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Aim Screening laboratory tests for patients with acute psychiatric symptoms are discouraged in general emergency services but are recommended by emergency psychiatric guidelines due to the high prevalence of abnormal findings in severe psychiatric patients. The present study aimed to evaluate the utility of screening laboratory tests in a real‐world, emergency psychiatric setting through focusing on how often abnormal values lead to medical interventions. Methods The electronic medical records were reviewed for adult patients who were involuntarily admitted to Tokyo Metropolitan Matsuzawa Hospital for an imminent risk of self‐harm or harm to others between October 2019 and September 2022. The number of patients, abnormal screening laboratory findings, and medical interventions were examined. Results Of the 600 patients identified in the review, 595 had abnormal laboratory findings, but only 97 (16.3%) underwent medical interventions related to these results. Frequently observed abnormal findings, such as elevated creatine kinase and an elevated white blood cell count, were often attributed to the patient's agitation or were considered clinically nonsignificant. Notably, one‐third of the interventions prompted by laboratory findings resulted only in additional testing. More than half of the treatments were either of questionable necessity or nonurgent. Medical interventions other than additional tests were more likely to be prompted by the patient's medical history and presentation. Conclusion In the emergency psychiatric setting, abnormal laboratory findings are common, but clinical decisions largely rely on the patient's medical history and presentation, with few requiring immediate interventions. A history‐driven approach may enhance the clinical value of laboratory tests. Severe psychiatric patients often have abnormal laboratory test findings. Most abnormalities are attributed to agitation or are clinically insignificant, and interventions are limited. Medical intervention was often promoted by the patient's medical history.

Sincere praise reliably conveys positive or negative feedback, while flattery always conveys positive but unreliable feedback. These two praise types have not been compared in terms of communication effectiveness and individual preferences using neuroimaging. Through functional magnetic resonance imaging, we measured brain activity when healthy young participants received sincere praise or flattery after performing a visual search task. Higher activation was observed in the right nucleus accumbens during sincere praise than during flattery, and praise reliability correlated with posterior cingulate cortex activity, implying a rewarding effect of sincere praise. In line with this, sincere praise uniquely activated several cortical areas potentially involved in concern regarding others’ evaluations. A high praise-seeking tendency was associated with lower activation of the inferior parietal sulcus during sincere praise compared to flattery after poor task performance, potentially reflecting suppression of negative feedback to maintain self-esteem. In summary, the neural dynamics of the rewarding and socio-emotional effects of praise differed.

Background Obsessive–compulsive disorder (OCD) can cause physical complications, and psychiatric treatment sometimes improves these complications. However, it remains unclear whether managing a physical complication can contribute to the improvement of psychiatric symptoms or may alter the trajectory of psychiatric treatment. Case Presentation We report on a woman in her 50s with severe, long‐standing, treatment‐resistant OCD centered on contamination fears and compulsive defecation rituals. She rarely sought psychiatric help, and her symptoms worsened. Her compulsions led to rectal prolapse and fecal incontinence, which in turn exacerbated her OCD in a vicious cycle. After laparoscopic rectopexy resolved her incontinence, a marked reduction in repetitive cleaning behaviors occurred, including decreased time spent in the toilet and reduced toilet paper use. The physical improvement was followed by psychiatric engagement, regular outpatient visits, and subsequent therapeutic progress. Conclusion This case illustrates that a physical intervention could do more than alleviate somatic distress; it could act as a catalyst for psychiatric care. By breaking the cycle between a physical symptom and a compulsive behaviors, the surgical treatment created a crucial opening for establishing trust and motivation. This highlights the importance of integrated, cross‐disciplinary collaboration in managing complex OCD cases where somatic and psychiatric symptoms are deeply intertwined.

We examined the magnetic effect of thaumatin crystals, which are a well known model of protein crystals but which have hardly been studied for that effect. We succeeded in crystallizing thaumatin by magnetic levitation based on the magneto-Archimedes effect by the addition of the paramagnetic substance gadolinium chloride. We also carried out a chronological observation of the levitation process in a superconducting magnet, and visualized the magnetic orientation of the crystals by applying a magnetic field along the horizontal direction. In another major result, we carried out a diffraction experiment and performed a structural analysis of the crystals. We noticed from the results that no electron density from the gadolinium ion could be observed in the crystals. This suggests the possibility that the paramagnetic substance of the aqueous precipitant solution helps only to promote the crystals' levitation, and has little effect on thaumatin crystallization.

The systemic decline in autophagic activity with age impairs homeostasis in several tissues, leading to age-related diseases. A mechanistic understanding of adipocyte dysfunction with age could help to prevent age-related metabolic disorders, but the role of autophagy in aged adipocytes remains unclear. Here we show that, in contrast to other tissues, aged adipocytes upregulate autophagy due to a decline in the levels of Rubicon, a negative regulator of autophagy. Rubicon knockout in adipocytes causes fat atrophy and hepatic lipid accumulation due to reductions in the expression of adipogenic genes, which can be recovered by activation of PPARγ. SRC-1 and TIF2, coactivators of PPARγ, are degraded by autophagy in a manner that depends on their binding to GABARAP family proteins, and are significantly downregulated in Rubicon -ablated or aged adipocytes. Hence, we propose that age-dependent decline in adipose Rubicon exacerbates metabolic disorders by promoting excess autophagic degradation of SRC-1 and TIF2. Autophagic activity declines with age in several tissues and is linked to aging-associated functional decline and pathologies. Here the authors show that Rubicon, a negative regulator of autophagy, decreases in adipocytes with age, and its loss leads to adipocyte dysfunction via excess autophagic degradation of SRC-1 and TIF2.

BackgroundIn this study, we investigated the association between the early response of serum and hematological variables and the outcome of cabazitaxel therapy.Patients and methodsThe medical records of 59 consecutive patients who had previously received docetaxel chemotherapy for the treatment of metastatic castration-resistant prostate cancer (CRPC) and who received cabazitaxel at our hospital between January 2011 and March 2020 were retrospectively reviewed and statistically analyzed.ResultsThe median follow-up period after cabazitaxel initiation was 15.2 months. The 30% prostate-specific antigen (PSA) response rate, median PSA progression-free survival period, and overall survival (OS) period were 45.8%, 4.3 months, and 22.6 months, respectively. Within 1 to 2 cycles of cabazitaxel, we were unable to identify hematological or serum kinetics that had a relationship with OS. Analysis of the variables after 3 cycles of cabazitaxel, however, revealed two factors, PSA decline > 30% (p = 0.016) and neutrophil–lymphocyte ratio (NLR) decline > 30% (p = 0.044), as the predictors of favorable outcome for OS. We established a prognostic model for predicting the OS period composed of these two factors, which exhibited distinctly separated OS curves (p = 0.004). The C-index of a model incorporating these two factors was 0.703.ConclusionsThis is the first study to demonstrate that PSA and NLR decline 3 cycles after the initiation of cabazitaxel were associated with favorable outcome in patients with CRPC. Also, 3 cycles of cabazitaxel might be necessary to assess the efficacy of cabazitaxel therapy.

Inflammatory cytokines play a role in hematopoiesis and development of myelodysplastic syndromes (MDS). Although increased serum levels of inflammatory cytokines are associated with poor survival in MDS patients, clinical management does not include assessment of inflammation. We investigated the significance of inflammation in MDS using serum C-reactive protein (CRP) levels, an indicator of the degree of systemic inflammation that can be used in routine practice. We hypothesized that serum CRP levels can be used to further classify low-risk MDS. We conducted a retrospective analysis of 90 patients with low-risk MDS, defined by the international prognostic scoring system (IPSS). We examined the prognostic relevance of CRP and known prognostic factors at diagnosis. Increased serum CRP (≥ 0.58 mg/dL) was associated with poor survival (hazard ratio [HR]: 17.63, 95% confidence interval [CI] 5.83–53.28, P < 0.001) both overall and among the 73 patients with low-risk MDS as defined by the revised IPSS (HR: 28.05, 95% CI 6.15–128.04, P < 0.001). Increased CRP might predict poor prognosis and serum CRP levels can indicate clonal hematopoiesis and non-hematological comorbidity in patients with low-risk MDS.

Hemophagocytic lymphohistiocytosis (HLH) is an uncontrolled hyperinflammatory disorder driven by an overactive immune system that results in high mortality. Post-transplant-associated hemophagocytic lymphohistiocytosis (PT-HLH) is a type of secondary HLH that occurs following allogeneic hematopoietic stem cell transplantation (allo-HSCT). The clinical features of PT-HLH remain unclear and diagnostic and prognostic tools have not yet been established. Here, we retrospectively evaluated the clinical manifestations and outcomes of PT-HLH in 94 patients who underwent allo-HSCT. According to our PT-HLH criteria (hyperferritinemia and increased macrophage count in bone marrow), PT-HLH occurred in 12 patients (12.8%). The PT-HLH patients showed splenomegaly (P = .001), a higher risk of engraftment failure (P = .013), and an increased percentage of macrophages and hemophagocytes in bone marrow aspirates (P = .0009 and P = .0006, respectively). Moreover, univariate and multivariate analyses revealed that the survival rate was lower in PT-HLH patients than non-PT-HLH patients (P = .0017 and P = .034, respectively). This study defines the clinical features of PT-HLH and PT-HLH criteria that could be useful tools for diagnosing PT-HLH.

Although KRAS and TP53 mutations are major drivers of pancreatic ductal adenocarcinoma (PDAC), the incurable nature of this cancer still remains largely elusive. ARF6 and its effector AMAP1 are often overexpressed in different cancers and regulate the intracellular dynamics of integrins and E-cadherin, thus promoting tumor invasion and metastasis when ARF6 is activated. Here we show that the ARF6–AMAP1 pathway is a major target by which KRAS and TP53 cooperatively promote malignancy. KRAS was identified to promote eIF4A-dependent ARF6 mRNA translation, which contains a quadruplex structure at its 5′-untranslated region, by inducing TEAD3 and ETV4 to suppress PDCD4; and also eIF4E-dependent AMAP1 mRNA translation, which contains a 5′-terminal oligopyrimidine-like sequence, via up-regulating mTORC1. TP53 facilitated ARF6 activation by platelet-derived growth factor (PDGF), via its known function to promote the expression of PDGF receptor β (PDGFRβ) and enzymes of the mevalonate pathway (MVP). The ARF6–AMAP1 pathway was moreover essential for PDGF-driven recycling of PD-L1, in which KRAS, TP53, eIF4A/4E-dependent translation, mTOR, and MVP were all integral. We moreover demonstrated that the mouse PDAC model KPC cells, bearing KRAS/TP53 mutations, express ARF6 and AMAP1 at high levels and that the ARF6-based pathway is closely associated with immune evasion of KPC cells. Expression of ARF6 pathway components statistically correlated with poor patient outcomes. Thus, the cooperation among eIF4A/4E-dependent mRNA translation and MVP has emerged as a link by which pancreatic driver mutations may promote tumor cell motility, PD-L1 dynamics, and immune evasion, via empowering the ARF6-based pathway and its activation by external ligands.

Primary aldosteronism (PA) is typically managed with mineralocorticoid receptor antagonists (MRAs) barring adrenalectomy. The efficacy of esaxerenone, a nonsteroidal MRA, were explored in patients with PA. Various parameters such as the urinary albumin to creatinine ratio (UACR) and serum levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were evaluated in 25 PA patients before and 3 and 6 months after esaxerenone treatment. Systolic and diastolic blood pressure (BP), and the estimated glomerular filtration rate decreased after treatment, while serum levels of potassium and active renin increased. Significant reductions were observed in UACR 3 and 6 months after treatment. A significant decrease in NT-proBNP was evident at 6 months but not 3 months after treatment. Correlation analysis indicated that the reductions in BP and UACR at 3 months were independent of estimated daily salt intake. Furthermore, the effect of esaxerenone treatment on lowering UACR and NT-proBNP levels was independent of BP reduction. Responders whose systolic BP decreased 6 months after esaxerenone treatment by more than 10 mmHg compared to pretreatment had higher pretreatment NT-proBNP and similar UACR before and after treatment when compared with nonresponders. Esaxerenone improved mental, physical, and social quality of life (QOL) 6 months after treatment compared to healthy controls and increased over time. No patients discontinued treatment due to severe hyperkalemia or renal dysfunction. In conclusion, esaxerenone is a safe and effective MRA for PA treatment, offering significant benefits in terms of hypertension, albuminuria, NT-proBNP levels, and QOL improvement. Esaxerenone effectively lowers BP, UACR, and serum levels of NT-proBNP independent of dietary salt intake in mild PA patients. ARC active renin concentration, DBP diastolic blood pressure, MR mineralocorticoid receptor, MRA mineralocorticoid receptor antagonist, NT-proBNP N-terminal pro-brain natriuretic peptide, PA primary aldosteronism, QOL quality of life,  SBP systolic blood pressure,  SF-36  Medical Outcomes Study 36-Item Short-Form Health Survey,  UACR urinary albumin to creatinine ratio. Esaxerenone effectively lowers BP, UACR, and serum levels of NT-proBNP independent of dietary salt intake in mild PA patients. ARC active renin concentration, DBP diastolic blood pressure, MR mineralocorticoid receptor, MRA mineralocorticoid receptor antagonist, NT-proBNP N-terminal pro-brain natriuretic peptide, PA primary aldosteronism, QOL quality of life,  SBP systolic blood pressure,  SF-36  Medical Outcomes Study 36-Item Short-Form Health Survey,  UACR urinary albumin to creatinine ratio.