Fukuoka University

Intracranial mesenchymal tumor FET::cyclic adenosine monophosphate response element-binding fusion-positive is a soft tissue tumor with an extremely rare intracranial occurrence. Histological diagnosis is sometimes difficult, requiring confirmation of characteristic fusion genes. The patient was a 45-year-old male who presented with a chief complaint of pain and an abnormal sensation in the right trigeminal nerve area, in whom a neoplastic lesion in Meckel's cave was noted. The preoperative diagnoses included meningioma and schwannoma. The tumor was extirpated as much as possible, and the tumor tissue showed a high proliferative potential with rhabdoid features, raising the suspicion of a rhabdoid meningioma. However, immunostaining was positive for desmin and cluster of differentiation 99, suggesting the possibility of angiomatoid fibrous histiocytoma. For diagnosis, Ewing sarcoma breakpoint region1 gene-cyclic adenosine monophosphate response element-binding 1 fusion and Ewing sarcoma breakpoint region1 gene-activating transcription factor 1 fusion were examined at our institution, but were undetectable and did not lead to a diagnosis. Genomic profiling with FoundationOne CDx (Foundation Medicine, Cambridge, MA, USA) confirmed Ewing sarcoma breakpoint region1 gene-cyclic adenosine monophosphate response element modulator fusion and a diagnosis of intracranial mesenchymal tumor FET::cyclic adenosine monophosphate response element-binding fusion-positive was made. Diagnosis of intracranial mesenchymal tumor FET::cyclic adenosine monophosphate response element-binding fusion-positive requires both histological examination and confirmation of the fusion gene. Genomic profiling using the FoundationOne CDx is also useful when the fusion gene cannot be sufficiently confirmed at an individual's institution. Fullsize Image

Apremilast is a phosphodiesterase 4 inhibitor approved for moderate to severe psoriasis in Japan. Apremilast significantly improved Physician's Global Assessment (PGA) and Dermatology Life Quality Index (DLQI) both at 6 and 12 months in a previously published primary post‐surveillance study. Here, we performed a post hoc analysis of the surveillance data to evaluate patient characteristics, effectiveness, and safety among psoriasis patients who continued apremilast for 6 and 12 months. The PMS included 992 patients, of whom 646 of 992 patients continued treatment for 6 months and 509 of 992 patients subsequently continued treatment for 12 months. Baseline characteristics between these groups were similar. Among 992 patients, the treatment persistence rate was 65.1% at 6 months and 51.3% at 12 months after the start of apremilast treatment. PGA 0/1 response was 47.9% at 6 months and 60.8% at 12 months, whereas DLQI 0/1 responses at 6 months and 12 months were 38.5% and 58.7%, respectively. Among 646 patients who continued apremilast for 6 months, diarrhea was reported in 60 patients (9.3%), nausea in 35 patients (5.4%), and headache in 11 (1.7%) patients, which were mainly observed within the first month since treatment initiation. In 509 patients who continued apremilast for 12 months, diarrhea was reported in 43 patients (8.5%), nausea in 24 patients (4.7%), and headache in 6 (1.2%) patients; similar frequencies of these adverse reactions were observed within 6 months and between 6 and 12 months of follow‐up. It is important to continue apremilast by appropriately managing diarrhea and nausea in real‐world practice.

Objectives We aimed to evaluate differences in patient characteristics, treatment, and cancer‐specific survival between penile cancer patients aged 75 years or older and those younger than 75 years. Methods One hundred ninety‐six patients with penile cancer who were treated in 12 hospitals in the Kyushu–Okinawa region from 2009 to 2020 were retrospectively analyzed. Results The older (age ≥ 75 years) and younger (age < 75 years) groups comprised 80 and 116 patients, respectively. Among all patients with clinical stage 3 disease and those with stage 3A alone, cancer‐specific survival was significantly worse in the older group. Patients in the older group exhibited worse Eastern Cooperative Oncology Group Performance Status scores, lower albumin concentrations, and higher neutrophil‐to‐lymphocyte ratios. Treatment intensity was lower in the older patients, but the findings were not significant: partial penile resection was predominant in the older group, while patients in the younger group more frequently underwent total penile resection. In addition, pelvic lymph node dissection was less frequently performed in the older group. Conclusions Among patients with clinical stage 3 penile cancer, cancer‐specific survival was worse in those aged 75 years or older. Worse Eastern Cooperative Oncology Group Performance Status scores and less aggressive treatment in the older group may have been contributing factors.

In this paper, we introduce the notion of $L^p$-Green-tight measures of $L^p$-Kato class in the framework of symmetric Markov processes. The class of $L^p$-Green-tight measures of $L^p$-Kato class is defined by the p-th power of resolvent kernels. We first prove that under the $L^p$-Green tightness of the measure $\mu$, the embedding of extended Dirichlet space into $L^{2p}(E;\mu )$ is compact under the absolute continuity condition for transient Markov processes, which is an extension of recent seminal work by Takeda. Secondly, we prove the coincidence between two classes of $L^p$-Green-tightness, one is originally introduced by Zhao, and another one is invented by Chen. Finally, we prove that our class of $L^p$-Green-tight measures of $L^p$-Kato class coincides with the class of $L^p$-Green tight measures of Kato class in terms of Green kernel under the global heat kernel estimates. We apply our results to d-dimensional Brownian motion and rotationally symmetric relativistic $\alpha$-stable processes on $\mathbb {R}^d$.

Endoscopic antireflux therapy is a novel endoscopic treatment for refractory gastroesophageal reflux disease. We developed antireflux myoplasty (AR‐MP), a modified version of antireflux mucoplasty (ARM‐P), in which exposed bilateral sling fibers are sutured directly via endoscopic hand‐suturing. AR‐MP was performed on a 60‐year‐old man, resulting in symptomatic improvement and allowing discontinuation of acid‐suppressive medication 3 months after the procedure. One month postoperatively, endoscopy showed an improvement in the Hill classification from grade 3 to grade 1. Before AR‐MP, endoscopic pressure study integrated system findings showed a maximum intragastric pressure value of 13.7 mmHg, indicating a flat pattern. After AR‐MP, maximum intragastric pressure exceeded 20 mmHg, and the pattern shifted to uphill. AR‐MP is an innovative endoscopic technique that reconstructs the native antireflux mechanism by suturing the sling fibers and reforming the gastroesophageal flap valve. This innovative endoscopic procedure, like ARM‐P, provides immediate symptom relief and represents a breakthrough in the endoscopic treatment of gastroesophageal reflux disease.

Aim The favor effect on liver disease by odium‐glucose cotransporter inhibitor (SGLT2i) and GLP‐1 receptor agonist (GLP1Ra) was reported; however, the effect of the combination treatment of these drugs was not well known. Methods We retrospectively analyzed data for 643 patients with type 2 diabetes receiving SGLT2i + GLP1Ra combination treatment for at least 1 year (331 and 312 patients in the GLP1Ra‐ and SGLT2i‐preceding groups, respectively). Propensity score (PS) matching was used to compare the effects of the preceding drugs on liver function. Results The mean AST and ALT values at baseline, at the initiation of combination treatment, and at final observation were 29.8 ± 20.0 and 37.7 ± 29.5, 28.7 ± 17.3 and 35.3 ± 6.0, 26.0 ± 14.6 and 30.1 ± 21.6 IU/L, respectively, indicative of significant improvements in liver function (P < 0.001). Conversely, significant progress in the fibrosis‐4 (FIB‐4) index category was observed even after the combination treatment (P = 0.03). Subgroup analysis revealed that a significant decrease in ALT was observed only in patients with a baseline ALT ≥30 IU/L after the combination treatment (P = 0.005). Improvement of the FIB‐4 index category was observed in patients in the baseline FIB‐4 index ≥2.6 group and in the 1.3 ≤FIB‐4 index <2.6 group (46% and 19%, respectively). The matched model showed no significant differences in liver function after combination treatment between the SGLT2i‐ and GLP1Ra‐preceding groups. Conclusions SGLT2i + GLP1Ra combination treatment significantly improved liver dysfunction and prevented the progression of FIB‐4 index category among patients with an FIB‐4 index ≥1.3.

Aim This study aims to investigate regional disparities in the distribution of child and adolescent mental health professionals in Japan. It focuses on identifying areas where access to specialists is limited and proposes potential solutions to address these inequalities. Methods Data were collected from multiple sources, including government statistics and public reports, on population size, number of specialists, mental health facilities, rates of truancy, bullying, suicides, and child abuse. A cluster analysis using the K‐means method was conducted to categorize all 47 Japanese prefectures into groups based on access to child and adolescent psychiatric care. Results Significant regional disparities were found in the distribution of child psychiatry specialists, with a 4.7‐fold difference in student‐to‐specialist ratios across regions. Rural areas exhibited severe shortages of specialists compared to urban areas. Prefectures were classified into three clusters based on their access to mental health resources, with rural areas showing the greatest need for additional support. Conclusion There are considerable regional disparities in access to child and adolescent psychiatric care in Japan. To address these, policy measures, such as promoting specialist placement in rural areas, enhancing specialist training programs, and introducing telemedicine, are necessary. These steps can help ensure more equitable access to mental health services nationwide.

Co(II) was doped into the diamagnetic one-dimensional framework of bis(dimethylglyoximato) Ni(II) and Pd(II) complex [Ni/Pd II (Hdmg) 2 ] (Hdmg = dimethylglyoximate anion) (hereafter referred to as Co@Ni and Co@Pd samples) to study magnetic...

The purpose of the present study was to clarify the dynamic factors that induce pelvic rotation when soccer players kick a ball toward angled directions using an instep kick. Nine experienced, right-footed, male soccer players instep kicked a stationary ball in 3 different angled directions, 15°, 45°, and 75° relative to the run-up direction, and a motion capture system with a force plate recorded the kicking data. Kinematic and kinetic variables of the support leg, associated with pelvic rotation about the vertical axis, were compared among the kicking conditions. The pelvic rotation significantly increased in response to larger kicking angles, and it coincided with increase of the support leg hip joint and foot segment rotation about the vertical axis. The joint torque at the support leg hip joint significantly increased with the kicking angles. Additionally, the interaction torque due to the ground reaction force was the primary factor driving foot segment rotation relative to the force plate in angled kicking conditions, whereas no remarkable action of the free moment existed. Instep kicks toward angled directions involve a mechanism that increases the pelvic rotation about the support leg’s hip joint and foot segment, which differs from the mechanism involved in straight kicks.

Calcium and vitamin D have been suggested to be associated with the amelioration of symptoms of premenstrual syndrome (PMS). However, evidence for an association between the dietary intake of these nutrients and PMS is limited and inconsistent. We examined the cross-sectional association of calcium and vitamin D intake with PMS. Participants were 390 women aged 22–49 y who responded to a mail survey in 2022–2023. Dietary intake was assessed using a validated self-administered diet history questionnaire. PMS were assessed using the Premenstrual Symptoms Questionnaire. Logistic regression analysis was used to estimate odds ratios of PMS according to tertiles of calcium and vitamin D intake with adjustment for potential confounding variables. The prevalence of moderate to severe PMS was 10% (39 women). Neither calcium nor vitamin D intake was significantly associated with PMS. However, calcium intake was associated with a decreased prevalence of PMS, albeit without statistical significance, with multivariable-adjusted odds ratios (95% CI) for PMS in the lowest through highest tertiles of calcium intake of 1.00 (reference), 0.47 (0.18–1.25), and 0.27 (0.07–1.08), respectively (p for trend=0.06). The odds ratio of PMS was low in the highest tertile of vitamin D intake compared with the lowest, but without statistical significance (odds ratio 0.56, 95% CI 0.19–1.66). Our findings suggest that calcium and vitamin D intake was not appreciably associated with PMS. The suggestive inverse association between calcium intake and PMS requires further investigation.

Maoto, a traditional herbal medicine widely prescribed in Japan, has been shown to be effective in the treatment of influenza virus infection, but the mechanisms of its antiviral action remain unclear. We previously demonstrated that maoto binds to respiratory syncytial virus (RSV) spike proteins, thereby inhibiting their entry into host cells. In this report, a similar experiment was done to determine if maoto and its components have an anti-infective effect on the influenza virus. Our results indicate that maoto binds to the hemagglutinin (HA) spike protein, inhibiting virus entry into host cells in a manner analogous to its antiviral effect on RSV. This hemagglutinin-binding effect was observed across influenza A(H1N1), A(H3N2), and B viruses, highlighting the broad-spectrum inhibitory potential of maoto against diverse viral strains. Furthermore, maoto, internalized by cells along with the influenza virus, binds to a cap-dependent endonuclease (polymerase acidic [PA] protein) that is crucial for viral replication and inhibits its nuclease activity. Among maoto’s constituent crude drugs, Ephedrae Herba (EH) and Cinnamomi Cortex (CC) were found to bind to both hemagglutinin and PA, indicating that they are responsible for the anti-infective effect of maoto. Maoto is distinctive in its multiple points of antiviral action, exhibiting a broad spectrum of antiviral properties, which makes it a versatile therapeutic agent against various viral mutations. IMPORTANCE The influenza virus is a formidable pathogen responsible for global pandemics that claim over 300,000 lives annually. Employing an ingenious evolutionary strategy, this virus undergoes constant mutation, deftly evading the action of therapeutic agents and sustaining its relentless impact. Maoto, a traditional herbal medicine, has long been known for its efficacy against viral infections and is frequently prescribed in Japan for the treatment of influenza; however, the precise mechanisms of its action remain unclear. Our study was done to elucidate the antiviral mechanisms of maoto against the influenza virus, presenting data that supports its unique potential as a therapeutic agent capable of flexibly adapting to mutations of the influenza virus. These findings pave the way for the development of new drugs and the expansion of therapeutic options.

The effects of severe shear strain and hydrostatic compression on the magnetostructural correlation of manganese oxide Mn3O4 were investigated using magnetic measurements and x-ray diffraction analyses. Hydrostatic pressures up to PHP = 4 GPa were applied using a diamond anvil cell, whereas shear stress was applied through high-pressure torsion (HPT) processing at PHPT = 6 GPa. A correlation between the coercive field and Jahn–Teller distortion was observed. Hysteresis measurements for magnetization showed a sharp reduction in the coercive field starting from PHP = 2 GPa under hydrostatic pressure. By contrast, an increase of 40% was observed after one rotation (N = 1) during HPT processing. The Jahn–Teller effect was evaluated with the ratio of the long to short distances of the MnO6 octahedron, which remained constant at 1.24 up to PHP = 2 GPa and then increased to 1.26 at PHP = 3 GPa. However, under HPT processing, this ratio changed from 1.24 to 1.27 at N = 1 and decreased to 1.18 at N = 3. The Mn²⁺–O–Mn³⁺ bonding angle also changed according to the Jahn–Teller distortion in both compression modes. Thus, the local symmetry of the MnO6 octahedron and MnO4 tetrahedron was modified through compression and subsequent shear stress, allowing for control over the hysteresis of magnetization.

The Japanese Dermatological Association aimed to prepare a second edition of guidelines for the management of diabetic ulcer/gangrene with emphasis on the diagnosis and treatment of skin symptoms. This new edition serves as a tool to improve the quality of the diagnosis and treatment in each patient and, further, to improve the level of care for such skin conditions. All sections have been updated by collecting documents published since the publication of the first edition. In the antibacterial drug treatment for bacterial infection of ulcers, oral administration was added after consideration. In the treatment of antibacterial drugs for bacterial infection of ulcers, not only infusion but also oral administration was mentioned. In addition, clinical questions (CQs) for imaging tests for diagnosing ischemia of the limbs were newly created. The titles of some CQs were changed to conform to the actual clinical setting. (i) The content has been updated by adding and collecting documents for all sections; (ii) we have additionally included oral antibiotic treatment for bacterial infection of ulcers; (iii) we have added CQs pertaining to imaging tests for diagnosing ischemia of the limbs; and (iv) we have revised the titles of some CQs to conform to the actual clinical setting. In particular, the recommendation levels of dressing materials newly covered by Japanese national health insurance are mentioned. In addition, CQs regarding the initial treatment of electrical (CQ15) and chemical burns (CQ16), and the use of escharotomy (CQ22) have been created.

Background/aim: Despite advances in diagnosis and pharmacotherapy, surgery remains crucial for Crohn's disease (CD). Postoperative intra-abdominal septic complications (IASC) occur in 1.2-16.7% of cases. We investigated the frequency of postoperative IASC in elective surgeries for CD and the risk factors and potential biomarkers for postoperative IASC. Patients and methods: We conducted a retrospective single-center cohort study of patients who underwent abdominal surgery for CD at Fukuoka University Chikushi Hospital between January 2015 and December 2023. The primary focus was the incidence of IASC within 60 days postoperatively. Patient-related variables were examined using univariate and multivariable analyses. Results: The analysis included 206 of 249 surgeries. Postoperative IASC occurred in 26 patients (12.6%). Univariate analysis identified history of steroid use requiring steroid coverage (p=0.002), penetrating type (p=0.020), WBC count (p=0.037), neutrophil count (0.009), C-reactive protein (CRP) (p=0.035), CRP-albumin ratio (CAR) (p=0.034), neutrophil-to-lymphocyte ratio (NLR) (p=0.002), and operation duration (p=0.010) as significant factors. Multivariable analysis identified history of steroid use requiring steroid coverage (OR=6.23, 95%CI=1.61-24.1, p=0.008), high NLR (OR=3.43, 95%CI=1.30-9.04, p=0.013), and long duration of operation (OR=2.63, 95%CI=1.01-6.88, p=0.049) as independent predictors. The optimal cutoffs for predicting IASC were an NLR of 3.98 (sensitivity, 61.5%; specificity, 77.8%) and an operation time of 173 min (sensitivity, 65.4%; specificity, 65.0%), respectively. Conclusion: History of steroid use requiring steroid coverage, preoperative NLR ≧3.98, and duration of operation ≧173 min are independent risk factors for postoperative IASC in elective surgeries for CD. Recognition of high-risk patients would contribute to the decision-making process for perioperative management.

Fatigue is one of the most frequent non-motor symptoms associated with people with Parkinson’s disease (PwPD). In this study, we investigated the relationship between fatigue and patients’ background characteristics, disease severity, motor and non-motor symptoms, and cognitive and psychological assessments in PwPD. A total of 80 PwPD were included in this study, 40% of whom experienced fatigue. PwPD with fatigue were associated with being female, dyskinesia, and higher levels of levodopa equivalent daily dose, as well as increased severity of depression, apathy and sleep disturbances, in addition to lower quality of life. Fatigue in PwPD is a symptom that warrants clinical attention, as it is linked to multiple risk factors, indicating the need for further intervention studies that incorporate the perspective of personalized medicine.

Background: Deterioration in lifestyle associated with poor mental health could be an important concern during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies have investigated the association between mental health status and lifestyle changes during the pandemic in nationwide Japanese general population. Methods: This cross-sectional study was conducted using the data among 1,546 participants of the follow-up study of NIPPON DATA2010 in 2021. Recent mental status, as assessed using the Kessler 6 (K6) scale, and lifestyle changes compared to before the pandemic were determined using self-reported questionnaires. Some lifestyle changes such as decreased physical activity were defined as undesirable, whereas others such as decreased alcohol drinking were defined as desirable. The participants were divided into three groups based on the K6 scores: the K6<5, 5≤K6<9, and K6≥9 groups. The odds ratios (ORs) and 95% confidence intervals (CIs) of the K6 groups for each lifestyle change compared with that in the K6<5 group were estimated after adjusting for possible confounders. Results: The ORs of the K6≥9 group for all undesirable lifestyle changes were significantly high, especially increased alcohol drinking (OR 4.64; 95% CI, 2.71–7.93), and decreased physical activity (OR 4.63; 95% CI, 3.29–6.52). Among the desirable changes, the OR of the 5≤K6<9 group was significantly high for increased eating home cooking. Conclusions: Poor mental health showed a significant association with undesirable lifestyle changes, especially increased alcohol drinking and decreased physical activity, in a nationwide general Japanese population during the COVID-19 pandemic. Fullsize Image

We examined the effect of rust due to freshwater on the provenance determination of iron artifacts, which is typically conducted based on elemental concentrations determined using nondestructive X-ray fluorescence (XRF) spectrometry. This was achieved by comparing a rusted iron sickle collected from farmland in Fukuoka, Japan before and after rust removal. The data were collected at 30 positions on the surface of the sample using nondestructive XRF spectrometry before and after rust removal. The concentration distributions of all elements in the sample before and after rust removal were considerably different. The escape depths of the fluorescent X-rays were calculated based on the median chemical composition of the rusted sample and then compared, and the rust thickness was estimated based on the sample thickness before and after rust removal. The fluorescent X-rays emitted from the sample, except Ba Kα, reflected only information from the rusted part not the uncorroded metal part. The As/Sb scatter plots, which are often used in provenance determination of iron artifacts, were created to compare the sample before and after rust removal. The As/Sb values measured at 30 positions after rust removal were normally distributed, whereas those measured before rust removal were not. Similarly, the scatter plots obtained in both cases exhibited different distributions. Therefore, the provenance determination of ironware using nondestructive XRF spectrometry would be affected by its rusting due to freshwater.

Objectives:To identify predictors of prolonged severe urinary incontinence after robot-assisted radical prostatectomy (RARP), perioperative clinical parameters were investigated. Methods:Participants were 299 patients who underwent RARP at our institute. Prolonged severe urinary incontinence was defined as a 1-h (one-hour) pad test >50 g/h and/or use of >3 pads/day at 12 months after RARP. The cohort was divided into severe and non-severe urinary incontinence groups according to this criterion. Perioperative clinical parameters were compared between groups to identify predictors for prolonged severe urinary incontinence after RARP. Results:Twenty-seven patients (9.0%) were categorized into the severe urinary incontinence group. The remaining 272 patients (91.0%) were categorized into the non-severe urinary incontinence group. Univariate analysis revealed prolonged severe urinary incontinence as significantly associated with older age (P=0.011), high BMI (P=0.001), lymph node dissection (P=0.003), non-preservation of nerves (P=0.039), non-preservation of fascia of the levator ani muscle (P=0.009), and high risk in the D’Amico risk classification (P=0.010). Multivariate analysis revealed prolonged severe urinary incontinence as significantly correlated with high BMI (P=0.009) and high risk in the D’Amico risk classification (P=0.007). Conclusions:High BMI and D’Amico high-risk status are associated with prolonged severe urinary incontinence after RARP.