Individuals with attention deficit/hyperactivity disorder （ADHD） may exhibit autism spectrum disorder （ASD） characteristics, even without a formal ASD diagnosis. In this study, we aimed to investigate the clinical features of ADHD in adults according to the strength of their ASD traits. We included 96 adults diagnosed with ADHD who attended an ADHD-specialized outpatient clinic at Showa University Karasuyama Hospital. Autism trait severity, ADHD symptoms, and cognitive characteristics were assessed using the Autism Spectrum Quotient （AQ）, Conners’ Adult ADHD Rating Scale （CAARS）, and Wechsler Adult Intelligence Scale-III （WAIS-III）, respectively. We divided these participants into two groups according to the cutoff AQ value of 33: high-AQ （n＝30） and low-AQ （n＝66） groups. Next, we compared participants’ background and CAARS and WAIS-III scores between these groups. Furthermore, the WAIS-III subtest scores were compared within each group. The CAARS subscale scores related to impulsivity/emotional instability, DSM-IV hyperactive-impulsive, and ADHD index were significantly higher in the high-AQ group than in the low-AQ group. Conversely, the WAIS-III scores did not differ significantly between such groups. However, in the low-AQ group, the scores for verbal comprehension were significantly higher than those for working memory and processing speed. Therefore, the severity of ASD traits may be associated with the ADHD symptoms. Moreover, differences in functional impairment in ADHD were evident on the basis of the strength of the ASD traits. In conclusion, evaluating the strength of ASD characteristics in patients with ADHD may contribute to the selection of more ASD-inclusive treatment strategies.

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We examined the effects of maternal glycosuria during pregnancy on obesity in female offspring of reproductive age （Offspring-Re）. Data from Maternal and Child Health Handbooks maintained by the mothers of Offspring-Re at the time of their births were used in this single-center study. Offspring-Re with records of maternal glycosuria during pregnancy and pre-pregnancy body mass index （BMI） were recruited. Positive maternal glycosuria during pregnancy was defined as having at least one recorded （＋） or higher in the handbook. Obesity in Offspring-Re was defined as a pre-pregnancy BMI of ≥25kg/m². To estimate the effect of maternal glycosuria on obesity in Offspring-Re, logistic regression analysis was performed. Of the 313 Offspring-Re included, maternal glycosuria was positive and negative in 45 and 268, respectively. The incidence of obesity in Offspring-Re was 13.3％ and 2.6％ in the positive and negative maternal glycosuria groups, respectively （p＝0.005）, and increased with the degree of maternal glycosuria （p＝0.0001）. Multiple logistic regression analysis revealed that positive maternal glycosuria during pregnancy was a significant risk factor for obesity in Offspring-Re, even after adjusting for maternal pre-pregnancy BMI, gestational weight gain, and maternal high blood pressure during pregnancy （adjusted odds ratio, 5.50; 95％ confidence interval, 1.55-19.15; p＝0.010）. Collectively, these findings indicate that maternal glycosuria during pregnancy is a risk factor for obesity in Offspring-Re.

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Since many patients die without considering organ/tissue donation （OTD）, it is crucial to ascertain their end-of-life wishes in advance. Therefore, the present study aimed to evaluate the effectiveness of using explanatory documents （OTD） in helping physicians ascertain and record patients’ wishes in their medical charts. This study was a randomized controlled trial conducted in Japan. Explanatory documents with and without OTD descriptions were used. The primary outcome was to identify whether physicians recorded patient’s OTD wishes in their medical charts. More specifically, 30 physicians were included in the analysis, 27 of whom had no OTD experience. Of the 16 physicians who used documents with OTD information, 11 （40.7％; p＜0.001） created records. On the contrary, none of the 11 physicians who used documents without OTD information created any records. Among physicians with no OTD experience, those who used explanatory documents that included OTD information were found to record patients’ OTD wishes in their medical charts significantly more frequently. Conclusively, when physicians lacking OTD experience used documents with OTD information, they were more likely to ascertain patients’ wishes regarding OTD than when using documents without such information. Our findings demonstrate that the use of explanatory documents with OTD information could standardize the contents and timing of ascertaining patients’ OTD wishes. Our results could therefore contribute to the establishment of a healthcare system that respects all patients’ wishes during end-of-life care.

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The current methods of removing the tracheal occlusion balloon in fetal endoscopic tracheal occlusion （FETO） for congenital diaphragmatic hernia （CDH） are significantly invasive for both the mother and the fetus. This study explores the validity of a novel approach combining high-intensity focused ultrasound （HIFU） and limonene emulsion to achieve noninvasive balloon removal after FETO. A FETO balloon model using natural rubber injected with 0.3ml limonene emulsion was subjected to HIFU irradiation at five output voltages （240, 200, 160, 120, and 80Vpp） across 25 experiments. Using a high-speed camera, the model was observed for balloon rupture or shrinkage. Higher HIFU output power frequently led to rupture patterns. Further regression analysis revealed that higher output power tended to reduce the rupture time; however, it was statistically nonsignificant （p＝0.1361）. Cavitation and emulsion collapse observed using the high-speed camera confirmed that the rupture mechanism was attributable to the interaction between limonene and latex and the physical effects of HIFU. Limonene emulsion with latex subjected to HIFU can be used as a noninvasive method for balloon removal after FETO. Further research is warranted to clinically validate these results and identify the optimal HIFU output power for adequate balloon collapse.

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This study retrospectively examined the effects of head and neck volume reduction （external volume loss, EVL） on prescribed doses in 31 patients with oropharyngeal and hypopharyngeal cancer receiving curative intensity-modulated radiation therapy （IMRT） using the Tomotherapy system. This study focused on the relationship between treatment duration and EVL, differences in EVL between cases, and dose variation rates associated with EVL and other dosimetric indicators. To evaluate computed tomography （CT） volume data used in treatment planning （IMG_plan） and mega-voltage CT images taken during treatment （IMG_MV）, deformable image registration （DIR） was employed. This study noted a statistically significant moderate correlation between treatment duration and EVL, with head and neck volume decreasing at a rate of 0.09％ per day （r＝0.4515, p＜0.0001）. EVL varied by case, ranging from an average of 10.6％ to cases with little variation. Regarding EVL-related dose variation rates, the median EVL of 6.5％ led to a 1.3％ increase in dose at D0.03cc for planning target volume_highrisk but only a 0.3％ change in Dmax for Spinal cord_PRV （r＝0.5101, 0.0251; p＜0.0001, 0.4038）. This study emphasizes the significance of replanning treatments on the basis of volume changes during radiation therapy and suggests that using DIR technology for longitudinal dose assessments could be a critical practical tool for improving treatment precision. In future works, evaluating the impact of volume changes for each patient and determining the optimal timing for treatment replanning will be crucial for further improving patient outcomes.

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