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Abstract Background Age and sex differences in sarcopenic dysphagia are unknown. The purpose is to characterize age and sex differences in sarcopenic dysphagia. Methods A cross‐sectional and retrospective cohort study using information from the Japanese database on sarcopenic dysphagia was performed. We investigated age and sex differences between sarcopenic dysphagia and other forms of dysphagia. We investigated whether differences in prognosis for swallowing function, as assessed by the Food Intake Level Scale, and activities of daily living (ADL), as assessed by the Barthel Index were influenced by age and sex in patients with sarcopenic dysphagia. Results The study included 460 patients, including 229 men and 231 women, with a mean age of 81 ± 10 years. Fifty‐eight percent of the patients had sarcopenic dysphagia. Age was independently associated with sarcopenic dysphagia (odds ratio (OR): 1.056, 95% confidence interval (CI): 1.035, 1.078), although sarcopenic dysphagia could also be seen in those younger than 65 years. Sex was not independently associated with sarcopenic dysphagia. The age cut‐off for the diagnosis of sarcopenic dysphagia was 82 years in all patients (sensitivity, 0.660; specificity, 0.644), 80 years in men (sensitivity, 0.619; specificity, 0.631), and 83 years in women (sensitivity, 0.723; specificity, 0.577). Sarcopenic dysphagia showed no significant differences in the improvement of swallowing function and ADL based on age and sex. Conclusions Sarcopenic dysphagia was most common in older adults in their 80s or older. The possibility of sarcopenic dysphagia should be considered when dysphagia is present in people 80 years of age or older.

Abstract Background Postoperative shivering is mainly associated with low body temperature. However, postoperative shivering can develop even at normal or high core temperatures. This study aimed to investigate the factors associated with postoperative shivering in patients with maintained core temperature after surgery. Methods This retrospective study involved 537 patients who had undergone radical surgery for pancreatic cancer under general anesthesia from January 2013 to December 2023. The final analysis included 441 patients whose core temperatures after surgery were ≥ 36.5℃. Logistic regression analysis was performed to estimate the odds ratio (OR) of the incidence of postoperative shivering. Results Postoperative shivering occurred in 119 patients. After multivariable-adjusted logistic regression, postoperative shivering was significantly associated with patient age (per 1 year increase; OR = 0.98; 95% confidence interval [CI]: 0.96–0.996; p = 0.02), operation time (per 30 min increase; OR = 1.10; 95% CI: 1.01–1.19; p = 0.03), postoperative core temperature (restricted cubic spline, p = 0.001), postoperative peripheral temperature (restricted cubic spline, p = 0.001), effect site fentanyl concentration at extubation (OR = 0.66; 95% CI: 0.24–0.99; p = 0.049), and acetaminophen use (OR = 0.32; 95% CI: 0.18–0.58; p

Abstract Recent studies have revealed that the Sry-related HMG box gene 17 (SOX17) plays an important role in ovarian carcinogenesis. Unlike other types of ovarian cancer, ovarian clear cell carcinoma (OCCC) has a distinct pathobiological phenotype, often harboring an AT-rich interaction domain 1 A (ARID1A) mutation. In the present study, to determine the SOX17 in OCCC cells, we immunohistochemically examined SOX17 expression in 47 whole-tissue specimens of OCCC. Although not statistically significant, SOX17-high immunoreactivity tended to be related to unfavorable patient outcomes. We also aimed to determine the relationship of SOX17 with ARID1A. Double immunofluorescence staining demonstrated that SOX17 immunoreactivity was not associated with ARID1A immunoreactivity. Immunoblotting revealed that SOX17 was abundantly expressed in cultured OVISE and RMG-V OCCC cells, but not in OVTOKO OCCC cells. Polyubiquitinated bands of SOX17 were observed in MG132 treated OVTOKO, but not in OVISE or RMG-V OCCC cells. Notably, si-RNA-mediated knockdown of a deubiquitinase enzyme, ubiquitin C-terminal hydrolase L1, increased polyubiquitination followed by proteasome degradation of SOX17 in OVISE. These findings indicate that SOX17 is not uniformly and heterogeneously expressed in OCCCs, independent of ARID1A deficiency. Impaired ubiquitin-mediated proteasome degradation may stabilize SOX17 in some OCCC cells.

Abstract Aims/Introduction Coefficient of variation (CV) is an indicator for glucose variability in continuous glucose monitoring (CGM), and the target threshold of %CV in type 1 diabetes is proposed to be ≤36%. This study aimed to evaluate the clinical significance of CV in children and adolescents with type 1 diabetes. Materials and Methods Participants included 66 children with type 1 diabetes. A total of 48 participants were treated with multiple daily injections of insulin, and 18 with continues subcutaneous insulin infusion, using intermittently scanned CGM. The frequencies of the CGM metrics and glycosylated hemoglobin values were examined, and the significance of a threshold %CV of 36% was evaluated. Results The mean frequencies in time in range (TIR), time below range, %CV and the mean glycosylated hemoglobin value were 59.3 ± 16.1, 4.0 ± 3.5, 39.3 ± 6.2 and 7.3 ± 0.8%, respectively. The frequencies of participants who achieved a TIR >70% and a %CV of ≤36% were 24.1 and 27.3%, respectively. A total of 18 participants with a %CV of ≤36% had significantly higher TIR, lower time below range and lower glycosylated hemoglobin than the 48 with a %CV of >36% (72.6 ± 12.6 vs 52.4 ± 13.6, 2.4 ± 1.9 vs 4.6 ± 3.6, 6.9 ± 0.8 vs 7.4 ± 0.7%, respectively). Conclusions Children and adolescents with type 1 diabetes using intermittently scanned CGM had difficulties in achieving the recommended targets of TIR and CV. However, the target %CV of ≤36% seems to be an appropriate indicator for assessing glycemic control and risk of hypoglycemia in pediatric patients with type 1 diabetes with any treatment.

Abstract Background The concept of recovery has become internationally widespread. To promote personal recovery of individuals with mental disorders, it is important that they live life on their own terms. Many people with mental disorders wish to build intimate relationships and marry. However, people with mental disorders face obstacles in building such relationships and communicating with their partners. The program AIRIKI, which means “power to love,” was developed to help people with mental disorders gain confidence in building intimate relationships. The AIRIKI pilot study with one-group pre post test showed positive effects on self-esteem, hope, and communication. Therefore, the purpose of the proposed randomized controlled trial (RCT) is to determine the effects of the videoconferencing program on self-esteem, hope, and self-confidence in communication among un-married people with mental disorders. Methods The proposed randomized controlled trial has two arms (intervention group and control group). After baseline questionnaire assessment, participants will be allocated randomly. Within two months of allocation, the intervention group will participate in videoconferences about intimate relationships and marriage with 2–5 participants and 3 facilitators, which will last 3 h, for two days. Three facilitators will support participants in each session. The intervention group will complete a questionnaire for outcome assessment at termination and one month after the program. The control group will complete the outcome questionnaire at one month after baseline and two months after baseline. The questionnaire will include the Rosenberg Self-Esteem Scale (RSES), Herth Hope Index (HHI), and Self-confidence in Communication Scale (SCS). Control group members can participate in a videoconference program, which will be held separately from the intervention group, after completing their outcome assessments. Discussion This trial is the first randomized controlled trial of which we are aware to test the effects of an online program for un-married people with mental disorders to consider and discuss their romantic relationship and marriage. The results will provide information on the effectiveness of an online program for people with mental disorders to imagine their romantic relationships and marriages. Trial registration This trial has been registered with the UNIN Clinical Trials Registry (UMIN000052027; 2023/08/28).

Objective: There are few reports of subacute thyroiditis (SAT) during pregnancy. This study aimed to clarify the clinical characteristics of SAT in pregnant patients. Methods and results: Seven patients diagnosed with SAT during pregnancy at our institution from January 2004 to December 2021 were identified, and their clinical findings were retrospectively examined. At SAT diagnosis, the median age was 34 (range: 31–42) years, the median duration of pregnancy was 5 (4–24) weeks, and all patients had neck pain but no fever. On laboratory examination, median (range) free thyroxine, free triiodothyronine, and C-reactive protein levels were 2.66 (1.14–7.77) ng/dL, 7.1 (3.3–16.1) pg/mL, and 2.22 (0.42–5.79) mg/dL, respectively, and all patients had a hypoechoic lesion of the thyroid gland. Three patients (43%) were treated with steroids, and three patients (43%) received replacement therapy with levothyroxine for hypothyroidism following destructive thyroiditis. There were no pregnancy complications in any of the cases. These seven patients (pregnancy group) were compared with 217 non-pregnant female patients (non-pregnancy group) aged 31 to 42 years who were diagnosed with SAT at our institution from 2016 to 2019. The frequency of body temperatures above 37°C was lower in the pregnancy group than in the non-pregnancy group (0% vs 65%). Conclusion: Patients who develop SAT during pregnancy may have less fever than non-pregnant patients with SAT. There were no pregnancy complications in the pregnancy group in this study. This suggests that adverse pregnancy outcomes may be avoided by the appropriate management of SAT, including hypothyroidism after destructive thyroiditis.

Abstract Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in the elderly population, particularly the late-stage of dry AMD known as geographic atrophy (GA), lacks effective treatment options. Genetic mouse models of AMD have revealed the significance of impaired lipid metabolism and anti-oxidative capacity in early/intermediate stage of AMD, but remains unclear in GA that severely damages visual function. Here, to investigate the potential relevance of peroxidized lipids in RPE for late-stage dry AMD, GPx4fl/fl mice underwent subretinal injections of RPE-specific AAV-Cre vector or control AAV vector. RPE-specific GPx4 deficiency led to rapid RPE degeneration resembling key features of late-stage dry AMD, including preceding loss of RPE cell polarity, accumulation of acrolein, malondialdehyde, and 4-hydroxynonenal, photoreceptor loss, lipofuscin-laden subretinal melanophage infiltration, and complement activation. Treatment with α-tocopherol and ferrostatin-1 mitigated RPE degeneration, and shrunk mitochondria were observed in GPx4 deficient mice, suggesting involvement of ferroptosis. Unexpectedly, necrostatin-1s, an inhibitor of necroptosis, also ameliorated RPE degeneration, and activation of RIP3 and MLKL along with inactivation of caspase-8 was observed, indicating crosstalk between ferroptosis and necroptosis pathways. Our findings shed light on the intricate mechanisms underlying RPE degeneration in AMD and highlight GPx4/lipid peroxidation as potential therapeutic targets. RPE-specific ablation of GPx4 in mice provides a valuable tool for further elucidating the interplay between lipid peroxidation, cell death pathways, and AMD pathogenesis, offering new insights for preclinical research and therapeutic development targeting GA.

Background/purpose: Cognitive flexibility is a personality trait, which can influence how effectively a healthcare professional can manage a challenging clinical situation. This study explored the cognitive flexibility of undergraduate dental hygiene students at two universities in Asia to gather baseline information in order to consider whether there was an educational need for pre-clinical students with regards to this personality factor. Materials and methods: Participants were all undergraduate dental hygiene students in the 2022 academic year at Tokyo Medical and Dental University (TMDU; n = 79) and Taipei Medical University (TMU; n = 88). An anonymous questionnaire was distributed, which included questions on demographic information and the Cognitive Flexibility Inventory (CFI). Results: The response rates were 97.5% (TMDU) and 89.8% (TMU). The CFI total scores were 91.77 for TMDU and 95.87 for TMU, and there was no significant difference between the two schools. The Alternatives scores were significantly higher in TMU than TMDU (P = 0.044), but there were no significant differences in the Control scores between the two schools. There were also no significant differences between school years of both universities. Conclusion: The dental hygiene students from both dental schools exhibit moderate cognitive flexibility. The educators in both dental schools may consider whether they should investigate and develop this personality factor further during the undergraduate training of their dental hygiene students.

Abstract Aim Yokukansan is one of the most frequently used herbal medicines that can improve the behavioral and psychological symptoms of dementia. In this exploratory study, we investigated whether yokukansan affects the steady‐state blood concentrations of donepezil, risperidone, and the major metabolites of both drugs in a real‐world clinical setting. Methods A non‐randomized, open‐label, single‐arm study examining drug–drug interactions was conducted. Fifteen dementia patients taking donepezil for at least 4 weeks and eight schizophrenia patients taking risperidone for at least 2 weeks were orally administered 2.5 g of yokukansan three times a day before or between meals, and blood samples were collected before and 8 weeks after starting co‐treatment with yokukansan. Plasma concentrations of donepezil, risperidone, and each metabolite were measured using high‐performance liquid chromatography–tandem mass spectrometry and compared before and after the 8‐week administration of yokukansan. Results The plasma concentrations of donepezil and its metabolites (6‐O‐desmethyl‐donepezil, 5‐O‐desmethyl‐donepezil, and donepezil‐N‐oxide), risperidone, and its metabolite paliperidone did not differ before and after the 8‐week treatment with yokukansan. Conclusions The findings of this study show that the concomitant use of yokukansan may have little clinical impact on the steady‐state blood levels of donepezil and risperidone in patients with dementia or schizophrenia.