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A study was conducted on the baroreflex response in humans during acute high-altitude exposure. A neck chamber was employed in seven unacclimatized male subjects to plot R-R intervals while a four-parameter sigmoidal logistic function was used to analyze the baroreceptor response. The findings indicate that hypoxia reduces the sensitivity of carotid baroreflex cardiac response.

Researchers have investigated whether plasma arginine vasopressin (AVP) would be diminished in eight male volunteers during one-hour exposure of 3 atmospheres absolute (atm abs) air. Attention was given to the mechanisms which may cause any AVP response. It was established that an acute hyperbaric exposure of 3 atm abs boosted the negativity of inspiratory intrapleural pressure and inspiratory central venous pressure (CVP). There was no change to transmural CVP.

Osmolality or extracellular volume effects on the reduction of thirst in head-out water immersion of hypohydrated specimens is investigated. The investigation reveals that vascular volume stimulated cardiopulmonary baroreceptors exert more influence on the thirst sensations during immersion under water in hydrated subjects.

We examined the dynamics of capsule swallowing by healthy young men using the anterior-posterior view of videofluoroscopy as a first step in a study on capsule swallowing by dysphagic patients. The subjects were 14 healthy men who did not have any complaint of dysphagia. They were asked to swallow a #4 hard gelatin capsule filled with barium sulfate with 15 ml of water during the videofluoroscopic examination. This examination was repeated three times for each subject (total of 42 trials). In four of the 14 subjects, a swallowed capsule was retained at the upper esophageal sphincter, or the broncho-aortic constriction of the esophagus, or the lower esophageal sphincter. Except where retention occurred, the average capsule transit time from the mouth to the stomach was 6.0 +/- 2.4 s. Three of the four subjects who had capsule retention did not realize that the swallowed capsule was retained en route to the stomach. By considering the dynamics of swallowing a capsule with 15 ml of water in healthy men, we should be able to reveal the dynamics of capsule swallowing in dysphagic patients, and the capsule transit time from the mouth to the stomach. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine whether hemiplegic patients can propel a leg-pedalling wheelchair and whether it is easier and faster for them to pedal the wheelchair using both legs alternately than to propel an ordinary wheelchair with their unaffected hand and leg. DESIGN: Within-subject comparison. SUBJECTS: Subjects comprised 10 hemiplegic in-patients (8 males, 2 females), aged 63.7 (SD 12.7) years with severe or moderate gait disturbance due to stroke. METHODS: Subjects were asked to practice propelling the leg-pedalling wheelchair and ordinary wheelchair on both slalom and rectangular courses for a period of 7-10 days. Once they had become skilled in this, the wheelchair speed and patient's heart rate were measured, and a physiological cost index was calculated. RESULTS: Subjects could pedal the leg-pedalling wheelchair using both legs alternately. The speed of this wheelchair was faster than that of the ordinary wheelchair, and the physiological cost index for pedalling it was lower than that for propelling the ordinary wheelchair. However, subjects needed some help in transferring to the leg-pedalling wheelchair. CONCLUSION: The hemiplegic patients could pedal the leg-pedalling wheelchair using both legs alternately faster and more effectively with regard to speed and physiological cost index. [ABSTRACT FROM AUTHOR]

Presents a study to examine changes in central and peripheral hemodynamics in humans. Muscle sympathetic nerve activity (MNSA) during graded head-down tilt (HDT); Cardiopulmonary baroreceptors; Central venous pressure; Thoracic impedance; Sympathetic nerve activity; Forearm vascular resistance; Total peripheral resistance.

Seven college-age healthy men exercised on a wheelchair treadmill to evaluate muscle damage that may occur from wheelchair propulsion. An experimental model in which a participant performs up-hill running in a wheelchair was prepared. Plasma creatinekinase (CK), myoglobin (Mb) and lactatedehydrogenase (LDH) were measured as parameters. Blood samples were taken pre-, immediately after-, 24 h after- and 72 h after the exercise. All of these parameters significantly increased after the exercise, but their time-courses were apparently varied. It is concluded that wheelchair propulsion causes muscle damage in certain situations such as up-hill running. [ABSTRACT FROM AUTHOR]

Refers to a 1997 study by M.Ide, and others, entitled `Muscle Damage Occurring in Wheelchair Sports People,' which appeared in the `Spinal Cord' journal. Evaluation of muscle damage in nondisabled men; Use of the Bruce protocol.

O objetivo deste trabalho foi avaliar o efeito da somatotropina bovina recombinante (rBST - análogo do BST, obtido comercialmente pela técnica do DNA recombinante), sobre ganho médio diário (GMD), ingestão de matéria seca (IMS), matéria orgânica (IMO), energia metabolizável (IEM) e fibra em detergente neutro (IFDN), ingestão de matéria seca em relação ao peso vivo (IMS/PV), conversão alimentar (CA), rendimento de carcaça (RC) e digestibilidade aparente da matéria seca (DAMS), matéria orgânica (DAMO), proteína bruta (DAPB), energia bruta (DAEB) e fibra em detergente neutro (DAFDN). Foram utilizadas 24 novilhas mestiças (½ Nelore x ½ Red Angus), com aproximadamente 18 meses de idade e peso médio 255 kg. Os animais foram alimentados com uma dieta contendo silagem de milho, como volumoso, e polpa de citrus e farelo de soja, como concentrado, durante 84 dias. Essa dieta foi utilizada para os três tratamentos, que se diferenciaram pela aplicação de 250 mg de rBST, por via subcutânea, na fossa ísqueo-retal, onde: tratamento 1) controle (aplicação de dois mL de solução salina); 2) dose única e 3) uma dose a cada 14 dias. Os animais foram distribuídos em delineamento inteiramente casualizado, com três tratamentos e oito repetições. O GMD foi determinado a cada 14 dias. A ingestão de alimentos e a conversão da MS foram determinadas ao final do experimento. A digestibilidade aparente (DA) foi determinada durante um período de sete dias com uso de indicador interno. Não houve diferença entre animais tratados ou não com rBST sobre o GMD, IMS, IPB, IEM, IMO e IFDN, CAMS e RC. No entanto, a DA da MS, MO, PB, EB e FND foi superior para as novilhas que receberam rBST a cada 14 dias.

Introduction: A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance., Methods: A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge., Results: Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO., Discussion: For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hayashi, Yamazaki, Komatsu, Yamamoto, Ueda, Sato, Yamaguchi, Hatori, Honaga, Takakura, Wada, Tanuma and Fujiwara.)

Synthetic siRNA molecules without chemical modifications are easily degraded in the body, and 2'-O-modifications are frequently introduced to enhance stability. However, such chemical modifications tend to impact the gene knockdown potency of siRNA negatively. To circumvent this problem, we previously developed a prodrug-type siRNA bearing 2'-O-methyldithiomethyl (MDTM) groups, which can be converted into unmodified siRNA under the reductive environment in cells. In this study, we developed a nuclease-resistant prodrug-type 2'-O-MDTM siRNA for deployment in future animal experiments. To rationally design siRNA modified with a minimal number of 2'-O-MDTM nucleotide residues, we identified the sites susceptible to nuclease digestion and tolerant to 2'-O-methyl (2'-OMe) modification in the antisense strand of apolipoprotein B-targeted siRNA. Subsequently, we optimized the positions where the 2'-OMe and 2'-O-MDTM groups should be incorporated. siRNA bearing the 2'-O-MDTM and 2'-OMe groups at their respective optimized positions exhibited efficient knockdown potency in vitro and enhanced stability in serum., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The tumour microenvironment (TME), which is modulated after immune-chemotherapy, is involved in tumour growth and metastasis. Programmed cell death 1 (PD-1) expressed on tumour-infiltrating non-malignant cells plays an important role in the TME through the PD-1/programmed cell death ligand 1 (PD-L1) signalling pathway. However, its impact in patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) remains unclear., Methods: We conducted a retrospective study using tissue samples at relapse for patients with R/R DLBCL (n = 45) and evaluated the clinical impact of PD-1 expression on tumour-infiltrating non-malignant cells (microenvironmental PD-1, mPD-1). In addition, corresponding 27 samples at diagnosis were analysed to evaluate the changes in PD-1/PD-L1 expression in the TME after chemotherapy., Results: Patients with mPD-1 + DLBCL showed significantly better overall survival compared with patients with mPD-1 - DLBCL (hazard ratio, 0.30, p = 0.03). Among patients with mPD-1 - DLBCL, those positive for neoplastic or microenvironmental PD-L1 (nPD-L1 + or mPD-L1 + ) showed significantly worse outcomes. Microenvironmental PD-1 and PD-L1 expression has high correlation at relapse, although none was found at diagnosis., Conclusion: We determined the clinical impact of microenvironmental PD-1 expression and its relationship with neoplastic or microenvironmental expression of PD-L1 in patients with R/R DLBCL. The expression of PD-1 and PD-L1 in the TME dramatically changes during the chemotherapy. Therefore, evaluating TME at relapse, not at diagnosis is useful to predict the outcomes of R/R DLBCL patients., (© 2023 John Wiley & Sons Ltd.)

Objective: The aim of this study was to examine the relationship between the frequency and duration of physical therapy (PT) and the development of hospitalization-associated disability (HAD) in hospitalized geriatric patients with heart failure (HF)., Methods: This single-center, retrospective, observational study included hospitalized patients with HF aged 65 years or older who had received PT. Data regarding demographics, comorbidities, laboratory findings, medications, rehabilitation, and activities of daily living (ADLs) status were collected from electronic medical records. Based on the average frequency and duration of PT, patients were divided into three groups: Group 1, ≥3 days/week and ≥120 minutes/week; Group 2, ≥3 days/week and <120 minutes/week; and Group 3, <3 days/week and <120 minutes/week. Logistic regression analysis was performed to identify the association between the average frequency and duration of weekly PT and the incidence of HAD., Results: In all, 105 patients (mean age, 84.8 years; proportion of women, 59%) were enrolled in the study, and 43 (41.0%) patients exhibited HAD at discharge. In the multivariate logistic regression analysis, Group 2 (odds ratio [OR], 3.66) and Group 3 (OR, 6.71) had a significantly elevated risk of developing HAD using Group 1 as the reference, even after adjusting for age, ADLs before admission, cognitive function, and severity of HF., Conclusion: This study showed that a lower frequency and shorter duration of PT are associated with developing HAD in hospitalized geriatric patients with HF. However, further prospective studies are required to confirm these findings., Competing Interests: The authors declare no conflicts of interest., (©2024 Japanese Society of Physical Therapy.)

Various chemical modifications have been developed to create new antisense oligonucleotides (AONs) for clinical applications. Our previously designed prodrug-type phosphotriester-modified oligonucleotide with cyclic disulfides (cyclic SS PTE ON) can be converted into unmodified ON in an intracellular-mimetic reducing environment. However, the conversion rate of the cyclic SS PTE ON was very low, and the AON with cyclic SS PTE modifications showed much weaker antisense activity than corresponding to the fully phosphorothioate-modified AON. In this study, we synthesized several types of PTE ONs containing linear disulfides (linear SS PTE ONs) and evaluated their conversion rates under reducing conditions. From the results, the structural requirements for the conversion of the synthesized linear SS PTE ONs were elucidated. Linear SS PTE ON with promising promoieties showed a nuclease resistance up to 4.8-fold compared to unmodified ON and a cellular uptake by endocytosis without any transfection reagent. In addition, although the knockdown activity of the linear SS PTE gapmer AON is weaker than that of the fully phosphorothioate-modified gapmer AON, the knockdown activity is slightly stronger than that of the cyclic SS PTE gapmer AON. These results suggest that the conversion rates may be related to the expression of the antisense activity., (© 2023 Wiley-VCH GmbH.)

Acute kidney injury (AKI) is one of the major complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The use of multiple antimicrobials is one of the major causes of post-transplantation AKI, owing to the potential nephrotoxicity of each agent and of drug-drug interactions (DDIs). No satisfactory reports on DDIs the field of allo-HSCT have been published. We performed a retrospective analysis to compare the incidence of AKI within 100 days post-transplantation. A total of 465 allo-HSCTs in 416 patients were analyzed, and the cumulative incidence of AKI was 40.0%. AKI was associated with significantly reduced overall survival (hazard ratio [HR], 2.66; 95% confidence interval [CI] 1.95 to 3.55; P < .01) and increased transplantation-related mortality (HR, 4.77, 95% CI, 2.90 to 7.88; P < .01). A higher incidence of AKI was significantly associated with the use of ciprofloxacin, cefepime, tazobactam/piperacillin, meropenem, vancomycin, liposomal amphotericin B, ganciclovir, and foscarnet. Among these drugs, combinations of vancomycin plus tazobactam/piperacillin (HR, 2.23; P = .09 for interaction), ganciclovir plus cefepime (HR, 5.93; P = .04), and ganciclovir plus meropenem (HR, 2.63; P = .12) synergistically increased the risk of AKI, whereas combinations involving teicoplanin did not. This is the first report dealing with DDIs after allo-HSCT, indicating that such combinations should be avoided to preserve renal function and reduce AKI-related morbidity and mortality., (Copyright © 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Autoimmune neutropenia (AIN) is an exceptionally rare condition that occurs after liver transplantation. Here, we report an adult case of refractory AIN 3.5 years after liver transplantation. A 59-year-old man who underwent brain-dead donor liver transplantation in August 2018 developed rapid neutropenia (0.07 × 10 9 /L) in December 2021. The patient was diagnosed with AIN based on positivity for anti-human neutrophil antigen-1a antibody. There was no response to granulocyte colony-stimulating factor (G-CSF), prednisolone, or rituximab, and intravenous immunoglobulin (IVIg) therapy induced only a temporary recovery in neutrophil count. The patient continued to have a low neutrophil count for several months. However, the response to IVIg and G-CSF improved after the post-transplant immunosuppressant was changed from tacrolimus to cyclosporine. Post-transplant AIN has many unknown aspects. Tacrolimus-induced immunomodulation and graft-associated alloimmunity may be involved in its pathogenesis. Further studies are needed to elucidate the underlying mechanisms and explore new treatment options., (© 2023. Japanese Society of Hematology.)

Background: An artificial intelligence (AI)-integrated electromyography (EMG)-driven robot hand was devised for upper extremity (UE) rehabilitation. This robot detects patients' intentions to perform finger extension and flexion based on the EMG activities of 3 forearm muscles., Objective: This study aimed to assess the effect of this robot in patients with chronic stroke., Methods: This was a single-blinded, randomized, controlled trial with a 4-week follow-up period. Twenty patients were assigned to the active (n = 11) and control (n = 9) groups. Patients in the active group received 40 minutes of active finger training with this robot twice a week for 4 weeks. Patients in the control group received passive finger training with the same robot. The Fugl-Meyer assessment of UE motor function (FMA), motor activity log-14 amount of use score (MAL-14 AOU), modified Ashworth scale (MAS), H reflex, and reciprocal inhibition were assessed before, post, and post-4 weeks (post-4w) of intervention., Results: FMA was significantly improved at both post ( P = .011) and post-4w ( P = .021) in the active group. The control group did not show significant improvement in FMA at the post. MAL-14 AOU was improved at the post in the active group ( P = .03). In the active group, there were significant improvements in wrist MAS at post ( P = .024) and post-4w ( P = .026)., Conclusions: The AI-integrated EMG-driven robot improved UE motor function and spasticity, which persisted for 4 weeks. This robot hand might be useful for UE rehabilitation of patients with stroke. Clinical Trial Registry Name: The effect of robotic rehabilitation using XMM-HR2 for the paretic upper extremity among hemiparetic patients with stroke. Clinical Trial Registration-URL: https://jrct.niph.go.jp/ Unique Identifier: jRCTs032200045.

The combination of calcineurin inhibitors and short-term methotrexate has been used as a standard graft-versus-host-disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation. Mini-dose methotrexate (mini-MTX), consisting of 5 mg/m 2 /d on days 1, 3, 6, and 11, is occasionally selected as an alternative considering toxicity. The significance of day 11 administration remains unclear. We performed a retrospective study of 135 cases of unrelated bone marrow transplantation at our institute between 2006 and 2019 and compared the outcomes between day 11 MTX dose omitted (n = 72) and full-doses of mini-MTX (n = 63). In total cohort, the 4-year overall survival (OS) was 58.7 %, and the omitted group showed poor GVHD/relapse-free-survival (P = .01) with comparable OS (P = .11) and relapse-free survival (P = .11). Human leukocyte antigen (HLA) mismatch is a major risk factor for severe GVHD. We analyzed the impact of omitting day 11 MTX in 2 cohorts from HLA matched or mismatched donors. In both cohorts, the omitted group had a higher risk of severe acute and chronic GVHD. In conclusion, the omission of day 11 MTX was associated with a higher risk of severe GVHD. Therefore the omission of the day 11 dose is not recommended., (Copyright © 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Haploidentical-related donor transplantation using posttransplant cyclophosphamide (PTCy-haplo) and cord blood transplantation (CBT) are valid alternatives for patients with hematological malignancies when HLA-matched donor transplantation (MDT) is unavailable. However, the effects of graft-versus-host disease (GVHD) on outcomes after these transplants have not been fully elucidated. Therefore, we evaluated the effects of acute and chronic GVHD on transplant outcomes after PTCy-haplo transplants and compared them with CBT and MDT. We included a total of 914 adult patients with hematological malignancies in the Kyoto Stem Cell Transplantation Group registry who received PTCy-haplo (N = 120), CBT (N = 402), and MDT (N = 392), and achieved neutrophil engraftment. A multivariate analysis revealed that grade I-II acute GVHD improved of overall survival (OS) after PTCy-haplo [hazard ratio (HR) = 0.39, P = 0.018] and CBT (HR = 0.48, P < 0.001), but not after MDT (HR = 0.80, P = 0.267) compared with patients without acute GVHD. Grade I-II acute GVHD had a trend toward reducing the risk of nonrelapse mortality (NRM) after PTCy-haplo (HR = 0.13, P = 0.060) and this positive effect was significant after CBT (HR = 0.39, P = 0.003). A negative impact of grade III-IV acute GVHD on NRM was observed after CBT and MDT, but not after PTCy-haplo. Limited chronic GVHD had a positive impact on OS after CBT and MDT, but not after PTCy-haplo. In conclusion, mild acute GVHD improved outcomes after PTCy-haplo and CBT, and limited chronic GVHD improved outcomes after CBT and MDT. These data indicated that the effects of GVHD on transplant outcomes depended on transplant platforms.

Background: Gait recovery is one of the primary goals of stroke rehabilitation. Gait independence is a key functional component of independent activities in daily living and social participation. Therefore, early prediction of gait independence is essential for stroke rehabilitation. Trunk function is important for recovery of gait, balance, and lower extremity function. The Trunk Impairment Scale (TIS) was developed to assess trunk impairment in patients with stroke., Objective: To evaluate the predictive validity of the TIS for gait independence in patients with acute stroke., Methods: A total of 102 patients with acute stroke participated in this study. Every participant was assessed using the TIS, Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) within 48 h of stroke onset and at discharge. Gait independence was defined as FIM gait scores of 6 and 7. Multiple regression analysis was used to predict the FIM gait score, and multiple logistic regression analysis was used to predict gait independence. Cut-off values were determined using receiver operating characteristic (ROC) curves for variables considered significant in the multiple logistic regression analysis. In addition, the area under the curve (AUC), sensitivity, and specificity were calculated., Results: For the prediction of the FIM gait score at discharge, the TIS at admission showed a good-fitting adjusted coefficient of determination ( R 2  = 0.672, p  < 0.001). The TIS and age were selected as predictors of gait independence. The ROC curve had a TIS cut-off value of 12 points (sensitivity: 81.4%, specificity: 79.7%) and an AUC of 0.911. The cut-off value for age was 75 years (sensitivity: 74.6%, specificity: 65.1%), and the AUC was 0.709., Conclusion: The TIS is a useful early predictor of gait ability in patients with acute stroke., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2022.)

Prediction of responses to chimeric antigen receptor (CAR)-T cell therapies is essential to maximize their therapeutic efficacy for diffuse large B-cell lymphoma (DLBCL). While several tumor-intrinsic risk factors of resistance and/or early relapse have been identified, clinically useful markers that determine potential activity of CAR-T cells have not been fully investigated. T-cell property at the time of leukapheresis may serve as such a marker. Therefore, we evaluated the clinical impact of CD3 + cell count in peripheral blood at leukapheresis on clinical outcomes of CAR-T cell therapy. In total, 44 patients with relapsed or refractory (r/r) DLBCL who received tisagenlecleucel at Kyoto University Hospital were included. According to CD3 + cell counts, patients were categorized into CD3 LOW and CD3 HIGH groups with a threshold of 553/μL, based on receiver operating characteristic curve analysis. 1-year progression-free survival was significantly higher in the CD3 HIGH group than the CD3 LOW group (68.3% vs. 17.3%; adjusted hazard ratio [aHR], 0.37; p = 0.042). Overall survival was also superior in the CD3 HIGH group (aHR, 0.24; p = 0.043). Moreover, higher CD3 + cell counts at leukapheresis were associated with significantly higher lymphocyte counts in peripheral blood at day 7 after CAR-T cell infusion (median 860 vs. 420/μL, P = 0.021), suggesting more extensive expansion of infused CAR-T cells in vivo. In conclusion, we demonstrated that the CD3 + cell count at leukapheresis predicts both expansion of CAR-T cells after infusion and outcomes of CAR-T cell therapy, and are useful for building comprehensive therapeutic strategies at the time of leukapheresis., (© 2022. The Author(s).)

Context: J-DISCOVER is a prospective observational cohort study aiming to understand the current management of patients with early-stage type 2 diabetes mellitus (T2DM) in Japan, enrolling patients initiating second-line treatment., Objective: The current analysis examined the change in treatment satisfaction during the study period and factors affecting this change among patients in J-DISCOVER., Methods: We used data from the J-DISCOVER study, in which 1798 patients with T2DM aged ≥ 20 years were enrolled from 142 sites across Japan. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ)., Results: The mean DTSQ treatment satisfaction score increased from 25.9 points at baseline to 27.3 points at 6 months, which was maintained through 36 months. Among the baseline characteristics examined, higher baseline DTSQ treatment satisfaction scores (P < 0.0001), older age (≥ 75 vs < 65 years, P = 0.0096), living alone (P = 0.0356), and type of facility (clinics vs hospitals, P = 0.0044) had a significantly negative impact on the changes in DTSQ treatment satisfaction scores. Improvement in mean glycated hemoglobin (HbA1c) from baseline (7.7%) to 36 months (7.1%) was associated with positive changes in the DTSQ treatment satisfaction score (P = 0.0003)., Conclusion: Changes in DTSQ treatment satisfaction scores were related to HbA1c improvement, suggesting that the management strategy was appropriately planned for each patient. The results also suggest that the availability of social support for patients with T2DM who are elderly or living alone may be an important factor affecting treatment satisfaction, adherence, and clinical outcomes., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society.)