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Background: Health effects of multiple role occupancy and their mechanism are not fully addressed. We examined (1) the association between the number of social roles and self-rated health (SRH) and (2) the mediation effects of ikigai (the sense of life worth living) and the size of close social networks to the association., Methods: We analysed the cross-sectional baseline questionnaire data of the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT) of 22 180 men and 26 616 women in age 40-59 years. The independent variable was the number of social roles, counting five social roles as a spouse, parent, child, worker and a role in a community. The dependent variable was poor SRH. Logistic regression was used to estimate the ORs for poor SRH by the number of social roles and to test linear trends. Mediation analyses were conducted to estimate the proportion mediated by ikigai and the size of close social networks., Results: Compared with people with 0-1 social role, those who had two or more roles had a lower OR of poor SRH in both men and women. There was a linear inverse trend in the association; people having the largest (5) versus lowest (0-1) number of social roles had the lowest ORs: 0.55 (95% CI 0.46 to 0.66) in men and 0.72 (95% CI 0.61 to 0.86) in women. The estimated proportion mediated by ikigai was over 50%, whereas the size of close social networks mediated the association by approximately 20%., Conclusion: An inverse association between the number of social roles and poor SRH and mediation effects of ikigai and the size of close social networks were identified. Having even one more social role might benefit subjective health via increased ikigai and the size of close social networks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objective: To assess the association between socioeconomic status (SES) and diabetes prevalence among a Japanese population with a wide age range, stratified by gender., Patients and Methods: Socioeconomic, behavioral, and diabetes-related data (diagnosis or medication use based on self-report) were collected from 112,492 participants aged 40 to 74 years using self-administered questionnaires in a population-based study across seven regions in Japan from January 1, 2011, through December 31, 2016. Logistic regression analyses, stratified by gender, were performed to estimate the association between each SES (income, education, and occupation) and diabetes prevalence after adjusting for demographic status, family history of diabetes, health-related behaviors, and body mass index. We also examined the heterogeneity of age (before or after retirement age - 60 years) with this association., Results: In women but not in men, lower household income and education were significantly associated with diabetes prevalence (lowest income quartiles vs highest income quartiles: 1.26 [Q1-Q3: 1.10-1.45]; junior high school vs college or higher: 1.20 [Q1-Q3: 1.13-1.28]). Unemployment was significantly associated with diabetes prevalence both in women and men (unemployed vs professionals or office workers: 1.18 [Q1-Q3: 1.10-1.27] in women, and 1.11 [Q1-Q3: 1.05-1.18] in men). The association of education and occupation with diabetes prevalence tended to be stronger at younger ages, although the heterogeneity by age was not significant., Conclusion: Lower SES was associated with higher diabetes prevalence, especially in women, and the associations were stronger at younger ages in Japan. As in other countries, the strength of associations between SES and diabetes prevalence varied by gender in Japan., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

We herein report a 47-year-old man who presented with progressive paraparesis. Imaging revealed a right upper pulmonary nodule, massive bilateral adrenal metastases, thoracolumbar vertebral osteolysis, and subcutaneous nodules. A biopsy of the right buttock nodule revealed a poorly differentiated metastatic carcinoma with high programmed cell death-ligand 1 expression and extensive chromosomal rearrangements. The patient died 10 days after the initiation of pembrolizumab treatment. Autopsy findings confirmed pulmonary pleomorphic carcinoma with extensive metastases. Quantification of chromosomal rearrangements revealed a jump-up mutation from the normal karyotype, followed by a further incremental increase in the degree of deviation.

Background and Objective: Embolic stroke of undetermined source (ESUS) patients undergoing long-term rhythm monitoring with Implantable Loop Recorder (ILR) have an atrial fibrillation (AF) detection rate of approximately 12 % at 1 year and 30 % with extended follow-up over 3 years. However, research specifically focusing on the majority of patients in whom AF is not detected through implantable cardiac monitors remains limited. Abnormal lipid profiles may be associated with embolic risks from non-AF sources. This study aimed to develop a model to predict the absence of AF in patients with ESUS using multiple variables, including lipid profiles., Methods: A retrospective, multicenter cohort study was conducted across four institutions, involving 99 ESUS patients. Patients were categorized based on AF detection via ILR. Patient characteristics, blood test results, and echocardiographic findings were assessed through univariate and multivariate logistic regression analyses. ROC curve analysis was performed to evaluate the biomarkers' predictive accuracy., Results: AF was detected in 30.3 % of patients over a median follow-up of 25.5 months. Multivariate analysis confirmed elevated D-dimer (OR: 2.77, p = 0.002), low LDL/HDL ratio (OR: 2.0, p = 0.01), and CHA2DS2-VASc score (OR: 1.4, p = 0.04) as independent predictors of AF detection. The CHA2DS2-VASc score was excluded due to multicollinearity, and patients with D-dimer < 0.9 μg/ml and LDL/HDL ratio > 1.98 had significantly lower AF detection rates (6.8 %, P < 0.001; sensitivity 93.1 %, specificity 44.2 %)., Conclusion: Combining D-dimer and LDL/HDL ratios provides an effective and accessible method for predicting the absence of AF in patients with an ILR for ESUS., Competing Interests: 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., (© 2025 The Author(s). Published by Elsevier B.V.)

Background: Natural disasters may have negative health effects on survivors. However, long-term observations on this are lacking. Therefore, this study investigated the association between the degree of housing damage caused by the Great East Japan Earthquake (GEJE) and all-cause mortality using the data from the cohort study conducted by the Tohoku Medical Megabank (TMM) Project in disaster-stricken areas., Methods: The community-based cohort study of the TMM Project which conducted a baseline survey from May 2013 to March 2016 collected data using questionnaires and blood and urine tests. The present large-scale prospective cohort study was a follow-up survey in which the degree of house damage and all-cause mortality were analysed using Cox proportional hazards regression, adjusting for sex, age and other potentially confounding variables. The degree of house damage was categorised into 'did not live in the disaster area', 'no damage', 'small-scale damage' and 'large-scale damage'. Among the 58 320 participants, 1763 deaths were confirmed during the follow-up which averaged 6.5 years., Results: The multivariate analysis showed a hazard ratio (95% CI) of 0.96 (0.82 to 1.13) for those who did not live in the disaster area, 0.98 (0.87 to 1.10) for small-scale damage and 0.98 (0.85 to 1.14) for large-scale damage, compared with no damage, but no significant association with all-cause mortality was observed., Conclusion: The results of this large-scale prospective cohort study of GEJE survivors showed no significant relationship between the degree of house damage and all-cause mortality. Further long-term follow-up studies are needed to examine the long-term health effects of natural disasters on survivors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Patients undergoing dialysis are at risk of osteoporosis and sarcopenia because of mineral and bone disorders or malnutrition. Additionally, maintaining muscle mass is important to prevent osteoporosis. The psoas muscle mass index (PMI) was recently used to evaluate muscle mass. However, few studies have evaluated the association between the PMI and bone mineral density (BMD); therefore, we examined the association between PMI and BMD in the femoral neck (FN) of 80 patients (45 males, age, 71 (60-76) years; dialysis duration, 74 (36-140) months) undergoing hemodialysis. FN-BMD was measured using dual-energy X-ray absorptiometry, and PMI was evaluated using psoas muscle areas on computed tomography. FN-BMD and PMI were significantly higher in males than in females. In a correlation analysis, sex, BMI, serum creatinine levels, HbA1c levels, and PMI were positively correlated with FN-BMD, whereas age, history of bone fracture, difficulty in walking and bone-specific alkaline phosphatase level were negatively correlated. In the multivariate regression analysis using clinical factors significantly correlated to FN-BMD, including PMI, both sex (standardized coefficient: 0.249, p = 0.028) and PMI (standardized coefficient: 0.249, p = 0.038) were extracted. Multivariable linear regression analysis using PMI and traditional osteoporosis factors revealed that PMI was significantly and independently associated with FN-BMD (standardized coefficient: 0.308, p = 0.010). In conclusion, PMI was positively associated with FN-BMD. Attention should be paid to the possibility of decreased BMD with decreased muscle mass., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics declaration: Studies involving human participants were reviewed and approved by the Institutional Review Board of Minami-Uonuma City Hospital (R3-3). Due to the retrospective nature of the study, the Institutional Review Board of Minami-Uonuma City Hospital waived the need to obtain informed consent., (© 2024. The Author(s).)

Background: Ethanol infusion into the vein of Marshall (EIVOM) has been performed as an adjunctive atrial fibrillation therapy. However, the time course change, quantitative lesion investigation, and effects on epicardial fat pads and fractionated atrial electrograms created by EIVOM have never been investigated., Objective: This study aimed to perform a quantitative analysis of lesions created by EIVOM., Methods: We created voltage maps using a 3-dimensional mapping system immediately before and 30 minutes and 60 minutes after performing EIVOM to study the time course change in the lesions. We compared differences in the average contact force value required for successful conduction block in the Marshall vein area of patients with and without EIVOM. We also investigated effects of EIVOM on the area of complex fractionated atrial electrograms before and after EIVOM. We measured the total epicardial fat pad volume before and after EIVOM by computed tomography., Results: Voltage was significantly reduced after EIVOM, and there were significant differences in voltage reduction between the control status and 30 minutes and 60 minutes after EIVOM (P < .05). The average contact force value was significantly lower with vs without EIVOM (P < .05). The total epicardial fat volume and complex fractionated atrial electrogram area also significantly decreased after EIVOM (P < .05)., Conclusion: EIVOM provided significant therapeutic effects on the left atrial tissue perpetuating atrial fibrillation, which was demonstrated by a quantitative analysis., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)