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Background In Japan, the number of older people with various health problems and difficulties in living is increasing. In order to practice patient-centered care for them, not only medical professionals but also multidisciplinary teams including care professionals and patients need to practice shared decision making (SDM) in the context of long-term care. For this reason, a measure of SDM in consultations with healthcare professionals (HCPs) other than physicians is needed. Therefore, this study aimed at adapting the patient and physician versions of the 9-item Shared Decision Making Questionnaire (SDM-Q-9, SDM-Q-Doc) for consultations with HCPs other than physicians in Japan. Methods A pair of SDM measures that can be used by HCPs other than physicians, “Care SDM-Questionnaire for care receivers (SDM-C-patient)” and “Care SDM-Questionnaire for care providers (SDM-C-provider)” were prepared based on the Japanese versions of the SDM-Q-9 and SDM-Q-Doc. The internal consistency and conceptual structure of these measures were tested by secondary analysis of data from 496 participants from a workshop on SDM for different HCPs. Measurement invariance were tested by multigroup confirmatory factor analysis (CFA) for the patient (SDM-C-patient and SDM-Q-9) and provider (SDM-C-provider vs. SDM-Q-Doc) versions. Results Both the Japanese SDM-C-patient and SDM-C-provider demonstrated high internal consistencies (Cronbach’s α coefficient was 0.90 and McDonald’s ω coefficient was 0.90 for both measures). CFA showed one-factor structures for both measures and original measures for physicians. Moreover, multigroup CFA showed configural and metric invariance between the novel care measures and original physician’s measures. Conclusions Thus, the novel SDM measures for care providers in Japan as well as the original physician’s measures could be used in training setting. As these measures were tested only in a training setting, their reliability and validity as new measures for care should be tested in a clinical setting in future.

Many older people with end-stage dementia die of pneumonia, but the details of their distress have been unclear. The present study clarified the distress experienced by such individuals due to pneumonia.We searched for literature corresponding to 5 clinical questions (CQs) concerning including "What distress is experienced by older people with end-stage dementia due to pneumonia (CQ1) ?" using a search formula with the Web version of the Central Medical Magazine, MEDLINE (STN)/EMBASE (STN), Cochrane Library, and extracted 604 articles. Forty-two articles corresponding to 5 CQs were extracted by primary screening using abstracts, and 17 articles were adopted after the secondary screening. A total of six articles corresponding to CQ1 were ultimately analyzed.Older people with end-stage dementia who died of pneumonia reported more discomfort and dyspnea than those who died of dehydration. Their main symptoms were respiratory symptoms, such as cough, sputum, and dyspnea, a fever and somnolence. Distress such as dyspnea and discomfort among older people with end-stage dementia recovering from pneumonia peaked on the day of the diagnosis. Furthermore, in older people with end-stage dementia dying of pneumonia, distresses began approximately one week before death and peaked on the day before death. A few days before death, several distressing symptoms, such as pain, dyspnea and restlessness/agitation, were often observed at the same time.If older people with end-stage dementia contract pneumonia and die from it, attentive palliative care is needed to manage their severe discomfort, dyspnea and other sources of distress.

Lung cancers with anaplastic lymphoma kinase (ALK) rearrangements are highly sensitive to treatment with ALK tyrosine kinase inhibitors (TKIs). Due to the very low rate of patients with squamous cell carcinoma enrolled in clinical trials, the efficacy of ALK inhibitors in patients with ALK‐rearranged squamous cell carcinoma in the lung remains unclear. Herein, we present the case of a 70‐year‐old female patient with squamous cell lung cancer harboring the echinoderm microtubule‐associated protein‐like 4 (EML4)‐ALK fusion gene. The patient was treated with the ALK‐TKI alectinib as first‐line regimen and achieved a dramatic response without severe adverse events, demonstrating alectinib as a therapeutic option for patients with ALK‐positive squamous cell carcinoma., The efficacy of ALK inhibitors in patients with ALK‐rearranged squamous cell carcinoma in the lung remains unclear. We present the case of a female patient with squamous cell lung cancer harboring the EML4‐ALK fusion gene. She was treated with the ALK‐TKI alectinib and achieved dramatic response without severe adverse events.

A 52‐year‐old man underwent pneumonectomy of the left lung for previously diagnosed primary spindle cell carcinoma (pT4aN1M0, stage III B) with programmed death‐ligand 1 expression (tumor proportion score ≥95%) and without epidermal growth factor receptor gene mutation and anaplastic lymphoma kinase fusion gene. However, brain metastasis and chest wall tumor relapse occurred. Considering insufficient improvement with gamma knife treatment for brain metastasis and combination chemotherapy (paclitaxel, carboplatin, and bevacizumab), pembrolizumab monotherapy and palliative irradiation therapy for chest metastases were started after brain tumor volume reduction using craniotomy. Brain edema and chest wall metastases markedly improved following a pseudoprogression of the brain edema accompanied by a performance status decline; this effect continued until 11 cycles of pembrolizumab administration., Lung spindle cell carcinoma has a poor prognosis and is usually resistant to cytotoxic chemotherapy. Our findings suggest that immune checkpoint inhibitors (ICIs) are a novel therapeutic strategy for lung spindle cell carcinoma.

Older adults at the end-of-life stage receiving home visits from physicians often experience symptoms such as dyspnea, pain and fatigue, among others. This study aimed to investigate the practices and opinions of physicians providing home visits regarding palliative care for older adults with respiratory symptoms due to non-malignant diseases in Japan.A nationwide questionnaire survey on home palliative care for non-cancer chronic respiratory diseases was sent to 2988 home-care physicians in 2020 through postal mail and/or email. The questions focused on their background, their use of rating scales to evaluate the intensity of dyspnea, and their practices and opinions regarding home palliative care for respiratory diseases or symptoms.Valid responses were collected from 592 physicians (19.8%). A total of 251 participants (43.1%) used a rating scale to evaluate the intensity of dyspnea. While 87.8%, 86.6%, 67.3%, and 60.0% of physicians considered pulmonary rehabilitation, morphine, sedative medications, and non-invasive positive pressure ventilation (NPPV), respectively, as effective in relieving respiratory distress, 73.0%, 66.9%, 57.3%, and 55.2% of those physicians, respectively, used each modality to relieve respiratory distress. Frequently involved physicians in the aforementioned care prescribed morphine or sedative medications and used NPPV more frequently.This study found a discrepancy between the proportion of physicians who considered palliative care as effective and those who prescribed it. Geriatr Gerontol Int 2022; 22: 943-949.

Severe cardiac dysfunction can manifest with diurnal breathing irregularity. However, it remains to be clarified whether or not diurnal breathing irregularity is observed in patients with heart diseases, including relatively mild chronic heart failure (CHF), compared to those without heart diseases. In this cross-sectional study, consecutive inpatients who were admitted for evaluation of sleep-disordered breathing were enrolled. We extracted 3.5 min of stable respiratory signals before sleep onset using polysomnography, analyzed the airflow data using fast Fourier transform, and quantified breathing irregularities using Shannon entropy S. A total of 162 subjects were evaluated. Among these, 39 subjects had heart diseases, including ischemic heart disease (IHD), atrial fibrillation (Af), CHF, and a history of aortic dissection. The values of Shannon entropy S of airflow signals in subjects with heart diseases were significantly higher than in those without heart diseases (p

In 2020, the COVID-19 pandemic has had unprecedented impacts on various aspects of the world. Each academic society has published a guide and/or guidelines on how to cope with COVID-19 separately. As the one and only nationwide association of academic societies that represent medical science in Japan, JMSF has decided to publish the expert opinion to help patients and care providers find specifically what they want. This expert opinion is a summary of recommendations by many academic societies and will be updated when necessary. Patients that each academic society targets differ even though they suffer from the same COVID-19, and recommendations can be different in a context-dependent manner. Readers are supposed to be flexible and adjustable when they use this expert opinion.

We discuss the interaction of an open heavy meson ($\bar{D}$ and $\bar{D}^{\ast}$ for charm or $B$ and $B^{\ast}$ for bottom) and a nucleon ($N$) by considering the $\pi$, $\sigma$, $\rho$, and $\omega$ exchange potentials. We construct a potential model by respecting chiral symmetry for light quarks and spin symmetry for heavy quarks. Model parameters are adjusted by referring the phenomenological nuclear (CD-Bonn) potentials reproducing the low-energy $NN$ scatterings. We show that the resulting interaction may accommodate $\bar{D}N$ and $BN$ bound states with quantum number $I(J^{P})=0(1/2^{-})$, and a $BN$ bound state with $I(J^{P})=1(1/2^{-})$. We find that, in the present potential model, the $\sigma$ exchange potential plays an important role., Comment: 16 pages, 3 figures, 5 tables, published version

Primary palliative care is essential for the continuity of care in severe COPD. This study aimed to identify essential factors and aspects to enhance the quality of primary palliative care for adults with severe COPD living in the community. Interviews with medical professionals from six institutions located in two major metropolitan areas in Japan were conducted, and these interviews were analyzed by using a qualitative content analysis approach. Results indicate that effective collaborative communication among team members, long-term care insurance system and related services, and palliative care techniques were the primary themes.

Die kryptogene organisierende Pneumonie (COP) spricht in der Regel gut auf eine Steroidtherapie an. Bei einem Ausschleichen der Steroiddosis kommt es jedoch häufig zu Rezidiven. In unserem Krankenhaus stellte sich ein 74-jähriger Mann mit Verdacht auf steroidresistente COP vor. Eine Thorax-Computertomographie (CT) ergab trotz Verabreichung oraler Steroide in mittlerer Dosierung neue Konsolidierungen im Bereich des linken Lungenunterlappens. Bei einer erneuten transbronchialen Lungenbiopsie wurde eine Lungenkryptokokkose festgestellt. Nach Einleitung einer Behandlung mit Antimykotika verkleinerten sich die Konsolidierungen im linken Unterlappen sukzessive. Bei immungeschwächten Patienten mit Lungenkryptokokkose kommt es zu unterschiedlichen CT-Befunden, wobei Konsolidierungen häufig beobachtet werden. Im Falle einer steroidrefraktären COP sollte eine zugrunde liegende Lungenkryptokokkose in Betracht gezogen werden.

Context Tramadol is conditionally recommended for cancer pain and is a less expensive drug compared to strong opioids. Thus, tramadol may help reduce health care costs. Objectives To investigate factors that predict the clinical efficacy of tramadol for cancer pain. Methods A retrospective study using electronic medical records was conducted on patients who received tramadol for cancer pain from January 2016 to December 2020. Patients who continued tramadol for >28 days or discontinued tramadol before 28 days owing to pain improvement were considered as clinical efficacy cases. Results We identified 183 eligible patients; 104 cases had clinical efficacy. The median starting tramadol daily dose was 100 mg, and the median administration duration was 22 days. Overall, 169 patients (92.3%) discontinued tramadol; pain improvement was the most common reason (34.9%). Age (>70 years), a performance status of 0-1, and an albumin-bilirubin grade of 1 were independent predictors for the clinical efficacy of tramadol. Patients with multiple predictors had significantly higher achievement rates than those without. Conclusion Tramadol could have greater clinical efficacy for cancer pain in patients who are elderly, have good performance status, and have good liver function.

Background We developed a novel training program for health care professionals that incorporated shared decision making (SDM) skills training into an advance care planning (ACP) training course, the first in Japan. This study aimed to assess the training program’s impact on health care professionals’ knowledge, skill, attitudes, and confidence to initiate ACP. Methods Using the novel Japanese educational program, we evaluated the effect of 8-month programs conducted eight community training sites of professionals who can practice ACP in a local area in Aichi Prefecture (the Aichi ACP Project). SDM skills training was provided during the workshops conducted in the ACP training course, and the participants’ satisfaction and understanding of the training were assessed. After the completion of two workshops, information on SDM skill results from the training and submitted assignments were collected anonymously from the training sites. Result A total of 404 participants completed all education programs. After the first workshop, at least 95% of trainees stated that they were satisfied with the training and that it was useful for ACP practice. The evaluation of the results between the first and second workshops indicated improvement in SDM skills on some items of the SDM measures. In the second workshop, at least 90% of participants submitted implementation reports, and after the second workshop, a survey of confidence in ACP practice was administered, with responses indicating improvement. There were high levels of interest in education related to the ACP practices of oneself and others. Conclusions This educational program can be an effective for developing professionals who can practice ACP with SDM skills.

Immunoglobulin G4 (IgG4)‐related disease is established as a new clinical entity, characterized by high levels of plasma IgG4 and IgG4‐positive plasma cell infiltration. However, the elevation of plasma IgG4 and infiltration of IgG4‐positive cells have been observed in other diseases, including malignancy. We experienced a case of prominent IgG4‐positive lymphadenopathy, which was diagnosed as a reactive lesion in response to lung cancer. The cancerous lesion was so small in size that it was difficult to reveal the coexisting lung cancer. Surgical lymph node biopsy and endobronchial ultrasound‐guided transbronchial needle aspiration did not reveal lymph node metastasis of cancer. Mediastinal lymph node dissection finally revealed it. After the right upper lobectomy, the patient underwent postoperative chemotherapy and remains cancer‐free after 1 year. Our case suggests that close examination and careful follow‐up are necessary when IgG4‐positive lymphadenopathy is observed., This article discussed a case in which prominent lymphadenopathy with immunoglobulin G4‐positive cell infiltration was caused in response to microscopic lung cancer. Surgical lymph node biopsy, as well as endobronchial ultrasound‐guided transbronchial needle aspiration, could not reveal coexisting malignant cells in the mediastinal lymph node.

A 70-year-old woman with bilateral pleural effusion and respiratory failure was admitted to our hospital. Nephrotic syndrome due to minimal change disease had been diagnosed four months before admission. Because blood tests and a pleural fluid analysis did not reveal the etiology of her condition, we performed a video-assisted thoracoscopic pleural biopsy. No specific thoracoscopic findings were noted. The pathological findings revealed an increase in immunoglobulin G4 (IgG4)-positive cells; IgG4-related pleuritis was diagnosed. Her pleuritis improved with oral corticosteroid therapy. A further investigation was performed on previous kidney samples; however, the etiology of the nephrotic syndrome was not IgG4-related disease but minimal change disease.

The X(3872) is investigated by employing the quark-hadron hybrid model, that consists of the $$c\bar{c}$$ core, $$D^{(*)}\bar{D}{}^*$$ , $$J/\psi \omega $$ , and $$J/\psi \rho $$ two-meson states. Due to the attraction from the $$c\bar{c}$$ - $$D\bar{D}{}^*$$ coupling and from the OPEP tensor coupling, a very thin peak can appear at the $$D^{0}\bar{D}{}^{*0}$$ threshold. The energy of the corresponding pole of the scattering matrix is $$E=+0.06-0.14i$$ MeV, which is on the physical sheet and above the threshold, the same as the one of the poles from the LHCb data analysis.

In patients with overlap syndrome (OVS), the pathophysiologies of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease can interact with one another. Focusing on low arousal threshold, the authors evaluated polysomnographic features of OVS patients. This retrospective, multicenter study was conducted at three hospitals in Japan. Patients aged ≥ 60 years who underwent polysomnography and pulmonary function testing were reviewed. Severity of airflow limitation (AFL) was classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria. Low arousal threshold was predicted based on the following polysomnography features: lower apnea-hypopnea index (AHI); higher nadir oxygen saturation, and larger hypopnea fraction of total respiratory events. These features were compared among patients with only OSA (n = 126), OVS with mild AFL (n = 16), and OVS with moderate/severe AFL (n = 22). A low arousal threshold was more frequently exhibited by OVS patients with moderate/severe AFL than by those with OSA only (p = 0.016) and OVS with mild AFL (p = 0.026). As forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) decreased in OVS patients, the mean length of apnea decreased (r = 0.388, p = 0.016), hypopnea fractions increased (r = − 0.337, p = 0.039), and AHI decreased (r = 0.424, p = 0.008). FEV1/FVC contributed to low arousal threshold independent of age, sex, smoking history, hospital, or body mass index in all subjects (OR 0.946 [95% CI 0.909–0.984]) and in OVS patients (OR 0.799 [95% CI 0.679–0.940]). This study first described peculiar polysomnographic features in OVS patients with moderate/severe AFL, suggesting a high prevalence of low arousal threshold.

We investigate the hidden-charm pentaquarks as a Λc͞D⁽*⁾ – Σc⁽*⁾͞D⁽*⁾ hadronic molecule coupling to a compact five-quark state. The coupling to the compact state leads to an hadron short-range interaction generating an attraction. In addition, the one pion exchange potential (OPEP) as a long-range interaction is introduced by the Lagrangians satisfying the chiral and heavy quark spin symmetries. The OPEP has been known as a driving force to bind atomic nuclei, where the tensor term leading the coupled-channel effect generates a strong attraction. The mass degeneracy of heavy hadrons due to the heavy quark spin symmetry enhances the OPEP derived by the πD⁽*⁾͞D⁽*⁾ and πΣc⁽*⁾Σc⁽*⁾ couplings. Introducing those interactions, we consistently explain the masses and widths of the Pc states reported by LHCb in 2019. The short range interaction has a dominant role to determine the energy-level structures, while the OPEP tensor term does the decay width., Facultad de Ciencias Exactas

Background Poor oral health conditions are known to affect frailty in the older adults. Diabetes is a risk factor for both poor oral health and frailty, therefore, oral health status may affect frailty in diabetic patients more than in the general population. The purpose of this study was to evaluate the influence of oral health and other factors on frailty and the relationship among oral health, diabetes and frailty in older adult patients with type 2 diabetes. Methods Patients with type 2 diabetes aged 75 years or older were included in this cross-sectional study. Eligible patients were surveyed by questionnaire for frailty, oral health status, and cognitive and living functions. Factors influencing pre-frailty, frailty, and individual frailty screening index (FSI) classes were evaluated. Results Of the 111 patients analyzed, 66 cases (59.5%) were categorized as robust, 33 cases (29.7%) as pre-frailty, and 12 cases (10.8%) as frailty. The oral frailty index, the cognitive and living functions score, and BMI were found to be factors influencing pre-frailty or frailty. In the evaluation of individual FSI classes, BMI had an influence on those with a FSI ≤2. The cognitive and living functions score was a factor influencing those with FSI ≤3. The oral frailty index was found to have a significant influence on all FSI classes. Conclusions Poor oral health has an influence on frailty in patients with type 2 diabetes aged ≥75. In this patient population, as frailty progresses, the impact of oral health on frailty may increase. Trial registration: This study was retrospectively registered in UMIN-CTR (UMIN000044227).

A previous pooled analysis demonstrated significant relief of breathlessness following opioid administration in patients with chronic obstructive pulmonary disease. However, in clinical practice, it is important to know the characteristics of patients responding to opioids, the best prescription methods, and the evaluation measures that can sufficiently reflect these effects. Thus, we performed a systematic review of systemic opioids for non-cancer chronic respiratory diseases. Fifteen randomized controlled studies (RCTs), four non-randomized studies, two observational studies, and five retrospective studies were included. Recent RCTs suggested that regular oral opioid use would decrease the worst breathlessness in patients with a modified Medical Research Council score ≥ 3 by a degree of 1.0 or less on a scale of 1–10. Ergometer or treadmill tests indicated mostly consistent significant acute effects of morphine or codeine. In two non-randomized studies, about 60% of patients responded to opioids and showed definite improvement in symptoms and quality of life. Furthermore, titration of opioids in these studies suggested that a major proportion of these responders had benefits after administration of approximately 10 mg/day of morphine. However, more studies are needed to clarify the prescription method to reduce withdrawal due to adverse effects, which would lead to significant improvements in overall well-being.

We reevaluate the electric dipole moment (EDM) of charged leptons in the standard model using hadron effective models. We find unexpectedly large EDM generated by the hadron level long-distance effect, $d_e = { 5.8 \times 10^{-40} }$, $d_\mu = { 1.4 \times 10^{-38}}$, and $d_\tau = { -7.3 \times 10^{-38} }$ ecm, with an error bar of 70\%, exceeding the conventionally known four-loop level elementary contribution by several orders of magnitude., Comment: 6 pages, 5 figures, version published in Phys. Rev. Lett

Since the end of 2019, a life-threatening infectious disease (coronavirus disease 2019: COVID-19) has spread globally, and numerous victims have been reported. In particular, older persons tend to suffer more severely when infected with a novel coronavirus (SARS-CoV-2) and have higher case mortality rates; additionally, outbreaks frequently occur in hospitals and long-term care facilities where most of the residents are older persons. Unfortunately, it has been stated that the COVID-19 pandemic has caused a medical collapse in some countries, resulting in the depletion of medical resources, such as ventilators, and triage based on chronological age. Furthermore, as some COVID-19 cases show a rapid deterioration of clinical symptoms and accordingly, the medical and long-term care staff cannot always confirm the patient's values and wishes in time, we are very concerned as to whether older patients are receiving the medical and long-term care services that they wish for. It was once again recognized that it is vital to implement advance care planning as early as possible before suffering from COVID-19. To this end, in August 2020, the Japan Geriatrics Society announced ethical recommendations for medical and long-term care for older persons and emphasized the importance of conducting advance care planning at earlier stages. Geriatr Gerontol Int 2020; 20: 1112-1119.

Severe cardiac dysfunction can manifest with diurnal breathing irregularity. However, it remains to be clarified whether or not diurnal breathing irregularity is observed in patients with heart diseases, including relatively mild chronic heart failure (CHF), compared to those without heart diseases.In this cross-sectional study, consecutive inpatients who were admitted for evaluation of sleep-disordered breathing were enrolled. We extracted 3.5 min of stable respiratory signals before sleep onset using polysomnography, analyzed the airflow data using fast Fourier transform, and quantified breathing irregularities using Shannon entropy S.A total of 162 subjects were evaluated. Among these, 39 subjects had heart diseases, including ischemic heart disease (IHD), atrial fibrillation (Af), CHF, and a history of aortic dissection. The values of Shannon entropy S of airflow signals in subjects with heart diseases were significantly higher than in those without heart diseases (p 0.001). After excluding CHF, the Shannon entropy S was also significantly higher in subjects with heart diseases than in those without heart diseases (p 0.001). The values of Shannon entropy S were significantly correlated with plasma brain natriuretic peptide levels (r = 0.443, p 0.001). Although the values were also significantly correlated with body mass index, the presence of heart diseases was independently associated with breathing irregularity in the multiple logistic analysis. Matching analysis revealed consistent differences between subjects with heart diseases and without heart diseases.Breathing irregularity was observed before sleep onset in subjects with heart diseases who underwent polysomnography to diagnose sleep-disordered breathing.

${\overline{D}}^{0}$-meson photoproduction off the proton is studied at energies from the process threshold up to 20 GeV. The background part of the process is modeled within the Regge model with the help of ${\overline{D}}^{0}$-meson trajectories that are being exchanged in the $t$ channel or ${\mathrm{\ensuremath{\Lambda}}}_{c}^{+}$-baryon trajectories exchanged in the $u$ channel. These contributions create cross sections which are smooth functions of energy. The introduction of exchanges of three hidden-charm pentaquarks with spin $1/2$ and $3/2$ in the $s$ channel then creates sharp peaks in the cross section predictions. In order to account for the finite size of the particles involved, we introduce hadron form factors. In analysis of model predictions with pseudoscalar and pseudovector couplings in the strong vertex, the contact term was shown to play a non-negligible role. A great merit of the proposed approach is its limited number of parameters that need to be adjusted as there are to this date no data available for this process. Being limited by the broken SU(4) symmetry and guided by other works that show their predictions of this process, we could adjust the parameters manually in order to provide at least qualitative results.

Latent TGF-β binding protein 4 is an important factor that influences anti-inflammatory and cell-protective responses in the pathogenesis of pulmonary empysema Rationale: Deficiency of the extracellular matrix protein latent transforming growth factor-β (TGF-β)-binding protein-4 (LTBP4) results in lack of intact elastic fibers, which leads to pulmonary emphysema. However, how LTBP4 is involved in the pathogenesis of emphysema associated with elastic fiber assembly is largely unknown. Methods: To investigate the anti-inflammatory effects of LTBP4, we utilized human lung fibroblast cell lines (L299). L299 cells were transfected with LTBP4 siRNA. To evaluate the anti-inflammatory and cell-protective effects of LTBP4 in lungs, we analyzed the mRNA expression patterns of proinflammatory cytokines (MIP-1α, MCP-1, IP-10, and MIP-2), MMPs (MMP-1 and MMP-12) , TIMP-1, elastin and tropoelastin. The role of LTBP4 associated with elastic fiber assembly was evaluated in collagen-based cell contraction assay. Results: In the LTBP4-deficiency group, mRNA levels of MIP-1α, MCP-1, IP-10, MIP-2, MMP-1, MMP-12, and TIMP-1 were significantly decreased(p＜0.05) and elastin and tropoelastin were significantly increased (p＜0.05). The collagen-based cell contraction assay showed that the collagen gel size change was measured and LTBP4-deficiency is involved in the decreased level of elastic contraction(p＜0.05). Conclusion: Our results suggest a unique function for LTBP-4 that influences anti-inflammatory and cell-protective responses in elastic fiber assembly. These data are potentially useful for the treatment or prevention of pulmonary emphysema.