Hashimoto Municipal Hospital

Alpheus lobidens De Haan, 1849 (type locality: Japan) and A. crassimanus Heller, 1862 (type locality: Nicobar Islands, Andaman Sea), two taxonomically challenging snapping shrimps previously regarded as conspecific, are rediagnosed based on the holotype and on the newly collected material from the Andaman Sea, respectively. Most importantly, the female holotype of A. lobidens has a balaeniceps ridge on the pollex of the minor chela, whereas in A. crassimanus, the minor cheliped fingers of females are simple, devoid of balaeniceps setae. Other characters diagnostic to A. lobidens include the laterally compressed rostrum reaching the distal margin of the first article of the antennular peduncle, the highly elevated rostral carina widening posteriorly, and the broad, deeply depressed adrostral furrows. These features set A. lobidens apart from other taxa previously referred to A. lobidens or A. lobidens complex in literature. Alpheus polynesicus Banner & Banner, 1975, originally described as a subspecies of A. lobidens and later synonymised with A. lobidens, is reinstated as a full species based on evidence from literature. Four new species, which have been confused with A. lobidens, are described from Japan, based on molecular and morphological data, as well as their colour patterns in life: A. yoshigoui sp. nov., A. nigrofasciatus sp. nov., A. latifasciatus sp. nov., and A. aestuaricola sp. nov. These new species are now referred to the A. crassimanus species complex and compared with allied species, including those from outside the Indo-West Pacific. The Japanese records of A. heeia Banner & Banner, 1975 are all referred to A. nigrofasciatus sp. nov. Molecular phylogenetic analyses using two mitochondrial markers (16S rRNA and COI genes) have shown that two morphologically distinct morphs distinguished by the presence or absence of sclerotised setae on the mesial face of the third maxilliped carpus (= penultimate article) belong to the same species, A. nigrofasciatus sp. nov. The taxonomic identities of several lineages of Alpheus recovered in the phylogenetic analyses remain unresolved due to difficulties in accessing voucher specimens. References to A. lobidens and A. crassimanus have been reviewed as thoroughly as possible.

The associations between symptom characteristics and patients' interpretations and sources of knowledge about acute coronary syndrome (ACS) remains unclear. We enrolled 81 patients with ACS. Patients who misinterpreted their symptoms more frequently reported atypical features such as tenderness (13.3% vs 0%; P=0.028) and syncope (11.8% vs 0%; P=0.011). Common knowledge sources among patients who correctly interpreted their symptoms included television, healthcare professionals, and the internet without social media. Patients experiencing atypical symptoms often misinterpret them. Most knowledge sources for those who interpreted correctly were traditional.

Abstract Background While the thresholds of fractional flow reserve (FFR) and non-pressure hyperaemic ratios (NHPR) for identifying myocardial ischemia (≤0.75 for FFR, ≤0.89 for NHPR) and guiding coronary revascularization (≤0.80 for FFR, ≤0.89 for NHPR) are well established, the values associated with anginal symptoms and impaired exercise capacity in patients with chronic coronary syndrome (CCS) remain unknown. Purpose To identify the FFR and diastolic pressure ratio (dPR) thresholds associated with anginal symptoms and impaired exercise capacity in patients with CCS. Methods This prospective multicentre registry enrolled 208 patients with suspected CCS undergoing coronary angiography with invasive intracoronary pressure measurements at five institutions in our city, Japan. Patients with normal coronary arteries (n=12), coronary anatomies unsuitable for intracoronary pressure assessments (n=21), and one patient who did not undergo intracoronary pressure measurements were excluded, leaving 174 patients for analysis. All patients underwent a 6-minute walk test before cardiac catheterization, meaning that the test results were not influenced by prior knowledge of the severities of their disease. Anginal symptoms and 6-minute walk distance were assessed, with impaired exercise capacity defined as a walk distance below the expected distance based on age, sex, height, and body weight. The Youden index with receiver operating characteristic (ROC) curve analysis was used to determine the FFR and dPR thresholds associated with anginal symptoms and impaired exercise capacity. Results The median age of the patients was 73 [67, 77], and 78% were male. The median 6-minute walk distance was 395 m [325, 447]. Anginal symptoms were reproduced in 40 (23%) patients during the 6-minute walk test, and 39 (22%) had impaired exercise capacity. The median FFR was 0.73 [0.55, 0.85], and the median dPR was 0.85 [0.56, 0.93]. In ROC curve analyses, the area under the curve (AUC) for FFR in identifying anginal symptoms during 6-minute walk test was 0.68 [0.58, 0.79] (P<0.001), while that for dPR was 0.69 [0.59, 0.79] (P<0.001) [Fig.1]. The FFR threshold associated with anginal symptom was 0.53, with a sensitivity of 46% and specificity of 91%, while dPR threshold was 0.63, with a sensitivity of 51% and specificity of 85%. The AUC for FFR in identifying impaired exercise capacity was 0.55 [0.44, 0.66], and that for dPR was 0.56 [0.45, 0.67], indicating that neither FFR nor dPR was significantly associated with impaired exercise capacity (P=0.301 for FFR, P=0.257 for dPR, respectively) [Fig.2]. Conclusion The hemodynamic severity of coronary stenoses, as assessed by FFR and dPR, was associated with anginal symptoms but not with impaired exercise capacity. The FFR and dPR thresholds associated with anginal symptoms were lower than those typically used for ischaemia detection and revascularization decisions.

Background: Improving the anaerobic threshold (AT) provides benefits by avoiding overload, especially for patients with advanced COPD. However, the variables related to improving AT are poorly known. The aim of this study was to investigate which variables are related to improved AT after pulmonary rehabilitation (PR) using cardiopulmonary exercise testing (CPET). Methods: Stable patients with severe and very severe COPD who performed 4-week PR and whose ATs were identified both before and after PR were selected; they were divided into two groups based on whether the AT increased after PR, and their responses were compared. Results: In the 26 eligible subjects, there was no correlation between the mean change from baseline after PR in the inspired minus expired mean O2 concentrations (ΔFO2) and minute ventilation (V˙E) at peak exercise. Compared with the AT no-increase group, the AT increase group, at peak exercise, showed significant increases in peak oxygen uptake (V˙O2) and ΔFO2 but not in V˙E, after PR. The increase in V˙O2 at the AT after PR was well correlated with the mean change after PR in ΔFO2 at peak exercise (r = 0.66, P < .001), rather than V˙E. Of all the peaks and throughout exercise variables, ΔFO2 at peak exercise was identified as one of the variables more closely correlated with improved AT after PR. Conclusions: Improvement of ΔFO2 at peak exercise, rather than V˙E, correlated with an increased AT in subjects with advanced COPD, which suggests that improving ΔFO2 independent of V˙E may be a useful strategy to individualize PR.

Clinical pallor has traditionally served as a screening tool for anemia; however, its assessment lacks objectivity. Therefore, this study aimed to investigate the correlation between skin and mucosal color, as measured by a spectrophotometer, and venous hemoglobin (Hb) values, to identify the optimal anatomical assessment site for detecting anemia. A cross-sectional design. Ninety-two adult Japanese outpatients participated in the study. Using a spectrophotometer, the color of the lip and conjunctiva was measured indirectly, while the color of the nail, palm, and inside of the upper arm was measured directly. Colors were quantified using the L*a*b* color scale. This is an international color scale, where the L* value is an index of brightness, a* value is red/green, and b* value is yellow/blue. The color difference (Δ E*) was employed to evaluate the discriminability of anemia identification across different assessment sites. Additionally, Hb values were recorded, with anemia defined as Hb <12.0 g/dL. The a* values of the lip, conjunctiva, palm, and arm exhibited a positive correlation with Hb values and were significantly lower in the anemic group. While the Δ E* levels for the conjunctiva and lip were readily discernible by the human eye when comparing the normal and anemic groups, recognition at this level proved challenging for other sites. The conjunctiva and lip demonstrate potential suitability for visual diagnosis of anemia. In the nail, palm, and arm, anemia detection may require highly trained observation. Consequently, reliance on these sites for anemia diagnosis may lead to potential oversight.

Abstract The prevalence of work‐related mental disorders in Japan has been increasing in recent years, amplifying concerns surrounding the psychological wellbeing of Japanese employees. The aim of this psychometric study was to evaluate the mental health conditions of Japan's workforce by utilizing the Depression, Anxiety, and Stress Scale (DASS‐42), a widely known self‐reporting 42‐item questionnaire that measures depression, anxiety, and stress. A nationwide survey was performed with a research sample of N = 1,174 Japanese employees aged between 23 and 61 years (M = 34.86 years, SD = 5.71 years). The results indicate that the employees' psychological wellbeing aligns with the observed national increased prevalence of occupational health issues: depression scores exceeding the normal range were evident in 1,145 (97.53%) of the study participants, with 1,165 (99.23%) scoring above the normal range for anxiety and 1,037 (88.33%) for stress. The DASS‐42 mean scores indicate that Japanese employees are typically subject to severe depression, extremely severe anxiety, and moderate stress. It was also found from one‐way analysis of variance and the independent samples t‐test that psychological distress is more prevalent in women than in men, whereas age and education do not necessarily predict the development of depression, anxiety, and stress. However, it was observed that individuals working in certain occupation sectors, such as agriculture and finance, may be at a heightened risk of developing mental disorders.

【目的】脂肪肝疾患（Steatotic Liver Disease：SLD）は，肝疾患のみならず2型糖尿病や心血管疾患と関連が指摘されており，早期発見が重要である．本研究では，地域住民を対象とした健康啓発活動の一環として，Point-of-Care Ultrasound（POCUS） を活用した脂肪肝チェックの有用性を検討した．【対象と方法】2023年10月～2024年3月の期間に，市民対象イベント計3回でブースを設営し，携帯型超音波装置を用いたPOCUS脂肪肝スクリーニングを実施した．脂肪肝の判定は，超音波検査士および超音波専門医が肝腎コントラストを基準に評価した．さらに，被検者には聞き取り形式のアンケート調査を行った．【結果と考察】検査対象123例（男性75例，女性48例）のうち，脂肪肝は43例（35％）であった．脂肪肝群はBMIが有意に高く（25.3 vs 21.2 kg/m2，p < 0.001），運動習慣のない割合も高い傾向があった（66.7％ vs 44.3％，p = 0.065）．また，53例（43.1％）は超音波検査を初めて受ける症例であった．【結論】POCUS脂肪肝スクリーニングは，一般市民を対象とした健康啓発活動において，超音波検査未経験者への機会提供と脂肪肝の発見に有用と示された．今後，地域医療や予防医学の分野において，POCUSの活用が期待される．

Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.