Search

Hot QCD physics studies the nuclear strong force under extreme temperatureand densities. Experimentally these conditions are achieved via high-energycollisions of heavy ions at the Relativistic Heavy Ion Collider (RHIC) and theLarge Hadron Collider (LHC). In the past decade, a unique and substantial suiteof data was collected at RHIC and the LHC, probing hydrodynamics at the nucleonscale, the temperature dependence of the transport properties of quark-gluonplasma, the phase diagram of nuclear matter, the interaction of quarks andgluons at different scales and much more. This document, as part of the 2023nuclear science long range planning process, was written to review the progressin hot QCD since the 2015 Long Range Plan for Nuclear Science, as well ashighlight the realization of previous recommendations, and presentopportunities for the next decade, building on the accomplishments andinvestments made in theoretical developments and the construction of newdetectors. Furthermore, this document provides additional context to supportthe recommendations voted on at the Joint Hot and Cold QCD Town Hall Meeting,which are reported in a separate document.

Objectives: This study aimed to explore the association between the coronavirus disease (COVID-19) pandemic and overweight incidence among preadolescent elementary school children in Japan., Methods: A population-based longitudinal study was conducted in Adachi City, Tokyo, Japan, using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study. The control group (2016-2018) comprised 434 children, and the COVID-19 exposure group (2018-2020) included 3500 children. Overweight was defined as a body mass index (BMI) z-score of 1 SD or more according to the World Health Organization standards. The study design involved comparing BMI z-scores before and after exposure to the pandemic, considering the associated lifestyle changes and potential consequences on physical activity, parental employment status and income., Results: By 6th grade, the prevalence of overweight increased from 17.7% to 19.2% in the control group and 22.5% to 29.5% in the COVID-19 exposure group. Difference-in-differences analysis revealed that children's exposure to COVID-19 significantly increased BMI z-scores (coefficient 0.22, 95% confidence interval (CI) 0.14-0.29) and a higher odds ratio of overweight (odds ratio 2.51, 95% CI 1.12-5.62), even after adjusting for time-varying covariates., Conclusion: The COVID-19 pandemic has been associated with an increased prevalence of overweight among elementary school children in Japan., (© 2024 World Obesity Federation.)

Motile cilia have a so-called "9 + 2" structure, which consists of nine doublet microtubules and a central pair apparatus. The central pair apparatus (CA) is thought to interact mechanically with radial spokes and to control the flagellar beating. Recently, the components of the CA have been identified by proteomic and genomic analyses. Still, the mechanism of how the CA contributes to ciliary motility has much to be revealed. Here, we focused on one CA component with a large molecular weight: FAP47, and its relationship with two other CA components with large molecular weight: HYDIN, and CPC1. The analyses of motility of the Chlamydomonas mutants revealed that in contrast to cpc1 or hydin, which swam more slowly than the wild type, fap47 cells displayed wild-type swimming velocity and flagellar beat frequency, yet interestingly, fap47 cells have phototaxis defects and swim straighter than the wild-type cells. Furthermore, the double mutant fap47cpc1 and fap47hydin showed significantly slower swimming than cpc1 and hydin cells, and the motility defect of fap47cpc1 was rescued to the cpc1 level with GFP-tagged FAP47, indicating that the lack of FAP47 makes the motility defect of cpc1 worse. Cryo-electron tomography demonstrated that the fap47 lacks a part of the C1-C2 bridge of CA. Taken together, these observations indicate that FAP47 maintains the structural stiffness of the CA, which is important for flagellar regulation., (© 2024 The Author(s). Cytoskeleton published by Wiley Periodicals LLC.)

Ferroptosis is a form of regulated cell death that is induced by inhibiting glutathione peroxidase 4 (GPX4), which eliminates lipid peroxidation. Ferroptosis induction is influenced by the cell environment. However, the cellular states altering ferroptosis susceptibility remain largely unknown. We found that melanoma cell lines became resistant to ferroptosis as cell density increased. Comparative transcriptome and metabolome analyses revealed that cell density-dependent ferroptosis resistance was coupled with a shift toward a lipogenic phenotype accompanied by strong induction of stearoyl-CoA desaturase (SCD). Database analysis of gene dependency across hundreds of cancer cell lines uncovered a negative correlation between GPX4 and SCD dependency. Importantly, SCD inhibition, either pharmacologically or through genetic knockout, sensitized melanoma cells to GPX4 inhibition, thereby attenuating ferroptosis resistance in cells at high density. Our findings indicate that transition to an SCD-inducing, lipogenic cell state produces density-dependent resistance to ferroptosis, which may provide a therapeutic strategy against melanoma., (© 2024 Wiley Periodicals LLC.)

The usefulness of the derived neutrophil-to-lymphocyte ratio (dNLR) and its dynamics before/after durvalumab consolidation therapy to predict safety or efficacy remains unclear. We retrospectively reviewed patients with locally advanced non-small cell lung cancer treated with durvalumab consolidation therapy after chemoradiotherapy (D group) or chemoradiotherapy alone (non-D group) at multiple institutions. We investigated the association between dNLR, or its dynamics, and pneumonitis, checkpoint inhibitor-related pneumonitis (CIP), irAEs, and efficacy. Ninety-eight and fifty-six patients were enrolled in the D and non-D groups, respectively. The dNLR at baseline was significantly lower in patients who experienced irAEs or CIP than in those who did not. The low dNLR group, 28 days following durvalumab consolidation therapy (dNLR28 ≤ 3), demonstrated longer progression-free survival (PFS) and overall survival (OS) than the high dNLR group (dNLR28 > 3) (PFS, hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22-0.88, p = 0.020; OS, HR 0.39, 95% CI 0.16-0.94, p = 0.037). Among patients with high dNLR at baseline (dNLR > 3), the dNLR28 ≤ 3 group showed longer PFS than the dNLR28 > 3 group (p = 0.010). The dNLR is a predictive factor for irAEs and CIP in patients receiving durvalumab consolidation therapy. The dNLR at 28 days after durvalumab consolidation therapy and its dynamics predict favorable outcomes., (© 2024. The Author(s).)

Background and Aim: Effective treatment of lesions that develop in the irradiated area of head and neck squamous cell carcinoma is a major concern. This study aimed to clarify the efficacy and safety of endoscopic resection for such lesions., Methods: Among consecutive patients who underwent endoscopic resection for histologically proven head and neck squamous cell carcinoma between January 2014 and December 2021, those who received definitive radiotherapy/chemoradiotherapy before endoscopic resection were included in this single-center, retrospective study. Short- and long-term outcomes were evaluated., Results: Among 422 patients who underwent endoscopic resection for 615 lesions, 43 patients with 57 lesions were eligible. All 57 lesions were treated with endoscopic submucosal dissection and en bloc resection was achieved in all lesions. Grade 3 of Common Toxicity Criteria for Adverse Events v5.0 occurred in eight (19%) patients (dysphagia, seven; stricture, three; aspiration pneumonia, two; and pharyngeal necrosis, one [some cases overlapped]), but no grade ≥ 4 events occurred. Enteral nutrition by gastrostomy was temporarily required in two patients owing to dysphagia and laryngeal necrosis. During the median follow-up of 40 (interquartile range, 29.5-61) months after endoscopic submucosal dissection for the lesions developed in the irradiated area, local recurrence and metachronous lesions developed in two (5%) and nine (21%) patients, respectively. However, total laryngectomies and tracheostomies were avoided in all patients. The 3-year overall and disease-specific survivals were 81% (95% confidence interval, 64%-91%) and 94% (95% confidence interval, 79%-99%), respectively., Conclusions: Favorable local control and safety of endoscopic submucosal dissection were demonstrated., (© 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: Poverty negatively impacts beneficial aspects of mental development, such as resilience. Toothbrushing, an oral health behavior, has the potential to protect children's resilience through its anti-inflammatory and self-management effects and may be more effective for children, especially children in poverty. This study investigated whether toothbrushing boosts resilience among children, especially children under poverty, and modifies the association between poverty and resilience using a longitudinal population sample of school children., Methods: Data from the Adachi Child Health Impact of Living Difficulty (A-CHILD Study) were analyzed. A baseline study was conducted in 2015 in which the children were in first grade and followed through fourth grade (N = 3459, response rate: 80%, follow-up rate: 82%). Poverty was assessed by material deprivation (life-related deprivation and child-related deprivation) and annual household income at baseline. Children's toothbrushing frequency was assessed at baseline and classified into less than twice a day or twice or more a day. Children's resilience was assessed at baseline and follow-up using the Children's Resilient Coping Scale (range 0-100)., Results: Children who brushed their teeth twice or more a day in first grade had 3.50 points greater resilience scores in fourth grade than those who brushed their teeth less than twice a day in first grade. After adjusting for confounders, including resilience in first grade, among underpoverty children, those who brushed their teeth twice or more a day in first grade had higher resilience scores [2.66 (95% CI = 0.53, 4.79)] than those who brushed their teeth less than twice a day. Among nonpoverished children, toothbrushing frequency in first grade did not significantly correlate with resilience in fourth grade., Conclusions: The beneficial effect of toothbrushing twice or more a day on resilience was more significant among children in poverty than among those without poverty in elementary school in Japan. Health policy focused on frequent toothbrushing may contribute to boosting resilience among children living in poverty., (© 2024. The Author(s).)

Background: Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes., Methods: Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography., Results: Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, P =0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; P =0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir ( P <0.001 and P =0.022) and booster pump strain ( P =0.011 and 0.028) at rest and during exercise, respectively., Conclusions: Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events., Competing Interests: Dr Obokata received speaker honoraria from Novartis, Otsuka pharmaceutical, Eli Lilly, and Boehringer Ingelheim. Dr Ishii received lecture fees from AstraZeneca Inc, Bayer Pharmaceutical Co, Ltd, Boehringer Ingelheim Japan, Bristol-Myers Squibb Inc, Daiichi-Sankyo Pharma Inc, MSD K. K., Mitsubishi Tanabe Pharma Co, Ltd, Mochida Pharmaceutical Co, Ltd, Novartis Japan, and Pfizer Japan Inc. The authors certify that these honoraria and lecture fees are not relevant to this study. The other authors report no conflicts.

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome requiring improved phenotypic classification. Previous studies have identified subphenotypes of HFpEF, but the lack of exercise assessment is a major limitation. The aim of this study was to identify distinct pathophysiologic clusters of HFpEF based on clinical characteristics, and resting and exercise assessments., Methods: A total of 265 patients with HFpEF underwent ergometry exercise stress echocardiography with simultaneous expired gas analysis. Cluster analysis was performed by the K-prototype method with 21 variables (10 clinical and resting echocardiographic variables and 11 exercise echocardiographic parameters). Pathophysiologic features, exercise tolerance, and prognosis were compared among phenogroups., Results: Three distinct phenogroups were identified. Phenogroup 1 (n = 112 [42%]) was characterized by preserved biventricular systolic reserve and cardiac output augmentation. Phenogroup 2 (n = 58 [22%]) was characterized by a high prevalence of atrial fibrillation, increased pulmonary arterial and right atrial pressures, depressed right ventricular systolic functional reserve, and impaired right ventricular-pulmonary artery coupling during exercise. Phenogroup 3 (n = 95 [36%]) was characterized by the smallest body mass index, ventricular and vascular stiffening, impaired left ventricular diastolic reserve, and worse exercise capacity. Phenogroups 2 and 3 had higher rates of composite outcomes of all-cause mortality or heart failure events than phenogroup 1 (log-rank P = .02)., Conclusion: Exercise echocardiography-based cluster analysis identified three distinct phenogroups of HFpEF, with unique exercise pathophysiologic features, exercise capacity, and clinical outcomes., Competing Interests: Disclosures Dr. Obokata has received speaker honoraria from Novartis, Otsuka Pharmaceutical, and Nippon Boehringer-Ingelheim. Dr. Ishii has received lecture fees from AstraZeneca, Bayer Pharmaceutical, Boehringer Ingelheim Japan, Bristol-Myers Squibb, Daiichi-Sankyo Pharma, MSD, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Novartis Japan, and Pfizer Japan., (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Objective: To identify the optimal gestational weight gain (GWG) thresholds for behavioral problems and prosocial behavior in 6- to 7-year-old children., Methods: A retrospective cohort study was conducted using data from the Adachi Child Health Impact of Living Difficulty study, including all first-graders in public schools in Adachi, Tokyo, in 2017, 2019, and 2021 (n = 11 048, response rate = 80.1%). GWG was based on clinical records in the Mother and Child Health Handbook. Total difficulties and prosocial behavior were assessed using the Strength and Difficulties Questionnaire. Logistic regression models with restricted cubic splines, and quintile categories were employed to examine the association of GWG with the clinical range of total difficulties and prosocial behavior, controlling for covariates., Results: The association between GWG and total difficulties exhibited a reverse J-shaped pattern, with low GWG, but not high GWG, increasing the risk (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.01-1.42, P = 0.039 for GWG < 7 kg; OR 1.03, 95% CI 0.85-1.24, P = 0.786 for GWG > 14 kg), referencing the median (10 kg). High GWG was associated with a lower risk of problems in prosocial behavior (OR = 0.77, 95% CI 0.62-0.95, P = 0.017 for GWG > 14 kg; OR 1.06, 95% CI 0.88-1.27, P = 0.532 for GWG <7 kg)., Conclusion: GWG less than 7 kg may increase the risk of total difficulties, whereas GWG over 14 kg may serve as a protective factor for prosocial behavior in 6- to 7-year-old children., (© 2024 International Federation of Gynecology and Obstetrics.)

Introduction: Fatigue is reportedly associated with a poor prognosis in dialysis patients. The aim of the present study was to investigate whether fatigue on dialysis days or non-dialysis days is associated with mortality in patients on chronic hemodialysis., Methods: This was a prospective study of 134 hemodialysis patients. The level of fatigue was evaluated using a visual analog scale (VAS). The association between high fatigue evaluated by the highest quartile of the VAS value and all-cause death was investigated., Results: The fatigue scale score was significantly higher on dialysis than on non-dialysis days. During the follow-up period (median 6.8 years), 42 patients died. Patients with high post-dialysis fatigue in the higher quartiles died more frequently compared to those with in the lower quartiles (p = 0.012). Multivariate Cox regression analysis showed that high post-dialysis fatigue was an independent predictor of all-cause death (adjusted hazard ratio 2.12, 95% confidence interval 1.10-4.07)., Conclusion: Higher post-dialysis fatigue is related to increased mortality., (© 2024 International Society for Apheresis and Japanese Society for Apheresis.)

Background and Aims: There is a high incidence of stricture after endoscopic submucosal dissection (ESD) for cervical esophageal cancer. We aimed to elucidate the risk factors for stricture and evaluate the efficacy of steroid injection for stricture prevention in the cervical esophagus., Methods: We retrospectively analyzed 100 patients who underwent ESD for cervical esophageal cancer to: (1) identify the factors associated with stricture among patients who did not receive steroid injection; (2) compare the incidence of stricture between patients with and without steroid injection., Results: Among 48 patients who did not receive steroid injection, there were significant differences in tumor size (P = .026), resection time (P = .028), and circumferential extent of the mucosal defect (P = .005) between patients with stricture (n = 5) and without stricture (n = 43). Compared with patients without steroid injection, patients with steroid injection had a significantly lower incidence of stricture when the post-ESD mucosal defect was < 3/4 and ≥ 1/2 (40% versus 8%, P = .039). As for the patients with a post-ESD mucosal defect of ≥ 3/4 (n = 13), local steroid injection was performed for all the patients, and 6 patients (46%) developed stricture., Conclusions: Patients who underwent ≥ 1/2 circumferential resection were at high risk of cervical esophageal stricture. Steroid injection had a stricture-prevention effect in patients with < 3/4 and ≥ 1/2 circumferential resection, but seemed to be insufficient in preventing stricture in patients with ≥ 3/4 circumferential resection., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Introduction: Anterior congenital radial head dislocation (CRHD) is a rare abnormality that is less commonly seen in the adult population. Most of the time, adult-onset symptoms are due to the prolonged dislocation of the radiocapitellar joint that has been present since birth. One of the possible complications of having a prolonged radial head dislocation is the presence of neuropathies such as posterior interosseous nerve (PIN) palsy. There has been, however, no literature published regarding the relationship of CRHD with PIN palsy., Case Report: We here report a 66-year-old male incidentally diagnosed with anterior CRHD with concomitant PIN palsy after acquiring a fracture of the lateral humeral condyle. Open reduction internal fixation of the lateral condyle was done along with decompression of the said nerve. PIN palsy was completely recovered 2 months after surgery., Conclusion: Surgeons must be aware that PIN palsies can occur in the presence of a chronic radial head dislocation, even if asymptomatic. Prompt nerve decompression as well as removal of the mechanical block is pertinent to avoid the perilous effects of an irreversible PIN palsy., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Competing Interests: T. Kanesaka has received honoraria from Olympus, AstraZeneca, and AI Medical Service. R. Ishihara has received honoraria from Olympus, FUJIFILM Medical, Daiichi-Sankyo, Miyarisan Pharmaceutical, AI Medical Service, Astra Zeneca, MSD, and Ono Pharmaceutical. Y. Tani, K. Higashino, K. Aoki, T. Fujii, and T. Michida declare that they have no conflict of interest.

To establish an easy way to perform volumetry of the thyroid gland using ultrasonography, we evaluated the accuracy of the products of the depth and width of the right thyroid lobe as indices of thyroid volume. The depth and width of both thyroid lobes were measured using ultrasonography before surgery in 193 patients with Graves' disease. The products were compared with the weight of the thyroid obtained from operative records. We also evaluated the depth and width of the right thyroid lobe in 312 subjects who presented without any thyroid disease. The products of depth and width of the right and left lobes of patients with Graves' disease correlated similarly well with the weight of the thyroid obtained from operative records (ρ = 0.896 for right, ρ = 0.886 for left, p < 0.0001). Because the right lobes were larger than the left lobes, the products of the depth and width of the right lobe were adopted as novel parameters for an easy volumetric approach. The relationship between the weight and the measurements of the right lobe was described using the following regression equation: weight (g) = [11.8 × depth (cm) × width (cm)] - 16.0. The products of the subjects without any thyroid diseases were distributed between 0.6 cm 2 and 4.4 cm 2 , with a median of 2.0 cm 2 . The upper limit of these values in these subjects was estimated to be 3.8 cm 2 . This easy ultrasonographic volumetric technique makes it possible to perform a semi-quantitative assessment of thyroid volume and to differentiate diffuse goiter from normal-sized thyroids.

Aims: The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging based on resting assessments. Exercise echocardiography is often used to unmask abnormalities that develop during exercise, but the diagnostic criteria have not been standardized. This study aimed to elucidate how cardiologists utilize exercise echocardiography to diagnose HFpEF in real-world practice., Methods and Results: An international web-based survey involving 87 cardiologists was performed. We also performed a retrospective cross-sectional study to investigate the impact of different exercise echocardiographic diagnostic criteria in 652 dyspnoeic patients who underwent exercise echocardiography. The HFA-PEFF algorithm was the most commonly used exercise echocardiography criterion for HFpEF diagnoses (48%), followed by the ASE/EACVI criteria (24%) and other combinations of multiple parameters (22%). Among 652 patients, the proportion of HFpEF diagnosis varied substantially according to the criteria used ranging from 20.1% (ASE/EACVI criteria) to 44.3% (HFA-PEFF algorithm). Many cases (49.4-70.5%) remained indeterminate after exercise echocardiography, but only 41% of surveyed cardiologists would utilize exercise right heart catheterization to resolve an indeterminate result. Despite these diagnostic uncertainties, 54% of surveyed cardiologists would utilize exercise echocardiography results to initiate sodium-glucose co-transporter 2 inhibitors., Conclusion: In real-world practice, exercise echocardiographic criteria utilized across cardiologists vary, which meaningfully impacts the frequency of HFpEF diagnoses, with indeterminate results being common. Despite these diagnostic uncertainties, many cardiologists initiate pharmacotherapy based on exercise echocardiography. The lack of consensus on universal diagnostic criteria for exercise echocardiography and approaches to indeterminate results may limit the delivery of evidence-based treatment for HFpEF., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Rectal implantation cysts can occur at anastomotic sites after low anterior resection (LAR) for rectal cancer. Herein, we report a case of primary adenocarcinoma arising from a rectal implantation cyst after LAR for rectal cancer. A 70-year-old woman was referred to our hospital for diagnosis and treatment of a growing cystic lesion. She had LAR performed for rectal cancer 29 years previously and had a rectal implantation cyst detected 13 years previously. On the first visit to our hospital, serum CEA and CA19-9 levels were elevated, and computed tomography (CT) scans revealed a cystic lesion near the anastomosis. CT-guided biopsy revealed no cancer tissue in the cystic lesion. After that, the cystic lesion naturally shrank, and serum CEA and CA19-9 levels became normal. Follow-up included 3 monthly serum CEA and CA19-9 testing and 6 monthly CT scans. Two years later, serum CEA and CA19-9 levels were elevated again. Colonoscopy revealed an ulcerative lesion at the anastomotic site, in which adenocarcinoma was confirmed. Abdominoperineal resection with sacral resection was performed, and postoperative histopathological examination revealed a primary adenocarcinoma with mucinous component at the implantation cyst. Since rectal implantation cysts can become malignant after extended periods, clinicians need to be aware of this disease., (© 2024. Japanese Society of Gastroenterology.)

Background: This registry aims to allow for a prospective non-interventional observational study of ulcerative colitis. This will facilitate monitoring of the current state of ulcerative colitis in Japan and improving the long-term disease course and adverse events associated with current treatment options., Methods: Inclusion of patients from five centres in Japan is planned. The study is expected to take place from July 15, 2020, to November 30, 2024. Background, demographics, and medical history/information will be collected from electronic medical records at enrolment. Medical information including medications, laboratory data, and disease activity will be collected automatically from electronic medical records throughout the study. Patient-reported quality of life data will be collected directly from patients via smartphone. Efficacy endpoints (clinical remission rate, clinical improvement rate, and endoscopic healing rate) and safety endpoints (incidence of adverse events and specific ulcerative colitis-related events) will be collected according to treatment administered. Treatment categories include no treatment, 5-aminosalicylic acids, corticosteroids, immunomodulators, immunosuppressants, anti-tumour necrosis alpha agents, cytapheresis, Janus kinase inhibitors, anti-integrin antibodies, and anti-interleukin-12/23 antibodies., Conclusions: The dataset will include cross-sectional and longitudinal data and is expected to capture the state of ulcerative colitis in Japan. Patients will be included on a large scale, and the registry will be established automatically from electronic medical records and direct patient input, facilitating the accurate recording of medical information for patients with ulcerative colitis in Japan and minimizing limitations intrinsic to databases that require manual data entry, such as the burden on participating investigators and entry of data with errors/typos., Competing Interests: KM has received full support for the current study from Pfizer Japan Inc.; grants and honoraria from Mitsubishi Tanabe Pharma, AbbVie Inc., EA Pharma Co., Ltd., Kyorin Pharmaceutical Co., Ltd., Mochida Pharmaceutical Co., Ltd., ZERIA Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., and JIMRO Co., Ltd; and honoraria from Takeda Pharmaceutical Co., Ltd., Pfizer Inc, Janssen Pharmaceutical K.K., Gilead Sciences, and Eli Lilly Japan K.K. SH has received full support for the current study from Pfizer Japan Inc.; and honoraria from AbbVie GK, Mochida Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co., Ltd., EA Pharma Co. Ltd., and Kissei Pharmaceutical Co., Ltd. KA has received full support for the current study from Pfizer Japan Inc.; and honoraria from Nippon Kayaku Co. Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Co., Ltd., AbbVie GK., JIMRO Co., Ltd., EA Pharma Co. Ltd., AYUMI Pharmaceutical Corporation, Mochida Pharmaceutical Co., Ltd., Aspen Japan K.K., Pfizer Japan Inc., Eli Lilly Japan K.K., Alfresa Pharma Co. Ltd., Sandoz K.K., and KYORIN Pharmaceutical Co., Ltd. YT has received full support for the current study from Pfizer Japan Inc. TT has received full support for the current study from Pfizer Japan Inc.; and grants from Mitsubishi Tanabe Pharma Corporation, Zeria Pharmaceutical Co., Ltd., AbbVie Inc, Mochida Pharmaceutical Co., Ltd., and EA Pharma Co., Ltd. HO has received full support for the current study from Pfizer Japan Inc.; and honoraria from Miyarisan Pharmaceutical Co. Ltd., Fujifilm Medical Co., Ltd., Terumo Corporation, FANCL Corporation, Jansen Pharmaceutical, Mitsubishi-Tanabe Pharmaceutical, Takeda Pharmaceutical, EA Pharma, JIMRO, Pfizer Japan Inc., and Mochida Pharmaceutical. TY has received full support for the current study from Pfizer Japan Inc. AA has received full support for the current study from Pfizer Japan Inc., and honoraria from Takeda Pharmaceutical Company and Miyarisan Pharmaceutical Company. YS has received full support for the current study from Pfizer Japan Inc. TM has received full support for the current study from Pfizer Japan Inc.; honoraria from Jansen Pharmaceutical, Mitsubishi-Tanabe Pharmaceutical, Takeda Pharmaceutical, EA Pharma, JIMRO, Kyorin Pharmaceutical, Viatris, Pfizer Japan, Mochida Pharmaceutical, Kissei Pharmaceutical, and Nippon Kayaku; and participates on the Data Safety Monitoring Board or Advisory Board of Jansen Pharmaceutical and Takeda Pharmaceutical. YI has received full support for the current study from Pfizer Japan Inc. TS has received full support for the current study from Pfizer Japan Inc. TK has received full support for the current study from Pfizer Japan Inc.; grants from JMDC Inc., Gilead Sciences, Inc., Eli Lilly Japan K.K., Ferring Pharmaceuticals, Bristol-Myers Squibb, Google Asia Pacific Pte. Ltd; grants and honoraria from Zeria Pharmaceutical Co., Ltd., JIMRO Co., Ltd.; grants, honoraria, and payment for expert testimony from Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co., Ltd., Activaid, Nippon Kayaku Co., Ltd., Alfresa Pharma Corporation, Kyorin Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corporation, AbbVie GK, Pfizer Japan Inc.; grants and payment for expert testimony from EA Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd.; payment for expert testimony from KISSEI Pharmaceutical Co., Ltd.; and honoraria from Thermo Fisher Diagnostics K.K., (© 2024 Society for Clinical Epidemiology.)

Aims: Cardiopulmonary exercise testing (CPET) combined with exercise echocardiography (CPETecho) allows simultaneous assessments of cardiac, pulmonary, and ventilation in heart failure (HF) with preserved ejection fraction (HFpEF). This study sought to determine whether simultaneous assessment of CPET variables could provide additive predictive value over exercise stress echocardiography in patients with dyspnoea., Methods and Results: CPETecho was performed in 443 patients with suspected HFpEF (240 HFpEF and 203 controls without HF). Patients with HFpEF were divided based on peak oxygen consumption (VO 2 , ≥10 or <10 ml/min/kg) or the slope of minute ventilation to carbon dioxide production (V E vs. VCO 2 slope ≥45.0 or <45.0). The primary endpoint was defined as a composite of all-cause mortality, HF hospitalization, unplanned hospital visits requiring intravenous diuretics, or intensification of oral diuretics. During a median follow-up of 399 days, the composite outcome occurred in 57 patients. E/e' ratio during peak exercise was associated with adverse outcomes. Patients with HFpEF and lower peak VO 2 had increased risks of the composite event (hazard ratio [HR] 5.05, 95% confidence interval [CI] 2.65-9.62, p < 0.0001 vs. controls; HR 3.14, 95% CI 1.69-5.84, p = 0.0003 vs. HFpEF with higher peak VO 2 ). Elevated V E versus VCO 2 slope was also associated with adverse events in HFpEF. The addition of either the presence of abnormal peak VO 2 or V E versus VCO 2 slope increased the predictive ability over the model based on age, sex, atrial fibrillation, left atrial volume index, and exercise E/e' (p < 0.05)., Conclusion: These data provide new insights into the role of CPETecho in patients with HFpEF., (© 2024 European Society of Cardiology.)

We report metal-free organic 1,2-diketones that exhibit fast and highly efficient room-temperature phosphorescence (RTP) with high colour purity under various conditions, including solutions. RTP quantum yields reached 38.2% in solution under Ar, 54% in a polymer matrix in air, and 50% in crystalline solids in air. Moreover, the narrowband RTP consistently dominated the steady-state emission, regardless of the molecular environment. Detailed mechanistic studies using ultrafast spectroscopy, single-crystal X-ray structure analysis, and theoretical calculations revealed picosecond intersystem crossing (ISC) followed by RTP from a planar conformation. Notably, the phosphorescence rate constant k p was unambiguously established as ∼5000 s -1 , which is comparable to that of platinum porphyrins (representative heavy-metal phosphor). This inherently large k p enabled the high-efficiency RTP across diverse molecular environments, thus complementing the streamlined persistent RTP approach. The mechanism behind the photofunction has been elucidated as follows: (1) the large k p is due to efficient intensity borrowing of the T 1 state from the bright S 3 state, (2) the rapid ISC occurs from the S 1 to the T 3 state because these states are nearly isoenergetic and have a considerable spin-orbit coupling, and (3) the narrowband emission results from the minimal geometry change between the T 1 and S 0 states. Such mechanistic understanding based on molecular orbitals, as well as the structure-RTP property relationship study, highlighted design principles embodied by the diketone planar conformer. The fast RTP strategy enables development of organic phosphors with emissions independent of environmental conditions, thereby offering alternatives to precious-metal based phosphors., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

In Japan, a considerable number of foreigners encounter challenges in accessing appropriate healthcare services due to the lack of insurance coverage. However, the absence of a public database on these individuals makes it difficult to assess their health problems and healthcare access status. This study aims to investigate the characteristics of vulnerable Thai patients in Japan and to shed light on the specific challenges they face within Japan's healthcare system. A retrospective analysis was conducted using records of patients who required emergency healthcare support from the Royal Thai Embassy in Tokyo between 2004 and 2020. Descriptive statistical analyses were performed to examine the general characteristics, insurance status, and diseases of the patients. Additionally, patients were classified as either prolonged residents or brief residents based on their duration of stay in Japan until hospital admission (1 year or more or less than 1 year). A total of 74 patients were identified, with the majority (91.9%) lacking insurance coverage. Notably, there was an increase in the number of brief residents, including tourists, during the 2010s. Prolonged residents were more likely to experience chronic diseases, whereas brief residents were more prone to sustaining injuries. The patient records from the Thai Embassy consistently highlight the urgent requirement for emergency healthcare support within this population. However, the existing policies in Japan fall short in adequately addressing the healthcare access needs of this vulnerable population. Therefore, it is crucial to provide additional support and interventions to enhance their healthcare access., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: It is well known that low educational attainment is associated with cognitive function decline in older age. Childhood book availability may help to preserve cognitive function in older adults with low education. The study objective was to examine the association between childhood book availability and cognitive function among older adults with low educational attainment, and to investigate the mediating effect of the volume of reading-related brain regions (e.g., superior temporal cortex)., Methods: A cross-sectional study of community-dwelling older Japanese adults aged 65-84 years was conducted (n = 474). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Childhood book availability was assessed using a retrospective questionnaire. Brain region volume was measured using magnetic resonance imaging. Multivariate regression modeling and structural equation modeling were used for analysis., Results: Both high educational attainment and childhood book availability were independently associated with high MMSE score. Stratification of educational level showed that childhood book availability was positively associated with MMSE score among participants with low educational attainment (coefficient = 1.48, 95% confidence interval [CI]: 0.31 to 2.66), but not among those with moderate or high educational attainment (coefficient = -0.01, 95% CI: -1.44 to 1.42 and -1.21, 95% CI: -3.85 to 1.42, respectively). Among participants with low educational attainment, left superior temporal cortex volume mediated the association between childhood book availability and MMSE score., Discussion: The availability of books in childhood helps to preserve cognitive function in older adults with low education via left superior temporal cortex volume. Further research is needed to replicate these findings., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Objectives : Proximal junctional kyphosis (PJK) and failure (PJF), the most prevalent complications following long-segment thoracolumbar fusions for adult spinal deformity (ASD), remain lacking in defined preventive measures. We studied whether one of the previously reported strategies with successful results-a prophylactic augmentation of the uppermost instrumented vertebra (UIV) and supra-adjacent vertebra to the UIV (UIV + 1) with polymethylmethacrylate (PMMA)-could also serve as a preventive measure of PJK/PJF in minimally invasive surgery (MIS). Materials and Methods : The study included 29 ASD patients who underwent a combination of minimally invasive lateral lumbar interbody fusion (MIS-LLIF) at L1-2 through L4-5, all-pedicle-screw instrumentation from the lower thoracic spine to the sacrum, S2-alar-iliac fixation, and two-level balloon-assisted PMMA vertebroplasty at the UIV and UIV + 1. Results : With a minimum 3-year follow-up, non-PJK/PJF group accounted for fifteen patients (52%), PJK for eight patients (28%), and PJF requiring surgical revision for six patients (21%). We had a total of seven patients with proximal junctional fracture, even though no patients showed implant/bone interface failure with screw pullout, probably through the effect of PMMA. In contrast to the PJK cohort, six PJF patients all had varying degrees of neurologic deficits from modified Frankel grade C to D3, which recovered to grades D3 and to grade D2 in three patients each, after a revision operation of proximal extension of instrumented fusion with or without neural decompression. None of the possible demographic and radiologic risk factors showed statistical differences between the non-PJK/PJF, PJK, and PJF groups. Conclusions : Compared with the traditional open surgical approach used in the previous studies with a positive result for the prophylactic two-level cement augmentation, the MIS procedures with substantial benefits to patients in terms of less access-related morbidity and less blood loss also provide a greater segmental stability, which, however, may have a negative effect on the development of PJK/PJF.