Ensuring good sleep quality and adequate sleep duration is crucial for health. Sleep apnea syndrome (SAS) impairs sleep quality and increases the risk of diabetes, cardiovascular diseases, and accidents. The author has significantly advanced the understanding of SAS in Japan through over 20 years of epidemiological studies. Findings have revealed that individuals with a 3% oxygen desaturation index (ODI) ≥15 events/h have a 1.69-fold higher risk of developing diabetes. Those with mild to severe sleep-disordered breathing (SDB) with a 3% ODI ≥5 events/h face high risks of heart disease and lacunar infarction, at 26.1% and 30.1%, respectively. Among shift workers aged ≥40, SDB was significantly associated with elevated blood pressure. Additionally, the risk of traffic accidents in SDB patients is approximately 2.5 times higher than in those without SDB. The author advocated for routine SAS screening, especially for professional drivers, to enhance public safety. In collaboration with the Ministry of Land, Infrastructure, Transport and Tourism, comprehensive guidelines for SAS screening were developed, emphasizing the necessity of objective methods due to the disconnect between subjective sleepiness and objective alertness. These methods include pulse oximetry and the 3-minute psychomotor vigilance test (PVT). Highlighting the health risks for night-shift workers with SDB, the author promoted regular screening and early intervention. Additionally, pediatric SAS was linked to attention-deficit hyperactivity disorder-like symptoms, stressing the need for early treatment. Post-disaster health initiatives showed increased insomnia among Fukushima recovery workers, with continuous positive airway pressure therapy proving beneficial. The author also developed health security measures using PVT for doctors working long hours, linking reduced wakefulness to depression and burnout. These contributions have significantly improved public health and safety in Japan, influencing health policies and promoting widespread SAS screening and sleep debt evaluation. Continued support from doctors of the Japan Medical Association is essential to maintain these advancements.

Recent advances in molecular biology have led to significant progress in the fields of otology and audiology. Rodents, particularly genetically modified mice, have traditionally served as the primary model for inner ear research. However, growing evidence highlights inter-species differences in hearing research. Simultaneously, the use of human inner ear specimens has become increasingly restricted due to difficulties in specimen collection and ethical concerns. Similarly, the use of human fetuses to study inner ear development is challenging due to ethical issues. Therefore, the embryology of the mammalian inner ear cochlea has been studied using rodent models. These challenges underscore the need for a new research platform that better approximates the human inner ear. The common marmoset (Callithrix jacchus), a New World monkey native to South America, has emerged as a promising alternative. Initially studied in adult models, this primate is now being applied to developmental inner ear research. Its use is expected to yield novel insights. Offering a viewpoint distinct from conventional rodent-based studies. In this study, we outline the advantages of the common marmoset in hearing research and discuss its potential as a primate model animal for future inner ear studies.

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder characterized by heterogeneous clinical manifestations and diverse autoantibody production. Despite advances in treatment, many patients experience disease flares throughout their lives, and current biomarkers like anti-double-stranded DNA antibodies and serum complement levels have limitations in accurately reflecting disease activity. This review examines emerging and established biomarkers for SLE diagnosis, disease activity monitoring, and treatment response prediction.

We discuss immune cell subsets as potential biomarkers, focusing on plasmacytoid dendritic cells, T cell and B cell subsets, especially focused on T cell subsets. The review highlights how imbalances in these cellular populations correlate with disease activity and specific organ involvement. Furthermore, we discuss cytokines, chemokines, autoantibodies, and complement as biomarkers in SLE.

The identification and validation of reliable biomarkers in SLE will ultimately improve clinical decision-making regarding treatment selection, glucocorticoid tapering, and prediction of disease remission, leading to more personalized and effective management strategies.

The article presents the research and social implementation efforts undertaken by my colleagues and me at the Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine. We cloned the human oxytocin receptor using molecular biology techniques and investigated its transcriptional regulatory mechanisms in the human uterus during parturition. Additionally, we adapted a mouse placenta-specific gene expression system to develop a preeclampsia model and explored potential therapeutic strategies. Our research also focused on improving surgical techniques for peripartum hysterectomy in cases of critical obstetric hemorrhage and vasa praevia with placenta praevia, which may also lead to sudden fetal death during parturition. Concurrently, based on epidemiological data, we adopted a social approach strengthening obstetric care teams and identifying key issues within Japan's delivery system. Furthermore, we developed a web-based postpartum care procedure. I hope that research and practices aimed at enhancing maternal safety and well-being will continue to progress further in the future.

Epigenetic regulation mechanisms such as deoxy ribonucleic acid (DNA) methylation are important for controlling various biological phenomena by regulating gene expression at the genome level. Epigenetic abnormalities are associated with the onset of diseases including cancers. Aberrant DNA methylation is an important epigenetic change in the development and progression of colorectal cancer. DNA methylation in tumor tissues occurs mainly in CpG islands in the promoter regions of genes and inactivates gene functions by negatively suppressing transcription. The CpG island methylator phenotype (CIMP) is an important carcinogenic mechanism in colorectal cancer related to DNA methylation and is involved in approximately 20% of all colorectal cancers. However, CIMP does not always represent the genome-wide DNA methylation status in colorectal cancer. We developed a new method to assess genome-wide DNA methylation status and showed that it is a predictor of the efficacy of anti-estimated glomerular filtration rate (EGFR) antibody drugs and a prognostic factor. This new method has received regulatory approval as a new in vitro diagnostic for predicting sensitivity to anti-EGFR antibody drugs in colorectal cancer.

Introduction: Variations in intensive care unit (ICU) policies and physician characteristics influence mortality, potentially leading to regional differences in mortality rates. Previous studies have not specifically focused on septic shock or older patients and have lacked consideration of the context effect. We hypothesized that regional variability in mortality exists among older patients with septic shock and investigated factors associated with mortality.

Methods: Administrative medical claims data were analyzed. Participants were enrolled from April 2015 to March 2020 in Fukuoka Prefecture, Japan. ICU physicians were classified based on board certification in intensive care medicine as either "intensivists" or "ICU-dedicated physicians". The primary outcome was 28-day mortality after ICU admission. Data from all ICUs in Fukuoka Prefecture and 9 secondary medical areas were analyzed. We calculated and compared the 28-day mortality rates across regions. Multilevel logistic regression analyses were conducted to adjust for the context effect.

Results: Among the 1,238 participants, mortality across regions ranged from 18.3% to 41.4%. Based on multilevel logistic analyses, age, sex, postsurgical admission, and the number of ICU beds per intensivist were significantly associated with mortality. The adjusted odds ratio from the multilevel analysis for having no intensivists versus having ≥1 intensivist per 4 ICU beds was 1.99 (95% confidence interval 1.15-3.44, p = 0.01).

Conclusions: After accounting for the regional context effect, our analysis confirmed regional mortality variability in mortality among older patients with septic shock. Mortality was influenced by whether ICU physicians are board-certified in intensive care medicine. These findings suggest that sufficient commitment in terms of time, intensity, and knowledge is crucial to reducing mortality in older patients with septic shock.

Introduction: The term "artificial intelligence (AI) " refers to the development of systems that possess intellectual processes characteristic of humans, such as the ability to reason, discern meaning, generalize, and learn from experience. This study aimed to provide an overview of medical students' knowledge, perceptions, and concerns about AI in healthcare.

Methods: This study utilized a qualitative approach, employing semi-structured interviews in focus groups of medical undergraduates to explore their perceptions, knowledge, and concerns about AI in healthcare. The interviews complied with the standards for reporting qualitative research set by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Seven focus groups were formed, with an average size of 8-10 participants per group. Each group was diverse in terms of sex and year of study.

Results: 156 participants responded to the survey, of whom 124 completed the questionnaires. Sixty-six undergraduate medical students consented to attend in-person focus groups for discussions. Four major themes are the advantages of AI in healthcare, education, and training in AI, future implications of AI, and ethical concerns, and sixteen subthemes emerged from this study's data analysis. Most students (57.7%) believed that artificial intelligence (AI) should be integrated into medical education. A substantial proportion (42.2%) of medical students demonstrated varying knowledge regarding the advantages of AI in healthcare. A significant number of students, 37.8%, articulated concerns regarding the future implications of AI; a minority of students, 22.7%, expressed ethical concerns regarding biases, privacy issues, security risks, and unequal access.

Conclusions: Medical students generally view AI positively, recognizing its benefits in diagnosis and treatment. Many emphasized the need to integrate AI into medical education to prepare for future changes in healthcare. Future research should focus on developing evidence-based training programs and strategies to tackle these issues.

Introduction: Generative artificial intelligence (AI) has become more accessible due to technological advancements. While it can support more efficient learning, improper use may lead to legal issues or hinder self-directed learning. Medical education is no exception, as generative AI has the potential to become a powerful tool. However, its practicality remains uncertain. Therefore, we investigated how generative AI is perceived among medical students and utilized within the realm of medical education.

Methods: In January 2024, we conducted a study with 123 second-year medical students who had completed a physiology course and laboratory training at Gunma University, Japan. Students used ChatGPT (Chat Generative Pre-trained Transformer) 3.5 (OpenAI) for four tasks and evaluated its responses. A survey on the use of generative AI was also conducted. Responses from 117 participants were analyzed, excluding six non-participants.

Results: Among the students, 41.9% had used ChatGPT. The average scores for tasks 1-4 were 6.5, 4.6, 7.4, and 6.2 out of 10, respectively. Although 13% had a negative impression, 54 students found it challenging to apply for medical purposes. However, 64.1% expressed a willingness to continue using generative AI, provided its use extended beyond medical contexts.

Conclusions: Nearly 60% of students had never used generative AI before, which is consistent with general usage trends. Although they were impressed by the speed of generative AI responses, many students found that it lacked precision for medical studies and required additional verification. Limitations of generative AI, such as "hallucinations," were evident in medical education. It remains important to educate students on AI literacy and their understanding of the potential issues that generative AI could bring about.

Introduction:Work style reform has affected pediatric residents' balance between adequate training and wellness. This study aimed to investigate the impact of work style reform among pediatric trainees at the National Center for Child Health and Development (NCCHD), where several work style amendments were implemented from 2019 to 2024.

Methods: We conducted a questionnaire-based cross-sectional survey of pediatric trainees in 2024 and compared the data with a previous survey from 2019 to evaluate the impact of work style reform. The questionnaire included demographic and work condition data, the Center for Epidemiologic Studies Depression Scale, and the Maslach Burnout Inventory (MBI).

Results: Participants included 37 trainees (94.9%) in 2019 and 34 trainees (81.0%) in 2024. Median work hours per week (69.0-64.0, p = 0.04) and the frequency of night or holiday shift work (5-4 times/month, p = 0.002) decreased significantly in 2024. Compliance with daytime rest after night work also increased significantly (64.9%-91.2%, p = 0.01). All subscales of the MBI showed improvements, which remained significant after adjusting for demographics and work conditions (p < 0.001 for all).

Conclusions: Work style reform has improved work conditions and wellness in pediatric training at NCCHD. Further reports from other medical specialties are awaited to assess the broader impact of work style reform on physicians.

Introduction: Japan has a national health insurance system that covers at least 70% of regular medical costs and provides additional benefits for high medical costs. In addition, >60% of the population holds private health insurance to reduce financial toxicity. However, there has been a lack of real-world data on private health insurance in the oncology setting in Japan.

Methods: A cross-sectional survey of health insurance was conducted at 16 hospitals in Japan between 2013 and 2016. Patients were eligible if they were newly diagnosed with clinical stage IIIB or IV lung cancer. Data collected included patients' health insurance, clinical and sociodemographic characteristics, and self-reported outcomes 3 months after diagnosis.

Results: Of the 147 patients, 114 (77.6%) had private health insurance. Patients with private health insurance were significantly younger (p = 0.028), had better performance status (p = 0.029), and reported better quality of life (p = 0.017), specifically in social (p = 0.039) and emotional (p = 0.011) well-being. There were no significant associations between having private health insurance and treatment details, medical satisfaction, or financial issues. Most patients (99.3%) reported that national health insurance is necessary. A substantial proportion of patients (9.8%), particularly those without private health insurance (19.4%), reported that private health insurance is not necessary.

Conclusions: Having private health insurance was associated with better quality of life, though there were no significant differences in medical care or financial issues. Our findings suggest that private health insurance plays an auxiliary role in accessing medical care for patients with advanced lung cancer in Japan.

Introduction: Hearing loss is a major problem that negatively impacts human life worldwide. Although factors associated with hearing loss have been widely studied, the impact of hearing loss on social aspects such as work performance in the working-age population remains unclear. To investigate the social and somatic problems associated with hearing loss in working-age individuals, we analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), including a questionnaire concerning social aspects, mental health, physical health, and subjective hearing loss.

Methods: We used the JACSIS 2023 data set, which includes data from 33,000 participants. After excluding participants with inappropriate responses and including those aged 20-64 years, data from 20,691 participants were used for further analysis. We compared various characteristics of the hearing loss group (moderate-to-severe subjective hearing loss) with those of the control group (no subjective hearing loss).

Results: A total of 13,745 participants (male: 6,461; female: 7,284) were included in the control group, and 313 participants (male: 150; female: 163) were included in the hearing loss group. Multivariate logistic regression analysis revealed that both male and female participants in the hearing loss group exhibited higher incidences of tinnitus, presenteeism, somatic symptoms, and dyslipidemia compared with the control group. Additionally, subjective hearing loss was one of the independent explanatory variables for presenteeism in the working-age population.

Conclusions: Our findings indicate significant associations between moderate-to-severe subjective hearing loss and various work-related and somatic factors in a working-age population, and encourage future research to assess whether subjective hearing loss independently contributes to presenteeism in the working-age population.

Introduction: Health inequalities in dementia have been reported. Smoking is a risk factor for dementia and is disproportionately distributed in marginalized populations. This study examined the mediating effect of smoking on the association between income and dementia among older Japanese people.

Methods: This longitudinal study was based on the Japan Gerontological Evaluation Study from 2010 (response rate = 64.3%) to 2019 (follow-up rate = 98.5%). A total of 44,083 participants independent in daily life were analyzed (mean age: 73.7; women 53.2%). The outcome variable was the incidence of dementia between 2010 and 2019, and the explanatory variable was equivalent income measured in 2010. Causal mediation analyses with a Cox proportional hazard model were performed to evaluate the mediating effect of smoking status in 2010. Multiple imputation was performed for the missing data.

Results: Among the participants, the incidence rates of dementia were 16.2% for men and 18.2% for women. Low income was associated with the incidence of dementia (total effect in excess relative risk, ERR [95% confidence interval (CI) ]: 0.095 [0.032-0.157] in overall participants, 0.102 [0.011-0.192] for men, 0.082 [−0.003 to 0.168] for women). Causal mediation analyses showed that smoking mediated the association between income and dementia (natural indirect effect in ERR [95% CI]: 0.007 [0.004-0.011] for overall participants, 0.007 [0.002-0.013] for men, and 0.005 [0.001-0.009] for women). The proportions of the mediating effect were 7.7% for all participants, 7.3% for men, and 6.4% for women.

Conclusions: Our results showed that smoking partially explained the association between income and dementia. There is a possibility that smoking cessation may contribute to reducing health inequalities in dementia.

Introduction: The aging of the global population presents significant challenges in extending healthy life expectancy, particularly among older adults. The prevalence of musculoskeletal disorders and the growing demand for nursing care are expected to reduce healthy life expectancy. These outcomes are particularly influenced by disasters that cause major environmental changes. This study aimed to clarify the long-term effects on physical function resulting from temporary changes in the living environment of older adults who relocated to temporary housing (TH) following the Great East Japan Earthquake.

Methods: This retrospective cohort study included 4,680 residents of Soma City, Fukushima Prefecture, aged ≥64 years, who underwent locomotor function examinations between 2013 and 2022. Participants were categorized into two groups: TH (n = 440) and control (n = 4,240). The primary outcomes were grip strength and one-leg standing time. A growth curve model was used to estimate the longitudinal associations.

Results: The mean age- and sex-adjusted one-leg standing time was lower in the TH group than in the control group in 2013 (35.5 seconds vs. 39.3 seconds) and remained lower thereafter. The results showed an association between one-leg standing time and TH experience (intercept estimate: −4.32, 95% confidence interval: −7.49 to −1.16). No differences in grip strength were observed between the groups.

Conclusions: These results suggest that long-term support is necessary for evacuees, and it is essential to develop and implement support measures that effectively address muscle weakness and other aspects of physical function.

Introduction: Diabetes mellitus (DM) is an increasing public health concern in Japan and worldwide, highlighting the need for effective prevention. Lower limb muscle strength, a modifiable factor, may influence glycemic control, potentially in sex- and age-specific ways. This study examined the association between isokinetic knee extensor strength and DM prevalence in a large Japanese cohort.

Methods: A total of 14,017 Japanese individuals (men: 6,227; women: 7,790) aged 18-89 years participated in this study. All participants completed the maximum voluntary isokinetic knee extensor strength test (60°/s) and medical examination. DM was defined as blood glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%, or hypoglycemic medication. Multivariable odds ratios (ORs) and 95% confidence intervals were calculated using the lowest quartile knee muscle strength category as a reference after adjusting for potential confounders.

Results: The mean age of the participants was 50.1 years (standard deviation; 15.3); altogether, 1,225 participants (8.7%) had DM. Multivariable ORs of the highest quartile muscle strength were 0.61 (0.48-0.78) for men and 0.65 (0.57-0.88) for women, using the lowest quartile muscle strength as a reference. Knee extensor muscle strength was inversely associated with DM (p for trend <0.001 and 0.003, men and women, respectively). The inverse association was consistently observed in men aged 40 years and older, whereas it was less apparent in older women.

Conclusions: Isokinetic knee extensor muscle strength is inversely associated with the prevalence of DM, with potential differences by sex and age. These findings may help inform DM risk assessment and prevention strategies.

Introduction: Early detection of hearing impairment in young adults and raising social awareness of preventive measures are essential to mitigate the negative impact on individuals' quality of life and reduce the societal costs associated with hearing impairment. This study investigated the music listening habits of medical college students using audiological function tests to assess their impact on young adults' hearing functions.

Methods: We recruited 77 healthy volunteers who underwent a comprehensive assessment, including a questionnaire on music listening habits, pure-tone audiometry (PTA), tympanometry, extended high-frequency (EHF) audiometry, and loudness discomfort level (LDL) tests. Furthermore, we measured preferred music listening levels (PMLs). The association between music listening habits and PMLs and the results of various auditory function tests were examined.

Results: Among the 77 participants, 60 were men, and 17 were women, with a median age of 23 years. All participants exhibited a mean hearing threshold of less than 25 dB HL on PTA. Sixty-six (85.7%) participants used earphones/headphones daily, with a median usage duration of 2.0 hours. The correlations between the duration of earphones/headphones usage, EHF thresholds, and LDLs were not significantly different. The correlation between the duration of earphones/headphones usage and PMLs was weakly positive (r = 0.2772). A stronger positive correlation (r = 0.4625) was observed when focusing on 23 participants with high LDL values.

Conclusions: The positive correlation between the duration of earphones/headphones usage and PMLs suggested that inappropriate music listening habits might synergistically act as risk factors for hearing impairment in young adults.

Introduction: Tirzepatide, a novel dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist has shown significant promise in weight reduction and glycemic management in patients with type 2 diabetes (T2DM). However, there have been no reports evaluating the quality of life (QOL) in patients who switched from oral semaglutide to tirzepatide. This study prospectively investigated short-term changes in the QOL of these patients.

Methods: This study was a single-center, prospective observational study. Participants were patients with T2DM who switched from oral semaglutide to tirzepatide due to insufficient weight reduction between May 1, 2023, and December 31, 2023. The primary outcome was the change in the Diabetes Therapy-Related QOL (DTR-QOL) questionnaire scores from baseline to 3 months after switching. The changes in glycemic management and body weight were also assessed as secondary outcomes.

Results: Eleven patients were enrolled in this study. The total DTR-QOL score was significantly improved 3 months after switching (from 58.0 ± 9.9 to 81.5 ± 11.2, p < 0.001). Four subscale domains were also significantly improved (p < 0.001, p < 0.001, p = 0.015 and p < 0.001, respectively). There were no significant changes in glycated hemoglobin levels and body weight 3 months after switching (from 6.8 ± 1.0% to 6.4 ± 0.8%, p = 0.068 and from 86.5 ± 19.6 kg to 84.2 ± 19.7 kg, p = 0.099, respectively).

Conclusions: Switching from oral semaglutide to tirzepatide potentially improves overall QOL in patients with T2DM in a short period of time. Further large cohort studies will reinforce the results.

Introduction: The goal of tracheostomy in patients with long-term tracheal intubation is to facilitate weaning from mechanical ventilation (MV), achieve decannulation, and ultimately enable discharge to home. In this study, we investigated the factors influencing withdrawal from MV after tracheostomy and cannulation in patients undergoing long-term tracheal intubation. We also examined tracheostomy status (whether the tracheostomy tube was removed and whether the patient was weaned from MV) and discharge outcomes.

Methods: A total of 199 patients who underwent tracheostomy following long-term tracheal intubation were analyzed. Patients were classified into 3 groups based on tracheostomy status: group A (tracheostomy tube removed; n = 35); group B (tracheostomy tube not removed despite weaning from MV; n = 76); and group C (weaning from MV not achieved; n = 88).

Results: The duration of intensive care unit stay did not differ significantly among the groups. However, hospital stay was significantly shorter in group C than in groups A and B. Additionally, the rate of discharge to home was significantly higher in group A. Factors associated with difficulty in weaning from MV included a blood lymphocyte count <500, the presence of chest and abdominal disease, and a body mass index ≥30. Factors contributing to with difficulty in decannulation after weaning from MV included head and neck disease, age ≥75 years, C-Reactive Protein ≥5, and a blood lymphocyte count <500.

Conclusions: Weaning from MV and decannulation are key factors influencing discharge to home in patients undergoing tracheostomy after long-term intubation. These factors are primarily affected by the patient's underlying disease and general condition. We believe that addressing these factors through nutritional management, rehabilitation, and other supportive measures can improve the quality of life and increase the likelihood of discharge to home.

Introduction: Several studies have reported an association between postoperative complications and nutritional indices. Among these, serum prealbumin (PAB) levels have recently attracted attention as an indicator of nutritional status. However, the nutritional index most strongly associated with postoperative complications remains unclear. This study aimed to investigate the relationship between postoperative complications and nutrition-related indices, including PAB, in patients who underwent surgery for gastric cancer.

Methods: A total of 108 patients who underwent gastric cancer surgery were classified into 2 groups based on the presence or absence of postoperative complications. PAB, serum albumin (ALB), Controlling Nutritional Status (CONUT) score, and Prognostic Nutritional Index (PNI) were used as preoperative nutrition-related indices. The relationship between postoperative complications and nutrition-related indices was examined using multivariate logistic regression analyses.

Results: Among the participants, 84 were classified into the uncomplicated group and 24 into the complicated group. Multivariate logistic regression analysis revealed significant associations between all nutrition-related indices and postoperative complications, including PAB (odds ratio [OR], 0.808; 95% confidence interval [CI]: 0.716-0.911, p = 0.001), CONUT score (OR, 1.338; 95% CI: 1.095-1.635, p = 0.004), ALB (OR: 0.364, 95% CI: 0.157-0.845, p = 0.019), and PNI (OR: 0.931, 95% CI: 0.870-0.997, p = 0.042). Among these, PAB showed the strongest association, followed by CONUT, ALB, and PNI.

Conclusions: All nutritional indicators were associated with postoperative complications. Our findings suggest that PAB and CONUT scores may serve as useful predictors of postoperative complications in patients with gastric cancer.

Introduction: This study aimed to examine the effects of intradialytic exercise (IDE) on improving activities of daily living (ADL) and physical function in hospitalized hemodialysis (HD) patients. The research question focused on improving outcomes in ADL and physical function.

Methods: This study is a single-center, historical cohort study. Subjects were hospitalized HD patients undergoing rehabilitation between April 2017 and February 2023. Patients were divided into two groups: the IDE group, which received IDE, and the non-IDE group, which did not. The outcomes measured were Barthel Index (BI), grip strength, isometric knee extension strength (IKES), 10-meter walking speed (10MWS), and Short Physical Performance Battery (SPPB). Outcome measures were taken at admission and discharge, and changes were analyzed using a linear mixed model.

Results: The study included 76 participants (IDE group: 13, non-IDE group: 63). The IDE group showed significant improvements in ΔBI (13.7 [0.96-26.38] points) and Δ10MWS (0.25 [0.05-0.45] m/sec) (p < 0.05). No significant differences were observed between the two groups in ΔGrip strength (2.10 [−0.40 to 4.60] kg), ΔIKES (7.40 [−2.20 to 17.02] %), or ΔSPPB (1.23 [−0.48 to 2.94] points) (p > 0.05). However, the IDE group showed significant pre-post improvements in grip strength (1.55 [1.46-1.65] kg) and SPPB (2.44 [1.34-3.55] points) (p < 0.05).

Conclusions: IDE contributed to greater improvements in BI and 10MWS in HD patients. These findings suggest that adding IDE to inpatient rehabilitation may enhance functional recovery in this population.

Introduction: Older adults undergo physical and social changes that adversely affect their health. However, the prevalence and distribution of patients' pleasure and difficulties remain poorly documented. Moreover, the acceptability and feasibility of self-administered questionnaires concerning their social conditions among older patients are still uncertain. Our study aimed to elucidate the distribution of daily pleasure and difficulties among older patients and assess the acceptability of these screenings.

Methods:Descriptive epidemiology was conducted at a single center in Japan. From April 2023 to March 2024, self-reported questionnaires on activities of daily living (ADL), daily pleasure and difficulties, and the acceptability of these questions were distributed to all patients aged 80 years or older. The participants' long-term care (LTC) certification level, a nationwide measure in Japan, was used to assess their ADL.

Results:A total of 359 patients participated, with 192 (53.5%) not applying for LTC certification, 57 (15.9%) at Support Levels, and 101 (28.1%) at Care Need Levels. Among them, 242 (67.4%) reported daily pleasures, 56 (15.6%) experienced bathing difficulties, 73 (20.3%) encountered excretion problems, and 34 (9.4%) faced excessive financial burdens. These difficulties and financial burdens were more prevalent among those at Support Levels and Care Need Levels than those without LTC certifications. Most participants found these surveys acceptable.

Conclusions:Participants requiring LTC reported daily pleasures as frequently as those without LTC certification. However, those requiring LTC more frequently reported difficulties in daily activities and faced excessive financial burdens. Healthcare professionals should inquire about older patients' specific daily living needs.

Introduction: People with diabetes tend to show abnormalities in gait parameters, including walking speed and stride length, relative to those without diabetes. While inertial measurement units (IMUs) provide a portable alternative to optical motion capture systems, the reliability of gait analysis is influenced by factors such as walking distance, timing, and examiner differences. However, the impact of these parameters on gait analysis in patients with type 2 diabetes (T2D) remains unclear. This study aimed to evaluate the reliability of ORPHE ANALYTICS, an IMU-based gait analysis system, under varying measurement conditions in patients with T2D.

Methods: We conducted a single-center observational study (n = 9) to clarify the reliability of ORPHE ANALYTICS, a gait analysis motion sensor system developed by ORPHE Inc., which evaluates more than 15 gait parameters, in patients with T2D. The relative reliability was assessed using intraclass correlation coefficients (ICC): ICC _(1,1) or ICC _(1,3) for intra-rater reliability and ICC _(2,1) for inter-rater reliability based on the differences in distance (10 vs. 30 m), examiners, and timing (morning vs. afternoon).

Results: Intra-rater reliability was excellent (ICC _(1,1) and ICC _(1,3) ≥0.9) for all gait parameters except coefficient of variation of stride duration and lateral displacement. Measurements taken under different conditions of distance and timing exhibited almost good inter-rater reliability (ICC _(2,1) ≥0.75), while measurements by different examiners exhibited moderate to good reliability (ICC _(2,1) ≥0.50). Significant novel differences were observed in lateral sway during the swing phase, medial sway during the stance phase, and foot angle, with random errors (expressed as percentage of minimal detectable change) exceeding 40% under various measurement conditions.

Conclusions: ORPHE ANALYTICS exhibited good to excellent intra-rater and inter-rater reliability based on differences in distance and timing. However, persistent inter-rater reliability challenges in patients with T2D warrant analysis by a single examiner.

Introduction: Blood pressure (BP) affects the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). However, the implications of its variability are poorly understood. This study aimed to explore the determinants and prognostic significance of visit-to-visit BP variability (V2V-BPV) in HFpEF.

Methods: Consecutive patients with HFpEF at the Sakakibara Heart Institute of Okayama underwent routine BP measurements. V2V-BPV, calculated as the coefficient of variation of systolic BP over one year, was assessed. The primary endpoint comprised all-cause mortality and heart failure hospitalization.

Results: Among 288 outpatients with HFpEF (average age 73 ± 10 years, 60.8% male), BP was measured 6.1 ± 1.7 times, with a median V2V-BPV of 7.3%. The high V2V-BPV group (≥7.3%) had marginally but significantly elevated B-type natriuretic peptide (BNP) levels and higher Meta-Analysis Global Group In Chronic Heart Failure risk scores (MAGGIC scores). V2V-BPV was independently associated with an increased risk of the primary endpoints (hazard ratio 1.08 per percentage point; p = 0.025), even after adjustments for systolic BP, BNP, MAGGIC score, and the number of BP measurements. A similar relationship was observed between all-cause mortality and V2V-BPV (adjusted hazard ratio 1.12, p = 0.049 with MAGGIC score). Hemoglobin level was an independent predictor of high V2V-BPV in multiple sensitivity analyses.

Conclusions: In patients with HFpEF, V2V-BPV was independently associated with adverse events, with hemoglobin level emerging as a determinant. Further research is warranted to determine whether BP stabilization can improve the prognosis of HFpEF.

Introduction: Alcohol dependence is linked to various issues, including not only alcohol-associated/related liver disease (ALD) but also social isolation, making the assessment of alcohol consumption crucial for patient management. Meanwhile, a multisociety consensus group has introduced a new classification for steatotic liver disease (SLD), including ALD, based on alcohol consumption. The evaluation of alcohol intake uses tools such as the Alcohol Use Disorders Identification Test and Lifetime Drinking History; however, these tools may lack accuracy in clinical settings. Carbohydrate-deficient transferrin (%CDT) is a quantitative and objective biomarker for alcohol consumption. Therefore, we aimed to determine %CDT values that stratify alcohol consumption.

Methods: This cross-sectional analysis included 285 serum samples from patients receiving inpatient or outpatient treatment at two specialized alcohol dependency medical centers. Participants were alcohol-dependent patients who underwent detailed interviews regarding alcohol consumption, biochemical blood tests, and %CDT testing.

Results: Among the 285 samples, 32.6%, 19.6%, and 47.7% corresponded to alcohol consumption levels of ≤30 g/day for men/≤20 g/day for women, 30-60 g/day for men/20-50 g/day for women, and ≥60 g/day for men/≥50 g/day for women, respectively. %CDT values increased with increasing alcohol consumption (p < 0.05-0.0001). The cutoff values reflecting alcohol consumption of 30 g/day for men/20 g/day for women and 60g/day for men/50g/day for women were 1.67% and 2.48%, respectively. Gamma-glutamyl transferase (GGT) and GGT-CDT were able to distinguish between alcohol consumption above and below 60 g/day for men and 50 g/day for women (p < 0.0001). However, they had difficulty distinguishing between alcohol consumption above and below 30 g/day for men and 20 g/day for women.

Conclusions: %CDT, in conjunction with detailed interviews, can be used to detect alcohol consumption, particularly to distinguish whether it exceeds 30 g/day in men and 20 g/day in women. Applying this to the clinical management of patients with alcohol dependence accompanied by ALD or SLD may contribute to improving the quality of care.

Introduction: Despite treatment advancements, pancreatic cancer continues to have the lowest 5-year survival rate and a high age-adjusted mortality. Limited physical and functional reserves often restrict therapeutic options. Although the 6-minute walk distance (6MWD) and the Charlson Comorbidity Index (CCI) are established prognostic markers, their combined prognostic utility remains unexplored. This study evaluated the prognostic value of a composite index (6MWD-CCI) in patients who underwent pancreatic resection.

Methods: This retrospective study included 85 patients with pancreatic cancer who underwent resection between July 2019 and September 2022. Preoperative 6MWD (<400 m) and CCI scores were used to classify patients into three 6MWD-CCI risk groups (low, middle, and high). Physical, nutritional, and frailty parameters were also assessed. Kaplan-Meier and Cox regression analyses were performed to evaluate survival outcomes, adjusting for confounders.

Results: During a median follow-up of 802 days, 27 patients (31.8%) died. Low 6MWD, high CCI, and elevated 6MWD-CCI risk levels were significantly associated with reduced survival. The composite 6MWD-CCI demonstrated strong prognostic value, outperforming individual metrics even after adjustment for confounders.

Conclusions: The 6MWD-CCI is a practical and predictive tool for pancreatic cancer prognosis, integrating physical function and comorbidity burden to enhance risk stratification. Its incorporation into clinical workflows could improve preoperative planning. Validation through larger studies is recommended.

Introduction: Cellulitis, herpes zoster, and varicella are common infectious skin diseases with significant public health implications. While these conditions have been studied in some countries, comprehensive nationwide data on their seasonality and trends in Japan remain limited. Understanding these patterns is essential for effective public health planning and disease management.

Methods: This study analyzed monthly outpatient data for cellulitis, herpes zoster, and varicella using aggregated summary tables from the National Database of Health Insurance Claims of Japan for fiscal years 2014 to 2019. Seasonal patterns and trends were examined using seasonal decomposition of time series by locally estimated scatterplot smoothing.

Results: Distinct seasonal patterns were observed for the three diseases. Both cellulitis and herpes zoster peaked during the summer months, while varicella exhibited a winter predominance. Trend analysis revealed a 13.5% increase in cellulitis cases over the study period. Herpes zoster cases also increased, whereas varicella cases showed a significant decline between fiscal years 2014 and 2015, coinciding with the introduction of universal varicella vaccination. The seasonal patterns were consistent with findings from previous studies in other countries.

Conclusions: This nationwide study confirmed distinct seasonal patterns and trends for cellulitis, herpes zoster, and varicella in Japan. The findings enhance the understanding of the epidemiology of these infectious skin diseases at a nationwide population level and provide valuable insights for public health planning.

Introduction: Preventive programs, including cancer and diabetes screenings, were disrupted globally by the coronavirus disease 2019 (COVID-19) pandemic and had not returned to pre-pandemic levels even in 2021-2022. In Japan, COVID-19 was downgraded to the lowest-risk category under the Infectious Diseases Control Law in May 2023. However, whether participation in health check-ups recovered after this downgrade remains unclear. Additionally, understanding the impact of the pandemic on employees' mental health and attrition is crucial for maintaining services in future pandemics. To address these issues, we conducted a nationwide survey.

Methods: A questionnaire survey was conducted between December 16, 2023, and February 21, 2024, targeting member facilities of Japan Society of Ningen Dock and Preventive Medical Care. The questionnaires covered COVID-19-related rules before and after the downgrade, the negative impact on employees' mental health, and whether employee resignations increased compared to the pre-pandemic period. Participants also provided data on the number of health check-up examinees from 2019 to 2023.

Results: We emailed 1,381 facilities, of which 856 responded (response rate: 62.0%). An additional 124 facilities responded via the Society's website, yielding a total of 980 participants. While cancer screenings by local governments returned to pre-pandemic levels in 2023, gastric cancer screenings remained low. Nearly 30% of facilities reported a negative impact of the pandemic on employees' mental health, which was associated with factors such as being annexed to hospitals and employees' complaints about strict COVID-19-related rules. This negative impact was strongly linked to increased employee resignations.

Conclusions: While overall cancer screening rates recovered, gastric cancer screenings remained below pre-pandemic levels. Furthermore, the negative impact on employees' mental health was significantly associated with increased attrition, highlighting the need for mental health support for those engaged in preventive medicine to maintain services during future pandemics.

Introduction: The phase angle (PhA), calculated through bioimpedance analysis (BIA), is a measure of skeletal muscle quality and cellular integrity. This study aimed to explore the relationship between PhA and diabetic microangiopathy in patients with type 2 diabetes.

Methods: We conducted a cross-sectional analysis of 556 adult Japanese outpatients with type 2 diabetes who underwent body composition evaluation using BIA. Clinical characteristics, including diabetic microangiopathy (retinopathy, nephropathy, and neuropathy), were assessed for their association with PhA. Furthermore, in 23 patients who underwent a second BIA assessment, we examined the relationship between changes in PhA and glycated hemoglobin (HbA1c) levels longitudinally. Statistical methods employed included Wilcoxon's signed-rank test, regression analyses, and trend tests.

Results: PhA was significantly lower in patients with diabetic microangiopathy compared to those without it. It was positively correlated with the skeletal muscle mass index (SMI) and negatively correlated with the extracellular water-to-total body water ratio. Multiple regression analysis revealed that sex, age, nephropathy, peripheral neuropathy, hemoglobin, serum albumin, and low-density lipoprotein cholesterol levels were significant explanatory variables for PhA. In the longitudinal analysis, changes in HbA1c levels showed a significant negative correlation with changes in PhA, however, no association was observed between changes in HbA1c and changes in SMI.

Conclusions: PhA is significantly associated with age, malnutrition, and diabetic microvascular complications, and may provide insights into muscle and tissue health in patients with type 2 diabetes. Further research is required to examine causal relationships and explore potential interventions to preserve muscle quality in diabetic patients.

Introduction: The shortage of corneal donations has been a longstanding problem in Japan. However, there are limited data on the settings in which corneal donations occur. The aim of this study was to determine the association between out-of-hospital cardiac arrest (OHCA) and corneal donation. We also investigated potential corneal donors across various death settings (OHCA, in-hospital cardiac arrest (IHCA), and home death).

Methods: This was a case-control study in Hiroshima Prefecture, Japan, from 2015 to 2023. Cases included all corneal donors based on data provided by the Hiroshima Eye Bank, while controls consisted of potential corneal donors aged ≥10 years at Hiroshima City Hiroshima Citizens Hospital. After matching cases with controls at a 1:5 ratio using age group, sex, and date of death, we employed unconditional logistic regression to analyze the association between OHCA and corneal donation.

Results: From the combined data of the Hiroshima Eye Bank (n = 190), the hospital cohort (n = 4492), and the home cohort (n = 195), 190 were corneal donors and 3,394 were potential corneal donors. Among corneal donors, 5.3% (10/190) had OHCA, 26% (49/190) had IHCA, and 29% (55/190) died at home or in nursing homes. Among the various death settings, 72% (2,768/3,835) in the hospital cohort and 69% (134/195) in the home cohort were potential corneal donors, with OHCA patients in the hospital cohort showing the highest proportion (75%, 492/657). After adjusting for matching factors, OHCA was positively associated with corneal donation (13% [26/190] vs 15% [143/950]; odds ratio: 2.2, 95% confidence interval: 1.3-3.5, p = 0.0019).

Conclusions: Individuals who experienced OHCA may be more likely than individuals in other settings of death to become corneal donors. Further research is needed to confirm this study's findings and to explore strategies to address the issue of Japan's corneal donation shortage.

Extracellular vesicles (EVs) play various roles in cancer progression, mediating intercellular signaling. EVs carry bioactive substances such as ribonucleic acid, deoxyribonucleic acid, and proteins, each providing important functions in whole biological fields, not only in cancer. Particularly in clinical oncology, EVs have attracted much attention owing to their promising potential as new diagnostic and therapeutic targets. Ovarian cancer is one of the major causes of gynecologic cancer deaths and is often asymptomatic in the early stages; therefore, biomarkers that enable early diagnosis are critical to improving patient survival. Ovarian cancer cells easily spread through the abdominal cavity rather than through the bloodstream, forming direct metastatic foci in organs such as peritoneal membranes or omentum. The disease is treated multimodally with surgery and chemotherapy, even in advanced stages, and a certain degree of response to treatment is observed. However, most relapsed cancer gradually acquired resistance to chemotherapies. We have investigated various EV molecules in ovarian cancer and shown their clinical utility. In addition, the heterogeneity of EVs has emerged as a recent topic, and we have developed and used novel techniques to understand them. Applying these findings to clinical practice, EV-based approaches have the potential to revolutionize ovarian cancer management, enabling early detection, personalized monitoring, and targeted therapy. Continued innovation and interdisciplinary collaboration will be key to realizing the full potential of EV translational research to improve outcomes for patients with ovarian cancer.

As considering only the data of survey respondents overlooks the opinion of voiceless people, acknowledging the direction of response biases of social survey data is crucial. We aimed to examine the representativeness of social surveys among impoverished older individuals. We conducted a cross-sectional study. Using linkage data from the Japan Gerontological Evaluation Study (JAGES) and residential registry data of public assistance (PA), we examined the validity of responses on receiving PA, as documented by the JAGES. Furthermore, we assessed the sociodemographic factors associated with the response to the JAGES using information on age (65-74/75-84/≥85 years), sex (male/female), household composition (living alone or not), nationality (Japanese/others), and level of long-term care needs (not applicable/support required/care needed) using complete data of PA recipients. A multiple modified Poisson regression analysis was performed to calculate the adjusted incidence ratio (IR) for responses to each explanatory variable. Among the sampled 162 older PA recipients, 79 (48.8%) responded to the JAGES. Seven recipients were misclassified as non-recipients in JAGES survey. There was no misclassification among non-recipients. PA recipients living alone were more likely to respond to the JAGES (IR 1.48, 95% confidence interval, 1.02-2.13). Using linkage data of the PA and JAGES databases from different departments within the municipality, we observed that social survey data represented a greater proportion of individuals living alone than those living with others among older impoverished people. To provide equitable policies, stakeholders should collect further information on older impoverished individuals not living alone.

In February 2023, a report from the Japanese Ministry of Education, Culture, Sports, Science and Technology highlighted that half of the assistant professors at university hospitals spend five hours or less per week on research, with 15% not engaging in research at all. This disconnect between clinical practice and research may be exacerbated by work-style reforms predicting difficulties in allocating time for student guidance and dedicated research at Japanese university hospitals. This study proposes the integration of artificial intelligence (AI) tools, such as ChatGPT, to streamline administrative duties and enhance research productivity, suggesting a need for immediate development of ethical guidelines for AI use in healthcare to improve efficiency and patient care quality.

Intramedullary spinal cord abscesses rarely cause impaired consciousness without intracranial infection. We report the case of a 65-year-old woman who presented with neck pain and right upper limb weakness. She developed rapidly progressive impaired consciousness within three days of admission. Initial magnetic resonance imaging revealed a right-sided intramedullary lesion at C4-C5 with surrounding edema extending to the brainstem. Brain imaging showed no abnormalities. An initial diagnosis of a spinal cord tumor was made. Follow-up imaging demonstrated lesion expansion with ring enhancement. The patient subsequently developed impaired consciousness and quadriplegia. Emergency surgery revealed and drained a spinal cord abscess, with cultures growing α-hemolytic Streptococcus. The patient's consciousness improved quickly after surgery. Previously undiagnosed type 2 diabetes was identified during admission. Despite extensive investigation, no obvious source of infection was found. Antibiotic therapy with ampicillin was continued for one month. Imaging at two months showed complete resolution of the abscess. The patient regained independent walking ability after rehabilitation, with only slight residual right arm weakness. No recurrence was observed during ten years of follow-up. This case demonstrates that a cervical spinal cord abscess can cause impaired consciousness through brainstem edema without intracranial infection. Early surgical intervention combined with appropriate antibiotics may lead to favorable outcomes.

We encountered a 77-year-old woman who had a roof-dependent macro-reentrant left atrial (LA) flutter (LAFL), masked by probable epicardial conduction via the septopulmonary bundle (SPB). The SPB, an epicardial connection in the LA, may contribute to the maintenance and complexity of LAFL. Thus, when evaluating LAFL, physicians should consider the potential involvement of the SPB. Detailed observation using a three-dimensional mapping and comprehensive electrophysiological pacing maneuvers is crucial for identifying the re-entry circuit of LAFL.