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Abstract Background Acute kidney injury (AKI) incidence is extremely high worldwide, and patients who develop AKI are at increased risk of developing chronic kidney disease (CKD), CKD progression, and end-stage kidney disease (ESKD). However, there is no established treatment strategy for AKI. Based on the idea that exercise has a stabilizing effect on hemodynamics, we hypothesized that rehabilitation would have beneficial renal outcomes in patients with AKI associated with cardiovascular disease. Therefore, the purpose of this study was to determine whether rehabilitation can stabilize hemodynamics and positively impact renal outcomes in patients with AKI associated with cardiovascular disease. Methods In total, 107 patients with AKI associated with cardiovascular disease were enrolled in this single-center retrospective study and were either assigned to the exposure group (n = 36), which received rehabilitation at least once a week for at least 8 consecutive weeks, or to the control group (n = 71). Estimated glomerular filtration rate was assessed at baseline before admission, at the lowest value during hospitalization, and at 3, 12, and 24 months after enrolment. Trends over time (group × time) between the two groups were compared using generalized estimating equations. Moreover, congestive status was assessed by amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and the effect of rehabilitation on congestion improvement was investigated using logistical regression analysis. Results The time course of renal function after AKI, from baseline to each of the three timepoints suggested significant differences between the two groups (p

Abstract Background Few reports have been published on preoperative and long-term postoperative rehabilitation after kidney transplantation. Poor physical function after kidney transplantation is associated with adverse events; hence, physical function should be improved postoperatively. We report a case in which physical therapy was provided just before the operation and 12 months postoperatively to improve physical performance. Case presentation A 64-year-old man, working as a janitor and maintenance worker at a driving school, received a living-donor kidney transplant from his wife. The just before the operation assessment revealed a decline in his physical function, indicating he had become frail. Accordingly, physical therapy was initiated prior to kidney transplantation. Subsequently, his Short Physical Performance Battery score improved from 10 to 12, and his knee extension muscle strength improved from 0.38 to 0.43 kgf/kg, enabling him to resume work. The work functioning impairment scale improved from 13 to 7. Conclusions This case reveals that just before the operation and long-term rehabilitation is crucial in enhancing physical activity in kidney transplantation patients. Although this focused rehabilitation approach holds promise, evaluating its efficacy requires the examination of a larger cohort of cases.

Abstract Background Given rapid aging of the global population, preventing adverse events such as falls is essential for preserving functional capacity and quality of life among older adults, especially those at high risk due to hemodialysis (HD) treatment. We aimed to investigate the effects of a 3-year intradialytic exercise intervention on fall occurrence and physical performance in older patients undergoing HD. Methods Sixty-one patients were non-randomly assigned to the exercise (n = 31) and control groups (n = 30). The exercise group performed aerobic and resistance training during HD three times per week for 3 years. Handgrip strength, lower extremity muscle strength, 10-m walking speed, and Short Physical Performance Battery (SPPB) scores were assessed at baseline. Physical function was reassessed every year in the exercise group. All participants were followed up until the first fall or the end of the study period. Results There were no significant between-group differences in baseline data. Over a median follow-up of 35 months, 10 (16.3%) falls occurred, including 1 (3.2%) in the exercise group and 9 (30%) in the control group. Kaplan–Meier analysis revealed that the exercise intervention significantly reduced the occurrence of falls. No significant differences in physical function were observed among four time points in patients who completed the 3-year program. Conclusion Intradialytic exercise may represent an essential intervention for preventing falls in older patients undergoing HD. Trial registration: This study was retrospectively registered with the University Hospital Medical Information Network (UMIN 00044821, February 4, 2021).

Abstract High-speed image processing is essential for many real-time applications. On-chip photonic neural network processors have the potential to speed up image processing, but their scalability is limited in terms of the number of input/output channels because high-density integration is challenging. Here, we propose a photonic time-domain image processing approach, where real-world visual information is compressively acquired through a single input channel. Thus, large-scale processing is enabled even when using a small photonic processor with limited input/output channels. The drawback of the time-domain serial operation can be mitigated using ultrahigh-speed data acquisition based on gigahertz-rate speckle projection. We combine it with a photonic reservoir computer and demonstrate that this approach is capable of dynamic image recognition at gigahertz rates. Furthermore, we demonstrate that this approach can also be used for high-speed learning-based imaging. The proposed approach can be extended to diverse applications, including target tracking, flow cytometry, and imaging of sub-nanosecond phenomena.

Abstract Introduction Walking ability is an important prognostic factor for patients undergoing maintenance hemodialysis (HD). Since complications such as poor nutrition, anemia, malnutrition, and inflammation in patients undergoing HD may affect walking ability, the factors affected by 10-m walking speed must be investigated. This cross-sectional study enrolled 1205 outpatients undergoing HD and measured their 10-m walking speed. Methods Lower extremity muscle strength (LES), grip strength, one-leg standing time (OLST), and short physical performance battery (SPPB) score were measured as physical functions. Age, sex, body mass index, dialysis history, comorbidities, and hematological data were collected. Results A multiple regression analysis revealed that the 10-m walking speed was significantly associated with LES, grip strength, OLST, SPPB, and % creatinine production rate, even after adjusting for corresponding variables (R 2 = 0.69, p

Abstract Background Persistent postural-perceptual dizziness (PPPD) is a newly defined disorder characterized by functional dizziness. Due to its recent discovery, definitive treatment for PPPD has not been established; therefore, this study aimed to assess the effectiveness of virtual reality (VR)-guided, dual-task, trunk balance training for the management of PPPD using the mediVR KAGURA system. Methods We analyzed data of patients who presented with PPPD from January 1, 2021, to February 28, 2021. The VR group included patients who underwent mediVR KAGURA-guided training for 100 tasks (10 min). Patients with PPPD who received standard treatment and rehabilitation were assigned to the control group. Equilibrium tests were performed at baseline and immediately after mediVR KAGURA-guided training to examine its effectiveness in improving static and dynamic balance. Additionally, clinical questionnaires related to balance disorders were administered at baseline and 1 week after mediVR KAGURA-guided training to examine its effects on balance-related symptoms. The primary outcome was improvements in static and dynamic balance and Niigata PPPD Questionnaire (NPQ) scores. Results VR-guided training using mediVR KAGURA improved objective outcomes, including static and dynamic postural stability, after a single 10-min training session. Additionally, mediVR KAGURA-guided training improved scores on the Hospital Anxiety and Depression Scale and NPQ 1 week after the 10-min training session. Conclusion VR-guided training using mediVR KAGURA represents a viable method for managing balancing ability, anxiety, and symptoms in patients with PPPD. Such training provides a safe and cost-effective solution for PPPD management. Further studies are required to evaluate the clinical efficacy of this strategy. Trial registration: Institutional Ethics Committee of Kitano Hospital, approval number: 1911003. Registered 18 December 2019, https://kitano.bvits.com/rinri/publish_document.aspx?ID=426 .

Abstract Background Several methods are used for hearing loss screening; however, their benefits are uncertain. In this study, we aimed to determine the predictive factors of acute sensorineural hearing loss for clinical application by primary care doctors. Methods This retrospective, cross-sectional study included 365 patients with acute sensorineural hearing loss without prior therapy. The patients’ clinical data, demographic information, and medical histories were obtained, and they were asked about comorbidities. In addition, we assessed lifestyle factors such as stress level, alcohol consumption, marital status, and socioeconomic level. Logistic regression analysis was performed to investigate the diagnostic predictive ability of the selected factors associated with acute sensorineural hearing loss. The hearing levels of all patients were evaluated using pure tone audiometry. Results We identified significant predictive factors for acute sensorineural hearing loss. The absence of hyperacusis was a predictive factor for sudden sensorineural hearing loss. Younger age, female sex, and marital status were predictive factors for acute low-tone hearing loss. High body mass index, high socioeconomic level, low alcohol consumption, high stress level, hyperacusis, and vertigo/dizziness were predictive factors for Ménière’s disease. High body mass index and ear fullness were predictive factors for perilymph fistula. Low stress level was a predictive factor for acoustic tumours. Conclusions Our findings can be used to distinguish between the types of acute sensorineural hearing loss. Symptoms, physical status, and lifestyle factors identified during this study are useful markers for predicting acute sensorineural hearing loss occurrence.

Abstract Management of presenteeism in the context of chronic kidney disease (CKD) is essential for disease management, ensuring the workforce’s availability, and reducing health-related costs. The purpose of this case study was to investigate presenteeism, physical function, and exercise habits in three working patients with CKD and discuss their effects. Case 1 was a 71-year-old male security guard; Case 2 was a 72-year-old male agricultural worker; and Case 3 was an 83-year-old male civil engineering employee. Presenteeism was measured using the work functioning impairment scale (WFun), and physical function was measured using grip strength, skeletal muscle mass index, 10 m walk test, short physical performance battery, and exercise habits. The WFun assessment showed that only Case 3 had moderate presenteeism, and the barrier to employment was fatigue. Each value of physical function was higher than the reference value, but Case 3 had the lowest physical function values. All three patients had no exercise habits and were in the interest stage of behavior change. This case report indicates the existence of workers with CKD who need care for presenteeism, even if they have no problems with physical function or activities of daily living. To ensure work productivity in workers with CKD, clinicians may need to evaluate presenteeism, physical function, and exercise habits in addition to popular treatment and care.

Abstract Background Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. Methods We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score

Abstract This paper proposes a lightweight bidirectional scattering distribution function (BSDF) model for layered materials with anisotropic reflection and refraction properties. In our method, each layer of the materials can be described by a microfacet BSDF using an anisotropic normal distribution function (NDF). Furthermore, the NDFs of layers can be defined on tangent vector fields, which differ from layer to layer. Our method is based on a previous study in which isotropic BSDFs are approximated by projecting them onto base planes. However, the adequateness of this previous work has not been well investigated for anisotropic BSDFs. In this paper, we demonstrate that the projection is also applicable to anisotropic BSDFs and that the BSDFs are approximated by elliptical distributions using covariance matrices.

Patients with chronic kidney disease require intervention planning because their physical function declines with worsening disease. Providers can work closely with patients during the induction phase of dialysis. This single-center, retrospective observational study aimed to investigate the rate of decline in walking independence during the induction phase of dialysis and the factors that influence this decline, and to provide information on prevention and treatment during this period. Of the 354 patients who were newly initiated on hemodialysis between April 2018 and January 2022, 285 were included in the analysis. The functional independence measure-walking score was used to sort patients into decreased walking independence (DWI; n = 46) and maintained walking independence (no DWI; n = 239) groups, and patient characteristics were compared. After adjusting for various factors by logistic regression analysis, we observed that age, high Charlson comorbidity index (CCI), C-reactive protein, and emergency dialysis start (EDS) were significant predictors of DWI. Even during the very short period of dialysis induction, as many as 16.1% of patients had DWI, which was associated with older age, higher CCI, higher inflammation, and EDS. Therefore, we recommend the early identification of patients with these characteristics and early rehabilitation.

Summary: Macrophage recognition and phagocytosis of crystals is critical for the associated fibrosis and cancer. Of note, multi-walled carbon nanotubes (MWCNTs), the highly representative products of nanotechnology, induce macrophage NLRP3 inflammasome activation and cause asbestosis-like pathogenesis. However, it remains largely unknown how macrophages efficiently recognize MWCNTs on their cell surfaces. Here, we identify by a targeted screening of phagocyte receptors the phosphatidylserine receptors T cell immunoglobulin mucin 4 (Tim4) and Tim1 as the pattern-recognition receptors for carbon crystals. Docking simulation studies reveal spatiotemporally stable interfaces between aromatic residues in the extracellular IgV domain of Tim4 and one-dimensional carbon crystals. Further, CRISPR-Cas9-mediated deletion of Tim4 and Tim1 reveals that Tim4, but not Tim1, critically contributes to the recognition of MWCNTs by peritoneal macrophages and to granuloma development in a mouse model of direct mesothelium exposure to MWCNTs. These results suggest that Tim4 recognizes MWCNTs through aromatic interactions and mediates phagocytosis leading to granulomas.

Previous reports have shown the benefits of intradialytic exercise to patients undergoing hemodialysis. However, most of those studies assessed the effects of exercise in middle-aged patients and little is known about advanced-age patients undergoing hemodialysis. Therefore, the present randomized controlled trial was performed to determine the effectiveness of exercise therapy in advanced-age patients undergoing hemodialysis. This non-blinded, randomized controlled parallel trial enrolled a total of 101 patients who were randomly assigned to intradialytic exercise (n = 51) or usual care (n = 50) groups. The training program included both resistance and aerobic exercises and was performed three times per week for 6 months. The aerobic exercise intensity was adjusted to a target Borg score of 13 for 20 minutes. Four types of resistance exercises were performed using elastic tubing, with three sets of 10 exercises performed at moderate intensity (13/20 on the Borg scale). The usual care group received standard care. Lower extremity muscle strength, Short Physical Performance Battery score, and 10-m walking speed were the outcomes and were evaluated before the hemodialysis session and after 6 months of training. There were statistically significant improvements in Short Physical Performance Battery score (effect size, 0.57; 95% confidence interval, 0.15‒1.95) in the exercise group relative to the control group. There were no statistically significant differences in lower extremity muscle strength or in the 10-m walking speed between the two groups. These findings suggest that 6 months of intradialytic training could improve physical function in older patients undergoing hemodialysis.

Objective: Populations are aging in many countries, and the proportion of elderly people with severe to profound hearing loss is increasing in parallel with the increasing average life span. The objective of this study was to investigate the outcomes of cochlear implant (CI) surgery in elderly patients compared to those in younger patients. Methods: The outcomes of CI surgery were retrospectively investigated for 81 adults (32 men and 49 women) who underwent CI surgery at our hospital. They were divided according to age at the time of implantation into the younger group (n = 49) or elderly group (≥75 years of age; n = 32). Results: The mean sentence recognition score on the CI-2004 Japanese open-set test battery (±standard deviation) was 82.9% ± 24.1 in the younger group and 81.9% ± 23.2 in the elderly group, with no significant difference between the groups (Mann–Whitney U test). The incidence of major complications that required surgical treatment was not significantly different between the groups (4.1% vs. 6.2%, respectively). Thus, there were no severe complications that could affect general health status in either group. Three patients in each group died for reasons unrelated to CI surgery during follow-up. The proportion of patients who were alive and continued to use the CI five years after surgery was 92.8% and 91.5%, respectively. Conclusion: Our results show good speech recognition and a low incidence of major complications in elderly patients. This comprehensive report on the outcomes of CI surgery in elderly patients will be helpful to the elderly with severe to profound hearing loss when deciding whether to undergo CI surgery.

Disseminated intravascular coagulation (DIC) is a systemic life-threatening process that can cause thrombosis and hemorrhage. Chronic DIC has been associated with aortic aneurysm/dissection. Aortic aneurysm/dissection should be included in the differential diagnosis of elderly patients with hemorrhagic diathesis due to DIC of uncertain etiology. Treatment depends on various factors, including the severity of underlying disease, extent of DIC, and patient comorbidities, as well as the ability of the patient to maintain activities of daily living once discharged from the hospital. This report describes the clinical characteristics of four elderly patients with chronic DIC associated with aortic aneurysm/dissection who were treated in our institution. We also offer the recommendations around most appropriate nonsurgical treatment of these patients.

Resistance to receptor tyrosine kinase inhibitors is a major obstacle in treatment of lung adenocarcinoma. Yamaguchi et al.identify the orphan receptor ROR1 as a potential target to overcome this resistance, by virtue of its role in promoting cell survival through stabilisation of caveolae.

This report describes six elderly patients with acquired hemophilia A (AHA), including four individuals aged ≥90 years. Bleeding symptoms were subcutaneous or intramuscular hemorrhage (n=4), hematuria (n=1), and hemorrhagic shock after tooth extraction (n=1). Factor VIII (FVIII) activity ranged from

Changes in gene expression patterns by high nitrogen (High-N) and High-N plus cooling at the young microspore stage (High-N-cooling) in rice mature anthers were analyzed by semiquantitative RT-PCR with gene specific primers. Gene expression of alpha-expansin 18 (EXPA18) was repressed under High-N-cooling. Beta-expansin 1 (EXPB1), putative aldehyde dehydrogenase (ALDH) and Fructokinase II (FKII) were upregulated under High-N. EXPB1 and FKII were highly expressed under High-N-cooling. Comprehensive examination of gene expression patterns of 26 alpha-expansins (EXPAs) and 16 beta-expansins (EXPB s) showed that all expansins (EXP s)except EXPA12 were expressed in the anthers. Gene expression of EXP s did not change under High-N except EXPA1, EXPB1 and EXPB5 which were upregulated. In total, 18 EXPAs and 6 EXPB s were repressed under High-N-cooling, and among these, EXPA18, EXPA19 and EXPA20 had high similarities in the amino acid sequences, suggesting that these three genes may constitute a distinct functional gene subfamily related to the decrease in the pollen germination ability.

In vitro pollen germination experiment using agar plates showed that the growth under high nitrogen conditions enhanced the damage to pollen germination ability caused by the cooling at the young microspore stage. To clarify the physiological factors related to this damage to pollen germination, we performed the comparative proteome analysis of mature anthers and identified proteins that were changed by high nitrogen conditions or high nitrogen plus cooling conditions. Proteins were extracted from mature anther samples and separated by two-dimensional polyacrylamide gel electrophoresis. By comparing anther protein maps of the samples collected from the plants grown under standard nitrogen conditions, high nitrogen conditions and high nitrogen plus cooling conditions, we found 11 protein spots, which varied with the treatment. These protein spots were identified based on the rice proteome database and/or peptide mass fingerprinting (PMF) analysis after digestion with trypsin. Digested samples were analyzed by matrix-assisted laser desorption/ionization-time flight mass spectrometry to produce PMF data. Database searches using these PMF data revealed the identities of 9 proteins. Seven of these proteins were polypeptides involved in cell elongation, stress responses and sugar metabolism. The relation between the fluctuations of these proteins and the decrease in pollen germination are discussed.

The combined effects of high nitrogen supply, cool temperature regimes and shading on factors related to fertility in rice plants were investigated. High nitrogen supply during the period from the spikelet differentiation stage to the young microspore stage caused a decrease in the number of microspores per anther. High nitrogen supply plus cool treatment at the young microspore stage (12°C for 3 or 4 days) resulted in a conspicuous decrease in the number of engorged pollen grains per anther. Shading also decreased the number of microspores and pollen grains. The lowest numbers of microspores and pollen grains were observed in a treatment combining high nitrogen supply with shading and cooling. The number of pollen grains shed on the stigma and germinated pollen grains were decreased by cooling. These results suggested that the lower fertility due to high nitrogen supply combined with cooling resulted from 1) decrease in number of microspores, 2) large decrease in number of pollen grains per anther, and 3) decreases in number of pollen grains and germinated pollen grains on the stigma.