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To investigate the predictive capability of insulin resistance surrogate markers for insulin resistance and arterial stiffness based on sex. We assessed the association of triglyceride glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), visceral adiposity index (VAI), and lipid accumulation product (LAP) with homeostasis model assessment-insulin resistance (HOMA-IR) and brachial–ankle pulse wave velocity (baPWV) in both sexes. A total of 1720 men and 1098 women were evaluated. HOMA-IR showed good correlation with the TyG index (men: r = 0.47, women: r = 0.45), TG/HDL-C (men: r = 0.45, women: r = 0.41), VAI (men: r = 0.51, women: r = 0.48), and LAP (men: r = 0.55, women r = 0.49) (all p-values < 0.001). These markers positively correlated with increased baPWV in both sexes. The standardized partial regression coefficients were 0.11 and 0.14 for the TyG index, 0.13 and 0.16 for TG/HDL-C, 0.14 and 0.19 for VAI, and 0.12 and 0.17 for LAP in men and women, respectively (all p-values < 0.01; all p-values for sex interaction < 0.05). All insulin surrogate markers showed good correlation with HOMA-IR in both sexes. These indices were also associated with increased baPWV and the associations were stronger in women than in men. •This study shows that surrogate markers of insulin resistance (IR) were strongly correlated with HOMA-IR.•All surrogate markers of IR and HOMA-IR were associated with elevated baPWV.•However, the relation of surrogate markers of IR with baPWV differed by sex.•Surrogate markers of IR should be validated in men and women separately in predicting the risk of cardiovascular disease.

Cytotoxic effects of radiation play an important role in the treatment of head and neck cancer. However, irradiation is known to lead to the migration of various cancer cells, including those of head and neck cancer. Recently, fibroblasts in the cancer microenvironment have been reported to be involved in this mechanism. Nevertheless, the mechanism underlying migration of head and neck cancer cells remains unclear. Herein, we aimed to elucidate this migration mechanism induced by irradiation in terms of the interaction of head and neck cancer cells with fibroblasts. We used the head and neck squamous cell carcinoma (HNSCC) cell lines SAS and FaDu as well as fibroblast cell lines. These cells were irradiated and their viability was compared. In fibroblasts, changes in interleukin-6 (IL-6) secretion caused by irradiation were measured by enzyme-linked immunosorbent assay (ELISA). The cell migration ability of cancer cells was evaluated via a migration assay using a semipermeable membrane. HNSCC cells were cocultured with irradiated and nonirradiated fibroblasts, and their migration ability under each condition was compared. We also examined the effect of IL-6 on the migration of HNSCC cells. Furthermore, to investigate the effect of fibroblast-derived IL-6 on the migration ability of HNSCC cells, we conducted a coculture study using IL-6 neutralizing antibody. Irradiation reduced the survival of HNSCC cells, whereas fibroblasts were resistant to irradiation. Irradiation also increased IL-6 secretion by fibroblasts. Migration of HNSCC cells was enhanced by coculture with fibroblasts and further enhanced by coculture with irradiated fibroblasts. We also confirmed that the migration of HNSCC cells was induced by IL-6. The enhanced migration of cancer cells caused by coculturing with fibroblasts was canceled by the IL-6 neutralizing antibody. These results show that fibroblasts survive irradiation and induce the migration ability of HNSCC cells through increased secretion of IL-6.

PurposeRecent studies have revealed the impact of spinopelvic factors on the risk of dislocation after total hip arthroplasty (THA). This study examined the risk factors of impingement that can lead to dislocation using pre- and postoperative spinopelvic radiographs.MethodsWe studied 143 consecutive patients with end-stage hip osteoarthritis who were eligible for THA at our institute. Pre-operative pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), sagittal vertical axis (SVA) in the standing and sitting position, and centre-edge angle (CE) were measured. The post-operative SS, LL, SVA, femoral shaft angle, and radiographic alignment of the acetabular component were also measured. We performed a multiple linear regression analysis to determine the risk factors for anterior and posterior impingement using pre-operative demographic and radiographic parameters. The clearance of anterior and posterior implant impingement was used for the surrogate-dependent variable for dislocation.ResultsA total of 95 patients were included in the analysis. There were significant differences in SS, LL, and SVA between the standing and sitting positions (P < 0.001). A multiple linear regression analysis showed that the PI–LL, LL changes, and CE were associated with the posterior impingement (β = − 0.21, 0.24, and −0.27, respectively). Moreover, PI–LL was also associated with the anterior impingement in the sitting position (β = − 0.27).ConclusionOur results suggest that a flatback with a rigid spine leads to posterior impingement, and a well-balanced spine leads to anterior impingement, which can be a potential risk factor for dislocation.

Stereoselective halogenation is a highly useful organic transformation for multistep syntheses because the resulting chiral organohalides can serve as precursors for various medicinally relevant derivatives. Even though decarboxylative halogenation of aliphatic carboxylic acids is a useful and fundamental synthetic method for the preparation of a variety of organohalides, an enantioselective version of this reaction has not been reported. Here we report a highly enantioselective decarboxylative chlorination of β-ketocarboxylic acids to obtain α-chloroketones under mild organocatalytic conditions. The present method is also applicable for the enantioselective synthesis of tertiary α-chloroketones. The conversions of the resulting α-chloroketones into α-aminoketones and α-thio-substituted ketones via S N 2 reactions at the tertiary carbon centres are also demonstrated. These results constitute an efficient approach for the synthesis of chiral organohalides and are expected to enhance the availability of enantiomerically enriched chiral compounds with heteroatom-substituted chiral stereogenic centres. Due to the synthetic utility of the products, stereoselective halogenation is a powerful method for the synthesis of chiral compounds. Here the authors report an enantioselective decarboxylative chlorination, giving access to a range of α-chloroketones.

As the population ages, older adults face an increasing risk of physical inactivity and related health complications, highlighting the need for scalable interventions. Smartphone-based programs have emerged as a promising strategy to support sustained physical activity among older adults. This study aimed to evaluate whether a smartphone lecture program incorporating a digital peer support app would increase physical activity among older adults, compared to a conventional smartphone lecture program. This 2-arm, 1:1 parallel-arm, cluster-randomized trial was conducted in 2 urban regions of Japan (Sumida Ward, Tokyo, and Chiba City, Chiba). Eligible participants were community-dwelling adults aged ≥60 years, able to walk independently, and smartphone users; exclusion criteria included prior use of the peer support app or medical restrictions on walking. Participants were recruited offline during community smartphone lectures (closed-group recruitment). The intervention combined face-to-face lectures with app-based peer support, while outcomes were assessed both objectively (via smartphones) and through self-administered paper questionnaires. All participants received a baseline smartphone lecture. Intervention participants attended 2 additional sessions using a digital peer support app (Minchalle; A10 Lab Inc), which included features such as daily step goals, peer sharing, and group encouragement. Control participants attended 2 standard follow-up smartphone lectures. The primary outcome was the change in weekly average daily step count from baseline to Week 12. Secondary outcomes included total metabolic equivalent of task (MET)-minutes per week (assessed via the International Physical Activity Questionnaire), walking time (≥30 minutes per day), daily smartphone use, and number of smartphone use purposes. A total of 156 community-dwelling older adults were grouped into 40 clusters and randomized (20 intervention clusters, n=80 and 20 control clusters, n=76). In total, 124 participants (79.5%) completed the follow-up, and valid step data were available for 117 participants, with missing data ranging from 5.1% to 29.1%. Baseline daily steps averaged 3951 (SD 1686) in controls versus 4583 (SD 1973) in the intervention arm. An unadjusted mixed model for repeated measures showed significantly higher step changes for intervention participants at Week 12 (difference=579, 95% CI 36-1123; P=.04). No significant differences emerged for total METs (difference=646 MET-min per week, 95% CI -12 to 1303; P=.054) or walking ≥30 minutes per day (odds ratio [OR] 1.56, 95% CI 0.63-3.90; P=.33). However, the intervention arm demonstrated a significant increase in daily smartphone use (OR 4.10, 95% CI 1.15-14.6; P=.03) and in the number of smartphone use purposes (difference=0.58, 95% CI 0.12-1.05; P=.01). A smartphone lecture program integrated with app-based peer support led to modest but meaningful improvements in step counts among older Japanese adults, at Week 12 of the 12-week intervention. Future research should investigate long-term maintenance, additional measures of physical activity, and subpopulation responses to optimize digital health programs for older adults.

The selection of the sowing date is one of the most important decisions in soybean production. It is important for farmers to know the expected seed yield when developing a sowing plan. The objective of this study was to quantitatively reveal the decreased seed yield ratio during late sowing in southwestern Japan under irrigated conditions. Total above ground dry matter and distribution were measured from July to August sowing in 2018 and 2019 in Fukuyama, Hiroshima, Japan. The harvest index in the August sowing did not decrease compared to the July sowing under irrigated conditions. The decrease in yield was related to the total aboveground dry matter rather than to the harvest index. The decrease in total aboveground dry matter was related to the total amount of solar radiation intercepted rather than to radiation use efficiency. A significant regression equation was obtained for the relative yield, which was calculated from the maximum seed yield observed from early to mid-July. When seeds were sown after mid-July, our result showed that the seed yield will decrease by 0.60% per day for Sachiyutaka A1 and by 0.64% for Akimaro, even under conditions of 100% seedling establishment and controlled soil water conditions. This regression equation can be used in fields as an indicator of seed yield where irrigation is possible.

Background The development of computer-assisted technologies to diagnose anterior cruciate ligament (ACL) injury by analyzing knee magnetic resonance images (MRI) would be beneficial, and convolutional neural network (CNN)-based deep learning approaches may offer a solution. This study aimed to evaluate the accuracy of a CNN system in diagnosing ACL ruptures by a single slice from a knee MRI and to compare the results with that of experienced human readers. Methods One hundred sagittal MR images from patients with and without ACL injuries, confirmed by arthroscopy, were cropped and used for the CNN training. The final decision by the CNN for intact or torn ACL was based on the probability of ACL tear on a single MRI slice. Twelve board-certified physicians reviewed the same images used by CNN. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the CNN classification was 91.0%, 86.0%, 88.5%, 87.0%, and 91.0%, respectively. The overall values of the physicians’ readings were similar, but the specificity was lower than the CNN classification for some of the physicians, thus resulting in lower accuracy for the human readers. Conclusions The trained CNN automatically detected the ACL tears with acceptable accuracy comparable to that of human readers.

Purpose To elucidate the clinical impact of the novel oxytocin protocol using a syringe pump with a stratified dose compared with the conventional practice of putting oxytocin into the bag. Methods This is a retrospective cohort study. We collected the data of the patients who underwent elective cesarean delivery under neuraxial anesthesia between June 2019 and May 2020. The patients were allocated to two groups according to oxytocin administration methods; the control group (the attending anesthesiologist put oxytocin 5–10 units in the infusion bag and adjusted manually after childbirth) and the protocol group (the oxytocin protocol gave oxytocin bolus 1 or 3 units depending on the PPH risk, followed by 5 or 10 unit h −1 via a syringe pump). We compared the total amount of oxytocin within 24 h postpartum, estimated blood loss, and adverse clinical events within 24 h postpartum between the two groups. Results During the study period, 262 parturients were included. Oxytocin doses of intraoperative and postoperative were significantly lower in the protocol group (9.7 vs. 11.7 units, intraoperative, 15.9 vs. 18 units, postoperative). The subgroup analyses showed that the impact was more remarkable in the low PPH risk than in the high PPH risk. The multivariate linear regression analyses also confirmed the difference. The groups had no significant difference in blood loss, requirement of additional uterotonics, and other adverse events. Conclusions Our oxytocin infusion protocol significantly reduced oxytocin requirements in elective cesarean delivery under neuraxial anesthesia without increasing blood loss. However, we could not find other clinical benefits of the novel protocol.

Acute kidney injury (AKI) frequently occurs after cardiac surgery. Recently, transcatheter aortic valve implantation (TAVI), a less invasive option for aortic stenosis (AS), has been increasingly performed, particularly in elderly patients. We retrospectively investigated and compared the incidence and risk factors of postoperative AKI in patients who underwent surgical aortic valve replacement (SAVR) and TAVI. This was a retrospective single-center study. Seven days postoperatively, data were obtained from medical records. Patients were classified into SAVR and TAVI groups based on age, according to the policy of the Japanese Circulation Society. A total of 155 patients underwent surgery for AS between January 2020 and December 2021. Variables included age, sex, risk score, preoperative left ventricular ejection fraction, hypertension, and renal dysfunction. AKI was defined in accordance with the Kidney Disease: Improving Global Outcomes criteria. A total of 33 SAVR and 79 TAVI procedures were included in this study. The incidences of AKI in the SAVR and TAVI groups were 45.5% and 43.0%, respectively. No significant differences existed between the two groups. Weight ( p  = 0.0392) and pre-renal dysfunction ( p  = 0.0308) affected the incidence of AKI in the SAVR group, whereas no such variables were identified in the TAVI group. Within the current age-based treatment selection criteria for AS, no significant difference in the incidence of AKI was observed between the two procedures.Although preoperative renal function may be associated with postoperative AKI, further studies are required to select the optimal surgical procedure for patients with renal dysfunction.

Rapid dissemination of information regarding adverse drug reactions is a key aspect for improving pharmacovigilance. There is a possibility that unknown adverse drug reactions will become apparent through post-marketing administration. Currently, although there have been studies evaluating the relationships between a drug and adverse drug reactions using the JADER database which collects reported spontaneous adverse drug reactions, an efficient approach to assess the association between adverse drug reactions of drugs with the same indications as well as the influence of demographics (e.g. gender) has not been proposed. We utilized the REAC and DEMO tables from the May 2015 version of JADER for patients taking antidepressant drugs (SSRI, SNRI, and NaSSA). We evaluated the associations using association analyses with an apriori algorithm. Support, confidence, lift, and conviction were used as indicators for associations. The highest score in adverse drug reactions for SSRI was obtained for \"aspartate aminotransferase increased\", \"alanine aminotransferase increased\", with values of 0.0059, 0.93, 135.5, and 13.9 for support, confidence, lift and conviction, respectively. For SNRI, \"international normalized ratio increased\", \"drug interaction\" were observed with 0.0064, 1.00, 71.9, and NA. For NaSSA, \"anxiety\", \"irritability\" were observed with 0.0058, 0.80, 49.9, and 4.9. For female taking SSRI, the highest support scores were observed in \"twenties\", \"suicide attempt\", whereas \"thirties\", \"neuroleptic malignant syndrome\" were observed for male. Second, for SNRI, \"eighties\", \"inappropriate antidiuretic hormone secretion\" were observed for female, whereas \"interstitial lung disease\" and \"hepatitis fulminant\" were for male. Finally, for NaSSA, \"suicidal ideation\" was for female, and \"rhabdomyolysis\" was for male. Different combinations of adverse drug reactions were noted between the antidepressants. In addition, the reported adverse drug reactions differed by gender. This approach using a large database for examining the associations can improve safety monitoring during the post-marketing phase.