Allogeneic hematopoietic stem cell transplantation (allo-HCT) has been established as a curative treatment for hematological malignancies such as acute myeloid leukemia and myelodysplastic syndrome. Patients aged ≥ 70 years have traditionally been considered ineligible for this procedure, because of concerns over high transplant-related mortality rates and difficulties managing post-transplant complications. However, recent advances in supportive care, expanded donor availability, and the development of reduced-intensity conditioning (RIC) regimens have increased the availability of allo-HCT for older patients. Notably, the number of allo-HCT procedures performed in patients aged ≥ 70 has been steadily increasing in Japan and Western countries, reflecting a re-evaluation of transplant eligibility in older patients. When assessing transplant eligibility in older patients, it is crucial to consider not only disease risk stratification and treatment response, but also comprehensive evaluations of general health status, comorbidities, cognitive function, and social backgrounds. In particular, indexes such as the Hematopoietic Cell Transplantation-Comorbidity Index and Comprehensive Geriatric Assessment have proven useful for predicting patient prognoses and non-relapse mortality. Donor selection and the intensity of the conditioning regimen used can both significantly influence transplant outcomes. RIC or non-myeloablative regimens are generally recommended for patients aged ≥ 70 years. Human leukocyte antigen-matched related or younger unrelated donors are preferred, while haploidentical donors or cord blood may be considered when matched donors are unavailable, although evidence in older patients is limited. This review provides a comprehensive overview of the current status of and challenges related to allo-HCT in patients aged ≥ 70 years. Patient eligibility, conditioning strategies, donor selection, and transplant outcomes are discussed in detail, based on the latest available evidence.

Background We designed a single-center retrospective study comparing the performance of commercially explainable artificial intelligence (XAI)-powered computer-aided detection (CAD) system of abnormal findings on chest X-rays (CXR) with that of non-experts, and pulmonology experts.

Methods A total of 1,262 images of 1,262 subjects (mean age 49 years; 52% female) and 1,252 images of 1,252 subjects (mean age 51 years; 51% female) were obtained from DICOM formats in Hakuai Hospital Health Check-up Center, in the pre-and post-implementing XAI-powered CAD period, respectively. The ultimate decision of abnormality on CXR was made by two pulmonology experts. The diagnostic accuracy metrics were measured accuracy and negative predictive value (NPV) for detecting abnormality on CXR.

Results XAI-powered CAD systems achieved an accuracy of 0.84 (95% confidential interval [CI] 0.82–0.86) and NPV of 1.00 (95% CI 0.99–1.00) to detect the abnormality on CXR. For determining nodular shadows, it was found to be non-inferior to the pulmonology experts with an accuracy of 0.94 (95% CI 0.92–0.95), and NPV of 1.00 (95% CI 0.99–1.00). It tended to overestimate the abnormality of heart enlargement and pleural thickening with a tendency for lower sensitivity.

Conclusion It seems likely that in the future, the most accurate screening CXR will be a double check combining with the pulmonology experts with XAI-powered CAD systems.

Background A survey was conducted to determine the demand for the use of digital health content for health promotion, both among those interested in using digital tools and those interested in health promotion.

Methods This study targeted smartphone owners who attended a class on how to use a smartphone (CS) and/or a class on advancements in health (CH) held in Nanbu Town. The main questionnaire items included questions on age, gender, frailty, subjective cognitive decline (SCD), smartphone usage, and interest in health promotion using digital technology. An analysis was conducted on 33 participants in the CS and 33 participants from the CH who provided complete responses to the questionnaire.

Results The percentages of interest in using smartphones for accessing content on exercise, cognitive training, and nutrition management were 97.0%, 97.0%, and 87.9%, respectively, among CS participants and 69.7%, 78.8%, and 81.8%, respectively, among CH participants. The percentage of responses regarding interest in exercise content was significantly different between the two groups. Furthermore, some individuals responded that they were interested but concerned about how to use the services. No statistically significant differences were found with respect to the comparison of the percentages of responses by age group, frailty determination results, and SCD determination results among the participants of the CS and CR groups.

Conclusion Regardless of age or the risk of developing health problems, there is demand for content related to health promotion using digital tools for those who want to master digital tools and who want to improve their health. However, support should be provided to them to ensure that they correctly use those tools. Notably, some individuals who want to improve their health are not interested in using digital tools.

Background The objective of this study is to devise a simplified approach for estimating respiratory particle trajectory to avoid infection in gathering places of emergency departments.

Methods To the authors’ knowledge, no sufficient/obvious data exist on lateral routes of disease transmission through respiratory droplets along the x-axis. The present study establishes a preliminary baseline approach based on the upper pharynx-mouth geometry for lateral social distancing to protect susceptible persons from the droplets of an infected person. An enhanced version of ART (Aydin’s Research Team) model has been employed as a supplementary tool of Stokes’s law for quantification of motion dynamics of the virus/bacterium-laden droplets in public indoor places.

Results A range of droplet diameters varying from 1 μm to 2000 μm were considered in this study. The droplets with a diameter of ≤ 22.5 μm can completely evaporate during settling and droplet nuclei can remain in the air for extended periods. An individual Influenza virus can stay airborne for 34.4 days, while a single Streptococcus bacterium remains suspended for 18.6 hours. The proper social distancing between infected and healthy persons should be about 2.9 and 0.9 m longitudinally, and 0.45 and 0.15 m laterally based on the novel aspects of the present study for sneezing/coughing and breathing/talking, respectively. The trajectory of respiratory particles in the streamwise and radial directions resembles the shape of a truncated cone due to the upper pharynx-mouth relationship.

Conclusion The outcomes of this study can help further understanding of respiratory particle trajectory, thereby improving measures to mitigate disease transmission.

Background The Coronavirus disease 2019 ¹ global pandemic is transmitted through respiratory droplets from infected people. We aim to determine the risk factors for COVID-19 reinfection, and the degree of its severity in patients reinfected with it.

Methods We conducted a cross-sectional study on COVID-19 reinfection in Semarang, Indonesia using the two-stage sampling technique. There were a total of 312 participants. We used logistic regression tests for multivariate analysis of reinfection risk associated with various factors. The study spanned from June 2022 to October 2022.

Results We found that symptoms such as cough and sore throat, seen during first infection, often recurred during reinfection. The fixed multivariate result showed that males (OR 3.863; 95% CI 1.459-10.234; P = 0.007), persons having comorbidities (OR 2.382; 95% CI 1.025-5.536; P = 0.044), health workers (OR 32.881; 95% CI 3.120–346.566; P = 0.004) or non-health workers (OR 21.661; 95% CI 2.192–214.034; P = 0.008), persons with mild symptoms (OR 6.503; 95% CI 2.771–15.264; P < 0.001) or moderate symptoms (OR 43.408; 95% CI 5.963–315.980; P < 0.001) at first COVID-19 infection, persons displaying poor rule-following behavior (OR 4.162; 95% CI 1.569–11.037; P = 0.004) and having only a middle school education (OR 0.303; 95% CI 0.098-0.93; P = 0.037) were highly related parameters associated with COVID-19 reinfection.

Conclusion Thus, we found that males having comorbidities, employed in public jobs (health and non-health workers), with mild or moderate severity during first infection, and displaying poor rule-following behavior hold the highest risk factors for COVID-19 reinfection. Interestingly, having at least a middle school education seems to be a protective factor against COVID-19 reinfection.

Background Urosepsis is defined as sepsis caused by an infection of the urogenital tract and is a systemic response to infection. Urosepsis is commonly treated in the intensive care unit (ICU) because of its acute and potentially lethal nature. Acute kidney injury (AKI) is a common complication of septic shock in ICU patients. This study predicted cases in which patients required renal replacement therapy (RRT) during the early stages of hospitalization. We also examined the relationship between the clinical information obtained at admission and the subsequent need for RRT.

Methods This single-center, retrospective, observational study included 114 patients with sepsis caused by tract infections. We examined the multiple factors associated with AKI using clinical and social information. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines, with severe AKI defined as AKI requiring RRT. Logistic regression analyses were performed to identify the significant factors associated with severe AKI based on the information obtained at the time of admission.

Results Severe AKI occurred in 12 patients. Multivariate analysis revealed that two factors were significantly associated with severe AKI: a high leukocyte count in the peripheral blood (> 22,100/μL) at admission (odds ratio: 21.972, 95% CI: 1.798–268.481) and the administration of vasopressors (odds ratio: 13.327, 95% CI: 1.009–176.091).

Conclusion Physicians should be vigilant of the potential development of severe AKI in cases of urosepsis, particularly when patients require vasopressor and present with extremely high peripheral blood leukocyte counts at admission.

Background Brain injury accompanied by hemorrhage, such as cerebral contusion or intracerebral hemorrhage, leads to the accumulation of activated microglia around the lesion. In addition, microglia at the site of injury can act either damagingly or protectively, depending on the time; for instance, it is damaging in the acute phase and protective in the chronic phase. Moreover, during brain injury, glutamate-induced excitotoxicity leads to secondary damage to neurons. However, the source of glutamate released from cells remains largely unknown. Our previous studies have revealed that cystine/glutamate antiporter system x_c^- (xc-) in microglia is an important source of glutamate release and that the induction of expression of xCT, a component molecule of xc-, is vital.

Methods We investigated the effect of microglial xCT on traumatic brain injury using xCT-deficient mice.

Results In cultured microglia supplemented with crude brain extract and the affected side of the brain injury model accompanied by hemorrhage, the expression level of xCT was increased on the affected side, and induction was observed mainly in microglia. In addition, EAAT2 levels on the affected side decreased. On the affected side, the number of CD80-positive microglia was significantly increased, and the xCT expression rate was elevated in CD80-positive cells. Assuming that xCT in microglia is important, we investigated xCT-deficient mice and microglia-specific xCT knockdown mice and found that the extent of brain damage was milder than in wildtype mice. The proportion of CD80-positive microglia was lower than that in wild-type mice. Assuming that microglial xCT could be a therapeutic target, we performed an experiment using the xCT inhibitor SSZ administered intraperitoneally. The extent of damage was narrowed, and the ratio of CD80-positive microglia was reduced, demonstrating a therapeutic effect.

Conclusion Thus, microglial xCT is important in the pathology of brain injury accompanied by bleeding and is considered a promising therapeutic target.

Background Extensive burns induce systemic inflammation and increase vascular permeability, resulting in dehydration and edema. During burn injury, the release of high-mobility group box 1 (HMGB1) from damaged cells may promote an inflammatory response. In this study, we examined the relationship between changes in blood HMGB1 levels, vascular permeability, and lung tissue damage following burn injury.

Methods We examined changes in blood levels of HMGB1 using a mouse model of skin burns. Additionally, we examined intercellular adhesion structures that regulate the barrier function both the skin and lung. To assess changes in vascular permeability, lung tissues of mice with burn injuries were stained with Evans blue. To elucidate the role of HMGB1 in mediating the observed changes, cultured human vascular endothelial cells (HUVECs) and alveolar epithelial cells (H441) were treated with mouse burn serum or HMGB1 protein.

Results Herein, we observed HMGB1 leakage from burned mouse skin and elevated blood levels of HMGB1. Vascular permeability experiments using Evans blue staining confirmed increased permeability in the lung tissues of mice with burn injuries. Measurement of transendothelial electrical resistance revealed enhanced vascular permeability and reduced expression of the intercellular junction proteins in HUVECs. Conversely, treatment of H441 cells with HMGB1 disrupted the location and expression of the tight junction protein, zonula occludens-1. Treatment with the anti-HMGB1 antibody suppressed the disruption of cell-cell junctions in HMGB1-treated cells. These altered adhesion structures were also detected in pulmonary cells of mice with burn injuries. In H441 cells, HMGB1 treatment increased the activation of atypical protein kinase C (aPKC), which is essential for the formation of epithelial-specific cell-cell junctional structures. Inhibition of aPKC suppressed HMGB1-induced disruption of intercellular junction structures.

Conclusion Collectively, these findings suggest that HMGB1-mediated dysregulation of aPKC activity may underlie burn injury-induced vascular hyperpermeability by disrupting cell-cell adhesion.

Background Children with autism spectrum disorder frequently experience persistent sleep difficulties that persist into adulthood. These issues are linked to adverse outcomes like behavioral issues, poor academic performance, and increased parental stress, highlighting the importance of early interventions. We assessed an internet-based sleep education program for parents of children with autism spectrum disorder and conducted a preliminary examination of its potential to improve sleep quality and behavioral outcomes.

Methods Eighteen parent-child pairs participated in an internet-based sleep education program. Outcomes related to the program were assessed at three time points: baseline, 4 weeks post-intervention, and 10 weeks post-intervention. Key measures analyzed included sleep parameters, sleep habits, children’s behavioral problems, parental mental health, and parenting attitudes, using validated assessment tools.

Results At 4 weeks post-intervention, the program demonstrated a reduction in the time required for children to fall asleep, an enhancement in sleep efficiency, and an improvement in parental mental health. At 10 weeks post-intervention, improvements were also observed in children’s externalizing behavior problems. Parents reported increased confidence in managing their children’s sleep issues and noted a positive impact on family dynamics.

Conclusion The findings suggest that the internet-based sleep education program may be an effective and acceptable intervention for addressing sleep difficulties in children with autism spectrum disorder. This study contributes substantially to the existing literature, highlighting the potential for internet-based interventions to enhance sleep management strategies. This study was retrospectively registered with the jRCT on September 30, 2024 (jRCT1062240058).

Background Accurate assessment of pressure injuries is critical in clinical settings, especially when evaluating necrotic tissue using the DESIGN-R® scale widely adopted in Japan. This study aimed to integrate artificial intelligence (AI) into the evaluation process to enhance diagnostic consistency and accuracy. By leveraging deep learning and convolutional neural networks, we explored the potential of AI models in classifying necrotic tissue from wound images.

Methods A retrospective observational study was conducted using electronic medical records and wound photographs from patients treated at Tottori University Hospital between 2014 and 2022. Two supervised learning models were developed: a Categorical Classification Model (CCM) for multi-class prediction, and a Binary Classification Model (BCM) implementing a two-step binary classification. Necrotic tissue was categorized based on the DESIGN-R® scale into three classes: n0 (no necrosis), N3 (soft necrosis), and N6 (hard, adherent necrosis). The models’ performance was evaluated using standard classification metrics.

Results The CCM showed recall rates of 0.7824 for n0, 0.6620 for N3, and 1.0000 for N6. In contrast, the BCM achieved higher recall rates: 0.9074 for n0, 0.9884 for N3, and 1.0000 for N6. Overall metrics for CCM were: accuracy 0.8148, precision 0.8166, and F-1 score 0.8089. The BCM surpassed these with an accuracy of 0.8711, precision 0.8418, and F-1 score 0.8508. Across all performance indicators, the BCM demonstrated superior classification capability.

Conclusion The study demonstrated that AI, particularly the binary classification approach, can enhance necrotic tissue assessment in pressure injury evaluation. The BCM consistently outperformed the CCM, supporting its potential as a reliable tool to assist clinicians in objective and standardized pressure injury evaluation using the DESIGN-R® framework.

Background Survival rates improve significantly if basic life support (BLS) is administered for an out-of-hospital cardiac arrest (OHCA); however, it has a low rate of implementation. Even though bystanders’ low willingness to administer BLS may be a contributing factor, the factors influencing their willingness have not been sufficiently elucidated. Therefore, this study investigated the relationship between personality traits and the willingness to administer BLS in a large cohort.

Methods In a previous study, we found an association between the willingness to perform BLS and facilitative and obstructive factors. In this study, we used the same cohort and performed a secondary analysis of the willingness to perform BLS and the big five personality traits. This observational study assessed Japanese respondents’ willingness to perform three BLS techniques (with varying levels of intervention) and the big five personality traits, using a questionnaire. The collected data were analyzed using logistic regression.

Results Responses were obtained from 937 Japanese residents aged 20–65 years who had no experience performing BLS. The willingness to perform low-intervention actions—such as checking the victim’s condition and seeking assistance—was significantly and positively correlated with extraversion and agreeableness. Conversely, the willingness to perform higher-intervention actions—such as performing chest compressions and related actions—was positively correlated with openness and negatively correlated with neuroticism.

Conclusion Certain personality traits are related to the willingness to perform BLS. Hence, training methods based on personality traits may increase BLS implementation rates. For instance, creating awareness of affected individuals’ pain or joy of survival through anecdotes may be effective for individuals with low levels of agreeableness, whereas providing correct knowledge for dispelling anxiety and instilling prepared mindsets may be effective for individuals with high levels of neuroticism. Overall, the findings indicate the potential effectiveness of training methods tailored to individual personality traits.

Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by recurrent episodes of sympathetic overactivity, including hypertonia, tachycardia, hypertension, and hyperthermia, typically following severe brain injury. While PSH is well documented in adult populations, reports on pediatric patients, particularly those with severe motor and intellectual disabilities (SMID), remain limited. Here, we report three pediatric patients with SMID due to neonatal hypoxic-ischemic encephalopathy (NHIE) who developed PSH. All patients presented with characteristic PSH symptoms and were diagnosed according to the Pediatric Clinical Practice Guidelines based on the 2014 consensus criteria. Gabapentin (GBP) was initiated at low doses (5–10 mg/kg/day) in all patients, resulting in the rapid resolution of PSH symptoms. In two patients, symptoms partially recurred within several months but were controlled through GBP dose adjustment and the addition of clonidine or other agents. No severe adverse events were observed. To our knowledge, this is the first report describing the short-term efficacy of GBP in pediatric patients who developed PSH with SMID status due to NHIE. Our findings suggest that GBP is a valuable and well-tolerated therapeutic option for the management of PSH in children with these conditions.

Burn wounds cause pain through various mechanisms, making pain management challenging. Although treatment and management strategies for healing burns have been developed, clear guidelines for analgesia in burn injuries are lacking. Opioids are commonly used for pain relief, but regional anesthesia performed by anesthesiologists has shown effectiveness in some cases. We encountered a case in which epidural anesthesia was effective for analgesia of a lower-extremity burn injury in a 19-year-old man. The patient with burn injuries to his lower extremities was transferred to the emergency department. On the day of the injury, an epidural catheter was administered for burn pain. The epidural anesthesia was removed during hospitalization, but the pain worsened, so it was placed again to provide adequate analgesia. In this case, epidural anesthesia proved effective for managing the lower-extremity burn pain and facilitated patient rehabilitation. Epidural anesthesia should be actively considered for the management of burn pain.

Polycythemia vera is a chronic myeloproliferative neoplasm characterized by a marked increase in circulating erythrocyte volume in middle-aged and elderly patients; it is associated with increased white blood cell and platelet counts and splenomegaly. There is a high risk of conflicting complications during surgical treatment, such as thrombosis and hemorrhage, with thrombosis being the leading cause of death. Hence, it is important to take measures against both in the perioperative management. We report a case of perioperative management of a patient with polycythemia vera and resection of an intraepithelial carcinoma of the tongue. The patient, a 46-year-old man, had been under observation at our hospital’s Department of Internal Medicine for 10 years with a diagnosis of polycythemia vera. He came to our department with a complaint of white spots on the left tongue margin. Phlebotomy was performed when his blood count, hemoglobin, and hematocrit levels were elevated. The biopsy showed intraepithelial carcinoma. Preoperative examination revealed no abnormality, and a partial left-sided tongue resection was performed under general anesthesia. To prevent thromboembolism, the patient wore an elastic stocking from the time he entered the operating room. The patient underwent local hemostasis to prevent bleeding and systemic management centered on infusion therapy to prevent blood concentration. Four years and three months have passed since the surgery without recurrence.

Amyloidosis is a group of disorders in which specific precursor proteins form insoluble amyloid fibrils are deposited in various organs and extracellular spaces. Sjögren’s syndrome (SS) is a chronic inflammatory disease in which lymphocytes infiltrate the exocrine glands, such as the salivary and lacrimal glands, through an autoimmune mechanism. At advanced stages of SS, localized nodular amyloidosis has been reported in specific organs outside the glands. Herein, we report a case of localized nodular amyloidosis associated with SS. An 80-year-old woman, who had been biting her buccal mucosa for several years and was aware of the presence of a mass, which had increased in size since approximately 6 months, was referred to our hospital. The patient had a history of SS and systemic lupus erythematosus since her 50s. A needle biopsy was performed because malignancy was suspected by magnetic resonance imaging. The pathological diagnosis was ATTR-type amyloidosis. The patient underwent excision of the lesion to improve the swelling. The pathological findings showed plasma cell infiltration in some areas, which required differentiation from AL amyloidosis; therefore, the patient was referred to a facility specializing in amyloidosis. The pathological diagnosis was AL amyloidosis. Various clinical findings ruled out systemic involvement and the final pathological diagnosis was localized nodular amyloidosis. It has been reported that it may occur in the advanced stages of SS, and our patient had SS for 30 years. One year after the surgery, the patient’s prognosis was good.