deficits.” Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript. Result VHs are benign vascular proliferations that cause remodeling of bony trabeculae in the vertebral body of the spinal column. Horizontal trabeculae deteriorate leading to thickening of vertical trabeculae which causes a striated appearance on sagittal magnetic resonance imaging (MRI) and computed tomography (CT), “Corduroy sign,” and a punctuated appearance on axial imaging, “Polka dot sign.” These findings are seen in “typical vertebral hemangiomas” due to a low vascular-to-fat ratio of the lesion. Contrarily, atypical vertebral hemangiomas may or may not demonstrate the “Corduroy” or “Polka-dot” signs due to lower amounts of fat and a higher vascular component. Atypical vertebral hemangiomas often mimic other neoplastic pathologies, making diagnosis challenging. Although most VHs are asymptomatic, aggressive vertebral hemangiomas can present with neurologic sequelae such as myelopathy and radiculopathy due to nerve root and/or spinal cord compression. Asymptomatic vertebral hemangiomas do not require therapy, and there are many treatment options for vertebral hemangiomas causing pain, radiculopathy, and/or myelopathy. Surgery (corpectomy, laminectomy), percutaneous techniques (vertebroplasty, sclerotherapy, embolization), and radiotherapy can be used in combination or isolation as appropriate. Specific treatment options depend on the lesion's size/location and the extent of neural element compression. There is no consensus on the optimal treatment plan for symptomatic vertebral hemangioma patients, although management algorithms have been proposed. Conclusion While typical vertebral hemangioma diagnosis is relatively straightforward, the differential diagnosis is broad for atypical and aggressive lesions. There is an ongoing debate as to the best approach for managing symptomatic cases, however, surgical resection is often considered first line treatment for patients with neurologic deficit.

Abstract Background Chemotherapy-induced alopecia (CIA) is a distressing adverse effect of chemotherapy, with an estimated incidence of 65% and limited treatment options. Cyclophosphamide (CYP) is a common alopecia-inducing chemotherapy agent. Human dental pulp stem cells (DPSCs) secrete several paracrine factors that up-regulate hair growth. Conditioned medium (CM) collected from DPSCs (DPSC-CM) promotes hair growth; culturing mesenchymal stem cells under hypoxic conditions can enhance this effect. Methods The effect of DPSC-CM cultured under normoxic (N-) and hypoxic (H-) conditions against CYP-mediated cytotoxicity in keratinocytes was examined using cell viability assay, lactate dehydrogenase (LDH) cytotoxicity assay, and apoptosis detection. The damage-response pathway was determined in a well-established CIA mouse model by analyzing macroscopic effects, histology, and apoptosis. Reverse transcription-quantitative PCR and Caspase-3/7 activity assay were used to investigate the impact of DPSC-CM on the molecular damage-response pathways in CYP-treated mice. The effect of post-CIA DPSC-CM application on post-CIA hair regrowth was analyzed by macroscopic effects and microstructure observation of the hair surface. Furthermore, to investigate the safety of DPSC-CM as a viable treatment option, the effect of DPSC-CM on carcinoma cell lines was examined by cell viability assay and a subcutaneous tumor model. Results In the cell viability assay, DPSC-CM was observed to increase the number of keratinocytes over varying CYP concentrations. Furthermore, it reduced the LDH activity level and suppressed apoptosis in CYP-treated keratinocytes. DPSC-CM exhibited the cytoprotective role in vivo via the dystrophic anagen damage-response pathway. While both N-CM and H-CM downregulated the Caspase-3/7 activity level, H-CM downregulated Caspase-3 mRNA expression. The proportion of post-CIA H-CM-treated mice with > 90% normal hair was nearly twice that of vehicle- or N-CM-treated mice between days 50 and 59 post-depilation, suggesting that post-CIA H-CM application may accelerate hair regrowth and improve hair quality. Furthermore, DPSC-CM suppressed proliferation in vitro in certain carcinoma cell lines and did not promote the squamous cell carcinoma (SCC-VII) tumor growth rate in mice. Conclusions The potentiality of DPSC-CM and H-CM as a promising cytoprotective agent and hair regrowth stimulant, respectively, for CIA needs in-depth exploration.

Task-specific focal dystonia (TSFD), characterized by the loss of fine motor control and coordination, affects drummers’ lower-limb movements. This study explores lower-limb dystonia’s impact on drumming performance and underlying muscle activity in a professional rock drummer. The drummer executed an eight-beat pattern on a drum kit. The participant reported the occurrence of symptoms when he felt the abnormality such as the loss of control related to involuntary aspects of movement. We measured the peak amplitude of the bass drumhead vibration, synchronization errors as the time elapsed between the metronome onset and the bass drum onset, and amplitude of electromyographic (EMG) recordings centered on metronome beat. Dystonia symptoms primarily manifested in the initial beat, with fewer symptoms on syncopation of the third beat. Analysis revealed decreased bass-drum peak amplitude and earlier synchronization error during the initial beat. EMG measurements of 10 muscles in the affected right lower limb showed significant changes in the Biceps Femoris (BF), Tibialis Anterior (TA), Extensor Digitorum Longus (EDL), and Extensor Digitorum Brevis (EDB) muscles during symptom onset. We observed (1) earlier overactivation of the TA and EDL muscles during the leg lift-up motion or preparatory phase of pedaling, (2) reduced activation of the EDB muscle, and (3) increased activation of the BF muscle during the final pedaling movement when symptoms occurred. These findings suggest that lower-limb dystonia symptoms are characterized by a reduction in amplitude of the bass drumhead vibration and an increase in synchronization error, potentially due to premature overactivation of the ankle dorsiflexor muscles.

Preventing the accumulation of water in the gas diffusion layer (GDL) proves effective in enhancing the performance of polymer electrolyte fuel cells (PEFCs). To understand the water transport phenomena in GDLs and channels of PEFCs, cell hardware for operando synchrotron X-ray radiography was developed with a 100 mm channel length, facilitating the separate quantification of liquid water in the cathode and anode GDLs. The presence of liquid water in the cathode and anode GDLs was confirmed during operation with a supply of dry gas in a counter-flow configuration. Furthermore, the amount of liquid water in the cathode and anode GDLs increased toward the cathode inlet, while the amount of water in the cathode and anode channel regions increased toward each outlet. The liquid water distribution in the GDLs along the channel direction can be attributed to water transport from cathode to anode (back-diffusion), decreasing toward the anode outlet. Therefore, conducting radiography experiments aligned parallel to the GDLs and perpendicular to the channel could provide valuable insights for a more comprehensive understanding of water transport in cells.

Objectives: The reduced survival rate and diminished quality of life (QOL) observed in cancer patients with depression have garnered significant attention in recent years. Oral cancer can cause psychological and social stress because its incidence and treatment not only impair oral functions, such as mastication, swallowing, and articulation, but also disfigure the face. In this study, we investigated the factors that predict worsening psychiatric symptoms, such as anxiety and depression, in patients with oral cancer. Materials and methods: Thirty-seven patients with oral cancer who underwent radical resection with reconstructive surgery between 2017 and 2022 were enrolled. The Japanese version of the Hospital Anxiety and Depression Scale (HADS), a screening tool for anxiety and depression, was used to obtain preoperative scores and up to 9-month postoperative scores. Results: The number of patients that exceeded the cut-off values for adjustment disorder and depression was 19 (51.4%) preoperative and 20 (54.1%), 13 (35.1%), and 14 (37.8%) at 3, 6, and 9 postoperative months, respectively. The analysis of covariance showed that the primary site (F = 218.267, p = 0.0216) and marital status (F = 105.758, p = 0.0269) were factors that affected the HADS scores. Conclusion: The risk of postoperative anxiety and depression in patients with oral cancer undergoing radical resection with reconstruction may be increased in patients whose tongue is the primary site and in patients who are single.

Aims There is still little information available on the negative impact of online activities on psychotic experiences. This limitation is further compounded for online gaming, where even a beneficial impact has been suggested via the evocation of positive emotions. We aimed to examine how problematic online gaming (POG) is associated with subsequent psychotic experiences in adolescents. Methods This birth cohort study employed randomly sampled adolescents born between September 2002 and August 2004. The eligibility criterion was those who did not have psychotic experiences at age 14. We analyzed the association between POG at age 14 and subsequent psychotic experiences at age 16. Adolescents were categorized into the no, low, and high POG groups based on the behaviors and emotions related to online gaming at age 14. Missing data were handled using random forest imputations. Results A total of 1722 adolescents without psychotic experiences at age 14 were analyzed. At age 16, 55 adolescents exhibited psychotic experiences, while 225 showed potential psychotic experiences. Compared with the no POG group, a higher risk of psychotic experiences was shown in both the low (RR 1.93, 95% CI 1.74–2.15) and high (RR 2.81, 95% CI 2.50–3.15) POG groups. Findings were consistent when analyzing potential psychotic experiences. Conclusion POG appears detrimental to the development of psychotic experiences in adolescents. Our findings provide public health implications in the context of policymaking.

A technology that can effectively distinguish between various odorants with high sensitivity and selectivity has numerous applications ranging from water quality testing to disease diagnosis. Here, we report a cell-based odorant-sensing display that utilizes Sf21 cells expressing odorant receptors, co-receptors, and a calcium-sensitive fluorescent protein as the sensing elements for detecting multiple odorants. Integrated micropatterns of the sensor cells in a few hundred micrometer-size patterns were fabricated on photoactivatable cell-anchoring surfaces consisting of photo-responsive polymeric materials. In the microfluidic system equipped with the sensing display, the injection of two model odorants, such as Bombykal and 1-octen-3-ol, at micro-molar concentrations resulted in selective and rapid fluorescence emission from the corresponding sensor cell patterns. Furthermore, when both odorants were injected together, the fluorescence from each corresponding sensor cell could be observed simultaneously. This study provides the proof of principle that the current cell patterning system enables the discrimination of odors, including multiple odorants, through a finely patterned sensing display on the device.

Abstract Background Sex disparities in the association between epicardial adipose tissue volume (EATV) and cardiovascular disease have been reported. The sex-dependent effects of EATV on left atrial (LA) size have not been elucidated. Methods Consecutive 247 subjects (median 65 [interquartile range 57, 75] years; 67% of men) who underwent multi-detector computed tomography without significant coronary artery disease or moderate to severe valvular disease were divided into two groups: patients with sinus rhythm (SR) or atrial fibrillation (AF). Sex differences in the association between the EATV index (EATVI) (mL/m2) and LA volume index (LAVI) in 63 SR (28 men and 35 women) and 184 AF (137 men and 47 women) patients were evaluated using univariate and multivariate regression analyses. Results In overall that includes both men and women, the relationship between EATVI and LAVI was not significantly correlated for patients with SR and AF. The relationship between EATVI and LAVI differed between men and women in both SR and AF groups. In SR patients, there was a positive relationship between EATVI and LAVI in men, but not in women. In contrast, in patients with AF, a negative relationship was found between EATVI and LAVI in women, whereas no association was found in men. Conclusions We evaluated sex differences in the association between EATVI and LAVI in patients with either SR or AF, and found a positive relationship in men with SR and a negative relationship in women with AF. This is the first report to evaluate sex differences in the relationship between EATVI and LAVI, suggesting that EAT may play a role, at least in part, in sex differences in the etiology of AF.

Abstract School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students’ suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher’s responsibility. Intention to ask about students’ suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s–60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers’ suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.

The MHC class I-related 1 (MR1) molecule is a non-polymorphic antigen-presenting molecule that presents several metabolites to MR1-restricted T cells, including mucosal-associated invariant T (MAIT) cells. MR1 ligands bind to MR1 molecules by forming a Schiff base with the K43 residue of MR1, which induces the folding of MR1 and its reach to the cell surface. An antagonistic MR1 ligand, Ac-6-FP, and the K43A mutation of MR1 are known to inhibit the responses of MR1-restricted T cells. In this study, we analyzed MR1-restricted TCRs obtained from tumor-infiltrating lymphocytes (TILs) from breast cancer patients. They responded to two breast cancer cell lines independently from microbial infection and did not respond to other cancer cell lines or normal breast cells. Interestingly, the reactivity of these TCRs was not inhibited by Ac-6-FP, while it was attenuated by the K43A mutation of MR1. Our findings suggest the existence of a novel class of MR1-restricted TCRs whose antigen is expressed in some breast cancer cells and binds to MR1 depending on the K43 residue of MR1 but without being influenced by Ac-6-FP. This work provides new insight into the physiological roles of MR1 and MR1-restricted T cells.

Introduction ACE cleaves angiotensin I (Ang I) to angiotensin II (Ang II) inducing vasoconstriction via Ang II type 1 (AT1) receptor, while ACE2 cleaves Ang II to Ang (1–7) causing vasodilatation by acting on the Mas receptor. In diabetic kidney disease (DKD), it is still unclear whether plasma or urine ACE2 levels predict renal outcomes or not.Research design and methods Among 777 participants with diabetes enrolled in the Urinary biomarker for Continuous And Rapid progression of diabetic nEphropathy study, the 296 patients followed up for 9 years were investigated. Plasma and urinary ACE2 levels were measured by the ELISA. The primary end point was a composite of a decrease of estimated glomerular filtration rate (eGFR) by at least 30% from baseline or initiation of hemodialysis or peritoneal dialysis. The secondary end points were a 30% increase or a 30% decrease in albumin-to-creatinine ratio from baseline to 1 year.Results The cumulative incidence of the renal composite outcome was significantly higher in group 1 with lowest tertile of plasma ACE2 (p=0.040). Group 2 with middle and highest tertile was associated with better renal outcomes in the crude Cox regression model adjusted by age and sex (HR 0.56, 95% CI 0.31 to 0.99, p=0.047). Plasma ACE2 levels demonstrated a significant association with 30% decrease in ACR (OR 1.46, 95% CI 1.044 to 2.035, p=0.027) after adjusting for age, sex, systolic blood pressure, hemoglobin A1c, and eGFR.Conclusions Higher baseline plasma ACE2 levels in DKD were protective for development and progression of albuminuria and associated with fewer renal end points, suggesting plasma ACE2 may be used as a prognosis marker of DKD.Trial registration number UMIN000011525.

IntroductionParents and guardians (hereafter caregivers) of teenagers need high levels of mental health literacy (MHL) to manage mental health problems arising in teenagers in their care. Previous studies assessing MHL levels in caregivers of teenagers have reported mixed results, making it difficult to clearly estimate caregiver MHL levels. This study aimed to investigate MHL levels in Japanese caregivers of regular teenagers.MethodsResponses from caregivers (n = 1,397) of students entering junior and senior high schools to a self-administered online questionnaire were analyzed. The questionnaire assessed (a) knowledge about mental health/illnesses and (b) attitudes towards mental health problems in teens in their care (e.g., recognition of depression as a medical illness and intention to engage in helping behaviors).ResultsThe average proportion of correct answers to the knowledge questions (n = 7) was 55.4%; about one tenth (9.2%) of caregivers correctly answered only one or none of the questions. Few caregivers correctly answered about the life-time prevalence of any mental illnesses (46.1%) and appropriate sleep duration for teenagers’ health (16.5%). The proportions of caregivers who had the intention to listen to the teen in their care, consult another person, and seek professional medical help if the teen suffered from depression were 99.5%, 91.5% and 72.7%, respectively.ConclusionsMany teenagers’ caregivers appeared to be willing to help the teens in their care if they were suffering from mental health problems. However, there was much room for improvement in knowledge on mental health/illnesses and intention to seek help from medical professionals. Efforts toward better education should be made.

Objective: Oral cancer impairs mastication and swallowing and worsens the nutritional status of patients; however, preoperative malnutrition is rarely diagnosed and treated. Controlling nutritional status (CONUT) is an indicator of the overall nutritional status. Herein, we aimed to determine the utility of the CONUT score in predicting short-term outcomes in patients with oral cancer. Materials and methods: We included 85 patients with oral cancer who had undergone surgery between June 2007 and December 2022. Patients with a preoperative CONUT score of ≤2 were classified as the CONUT-low group, whereas those with a CONUT score of ≥3 were classified as the CONUT-high group, and their postoperative hospital stays were compared. In addition, factors associated with prolonged hospitalization were subjected to analysis of covariance (ANCOVA). Results: The median postoperative hospital stay for patients in the CONUT-low and CONUT-high groups were 46 (30–60.5, N = 69) and 59 (38–110, N = 16) days, respectively, revealing a significant difference between the two groups (p = 0.033). The relationship between hospital discharge and postoperative hospital stay was evaluated using the Kaplan-Meier method, and a significant difference was detected between the two groups (p = 0.0113). Furthermore, ANCOVA revealed a difference only in CONUT-high/low scores (F = 4.4251, p = 0.039). Conclusion: The preoperative CONUT score could be an independent risk factor for predicting prolonged hospitalization and a useful screening tool for nutritional status.

Category: Trauma; Ankle Introduction/Purpose: In surgery for ankle fractures with tibiofibular diastasis, it is important to vertically grasp the distal tibiofibular joint. However, it is difficult to do that because the tibiofibular joint surface is not under direct vision. Center-center method (CC) is an intraoperative fluoroscopic technique to determine the position of the syndesmotic clamp. CC has been reported to reduce the risk of syndesmotic malreduction, but It is unclear whether the axis by CC (CC axis) coincides with the axis perpendicular to the distal tibiofibular joint (trans-syndesmosis axis: TS axis). Therefore, the present study aims to 1) measure the difference between the CC axis and TS axis, and 2) compare the measured values when CC is performed at different distances from the ankle joint surface. Methods: The subjects were 150 patients who underwent CT scans for ankle joint disease and lower extremity trauma. CC is a method in which the ankle joint is rotated, and the midpoint of the anteroposterior margin of the tibia and fibula is superimposed by fluoroscopy. In the present study, CC was performed using Digitally reconstructed radiography (DRR) created from a CT image. At the ankle joint surface (0mm), CC axis and TS axis were projected onto the CT axis linked with DRR. The angle between the axes was measured (inter-axes angle). Also, the distance of the intersection of these axes through the medial cortex of the tibia was measured (inter-axes distance). It was also performed at 10mm and 20mm proximal to the ankle joint surface. One-way repeated measures analysis of variance and the post hoc Bonferroni tests were used to compare the measured values' difference according to the articular surface's height. Results: Overall, the TS axis was externally rotated relative to the CC axis, with a mean inter-axes angle of 8.5±6.8degrees. The inter-axes angle of 0mm, 10mm, and 20mm were 1.9±4.0degrees, 10±5.3degrees, and 13±5.1degrees, respectively (p < 0.001). Also, the intersection point of the TS axis with the medial tibial cortex was anterior to the intersection of the CC axis, with an inter-axes distance of 7.7±6.3mm overall. The inter-axes distance of 0mm, 10mm, and 20mm were 2.0±4.2mm, 9.0±4.9mm, and 11.3±5.2mm, respectively (p < 0.001). Both the inter-axes angle and the inter-axes distance were larger when the CC method was performed higher to the tibial plafond (P < .001), with the post hoc tests showing significant differences among all heights. Conclusion: The TS axis was externally rotated to the CC axis and positioned slightly anteriorly. Also, the inter-axes angle and distance were larger when the CC method was performed higher to the tibial plafond. If the surgeon aimed to clamp the syndesmosis along the TS axis, the CC method should be applied closer to the ankle joint surface, and the medial tip of the forceps be placed slightly anterior to the point determined by the CC axis.

We report a 15-year-old female patient who sustained peroneus brevis injury caused by an impingement between the hypertrophied peroneal tubercle and lateral malleolus. The patient had pain for 3 years in the lateral side of her left ankle with unsuccessful conservative treatment. The oblique sagittal images of 3-dimensional magnetic resonance imaging and ultrasonography were useful in depicting the peroneus brevis injury and identifying the location of impingement between the hypertrophied peroneal tubercle and the tip of the lateral malleolus. The flatfoot deformity of the patient further aggravated the impingement. The patient was treated surgically, with excision of the enlarged tubercle and tendon repair. The ankle pain resolved 12 months postoperatively. Although rare, clinicians should recognize this condition as the cause of lateral ankle pain.

Abstract Background This study aimed to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years and compare these outcomes with those of patients aged

Pentosidine (PEN) is an advanced glycation end-product (AGEs), where a fluorescent cross-link is formed between lysine and arginine residues in proteins. Accumulation of PEN is associated with aging and various diseases. We previously reported that a subpopulation of patients with schizophrenia showed PEN accumulation in the blood, having severe clinical features. PEN is thought to be produced from glucose, fructose, pentoses, or ascorbate. However, patients with schizophrenia with high PEN levels present no elevation of these precursors of PEN in their blood. Therefore, the molecular mechanisms underlying PEN accumulation and the molecular pathogenesis of schizophrenia associated with PEN accumulation remain unclear. Here, we identified glucuronic acid (GlcA) as a novel precursor of PEN from the plasma of subjects with high PEN levels. We demonstrated that PEN can be generated from GlcA, both in vitro and in vivo. Furthermore, we found that GlcA was associated with the diagnosis of schizophrenia. Among patients with high PEN, the proportion of those who also have high GlcA is 25.6%. We also showed that Aldo-keto reductase (AKR) activity to degrade GlcA was decreased in patients with schizophrenia, and its activity was negatively correlated with GlcA levels in the plasma. This is the first report to show that PEN is generated from GlcA. In the future, this finding will contribute to understanding the molecular pathogenesis of not only schizophrenia but also other diseases with PEN accumulation.

An X-ray computed nano-tomography (nano-CT) system has been established at the BL33XU beamline of SPring-8. The optical system consists of pseudo-Köhler illumination with a sector condenser zone plate, an apodization Fresnel zone plate as the objective lens, and a Zernike phase plate. The imaging detector is a fiber-coupling type X-ray camera. The performance of the X-ray nano-CT system was confirmed by imaging an X-ray test chart. The system was subsequently applied to the observation of a microporous layer for polymer electrolyte fuel cells and a simulated microporous layer including liquid water. The nano-CT system, which can perform a computed tomography measurement in less than 4 min, allowed visualization of a spherical water droplet produced in the microporous layer. In the present study, the shape of water droplets in a nanoscale porous structure is investigated.

Objectives: The development and treatment of oral cancer are highly invasive, either functionally or psychologically, having a significant effect on patients' daily lives. As such, social support is important, but few studies have been reported. The aim of this study was to investigate social support for patients with oral cancer and patients' level of social adaptation. Materials and methods: Patients with oral cancer who had undergone resection and reconstruction surgery in our department from February 2017 to June 2021 were included. The Social Support Questionnaire (SSQ) was used to evaluate the number of supporters (SSQN) and the satisfaction of patients (SSQS) with social support. The Social Adaptation Self-evaluation Scale (SASS) was used to evaluate the social adaptation of the patients, and their relationships were examined. Results: In total, 30 patients completed the questionnaire. We found a positive correlation between the SSQN and the SASS (rs ​= ​0.485–0.617 and p ​

Baffles in flow field channels for air in a polymer electrolyte fuel cell are known to enhance the performance by inducing convective flow through the gas diffusion layer (GDL) with smaller pressure loss than interdigitated flow fields. This work experimentally correlates performance enhancement with the amount of liquid water in a GDL. A parallel flow field (PFF) that has different inlet and outlet opening sizes is applied to induce cross-flow in the GDL under the rib between adjacent air channels. Operando synchrotron X-ray radiography experiments are conducted to compare the amount of water in the GDL with that for a PFF having the same inlet and outlet sizes. The performance enhancement by application of different opening sizes increases with decreasing relative humidity and increasing air flow rate. A significant performance enhancement is observed when the amount of water in the GDL substrate under the rib becomes almost zero. No performance enhancement is observed under over-humidified conditions, although a decrease in the amount of water in the GDL is still observed, which suggests that the performance becomes insensitive to the difference in the liquid water saturation as the saturation increases.

Objective: Understanding the extent of social reintegration is crucial in providing social support to patients. The incidence and treatment of oral cancer can result in functional and aesthetic impairments that significantly affect the daily lives of patients. Therefore, we aimed to determine the social adaptation status of patients after oral cancer surgery. Methods: Patients who had undergone resection and reconstructive surgery with free flaps for oral cancer between February 2017 and October 2020 and agreed to participate in this study were included. The social adaptation status of patients was assessed using the Japanese version of the Social Adaptation Self-evaluation Scale (SASS-J; higher scores denote better social adaptation) preoperatively and at 3- and 6-months postoperatively. Results: Thirty-four patients completed the SASS-J questionnaire. The median preoperative and 3- and 6-month postoperative SASS-J scores were 34 (26.5–39.25), 33.5 (25–38), and 33.5 (30–40), respectively, and did not differ significantly between these three categories. Analysis of covariance (ANCOVA) of 6-month postoperative SASS-J scores revealed significant differences for both the primary site of cancer (F = 6.6024, p = 0.0007) and marital status (F = 11.6866, p = 0.0019). Furthermore, multiple comparisons for the primary site of cancer indicated that the SASS-J scores of patients with tongue cancer were significantly lower than those of patients with mandibular cancer (p = 0.0178). Conclusions: These results indicate that the postoperative social adaptation status among patients who underwent oral cancer resection with reconstruction is worse in patients with tongue cancer and in those who are unmarried.

ABSTRACT: Dairy cattle must allocate energy to milk production and reproduction. Therefore, understanding the environmental factors that affect conception rates in nulliparous and primiparous cows is helpful in appropriate feeding management strategies before and after calving. Accordingly, the aim of this study was to investigate the influence of environmental factors before and after the first calving on the conception rate, representing the starting point of milk production. The records of the first artificial insemination (AI) from Holstein nulliparous cows (n = 533,672) and primiparous cows (n = 516,710) in Hokkaido, Japan, were analyzed using separate multivariable logistic regression models. The mean conception rates for nulliparous and primiparous cows from 2012 to 2018 were 55.2 and 39.2%, respectively. In both nulliparous and primiparous cows, the conception rate of crossbreeding using Japanese Black (JB) semen was significantly higher than that for purebred Holstein breeding. The conception rate using sexed semen decreased in the warmer months only in nulliparous cows. Moreover, we grouped primiparous cows according to milk yield during peak lactation (PY; < 25, 25–30, 30–35, ≥35 kg) and the interval from calving to first insemination (CFI; < 60, 60–79, 80–99, ≥100 d), and evaluated their combined effect on the conception rate. Both PY and CFI strongly affected the conception rate in primiparous cows, which decreased with an increase in PY, even for the group with CFI ≥100 d; however, the conception rate increased for a CFI ≥60 d regardless of PY. Taken together, this study demonstrates the long-term effect of PY and an independent effect of CFI on the conception rate of cows. These results provide guidance for management to execute appropriate AI implementation strategies before and after lactation.

Abstract Background The development of computer-assisted technologies to diagnose anterior cruciate ligament (ACL) injury by analyzing knee magnetic resonance images (MRI) would be beneficial, and convolutional neural network (CNN)-based deep learning approaches may offer a solution. This study aimed to evaluate the accuracy of a CNN system in diagnosing ACL ruptures by a single slice from a knee MRI and to compare the results with that of experienced human readers. Methods One hundred sagittal MR images from patients with and without ACL injuries, confirmed by arthroscopy, were cropped and used for the CNN training. The final decision by the CNN for intact or torn ACL was based on the probability of ACL tear on a single MRI slice. Twelve board-certified physicians reviewed the same images used by CNN. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the CNN classification was 91.0%, 86.0%, 88.5%, 87.0%, and 91.0%, respectively. The overall values of the physicians’ readings were similar, but the specificity was lower than the CNN classification for some of the physicians, thus resulting in lower accuracy for the human readers. Conclusions The trained CNN automatically detected the ACL tears with acceptable accuracy comparable to that of human readers.

Objective: Oral cancer is associated with functional impairment and changes in appearance due to disease progression and/or treatment. It therefore places a heavy psychological burden on patients. Coping styles of patients with cancer may affect their quality of life (QOL). However, there is limited research assessing this association. We aimed to clarify the relationship between coping styles and QOL in patients with oral cancer to underpin personalized patient care. Methods: Patients who underwent surgery with reconstruction for oral cancer between February 2017 and June 2021 were included in this study. Coping styles were assessed preoperatively using the Mental Adjustment to Cancer (MAC) scale. Mental and physical QOL was assessed preoperatively and at 3, 6 and 9 months postoperatively, using the Short Form-8 (SF-8) health survey. Results: Twenty-seven patients completed the MAC and SF-8. The median (interquartile range) scores of MAC subscales summary positive adjustment (SPA) and summary negative adjustment were 48.0 (44.0–55.0) and 34.0 (29.0–38.0) points, respectively. The mental component summary (MCS) scores of the SF-8 at the preoperative assessment and 3, 6 and 9 months postoperatively were 47.2 (43.5–50.6), 45.2 (41.2–51.3), 48.4 (43.7–52.0) and 47.7 (43.2–51.0) points, respectively; the physical component summary scores were 47.2 (42.4–51.0), 41.9 (38.4–47.7), 44.8 (41.4–49.9) and 47.0 (42.9–50.0) points, respectively. A positive correlation was noted between the SPA and MCS preoperatively, and 3 and 9 months postoperatively. Conclusions: Coping style may have predictive value for oral cancer patients with low mental QOL.

Abstract Background Patellar and patellar tendon pain is a common limitation to children’s participation in social and physical activities. Some factors have been implicated in the occurrence and protraction of knee pain, but the causal relationship is unknown. The purpose of this study was to investigate whether participants’ physical characteristics and activity level are risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents. Methods A three-year prospective cohort study was conducted with healthy students who were aged 8–14 years old, in Japan. Height, weight, heel-buttock distance, straight leg raising angle, and dorsiflexion angle of the ankle joint were collected as individual physical factors at the beginning of each year. The presence of self-reported patellar and patellar tendon pain and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was collected every month. Protraction was defined as either (1) pain lasting for more than three continuous months or (2) recurrent pain after more than three months of complete recovery. Participants who did not have any pain at the beginning of the observation period were included in the analysis. We analyzed the odds ratio (OR) of pain occurrence within a year of registration and protraction throughout the study period for all physical factors and HSS Pedi-FABS. Results We included 1133 participants in the analysis and 252 participants developed knee pain within a year. 34.8% of participants with pain experienced protraction during the follow-up period. A high HSS Pedi-FABS significantly predicted knee pain occurrence (OR 1.03, 95% confidence interval [CI] 1.01–1.05) and protraction (OR 1.03, 95% CI 1.00–1.05). In addition, younger children and girls were at a significantly higher risk of patellar and patellar tendon pain protraction (age, OR 0.81, 95% CI, 0.73–0.90; sex, OR 1.69, 95% CI, 1.09–2.64). Other physical factors did not significantly predict the occurrence or protraction of knee pain. Conclusions This study showed that a greater physical activity level was a risk factor for the occurrence and protraction of patellar and patellar tendon pain in childhood. In addition, younger age and female sex predicted higher risk of protraction of pain.

Abstract Power devices are operated under harsh conditions, such as high currents and voltages, and so degradation of these devices is an important issue. Our group previously found significant increases in reverse leakage current after applying continuous forward current stress to GaN p–n junctions. In the present study, we identified the type of threading dislocations that provide pathways for this reverse leakage current. GaN p–n diodes were grown by metalorganic vapor phase epitaxy on freestanding GaN(0001) substrates with threading dislocation densities of approximately 3 × 105 cm−2. These diodes exhibited a breakdown voltage on the order of 200 V and avalanche capability. The leakage current in some diodes in response to a reverse bias was found to rapidly increase with continuous forward current injection, and leakage sites were identified by optical emission microscopy. Closed-core threading screw dislocations (TSDs) were found at five emission spots based on cross-sectional transmission electron microscopy analyses using two-beam diffraction conditions. The Burgers vectors of these dislocations were identified as [0001] using large-angle convergent-beam electron diffraction. Thus, TSDs for which b = 1c are believed to provide current leakage paths in response to forward current stress.

Small cell neuroendocrine carcinoma is rare among urinary bladder cancer types, and to date, there are no case reports of concurrent antitranscriptional intermediary factor 1-γantibody-positive dermatomyositis. We describe the case of a 69-year-old Japanese man who presented with elevated creatine kinase levels and haematuria on medical examination. Approximately one month later, he developed dysphagia. Laryngoscopy confirmed laryngeal dysfunction. He also presented with muscle weakness and a skin rash. Magnetic resonance imaging of the upper extremities suggested bilateral brachial muscle myositis. He was diagnosed as having dermatomyositis and was later found to be positive for antitranscriptional intermediary factor 1-γ antibody. Computed tomography revealed an intravesical space-occupying lesion and right iliac lymphadenopathy, suggesting urinary bladder cancer. The patient was admitted to our hospital for treatment. Urinary bladder biopsy confirmed small cell neuroendocrine carcinoma because tumour cells were positive for synaptophysin, CD56, and chromogranin A. Thus, the patient was diagnosed as having an antitranscriptional intermediary factor 1-γantibody-positive dermatomyositis concomitant with urinary bladder small cell neuroendocrine carcinoma. The patient was treated with glucocorticoid and intravenous immune globulin therapy for dermatomyositis. Radiotherapy was selected for the carcinoma. Although muscle weakness and skin symptoms improved with treatment, dysphagia persisted. Furthermore, expression of the transcriptional intermediary factor 1-γ protein in tumour cells was also confirmed by immunohistochemistry, but the significance is unknown. It should be noted that antitranscriptional intermediary factor 1-γantibody-positive dermatomyositis can occur concomitantly with such a rare malignancy.

ObjectivesThis study aimed to characterize the content of frequently asked questions about the treatment of rheumatoid arthritis (RA) on the internet in Japan and to evaluate the quality of websites related to the questions.MethodsWe searched terms on the treatment of RA on Google and extracted frequently asked questions generated by the Google "people also ask" function. The website that answered each question was also obtained. We categorized the questions based on the content. The quality of the websites was evaluated using the brief DISCERN, Journal of American Medical Association benchmark criteria, and Clear Communication Index.ResultsOur search yielded 83 questions and the corresponding websites. The most frequently asked questions were regarding the timeline of treatment (n = 17, 23%) and those on the timeline of the clinical course (n = 13, 16%). The median score of brief DISCERN was 11 points, with only 7 (8%) websites having sufficient quality. Websites having sufficient quality based on the Journal of American Medical Association benchmark criteria and Clear Communication Index were absent.ConclusionsThe questions were most frequently related to the timeline of treatment and clinical course. Physicians should provide such information to patients with RA in the counseling and education materials.

ObjectivesThis study evaluated the reliability and validity of the Forgotten Joint Score-12 (FJS-12)-a measure of patients' ability to forget their joints in daily life-in patients who underwent total ankle replacement (TAR) or ankle arthrodesis (AA).MethodsPatients who underwent TAR or AA were recruited from seven hospitals. The patients completed the Japanese version of FJS-12 twice, at an interval of two weeks, at a minimum of one year postoperatively. Additionally, they answered the Self-Administered Foot Evaluation Questionnaire and EuroQoL 5-Dimension 5-Level as comparators. The construct validity, internal consistency, test-retest reliability, measurement error, and floor and ceiling effects were evaluated.ResultsA total of 115 patients (median age, 72 years), comprising 50 and 65 patients in the TAR and AA groups respectively, were evaluated. The mean FJS-12 scores were 65 and 58 for the TAR and AA groups, respectively, with no significant difference between groups (P = 0.20). Correlations between the FJS-12 and Self-Administered Foot Evaluation Questionnaire subscale scores were good to moderate. The correlation coefficient ranged from 0.39 to 0.71 and 0.55 to 0.79 in the TAR and AA groups, respectively. The correlation between the FJS-12 and EuroQoL 5-Dimension 5-Level scores was poor in both groups. The internal consistency was adequate, with Cronbach's α greater than 0.9 in both groups. The intraclass correlation coefficients of test-retest reliability was 0.77 and 0.98 in the TAR and AA groups, respectively. The 95% minimal detectable change values were 18.0 and 7.2 points in the TAR and AA groups, respectively. No floor or ceiling effect was observed in either group.ConclusionsThe Japanese version of FJS-12 is a valid and reliable questionnaire for measuring joint awareness in patients with TAR or AA. The FJS-12 can be a useful tool for the postoperative assessment of patients with end-stage ankle arthritis.

Materials informatics involves the application of computational methodologies to process and interpret scientific and engineering data concerning materials. Although this concept has been well established in the fields of biology, drug discovery, and classic materials research, its application in the field of dental materials is still in its infancy. This narrative review comprehensively summarizes the advantages, limitations, and future perspectives of materials informatics from 2003 to 2022 for exploring the optimum compositions in developing new materials using artificial intelligence. The findings indicate that materials informatics, which is a recognized and established concept in the materials science field, will accelerate the process of restorative materials development and contribute to producing new insights into dental materials research.

Abstract Aims In previous randomized controlled trials, the use of tolvaptan (TLV) at a fixed dose of 30 mg/day for 1 year did not provide renal benefits in patients with heart failure (HF). This retrospective, cohort study examined the renoprotective effects of long‐term, flexible‐dose, and lower‐dose TLV use. Methods and results Tolvaptan users were defined as patients receiving TLV for at least 180 consecutive days or those who continued it until death, any cardiac events, or renal replacement therapy even if it was taken for

Abstract Aims The prognostic significance of renal function variability has not been fully elucidated in heart failure (HF). This multicentre, prospective cohort study aimed to evaluate the usefulness of visit‐to‐visit variability in estimated glomerular filtration rate (eGFR) for predicting patients' outcomes in a real‐world HF population. Methods A total of 564 patients who had survived HF hospitalization were randomly assigned with a 2:1 ratio to derivation and validation cohorts, and they were then followed after discharge. Using the data for 6 months after discharge, each patient's visit‐to‐visit eGFR variability (EGV) was estimated. In the derivation cohort, Cox regression analyses were performed to assess the association of EGV with a subsequent composite event (death and HF hospitalization). In the validation cohort, the predictive performance was compared among Cox regression models with EGV, those with B‐type natriuretic peptide (BNP) and those with eGFR. Results In the derivation cohort (376 patients), median age, left ventricular ejection fraction (LVEF), BNP and eGFR at discharge were 72 years, 53.3%, 134.8 pg/mL and 58.7 mL/min/1.73 m2, respectively. During a median follow‐up of 2.2 years, higher EGV was associated with an increased risk of the composite event (adjusted hazard ratio [per standard deviation increase in log‐transformed EGV], 1.5; 95% confidence interval, 1.1–2.0). A similar finding was observed in a stratified analysis by LVEF. In the validation cohort (188 patients), better model fit, discrimination, reclassification and calibration were observed for EGV than for 6‐month averaged BNP or eGFR for predicting the composite event when added to HF risk prediction models. Adding EGV to models with BNP or eGFR improved model discrimination and reclassification. Conclusions EGV predicts HF outcomes regardless of LVEF. Risk prediction models with EGV have good performance in real‐world HF patients. The study findings highlight the clinical importance of observing visit‐to‐visit fluctuations in renal function in this population.

Abstract Background Mobility decrease leading to disability can gradually develop during early life, however, its related factors are not well clarified. Therefore, we investigate the related factors of mobility decrease at various levels, using nationwide data in Japan. Methods In total, 8681 independent community dwellers aged 20-89 years were analysed (average age, 51.6 years; 58.5% women). Three stages of mobility decrease were based on the locomotive syndrome risk test: Stage 1, emerging; Stage 2, progressing; Stage 3, progressed to restrict social engagement. Age was analysed using a simple quadratic function model. Results The prevalence of Stages 1-3 was 31.6% (n = 2746), 5.8% (n = 504), and 3.2% (n = 278), respectively. On the multivariable logistic regression, increased age in participants aged ≥40 years (stage 1: odds ratio[OR] 1.05-1.20, stage 2: OR 1.04-1.22, stage 3: OR 1.05-1.22), female (stage 1: OR 2.28, 95% confidence interval [CI] 1.99-2.61, stage 2: OR 2.40, 95% CI 1.77-3.25, stage 3: OR 1.80, 95% CI 1.19-2.72), overweight status (stage 1: OR 1.56, 95% CI 1.34-1.82, stage 2: OR 3.19, 95% CI 2.38-4.27, stage 3: OR 2.87, 95% CI 1.90-4.32), hypertension (stage 1: OR 1.20, 95% CI 1.01-1.41, stage 2: OR 1.99, 95% CI 1.49-2.64, stage 3: OR 2.10, 95% CI 1.44-3.05), and diabetes mellitus (stage 1: OR 1.62, 95% CI 1.17-2.24, stage 2: OR 1.57, 95% CI 0.93-2.66, stage 3: OR 2.10, 95% CI 1.13-3.90) were positively associated. The frequency of physical activity/sports, even a few per month, was inversely associated with all stages (stage 1: OR 0.59-0.72, stage 2: OR 0.50-0.67, stage 3: 0.36-0.53). A one-year increase in age had a stronger impact on mobility decrease in older adults than in younger ones. Increased age in participants aged

Our previous randomized controlled trial comparing the total dose of weekly versus biweekly continuous erythropoietin receptor activator (CERA) therapy to maintain optimal hemoglobin (Hb) levels showed no significant differences between the two therapies. This post-hoc analysis assessed whether the total dose of weekly versus biweekly CERA therapy to maintain Hb levels among HD patients differed among groups with or without iron supplementation. Of 107 patients, 40 received intravenous iron supplementation due to iron deficiency (iron group) and 67 did not (non-iron group). In the iron group, the weekly therapy tended to require a lower total CERA dose compared with the biweekly therapy (274 ± 274 vs 381 ± 223 μg/12 weeks, P = 0.051). Changes in circulating hepcidin levels, a negative regulator of intestinal iron uptake, after 2 weeks of CERA treatment were significantly lower in the weekly therapy compared with the biweekly therapy (−4.2 ± 6.3 vs 11.1 ± 7.3 ng/mL, P = 0.015). In the non-iron group, there were no significant differences in total CERA dose or changes in hepcidin levels between the two therapies. Shortening the CERA treatment interval combined with iron supplementation may lead to the more efficient treatment of HD patients with iron deficiency.

Abstract Background School teachers are well-positioned to recognize mental health problems in their students and to help them seek appropriate help. Therefore, teachers need to have high levels of mental health literacy (MHL). In East Asia, however, few studies have examined MHL levels in teachers. In this study, MHL levels were investigated in Japanese teachers. Methods Teachers (n = 665) from 27 Japanese high schools answered a self-administered questionnaire which assessed (a) knowledge about mental health/illnesses, (b) correct recognition of specific illnesses (depression, schizophrenia and panic disorder), (c) confidence in helping students with depressive symptoms, and (d) confidence in teaching mental health knowledge to students. Results The average proportion of correct answers to the knowledge questions (n = 20) was 58.1%. The proportion of those who correctly answered about the presence of a sharp increase of mental illnesses in adolescence was 51.7%. Few teachers correctly answered about the life-time prevalences of major mental illness in general (21.9%), depression (37.8%) and schizophrenia (19.8%). Depression, schizophrenia and panic disorder in vignette were correctly recognized by 54.1, 35.3 and 78.0% of teachers, respectively. Correct recognition was significantly lower in male than in female teachers. Only a small proportion of teachers had confidence in helping depressed students (19.9%) and in teaching mental health knowledge to students (11.1%). Conclusions MHL in Japanese high school teachers appears to be low. Education programs should be developed and implemented to improve teacher MHL with the aim of helping them to support students suffering from mental health problems.

Category: Bunion Introduction/Purpose: The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus. Methods: Patients scheduled to undergo surgery for idiopathic hallux valgus (rheumatoid forefoot deformity not included) were recruited. Patients less than 20 years old, and those with a history of foot and ankle surgery were excluded. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOL was assessed using the Self- Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses. Results: Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS. Conclusion: More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain. Assessment of pain elsewhere is necessary to evaluate foot- specific QOL in HV patients.

Objective: The psychological state of patients with advanced oral cancer should be evaluated as the disease and its treatment are considered to impose immense psychological burden. This study aimed to clarify the psychological state of patients with oral cancer immediately prior to their surgery. Materials and methods: This study included patients with oral cancer scheduled for a free flap reconstruction surgery between February 2017 and October 2020. The Japanese version of the Impact of Event Scale-Revised (IES-R), a self-administered assessment used to screen post-traumatic stress disorder (PTSD) symptoms, was used to investigate their psychological status. Results: The self-administered IES-R questionnaire was completed by 34 patients. The median IES-R score was 19 points (8−38), and the scores did not differ by background characteristics. Of the 34 patients, 14 (41.2%) had a cutoff value score of 25 points or higher. Discussion: PTSD symptoms may occur in some patients with advanced oral cancer prior to surgery. Support is required to alleviate anxiety regarding the patient's treatment, subsequent life, and prognosis.

Abstract Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) may be linked to development of chronic kidney diseases (CKD). The FIB4 index, a noninvasive liver fibrosis score, has been reported to predict CKD in non-diabetic patients, but there are no reports yet in diabetic cases. Therefore, we evaluated the prognostic impact of FIB4 index on the risk of developing diabetic kidney disease (DKD) in Japanese patients with type 2 diabetes in a retrospective cohort study. We assessed patients with type 2 diabetes with an eGFR ≥ 60 mL/min/1.73 m2 and without dipstick positive proteinuria (≥ 1 +) at their first visit to our department. Participants were divided into two groups based on the FIB4 index at their first visit: FIB4 index > 1.3 and FIB4 index ≤ 1.3. The primary endpoint was defined as a decrease in eGFR 1.3 (32.0%) and the median observation period was 6.0 (3.8–11.0) years. Kaplan–Meier survival analysis indicated that the risks of developing DKD, eGFR 1.3 patients than in FIB4 ≤ 1.3 patients. In the Cox regression analysis, an FIB4 index > 1.3 was a significant predictor for onset of DKD (HR 1.54, 95% CI 1.15–2.08) and proteinuria (HR 1.55, 95% CI 1.08–2.23), but not for an eGFR 1.3 has a prognostic impact on the development of CKD and proteinuria in type 2 diabetic patients. This warrants further investigation of the prognostic impact of the development of DKD or proteinuria.

Abstract Although continuous erythropoietin receptor activators (CERAs) are widely used erythropoiesis‐stimulating agents for correcting renal anemia in patients undergoing hemodialysis (HD), few reports have examined weekly CERA administration. In this randomized controlled trial, we compared the efficacy and changes in the parameters of iron metabolism and erythropoiesis between weekly and biweekly CERA administration. In total, 120 patients undergoing maintenance HD were randomized to the weekly or biweekly group. The primary end point was the total CERA dose needed to maintain the target hemoglobin (Hb) levels during a 12‐week evaluation period. There was no significant difference in the total dose between the weekly and biweekly groups (median 175.0 [interquartile range (IQR) 93.8–337.5] µg/12 weeks vs. 300.0 [IQR 125.0–375.0] µg/12 weeks, P = .18). The mean Hb levels during the evaluation period were 10.9 ± 0.8 g/dL in the weekly group and 10.7 ± 0.8 g/dL in the biweekly group (P = .25). Weekly CERA administration was well tolerated. Weekly CERA administration similarly managed anemia as biweekly administration in patients undergoing HD.

Nakatsuka et al. discover that the adipokine vaspin contributes to maintaining proximal tubular cell (PTC) homeostasis by ameliorating organelle stress. They find that upon internalization, vaspin interacts with the heat shock protein HSPA1L and that the proteins cooperate to prevent metabolic stress-induced cellular injuries in PTCs.

Abstract The adipose tissue is regarded as an endocrine organ and secretes bioactive adipokines modulating chronic inflammation and oxidative stress in obesity. Gal-9 is secreted out upon cell injuries, interacts with T-cell immunoglobulin-3 (Tim-3) and induces apoptosis in activated Th1 cells. Gal-9 also binds to protein disulfide isomerase (PDI), maintains PDI on surface of T cells, and increases free thiols in the disulfide/thiol cycles. To explore the molecular mechanism of obesity, we investigated Gal-9−/− and Gal-9wt/wt C57BL/6J mice fed with high fat-high sucrose (HFHS) chow. Gal-9−/− mice were resistant to diet-induced obesity associated with reduction of epididymal and mesenteric fat tissues and improved glucose tolerance compared with Gal-9wt/wt mice. However, the number of M1, M2 macrophages, and M1/M2 ratio in epididymal fat were unaltered. Under HFHS chow, Gal-9−/− mice receiving Gal-9−/− or Gal-9wt/wt bone marrow-derived cells (BMCs) demonstrated significantly lower body weight compared with Gal-9wt/wt mice receiving Gal-9−/− BMCs. We identified the binding between Gal-9 and peroxiredoxin-2 (PRDX2) in sugar chain-independent manner by nanoLC-MS/MS, immunoprecipitation, and pull-down assay. In 3T3L1 adipocytes, Gal-9 knockdown shifts PRDX2 monomer (reduced form) dominant from PRDX2 dimer (oxidized form) under oxidative stress with H2O2. The inhibition of Gal-9 in adipocytes may be a new therapeutic approach targeting the oxidative stress and subsequent glucose intolerance in obesity.

Surface Pre-Reacted Glass-ionomer (S-PRG) filler, which releases strontium (Sr2+), borate (BO33−), fluoride (F−), sodium (Na+), silicate (SiO32−), and aluminum (Al3+) ions at high concentrations, is a unique glass filler that are utilized in dentistry. Because of its multiple-ion releasing characteristics, S-PRG filler exhibits several bioactivities such as tooth strengthening, acid neutralization, promotion of mineralization, inhibition of bacteria and fungi, inhibition of matrix metalloproteinases, and enhancement of cell activity. Therefore, S-PRG filler per se and S-PRG filler-containing materials have the potential to be beneficial for various dental treatments and care. Those include restorative treatment, caries prevention/management, vital pulp therapy, endodontic treatment, prevention/treatment of periodontal disease, prevention of denture stomatitis, and perforation repair/root end filling. This review summarizes bioactive functions exhibited by S-PRG filler and its possible contribution to oral health.