Search

Idiopathic carpal tunnel syndrome is the most common entrapment neuropathy in hand surgery, and it is characterized by Noninflammatory fibrosis of subsynovial connective tissues. The prevalence and incidence differ between male and female individuals, and the mechanism underlying this difference remains largely unclear. In the present study, we collected subsynovial connective tissues from six male and six female patients diagnosed with idiopathic carpal tunnel syndrome during surgery. We performed a comprehensive gene expression analysis using RNA sequencing to compare the gene expression profiles between male and female patients with idiopathic carpal tunnel syndrome. We identified 26 genes with significantly different expressions between male and female patients, in which POSTN, COL1A1, and COL3A1, which are involved in extracellular matrix organization, and IGF1, an important fibrotic factor, were significantly upregulated in male patients. Immunohistochemistry confirmed the expression of proteins encoded by these genes in tissues, and male patients tended to show increased POSTN expression. Our results indicate that fibrosis of subsynovial connective tissues is induced by different mechanisms in male and female patients, and genes involved in extracellular matrix organization, especially POSTN, might be important factors in male patients. This study provides insight into the pathogenesis of idiopathic carpal syndrome and might contribute to the development of new treatment strategies. [ABSTRACT FROM AUTHOR]

The consensus‐based TOKYO criteria were proposed as a standardized reporting system for endoscopic transpapillary biliary drainage. The primary objective was to address issues arising from the inconsistent reporting of stent outcomes across studies, which has complicated the comparability and interpretation of study results. However, the original TOKYO criteria were not readily applicable to recent modalities of endoscopic biliary drainage such as biliary drainage based on endoscopic ultrasound or device‐assisted endoscopy. There are increasing opportunities for managing hilar biliary obstruction and benign biliary strictures through endoscopic drainage. Biliary ablation has been introduced to manage benign and malignant biliary strictures. In addition, the prolonged survival times of cancer patients have increased the importance of evaluating overall outcomes during the period requiring endoscopic biliary drainage rather than solely focusing on the patency of the initial stent. Recognizing these unmet needs, a committee has been established within the Japan Gastroenterological Endoscopy Society to revise the TOKYO criteria for current clinical practice. The revised criteria propose not only common reporting items for endoscopic biliary drainage overall, but also items specific to various conditions and interventions. The term "stent‐demanding time" has been defined to encompass the entire duration of endoscopic biliary drainage, during which the overall stent‐related outcomes are evaluated. The revised TOKYO criteria 2024 are expected to facilitate the design and reporting of clinical studies, providing a goal‐oriented approach to the evaluation of endoscopic biliary drainage. [ABSTRACT FROM AUTHOR]

The complexity of neuronal networks, characterized by interconnected neurons, presents significant challenges in control due to their nonlinear and intricate behaviour. This paper introduces a novel method designed to generate control inputs for neuronal networks to regulate the firing patterns of modules within the network. This methodology is built upon temporal deep unfolding‐based model predictive control, a technique rooted in the deep unfolding method commonly used in wireless signal processing. To address the unique dynamics of neurons, such as zero gradients in firing times, the method employs approximations of input currents using a sigmoid function during its development. The effectiveness of this approach is validated through extensive numerical simulations. Furthermore, control experiments were conducted by reducing the number of input neurons to identify critical features for control. Various selection techniques were utilized to pinpoint key input neurons. These experiments shed light on the importance of specific input neurons in controlling module firing within neuronal networks. Thus, this study presents a tailored methodology for managing networked neurons, extends temporal deep unfolding‐based model predictive control to nonlinear systems with reset dynamics, and demonstrates its ability to achieve desired firing patterns in neuronal networks. [ABSTRACT FROM AUTHOR]

Aims: Elevated plasma branched‐chain amino acids (BCAAs) are tightly linked to incident diabetes and its complications, while lower BCAAs are associated with adverse outcomes in the elderly and heart failure (HF) patients. The interplay between body compositions and plasma BCAAs, especially under the influence of co‐morbid diabetes in HF patients, is not well understood. Here, we examined the impact of diabetes on the prognostic value of plasma BCAA and its association with body compositions in HF patients. Methods and results: We retrospectively examined 301 HF patients (70 ± 15 years old; 59% male), among which 36% had diabetes. Blood samples for plasma BCAA measurements were collected in a fasting state after stabilization of HF and analysed using ultraperformance liquid chromatography. A dual‐energy X‐ray absorptiometry scan assessed regional body compositions, and muscle wasting was defined as appendicular skeletal muscle mass index (ASMI) < 7.00 and <5.40 kg/m2 for males and females, respectively, according to the criteria of the Asian Working Group for Sarcopenia. Although analyses of covariance revealed that plasma BCAAs were significantly higher in diabetic patients, low valine (<222.1 nmol/mL) similarly predicted adverse events defined by HF hospitalization, lethal arrhythmia, or all‐cause death in both diabetic and non‐diabetic patients independently of age, sex, and NT‐proBNP (adjusted hazard ratio [HR] 3.1, 95% confidence interval [CI] of 1.1–8.6 and adjusted HR 2.67, 95% CI 1.1–6.5, respectively; P for interaction 0.88). In multivariate linear regression analyses comprising age, sex, and regional body compositions as explanatory variables, plasma BCAAs were positively correlated with visceral adipose tissue area in non‐diabetic patients (standardized β coefficients [β] = 0.44, P < 0.001). In contrast, in diabetic patients, plasma BCAAs were correlated positively with ASMI (β = 0.49, P = 0.001) and negatively with appendicular fat mass index (AFMI; β = −0.42, P = 0.004). Co‐morbid diabetes was independently associated with muscle wasting (adjusted odds ratio 2.1, 95% CI 1.1–4.0) and significantly higher plasma 3‐methylhistidine level, a marker of myofibrillar degradation. In diabetic patients, ASMI uniquely showed a J‐shaped relationship with AFMI, and in a subgroup of HF patients with muscle wasting, diabetic patients showed 12% higher AFMI than non‐diabetic patients despite comparable ASMI reductions. Conclusions: Despite higher plasma BCAA levels in HF patients with diabetes, the prognostic value of low valine remained consistent regardless of diabetes status. However, low BCAAs were distinctly associated with fatty muscle degeneration in the extremities in diabetic patients, suggesting the importance of targeted interventions to prevent such tissue remodelling in this population. [ABSTRACT FROM AUTHOR]

Background: Parvalbumin Gad c1 is a major cod allergen used as a follow‐up marker of fish‐allergic children. However, the diagnostic efficacy of recombinant Gad c 1 (rGad c 1) for fish allergy diagnosis remains controversial. This study aimed to evaluate the efficacy of rGad c1 for diagnosing cod and horse mackerel allergy. Methods: This single‐centered, retrospective study obtained oral food challenges (OFCs) information performed for cod and horse mackerel. Cod‐, horse mackerel‐, and rGad c1‐specific immunoglobulins (sIgEs) were investigated. Diagnostic performances of these parameters were compared using areas under the curve (AUC). Results: We enrolled 45 and 38 children with suspected cod and horse mackerel allergies, respectively. The median age (interquartile range) of children with suspected cod allergy was 5.7 (0.7–11.7) years and that of children with suspected horse mackerel allergy was 6.0 (1.0–12.3) years. Fourteen and 22 children reacted to OFCs with 25 (10–40) g of cooked pacific cod and 40 (10–40) g of cooked horse mackerel, respectively. The cod sIgE and rGad c 1 sIgE AUCs for cod allergy diagnosis were 0.85 and 0.90, respectively. For horse mackerel allergy diagnosis, AUCs of horse mackerel and rGad c 1 sIgE were 0.76 and 0.72, respectively. Both AUCs for cod and mackerel allergy were significantly different. Conclusion: rGad c 1 sIgE is more effective than cod sIgE as a diagnostic marker of cod allergy, but less effective than horse mackerel sIgE as a diagnostic marker of horse mackerel allergy. Further studies are warranted to explore the potential applications of rGad c 1 sIgE in the diagnosis of various fish allergies. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effectiveness of remimazolam against normal saline (placebo) as a sedative agent for endoscopy in a multicenter, randomized, double‐blind, investigator‐initiated phase III controlled trial. Methods: We included 48 Japanese patients undergoing upper gastrointestinal endoscopy. For the procedure, an initial remimazolam dose of 3 mg and additional doses of 1 mg were administered, as determined in the phase II clinical study. The primary study end‐point was the successful sedation rate during gastrointestinal endoscopy, determined as a Modified Observer's Assessment of Alertness/Sedation score ≤4 before the start of endoscopy, the completion of gastrointestinal endoscopy, and two or fewer additional doses per 6 min. Results: The successful endoscopy sedation rates were 91.9% and 9.1% in the remimazolam and placebo groups, respectively (P < 0.01). The time from the end of endoscopy to arousal was 0.0 (0.0–0.0) min for both groups. The number of additional doses required to achieve sedation was lower in the remimazolam group than that in the placebo group (P < 0.01). Conclusions: Remimazolam demonstrated a significantly higher sedation effect during upper gastrointestinal endoscopy in Japanese patients with safe and fast recovery compared with placebo. [ABSTRACT FROM AUTHOR]

We investigate the stabilization problem of positive Markov jump linear systems by optimizing their transition probability rates. By using the convex property of posynomials and the standard mathematical programming that deals with the difference in convex functions, we show that transition probability rate synthesis problems can be solved via difference‐of‐convex (DC) programming. A numerical example is used to illustrate the effectiveness of our results. [ABSTRACT FROM AUTHOR]

This article discusses the impact of 1q amplification, a chromosomal abnormality, on the outcomes of patients with multiple myeloma (MM) who were treated with daratumumab, carfilzomib, and dexamethasone (DKd) in a real-world clinical setting. The study analyzed data from 35 patients who received DKd treatment and found that patients with 1q amplification had significantly shorter progression-free survival (PFS) and overall survival (OS) compared to those with 1q gain or without 1q abnormalities. The study suggests that 1q amplification may be a poor prognostic factor in MM patients undergoing daratumumab-based treatment. However, the study has limitations due to its retrospective nature and small sample size. [Extracted from the article]

To retrospectively analyze whether the second revision of the international staging system (R2‐ISS) influenced prognosis at treatment initiation in patients with multiple myeloma (MM) receiving anti‐CD38 antibody‐based triplet treatments. High‐risk chromosomal abnormalities were examined from diagnosis to treatment initiation and considered positive if detected once. R2‐ISS was recalculated at the initiation of treatment and defined as "dynamic R2‐ISS." Data from 150 patients who underwent the defined treatments were analyzed. The median progression‐free survival (PFS) was 19.5 months, and the median overall survival (OS) was 36.5 months. Dynamic R2‐ISS significantly stratified prognoses for both PFS and OS. The median PFS for patients with dynamic R2‐ISS IV was 3.3 months, and the median OS was 11.7 months, indicating extremely poor outcomes. Although the Revised International Staging System (R‐ISS) calculated at the initiation of treatment significantly stratified treatment outcomes, the patients classified as R‐ISS could be further stratified by R2‐ISS to provide better prognostic information. Dynamic R2‐ISS showed potential as a prognostic tool in patients with MM who are treated with anti‐CD38 antibody‐based triplet therapies. [ABSTRACT FROM AUTHOR]

Background: One advantage of endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is that it is difficult for reflux cholangitis, caused by duodenal pressure increasing due to duodenal obstruction, to occur. In addition, since stent deployment is performed away from the malignant stricture site, longer stent patency than with endoscopic retrograde cholangiopancreatography (ERCP) may be obtained. However, no study has previously compared EUS‐HGS and ERCP for patients without duodenal obstruction or surgically altered anatomy. The aim of the present study was to compare clinical outcomes between EUS‐HGS and ERCP in normal anatomy patients without duodenal obstruction. Method: In the ERCP group, patients who initially underwent biliary drainage were included. In the EUS‐HGS group, patients who underwent EUS‐HGS due to failed biliary cannulation were included. Patients with an inaccessible papilla, such as with surgically altered anatomy or duodenal obstruction, were excluded. Results: A total of 314 patients who underwent ERCP and EUS‐HGS were enrolled in this study. Of the 314 patients, 289 underwent biliary stenting under ERCP guidance, and 25 patients underwent biliary stenting under EUS‐HGS. After propensity score‐matching analysis, the adverse event rate tended to be lower in the EUS‐HGS group than in the ERCP group. Although overall survival was not significantly different between the EUS‐HGS and ERCP groups (p =.228), stent patency was significantly longer in the EUS‐HGS group (median 366.0 days) than in the ERCP group (median 76.5 days). Conclusions: EUS‐HGS had a lower adverse event rate, shorter procedure time, and longer stent patency than ERCP in cases of normal anatomy without duodenal obstruction. [ABSTRACT FROM AUTHOR]

Background: Patients with isolated IgG4‐related sclerosing cholangitis (IgG4‐SC) often undergo unnecessary resection. The aim of this study was to validate the revised Japanese diagnostic criteria for isolated IgG‐4‐SC and to improve awareness about this condition in the population. Methods: This was a Japanese retrospective multicenter study. We focused on the data and diagnostic yield obtained using the Japanese diagnostic criteria published initially in 2012 and revised later in 2020 for the diagnosis of isolated IgG4‐SC. Results: Patients with isolated IgG4‐SC could be classified into two groups based on the primary location of the lesion: the hilar type (n = 40) and the extrahepatic type (n = 13). In total, 10 patients with the hilar type had undergone unnecessary resection. The revised 2020 criteria are useful for the diagnosis of extrahepatic lesions, which are not included in the 2012 criteria. The need for a steroid trial was reduced from 37.7% when the diagnosis was based on the 2012 criteria to 7.6% when the diagnosis was based on the revised 2020 criteria. The diagnostic specificity also improved from 58.5% for the 2012 criteria to 88.7% for the revised 2020 criteria. Conclusion: Our validation of the 2020 criteria for the diagnosis of IgG4‐SC could contribute to avoiding unnecessary resection in patients with isolated IgG4‐SC, which can be classified into the hilar and extrahepatic types. The 2020 criteria can enhance the diagnosis rate of isolated IgG4‐SC and uncover this tough‐to‐diagnose entity based on inclusion of the imaging findings and decrease the dependence on a steroid trial. [ABSTRACT FROM AUTHOR]

This retrospective cohort study analyzed data from a Japanese health insurance database to assess the effectiveness of baloxavir (n = 4822) for preventing severe events compared with oseltamivir (n = 10,523) in patients with influenza B. The primary endpoint was hospitalization incidence (Days 2–14). The secondary endpoints included intravenous antibacterial drug use, pneumonia hospitalization, heart failure hospitalization, inhalational oxygen requirement, and use of other anti‐influenza drugs. The hospitalization incidence was significantly lower with baloxavir (0.15% vs. 0.37%; risk ratio: 2.48, 95% confidence interval: 1.13–5.43). Pneumonia and additional anti‐influenza therapy were also less frequent with baloxavir, thus supporting its use. Trial Registration: UMIN Clinical Trials Registry Study ID: UMIN000051382 [ABSTRACT FROM AUTHOR]

Aim: To investigate the attitudes and experiences of obstetricians and gynecologists in treating women with eating disorders (EDs) in Japan. Methods: Members of the Japan Society of Obstetrics and Gynecology were invited to participate in a web‐based survey from March 1 to 31, 2022. We asked about the attitudes of obstetricians and gynecologists toward women with weight loss‐related amenorrhea and their experiences in treating EDs. We also assessed the characteristics of physicians who see many ED patients. Results: A total of 662 ob/gyns. responded to the survey. While treating weight loss‐related amenorrhea, 25.8% reported screening patients for EDs. 88.5% of respondents reported having treated ED patients. The main medical concerns described when treating pregnant women with ED were fetal growth restriction and preterm delivery. The most common type of ED encountered by participants in both perinatal and infertility care settings was anorexia nervosa. Characteristics of physicians who treated 10 or more EDs per year were being board certified in women's health care and not providing delivery services (OR = 4.809, 1.896). The most common comment regarding optimizing the management of patients with EDs in obstetrics and gynecology practice was the need to implement guidelines for ED management. Conclusions: Many obstetricians and gynecologists in Japan treat patients with ED. Standardized guidelines for the management of EDs for obstetricians and gynecologists are needed. [ABSTRACT FROM AUTHOR]

Background: Portal vein thrombosis (PVT) is thought to arise from stagnant blood flow, yet conclusive evidence is lacking. Relative residence time (RRT) assessed using 4D Flow MRI may offer insight into portal flow stagnation. Purpose: To explore the relationship between RRT values and the presence of PVT in cirrhotic participants. Study Type: Prospective. Population: Forty‐eight participants with liver cirrhosis (27 males, median age 67 years [IQR: 57–73]) and 20 healthy control participants (12 males, median age 45 years [IQR: 40–54]). Field Strength/Sequence: 3 T/4D Flow MRI. Assessment: Laboratory (liver and kidney function test results and platelet count) and clinical data (presence of tumors and other imaging findings), and portal hemodynamics derived from 4D Flow MRI (spatiotemporally averaged RRT [RRT‐mean], flow velocity, and flow rate) were analyzed. Statistical Tests: We used multivariable logistic regression, adjusted by selected covariates through the Lasso method, to explore whether RRT‐mean is an independent risk factor for PVT. The area under the ROC curve (AUC) was also calculated to assess the model's discriminative ability. P < 0.05 indicated statistical significance. Results: The liver cirrhosis group consisted of 16 participants with PVT and 32 without PVT. Higher RRT‐mean values (odds ratio [OR] 11.4 [95% CI: 2.19, 118]) and lower platelet count (OR 0.98 per 1000 μL [95% CI: 0.96, 0.99]) were independent risk factors for PVT. The incorporation of RRT‐mean (AUC, 0.77) alongside platelet count (AUC, 0.75) resulted in an AUC of 0.84. When including healthy control participants, RRT‐mean had an adjusted OR of 12.4 and the AUC of the combined model (RRT‐mean and platelet count) was 0.90. Data Conclusion: Prolonged RRT values and low platelet count were significantly associated with the presence of PVT in cirrhotic participants. RRT values derived from 4D Flow MRI may have potential clinical relevance in the management of PVT. Evidence Level: 2 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Microporous aluminosilicate zeolites are useful industrial catalysts. However, their hydrothermal synthesis is a multistep process with complicated and unclear reactions, limiting their rational functional design. Herein, we compare the formation pathway and the structural and catalytic properties of several CHA zeolites to obtain fundamental knowledge for intentionally controlling the catalytic function of zeolites. Three CHA zeolites were synthesized using different starting silica/alumina sources in the presence of tetraethylammonium hydroxide as an inexpensive organic structure‐directing agent. FAU zeolite and an amorphous synthesis gel prepared using two different methods were used as starting materials. The obtained CHA zeolites were applied for exhaust gas purification (selective catalytic reduction of NOx with ammonia, NH3‐SCR), and their structural characteristics and formation pathways were investigated using a combination of analytical methods. Stepwise gel preparation (SGP), which divides the compositional control of the amorphous synthesis gel, promotes the decomposition of the initial additive (zeolite seed), resulting in the formation of CHA zeolites with abundant micropores and paired Al sites. This structural feature obtained using the SGP method improves the catalytic durability of the NH3‐SCR reaction. The present relationship, including different crystallization phenomena, structures, and catalytic abilities, provides useful insights into rational zeolite synthesis and its application. [ABSTRACT FROM AUTHOR]

Perampanel belongs to a novel class of antiseizure medications (ASMs). Studies examining the effect of hemodialysis on perampanel serum levels in clinical settings are lacking. We aimed to evaluate the changes in serum perampanel levels during hemodialysis. We studied patients with seizures who received oral perampanel between April 2020 and March 2023 and whose serum concentration of perampanel was measured before and after hemodialysis. We analyzed the serum concentrations of levetiracetam and lacosamide for comparison. Fourteen patients, with a mean age of 76.1 ± 7.88 years, were included. The dose of perampanel was 2.14 ± 1.27 mg. The hemodialysis clearance rate of perampanel, levetiracetam, and lacosamide was 0 ± 13%, 69 ± 11%, and 59.6 ± 8.2%, respectively. The post‐dialysis CD ratio decreased significantly with levetiracetam but not with perampanel. Adverse but acceptable effects of perampanel were observed in two patients. The serum concentrations of several ASMs have been shown to be reduced during hemodialysis. Our study revealed that the serum perampanel concentration does not decrease during hemodialysis. Owing to the low rate of adverse effects and the stability of perampanel serum concentration during hemodialysis, perampanel could be a favorable choice as an ASM for patients with seizures undergoing hemodialysis. Plain Language summary: Our study looked at how hemodialysis affects the serum levels of perampanel, a new type of medication for seizures. In 14 patients who started treatment between April 2020 and March 2023, perampanel serum levels did not decrease during hemodialysis, unlike other seizure medications. This shows that perampanel can be a good option for patients with seizures who need hemodialysis, with fewer side effects compared to other medications. [ABSTRACT FROM AUTHOR]

Histological diagnosis of sarcomas (malignant bone and soft tissue tumors) is challenging due to their rarity, morphological diversity, and constantly evolving diagnostic criteria. In this study, we aimed to assess the concordance in histological diagnosis of bone and soft tissue tumors between referring hospitals and a tertiary sarcoma center and analyzed the clinical impact of the diagnostic alteration. We analyzed 628 consecutively accessioned specimens from 624 patients who visited a specialized sarcoma center for treatment. The diagnoses at referring hospitals and those at the sarcoma center were compared and classified into four categories: agreed, disagreed, specified, and de‐specified. Of the 628 specimens, the diagnoses agreed in 403 (64.2%) specimens, whereas some changes were made in 225 (35.8%) specimens: disagreed in 153 (24.3%), specified in 52 (8.3%), and de‐specified in 20 (3.2%) cases. The benign/intermediate/malignant judgment changed for 92 cases (14.6%). The diagnostic change resulted in patient management modification in 91 cases (14.5%), including surgical and medical treatment changes. The main inferred reason for the diagnostic discrepancies was a different interpretation of morphological findings of the tumor, which accounted for 48.9% of the cases. This was followed by the unavailability of specialized immunohistochemical antibodies and the unavailability of genetic analysis. In summary, our study clarified the actual clinical impact of diagnostic discrepancy in bone and soft tissue tumors. This may underscore the value of pathology consultation, facilitating access to specialized diagnostic tools, and continued education. These measures are expected to improve diagnostic precision and ultimately benefit patients. [ABSTRACT FROM AUTHOR]

The relationships between body size and density of salmonids in natural streams have been well studied, and density‐dependent growth (somatic growth) is interpreted as the principal mechanism responsible for the relationship. Moreover, the body size–density relationship is known to vary over ontogeny. However, the relationship has been studied mostly by experimental procedures (e.g. stocking fish into streams), and knowledge about the relationship in natural populations (e.g. no human‐induced input of fish) is still inadequate. In this study, we compared the relationships between body size and density of young‐of‐the‐year (YOY) masu salmon, Oncorhynchus masou, between different ontogenetic stages, that is, fry (spring) and juveniles (autumn). We used the monitoring data of YOY body sizes and densities across three study sites collected from Horokashubuto stream in Hokkaido, northern Japan, from 2014 to 2022. In the juvenile stage, YOY body size correlated negatively with increasing density. This pattern is typical of the density dependence of salmonid growth demonstrated in many previous studies. In the fry stage, however, YOY body size correlated positively with increasing density. This study suggested that the patterns of density dependence vary as functions of the ontogenetic stages of salmonids. [ABSTRACT FROM AUTHOR]

Aims/Introduction: To conduct a multicenter survey of visually impaired patients with diabetes mellitus (DM) and to identify the physical and ocular characteristics that lead to blindness in Japan. Materials and Methods: Visually impaired patients with diabetes mellitus in Japan were divided into blind and low‐vision groups according to the World Health Organization classification. Data on parameters related to diabetes mellitus and ocular complications in the right and left eyes were collected from 19 highly advanced medical facilities and compared between the two groups. Results: Among 408 visually impaired persons (blind group: 257, low‐vision group: 151), 72.1% were under 70 years of age. The rates of neovascular glaucoma (NVG) (right eye, P = 0.041; left eye, P = 0.0031) or proliferative diabetic retinopathy (PDR) (right eye: P = 0.014, left eye: P = 0.0047) and the rate of proliferative membrane beyond half of the retinal area (right eye: P = 0.0263, left eye: P = 0.037) were significantly higher in the blind group. The direct cause of visual impairment was retinal atrophy, common in both groups. Neovascular glaucoma and diabetic macular edema were equally prevalent in the blind and low‐vision groups, respectively. Conclusions: In Japan, blind patients with diabetes mellitus are characterized by severe conditions such as neovascular glaucoma and progressive proliferative diabetic retinopathy upon their initial visit to an advanced care facility. These results highlight the importance of monitoring retinopathy through regular ophthalmological examinations, internal medicine, and appropriate therapeutic intervention. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Diet directly affects glucose metabolism, and eating behavior is influenced by various daily life stressors. This study was conducted to investigate the relationship between common psychosomatic stressors on endocrine hormones and eating behavior in patients with type 2 diabetes. Materials and Methods: This cross‐sectional study was performed in 40 patients with type 2 diabetes. Resting hormone blood sampling and four self‐reported questionnaires were employed. Results: Patients who scored higher on the 'anger/hostility' (AH) subcategory of the profile of mood state (POMS) questionnaire had significantly higher serum cortisol (β = 0.40, P = 0.01 by least squares adjusted for age and sex). In the eating behavior questionnaire, the subcategories of 'feeling of hunger/satiation' (β = 0.49, P < 0.01) and 'eating as diversion' (β = 0.39, P = 0.03) were associated with higher serum cortisol. Resting morning cortisol levels were higher in participants who rated high on the POMS‐AH and in those who reported 'irritated when hungry' and 'tend to eat when irritated or anxious'. Sleep quality showed no association with eating behavior. Conclusions: Mood state is associated with eating behavior. Anger increases cortisol levels and may lead to compulsive eating. Various forms of hostility are important factors in appetite control and increased cortisol secretion, and can be an impediment to successful dietary self‐management in patients with type 2 diabetes. Thus, assessment of mood state and control of negative mood are important therapeutic targets in diabetes management. [ABSTRACT FROM AUTHOR]

Background and Aim: The 10‐mm self‐expandable metal stent (SEMS) is the standard for endoscopic transpapillary biliary drainage before pancreatic cancer surgery. However, the efficacy of stents thinner than 10 mm has not been adequately validated. Therefore, we aimed to evaluate the safety of a 6‐mm fully covered SEMS (FCSEMS) for distal malignant biliary obstruction (DMBO) during preoperative chemotherapy for pancreatic cancer. Methods: This was a single‐arm, multicenter, prospective phase II study of endoscopic transpapillary initial biliary drainage for DMBO before pancreatic cancer surgery. The primary endpoint was stent‐related adverse events, and the key secondary endpoint was the non‐recurrent biliary obstruction (non‐RBO) rate during the observation period for both resectable (R) and borderline resectable (BR) pancreatic cancers. Results: The study enrolled 33 patients, among whom 32 received the study treatment. There were 23 and 9 cases of R and BR pancreatic cancers, respectively. The technical and clinical success rates were 97.0% and 90.1%, respectively. The stent‐related adverse event rate was 3.1% (n = 1, acute pancreatitis) (95% confidential interval, 0.00–16.2), which met the criteria to be considered safe. The overall non‐RBO rate during the observation period (median 96 days) was 78.1% (82.6% and 66.7% for R and BR pancreatic cancer cases, respectively). Conclusions: The 6‐mm FCSEMS is an extremely safe metallic stent with a low stent‐related adverse event rate of 3.1% for preoperative biliary drainage in pancreatic cancer. It is considered the optimal stent for preoperative biliary drainage in terms of the non‐RBO rate. UMIN Clinical Trial Registry (UMIN‐CTR 000041704). [ABSTRACT FROM AUTHOR]

Introduction: Clinically amyopathic dermatomyositis (CADM) with anti‐melanoma differentiation‐associated gene 5 (MDA5) antibody (Ab) with rapidly progressive interstitial lung disease (RP‐ILD) is often refractory for intensive immunosuppression. In this study, we verified the effectiveness and safety of plasma exchange (PEx) for this lethal disease. Methods: We retrospectively examined the clinical course and adverse effect (AE) of 12 patients with anti‐MDA5 Ab–positive CADM between January 2017 and December 2021 in our hospital. Results: Five out of six patients treated with simple PEx using fresh frozen plasma or 5% albumin survived with or without home oxygen therapy. Multiple PEx (15–20 times) were required to achieve satisfactory improvement as well as remission of CADM. The AEs caused by PEx were resolved using conventional methods. Conclusion: PEx might be a promising option for controlling the disease activity of anti‐MDA5 Ab–positive CADM with severe RP‐ILD and may contribute to better survival. [ABSTRACT FROM AUTHOR]

Background and Aims: Pancreatic cancer is one of the most lethal malignancies, partly due to resistance to conventional chemotherapy. The chemoresistance of malignant tumors is associated with epithelial‐mesenchymal transition (EMT) and the stemness of cancer cells. The aim of this study is to investigate the availability and functional mechanisms of trefoil factor family 1 (TFF1), a tumor‐suppressive protein in pancreatic carcinogenesis, to treat pancreatic cancer. Methods: To investigate the role of endogenous TFF1 in human and mice, specimens of human pancreatic cancer and genetically engineered mouse model of pancreatic cancer (KPC/TFF1KO; Pdx1‐Cre/LSL‐KRASG12D/LSL‐p53R172H/TFF1−/−) were analyzed by immunohistochemistry (IHC). To explore the efficacy of extracellular administration of TFF1, recombinant and chemically synthesized TFF1 were administered to pancreatic cancer cell lines, a xenograft mouse model and a transgenic mouse model. Results: The deficiency of TFF1 was associated with increased EMT of cancer cells in mouse models of pancreatic cancer, KPC. The expression of TFF1 in cancer cells was associated with better survival rate of the patients who underwent chemotherapy, and loss of TFF1 deteriorated the benefit of gemcitabine in KPC mice. Extracellular administration of TFF1 inhibited gemcitabine‐induced EMT, Wnt pathway activation and cancer stemness, eventually increased apoptosis of pancreatic cancer cells in vitro. In vivo, combined treatment of gemcitabine and subcutaneous administration of TFF1 arrested tumor growth in xenograft mouse model and resulted in the better survival of KPC mice by inhibiting EMT and cancer stemness. Conclusion: These results indicate that TFF1 can contribute to establishing a novel strategy to treat pancreatic cancer patients by enhancing chemosensitivity. [ABSTRACT FROM AUTHOR]

Objectives: For preoperative biliary drainage (PBD) of malignant hilar biliary obstruction (MHBO), current guidelines recommend endoscopic nasobiliary drainage (ENBD) due to the higher risk of cholangitis after endoscopic biliary stenting (EBS) during the waiting period before surgery. However, few studies have supported this finding. Therefore, we aimed to compare the outcomes of preoperative ENBD and EBS in patients with MHBO. Methods: Patients with MHBO who underwent laparotomy for radical surgery after ENBD or EBS were included from retrospectively collected data from 13 centers (January 2014 to December 2018). We performed a 1:1 propensity score matching between the ENBD and EBS groups. These patients were compared for the following: cholangitis and all adverse events (AEs) after endoscopic biliary drainage (EBD) until surgery, time to cholangitis development after EBD, postsurgical AEs, and in‐hospital death after surgery. Results: Of the 414 patients identified, 355 were analyzed in this study (226 for ENBD and 129 for EBS). The matched cohort included 63 patients from each group. The proportion of cholangitis after EBD was similar between the two groups (20.6% vs. 25.4%, P = 0.67), and no significant difference was observed in the time to cholangitis development. The proportions of surgical site infections, bile leaks, and in‐hospital mortality rates were similar between the groups. Conclusion: For PBD of MHBO, the proportion of AEs, including cholangitis, after EBD until surgery was similar when either ENBD or EBS was used. [ABSTRACT FROM AUTHOR]

Follicular lymphoma (FL) is an indolent lymphoma that becomes aggressive due to histological transformation (HT), leading to reduced survival. Patients with FL have different clinical courses and various treatment options. Some patients exhibit shorter survival and experience disease progression within 24 months of diagnosis/treatment (POD24); the optimal treatment remains an unmet needs. Thus, identifying factors that predict shorter survival is essential to stratify treatment and prolong the survival of patients with FL. To analyze risk factors for POD24 and HT in patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP) as first‐line treatment, we performed this post‐hoc analysis of patients with advanced indolent B‐cell lymphoma in a randomized clinical trial wherein six cycles of R‐CHOP were administered every 2–3 weeks. The primary analysis showed no differences in outcomes, which enabled the analysis of 248 patients with FL, assigned to two arms. All histopathological specimens from the 300 enrolled patients were reviewed by three expert hematopathologists. Multivariable analysis implicated Follicular Lymphoma International Prognostic Index (FLIPI) intermediate (odds ratio [OR] 2.531, 95% confidence interval [CI] 0.676–9.466) and high‐ (OR 2.236, 95% CI 0.160–31.226) risks, B symptoms (OR 2.091, 95% CI 0.747–5.851), and grade 3A (G3A) (OR 1.833, 95% CI 0.634–5.299) as risk factors for POD24. Furthermore, multivariable analysis through a median follow‐up of 15.9 years implicated G3A (OR 2.628, 95% CI 0.806–8.575) and high‐risk FLIPI (OR 4.401, 95% CI 0.186–104.377) as risk factors for HT. However, an analysis limited to the first 10 years revealed that the prognostic factors elucidated from the longer‐term analysis had a greater impact on HT. G3A and high‐risk FLIPI may independently predict POD24 and HT, thereby informing treatment stratification of patients with untreated advanced‐stage FL in future trials, particularly to address the unmet needs of patients with POD24. [ABSTRACT FROM AUTHOR]

Driver oncogenes are investigated upfront at diagnosis using multi‐CDx systems with next‐generation sequencing techniques or multiplex reverse‐transcriptase polymerase chain reaction assays. Additionally, from 2019, comprehensive genomic profiling (CGP) assays have been available in Japan for patients with advanced solid tumors who had completed or were expected to complete standard chemotherapy. These assays are expected to comprehensively detect the driver oncogenes, especially for patients with non‐small cell lung cancer (NSCLC). However, there are no reports of nationwide research on the detection of driver oncogenes in patients with advanced NSCLC who undergo CGP assays, especially in those with undetected driver oncogenes at diagnosis. In this study, we investigated the proportion of driver oncogenes detected in patients with advanced NSCLC with undetectable driver oncogenes at initial diagnosis and in all patients with advanced NSCLC who underwent CGP assays. We retrospectively analyzed data from 986 patients with advanced NSCLC who underwent CGP assays between August 2019 and March 2022, using the Center for Cancer Genomics and Advanced Therapeutics database. The proportion of driver oncogenes newly detected in patients with NSCLC who tested negative for driver oncogenes at diagnosis and in all patients with NSCLC were investigated. Driver oncogenes were detected in 451 patients (45.7%). EGFR was the most common (16.5%), followed by KRAS (14.5%). Among the 330 patients with undetected EGFR, ALK, ROS1, and BRAF V600E mutations at diagnosis, 81 patients (24.5%) had newly identified driver oncogenes. CGP assays could be useful to identify driver oncogenes in patients with advanced NSCLC, including those initially undetected, facilitating personalized treatment. [ABSTRACT FROM AUTHOR]

DiGeorge syndrome, also known as 22q11.2 deletion syndrome, shows cellular immunodeficiency due to by thymic hypoplasia and hypocalcemia caused by hypoparathyroidism. It was reported that erythrodermic psoriasis occurred in a patient with 22q11 deletion syndrome. Here, we report the first case of DiGeorge syndrome presenting with a severe palmoplantar pustulosis (PPP)‐like eruption with extra‐palmoplantar lesions on the distal limbs. Given that PPP is a subtype of pustular psoriasis, the pustular eruption may be associated with DiGeorge syndrome. We measured serum levels of citrullinated histone H3 (CitH3), a representative marker of neutrophil extracellular traps, interleukin (IL)‐8, and IL‐22 and compared them with nine cases of typical PPP. In the PPP patients, the three markers were higher than in healthy subjects with significant correlations between CitH3 and IL‐8/IL‐22. In our patient, CitH3, IL‐8, and IL‐22 were also high, and IL‐22 was remarkably elevated compared with the PPP patients. Our case suggests that a certain T cell abnormality associated with DiGeorge syndrome induces IL‐22 overproduction, leading to the PPP‐like eruption with extra‐ palmoplantar lesions. [ABSTRACT FROM AUTHOR]

Erionite (ERI) zeolite has recently attracted considerable attention for its application prospect in the selective catalytic reduction of NOx with NH3 (NH3‐SCR), provided that the high‐silica (Si/Al > 5.5) analog with improved hydrothermal stability can be facilely synthesized. In this work, ERI zeolites with different Si/Al ratios (4.6, 6.4, and 9.1) are synthesized through an ultrafast route, and in particular, a high‐silica ERI zeolite with a Si/Al ratio of 9.1 is obtained by using faujasite (FAU) as a starting material. The solid‐state 29Si MAS NMR spectroscopic study in combination with a computational simulation allows for figuring out the atomic configurations of the Al species in the three ERI zeolites. It is revealed that the ERI zeolite with the highest Si/Al ratio (ERI‐9.1, where the number indicates the Si/Al ratio) exhibits a biased Al occupancy at T1 site, which is possibly due to the presence of a higher fraction of the residual potassium cations in the can cages. In contrast, the Al siting in ERI‐4.6 and ERI‐6.4 proves to be relatively random. [ABSTRACT FROM AUTHOR]

Nematodes that parasitize salmonids are found in both seawater and freshwater. Unlike seawater species such as those in family Anisakidae, freshwater species have not been well studied. In particular, the influences of these nematodes on the body condition of salmonids remain unclear. We studied the effects of Salmonema cf. ephemeridarum on the body condition of masu salmon Oncorhynchus masou. We found a positive relationship between the number of parasites and fish fork length. In contrast, we found a negative relationship between the body condition (condition factor) of fish and the number of parasites. These results suggest that nematode infection could affect host energy reserves for future growth. [ABSTRACT FROM AUTHOR]

Inorganic semiconductors have been considered to be brittle at room temperature generally, but recently zinc sulfide (ZnS), a II-VI compound semiconductor, was found to exhibit extraordinarily large plasticity even at room temperature if itwas deformed in darkness. Room-temperature plastic deformation can achieve high density of glide dislocations in the crystalwithout significantly changing the point defect structure, and these dislocations themselves have a potential to provide unique functional properties different from those of the bulk. In this study, therefore, undoped ZnS crystals were plastically deformed at room temperature in darkness to generate only a large number of dislocations, and the changes in luminescence properties resulting fromthis processwere investigated for the first time. As a result, we found that ZnS deformed in darkness exhibits characteristic photoluminescence and persistent luminescence emissions with a visible green color. SEM-CL analyses also identified the emissions from the dislocations. Theoretical calculations indicated that individual dislocations in ZnS have the ability to trap photo-excited carriers. Such changes in luminescence properties due to room temperature plastic deformation in darkness can be considered to originate from dislocations rather than point defects. In other words, the dislocations themselves serve as the significant recombination centers, realizing visible light emission. [ABSTRACT FROM AUTHOR]

Background: We developed and tested the safety and efficacy of a cosmetic device to improve dark circles using electrical muscle stimulation of the orbicularis oculi muscle. Methods: Overall, 18 participants (36 eyes) were studied. The following five items were evaluated before and after the intervention:(1) the Clinical Dark Circle Score using clinical findings and photographs, (2) transcutaneous oxygen partial pressure (TcPO2) on the lower eyelid, (3) thermography, (4) two‐dimensional laser blood flowmetry, and (5) spectrophotometry. Results: The mean score at baseline was 2.0 ± 0.90 (mean ± standard deviation), and that at the end of the study was 1.2 ± 1.0 (Wilcoxon signed‐rank sum test, p < 0.0001), indicating a significant reduction. The spectrophotometer showed a significant decrease in a* and L* values before and after use (Wilcoxon signed‐rank sum test, p < 0.0001). There was also a weak negative correlation between the change in score and the change in blood flow and TcPO2 measured using a laser perfusion device (Spearman's rank correlation coefficient, r = –0.32 and –0.39, respectively). Stratified analysis of the baseline score showed a strong negative correlation between the change in score and the change in spectrophotometric a* in the subjects/group with mild periocular dark circles (Spearman's rank correlation coefficient, r = –0.46). Contrastingly, no correlation was observed for any of the measurements in the subjects/group with severe periocular dark circles. After 1 month, no device‐related ophthalmic adverse events were observed in any of the participants. Conclusion: Electrical muscle stimulation could improve periocular dark circles, especially in the subjects/group with mild periocular dark circles, and was safe. [ABSTRACT FROM AUTHOR]

Aim: Although the oncological impact of lateral lymph node dissection on enlarged lateral lymph nodes has been gradually accepted over the last decade, that on lateral lymph nodes without swelling remains doubtful. This study aimed to develop a prediction model for the future risk of lateral local recurrence and to clarify the value of adding lateral lymph node dissection in locally advanced rectal cancer without enlarged lateral lymph nodes. Methods: This retrospective, multi‐institutional study recruited 812 patients with cStage II/III low rectal cancer without enlarged lateral lymph nodes <7 mm. Total lateral local recurrence was a hypothetical value of future risk of lateral local recurrence when lateral lymph node dissection was never performed. Results: Overall, total lateral local recurrences were observed in 67 patients (8.3%). In the multivariate analyses, the strongest risk factor for total local recurrences was no preoperative chemoradiotherapy (odds ratio [OR][95%Cl]: 33.2 [4.56–241.7], P < 0.001), followed by tumor distance ≤40 mm (OR [95%Cl]: 2.71 [1.51–4.86], P < 0.001) and lateral lymph node 5–7 mm (OR[95%Cl]: 2.38 [1.26–4.48], P = 0.007). In patients with lateral lymph nodes of 5–7 mm, the total lateral recurrence rate was 4.8% after preoperative chemoradiotherapy. Lateral lymph node dissection could reduce from a total lateral local recurrence of 21.6% to an actual lateral local recurrence of 8.0% in patients without preoperative treatment. Conclusion: We introduce a novel prediction model of future risk of lateral local recurrences, which has the potential to enable us to indicate lateral lymph node dissection selectively according to the patients' risks. [ABSTRACT FROM AUTHOR]

This study aimed to reveal the prevalence of heat‐labile enterotoxin (LT) gene‐positive Escherichia fergusonii in retail chicken meat and genetically characterize these strains. E. fergusonii harboring LT gene was isolated from 6 out of 60 (10%) retail chicken samples in Okinawa, Japan. Whole‐genome sequencing analysis revealed that LT gene‐positive E. fergusonii from chicken meat and feces contain an IncFII plasmid harboring elt1AB, and suggested to spread clonally to retail chicken through fecal contamination. Additionally, it was found that these strains harbor multidrug‐resistant genes on their plasmids. Their pathogenicity and continuous monitoring are required for confirmation. [ABSTRACT FROM AUTHOR]

Summary: Anti‐CD20 antibody in combination with chemotherapy extends overall survival (OS) in untreated advanced‐stage follicular lymphoma (FL), yet the optimal associated therapy is unclear. Data on the cumulative incidence of secondary malignancies postrelapse after conventional immunochemotherapy are scarce. A long‐term analysis of rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone (R‐CHOP) as first‐line treatment was conducted in a randomised clinical trial. A six‐cycle R‐CHOP regimen was administered every 2 or 3 weeks without rituximab maintenance. A prespecified evaluation was conducted 15 years after the completion of enrolment, following initial analysis results that showed no significant differences in outcomes at the 3‐year mark. In‐depth analyses were performed on the cohort of 248 patients with FL who were allocated to the two treatment arms. With a median follow‐up period of 15.9 years, the 15‐year OS was 76.2%. There were no protocol treatment‐related deaths, nor were there any fatal infections attributable to subsequent lymphoma treatment. At 15 years, the cumulative incidence of non‐haematological and haematological malignancies was 12.8% and 3.7% respectively. Histological transformation appeared after a median of 8 years. R‐CHOP maintains safety and efficacy in patients with advanced FL over extended follow‐up, making it a viable first‐line option for patients with advanced‐stage FL. [ABSTRACT FROM AUTHOR]

Indoles are important heterocycles in pharmaceuticals and agrochemicals, and their atom‐economical synthesis is needed. Herein, we describe the synthesis of indoles using sigmatropic rearrangements. The N‐allylaniline was oxidized by environmentally benign hydrogen peroxide, and spontaneous [2,3]‐Meisenheimer rearrangement gave N‐allyloxyaniline. Subsequent treatment with a ruthenium catalyst afforded N‐vinyloxyaniline, which underwent [3,3]‐sigmatropic rearrangement to give indoles, expelling water as the only byproduct. The whole sequence is free of quantitative salt byproducts, thereby avoiding aqueous work up and cutting off the inorganic waste. [ABSTRACT FROM AUTHOR]

The annulation of a methylenecyclopropane with acyl cyanoalkenes by using DABCO or quinuclidine as a catalyst to give 2,3‐dihydofurans has been developed. A stoichiometric amount of the Lewis bases promoted the isomerization of 2,3‐dihydrofurans to furans. 1H NMR spectra of the reaction in situ revealed that the methylenecyclopropane is opened by the Lewis base to form a reaction intermediate that is added to the cyanoalkenes. [ABSTRACT FROM AUTHOR]

Background: Allergic reactions to milk appear sooner than those to hen's eggs, irrespective of the total dose of the oral food challenges (OFCs) and type of matrices. The reported median times for the first symptom occurrence are 20-30 min with milk and 50-60 min with eggs. However, allergic reactions due to wheat have not yet been fully investigated. Methods: This study retrospectively collected data from OFC for milk and wheat conducted at Sagamihara National Hospital and Sendai Medical Center from 2009 to 2023. The time from the start of the OFC to the onset of symptoms was compared between children with cow's milk and wheat allergy. Results: Twenty-five and 13 children reacted to single-dose OFCs with milk products equivalent to 25 mL of raw cow's milk or 15 g of udon noodles, respectively. The median ages of patients with positive challenges were 1.4 and 2.8 years for milk and wheat, respectively, and the median times for the first symptom occurrence were 20 min and 53 min, respectively (p = .006). Conclusion: This multicenter study was the first to examine the time of symptom appearance during single-medium-dose milk and wheat challenges. Allergic reactions to wheat appear later than those for milk during OFC. For multiadministration OFC for wheat, the dosing interval should be longer than 60 min. Our findings can help improve the safety of OFCs. [ABSTRACT FROM AUTHOR]

Background: Breast carcinoma is a common tumor in women, but it rarely metastasizes to the oral region. Case presentation: An 83‐year‐old woman presented with numbness and pain on the right side of the mandible. The patient's medical history included breast cancer that was treated with surgery. Panoramic radiograph showed a radiolucency with ill‐defined margin in the right mandible. CT images showed an osteolytic lesion with cortical bone destruction in the right mandible. Histopathological diagnosis was invasive ductal carcinoma. Conclusion: Dental practitioner should be aware that metastatic tumor of the mandible may occur in the patient with breast cancer. [ABSTRACT FROM AUTHOR]

This article discusses the prognostic value of the Second Revision of the International Staging System (R2-ISS) in patients with multiple myeloma (MM) who undergo autologous hematopoietic stem cell transplantation (ASCT). The study, conducted at the Japanese Red Cross Medical Center, analyzed data from 94 patients and found that R2-ISS classification was useful in predicting prognosis. Patients classified as R2-ISS IV had poor outcomes, while those achieving minimal residual disease (MRD) negativity showed improved survival rates. The study suggests that intensification therapies, such as tandem ASCT and achieving MRD negativity, could potentially improve treatment outcomes for high-risk MM patients. [Extracted from the article]

Safe and efficient conservation of cultural artifacts requires preventing artifacts deterioration and energy‐saving environmental control. To achieve this, predicting deterioration caused by environmental conditions is necessary. Predicting the mechanical damage caused by humidity fluctuations necessitates knowledge of the mechanical properties of cultural artifacts materials. Although the mechanical properties of several artifacts have been extensively studied, no investigations have focused on the soils underlying wall paintings. This study aims to clarify some mechanical properties of the upper‐ and middle‐coat soils serving as the substrates for Hiten wall paintings at Horyu‐ji Temple. Mock‐up materials were prepared, and splitting tensile and uniaxial compressive tests were performed. Simultaneously, specimens with various equilibrium humidities were tested to clarify their humidity dependency. The tensile and compressive strengths, Young's modulus, proportional limit, and Poisson's ratio of the upper‐coat soil were 0.103–0.239 MPa, 1.16–2.55 MPa, 0.115–0.209 GPa, and 1.10–2.49 MPa, and 0.152, respectively. Moreover, the humidity‐induced strains for the upper‐ and middle‐coat soils were measured, and the moisture expansion coefficients were approximately 1240 and 2337 μST/−, respectively. The results of this study provide vital data for the conservation of the wall paintings and contribute to a deeper understanding of wall soil properties. [ABSTRACT FROM AUTHOR]

We investigate positive subtropical low cloud feedback mechanisms in climate models which have performed the CMIP6/CFMIP‐3 AMIP and AMIP uniform +4K experiments while saving CFMIP‐3 process diagnostics on model levels. Our analysis focuses on the trade cumulus/stratocumulus transition region between California and Hawaii, where positive low cloud feedbacks are present in the JJA season. We introduce a methodology to test various positive cloud feedback mechanisms proposed in the literature as the main causes of the low cloud responses in the models. Causal hypotheses are tested by comparing their predictions with the models' responses of clouds, cloud controlling factors, boundary layer depth and temperature/humidity tendencies to climate warming. Changes in boundary layer depth, relative humidity in the cloud layer, convective moistening rate and large‐scale humidity advection at the top of the boundary layer are shown to be crucial for identifying the main causes of the low cloud reductions in the models. For the cases examined, our approach narrows down the seven mechanisms considered to between one and three remaining candidates for each model. No single mechanism considered can explain the feedback in all of the models at the locations examined, but the surface latent heat flux/convective entrainment mechanism remains a candidate for BCC‐CSM2‐MR, IPSL‐CM6A‐LR, and MRI‐ESM2.0, while the surface upwelling longwave mechanism remains for CESM2, HadGEM3‐GC3.1‐LL, and MIROC6. Plain Language Summary: Climate models show reductions in low‐level clouds with the warming climate which are poorly understood. We examine cloud changes between California and Hawaii in six climate models. We consider seven potential explanations for the changes. We find that examining changes in the height of low level clouds, the moistening of the atmosphere by rising plumes of moist air, the humidity of the air and the rate at which dry air is mixed into the clouds from above allows us to narrow down the number of explanations compatible with each model. Key Points: Hypotheses for positive cumulus/stratocumulus feedback mechanisms are tested in six climate modelsWe narrow down the seven mechanisms considered to between one and three candidates for each modelBoundary layer depth, relative humidity, convective moistening, and humidity advection are key [ABSTRACT FROM AUTHOR]

Aims: The effects of genetic polymorphism on a personalized diet and exercise program for steatotic liver disease (SLD) are still unclear. Methods: Participants of this retrospective cohort study were 203 Japanese patients with SLD diagnosed by abdominal ultrasonography. All of them were introduced the personalized diet and exercise treatment. A diet of 25–30 kcal/kg multiplied by ideal body weight (BW) daily and aerobic and resistance exercise (exercise intensity of 4–5 metabolic equivalents daily, respectively) were performed for 6 days. Treatment efficacy was evaluated in terms of the rate of decrease of liver function tests, glycolipid metabolism markers, physical findings, image findings, and cardiovascular disease (CVD) risk score at 6 months compared with baseline. Furthermore, the impact of genetic polymorphism was also investigated. Results: At 6 months compared with baseline, liver function tests (AST, ALT, γGTP), glycolipid metabolism markers (hemoglobin A1c, triglycerides [TG], low‐density lipoprotein cholesterol), physical findings (BW, body mass index), image finding (liver stiffness measurement), and CVD risk score (Suita score) improved significantly. There was no significant difference in treatment efficacy, except for the rates of decrease of TG, according to genotype PNPLA3 rs738409, TM6SF2 rs58542926, and HSD17B13 rs6834314. The rates of decrease of TG with TM6SF2 CT were significantly higher than those with CC or TT, and the rates of TG with HSD17B13 AA were significantly higher than those with AG by multiple comparisons. Conclusion: Personalized diet and exercise program for SLD improved liver function tests, physical findings, glycolipid metabolism markers, and CVD risk score. Genetic polymorphism might partially affect treatment efficacy. Further studies should be performed to develop an individualized program for SLD, considering genetic polymorphism. [ABSTRACT FROM AUTHOR]

Background: The aim of the Japan‐Multidomain Intervention Trial for Prevention of Dementia in Older Adults with Diabetes (J‐MIND‐Diabetes) was to examine the efficacy of multi‐domain intervention in prevention of cognitive decline in older adults with type 2 diabetes and mild cognitive impairment (MCI). Method: The J‐MIND‐Diabetes is an 18‐month, multi‐centered, randomized controlled trial. Outpatients with type 2 diabetes aged 70‐85 years with MCI were recruited and randomized into multi‐domain intervention (management of metabolic and vascular risk factors, physical exercise, nutritional guidance, and promotion of social participation) and control groups (general instructions on dementia prevention) at a 1:1 allocation ratio using the stratified permuted‐block randomization methods. The primary outcome was a change from baseline to 18‐month follow‐up in a global composite score combining several neuropsychological tests, which include the MoCA‐J, the MMSE, the Rey‐Osterrieth Complex Figure Test (ROCFT), delayed recall test of a 10‐word list, the Digit Span, the Trail Making Test, the Digit Symbol Substitution Test, and the Letter Word Fluency Test. Result: Between March 13, 2019, and May 8, 2020, 361 patients were screened and 154 were randomly assigned to the multi‐domain intervention group (n = 81) or control group (n = 73). 110 (71%) participants completed the trial. The full analysis set included 136 patients. In the primary efficacy analysis, there was no significant differences in the change of composite score from baseline to 18‐month follow‐up between the intervention group and the control group (mean difference 0.066 [95% CI ‐0.089 to 0.222]). In the analysis for each neuropsychological test, scores of immediate and delayed recall tests of the ROCFT in the intervention group significantly improved by a mean of 1.627 points and 1.793 points, respectively. The mean difference in the change of score of delayed recall test of the ROCFT between intervention group and control group was significant (mean difference 1.803 [95% CI 0.169 to 3.436]). In subgroup analyses, intervention effect on composite score was significant among patients with moderate to severe white matter hyperintensities (mean difference 0.351 [95% CI 0.088 to 0.614]). Conclusion: The multi‐domain intervention could improve memory function in older adults with type 2 diabetes and MCI. [ABSTRACT FROM AUTHOR]