Higashihiroshima Medical Center

Direct evidence for the assimilation of nitrous oxide (N₂O), a potent greenhouse gas, by freshwater cyanobacteria has been lacking. Here, we report a cyanobacterium, isolated from a nitrogen-polluted river, that fixes N2O via dinitrogen (N2) gas by nitrogenase activity. N2O-reducing bacteria were enriched from river samples, under alternating light/dark conditions in the presence of atmospheric N2 and the absence of oxygen (O2), followed by isolation using fluorescence-activated cell sorting. The isolated strain, Nostoc sp. strain MS1 (NIES-4466), consists of moniliform coccoid cells and is phylogenetically affiliated with the genus Nostoc. A high-quality draft genome of strain MS1 revealed the presence of nitrogenase genes encoding the MoFe protein but the absence of N2O reductase genes, i.e., clades I, II, and III nosZ. When incubated in a He (95%)/CO2 (5%) atmosphere with 0.01% 15N-labeled N2O, the cells exhibited elevated 15N content relative to natural abundance (0.36%). The degree of 15N incorporation positively correlated with ethylene production from acetylene, implicating nitrogenase in N2O assimilation by strain MS1. While replacing He with N2 reduced N2O uptake, likely due to substrate competition, N2O consumption activity persisted, suggesting that freshwater cyanobacteria can function as an N2O sink. These findings, supported by genomic and 15N tracer analyses, highlight the previously unrecognized role of cyanobacteria in mitigating N₂O emissions in freshwater environments.

Athelges pileus sp. nov. is described as an abdominal bopyrid of the hermit crab Diogenes edwardsii collected from the Noto Peninsula, Japan. Athelges pileus sp. nov. is distinguished from its congeners by the following combination of characters. Female: head deeply sunk in thorax, anterolateral margin of head with pair of notches; anterior margin of frontal lamina concave; merus of pereopod 1 with broad and long projection ventrally; pereopods 5 and 6 with large gap between them; pleomeres 1-4 each with subovate biramous pleopods; each pleopod with peduncle, becoming smaller posteriorly; pleotelson with mushroom-shaped end. Male: pleon subovate with anal cone distally. The present species is the 14th member of the genus Athelges, and the second species from Asia. This is the second species of Athelges infesting Diogenes edwardsii. We also provide a partial sequence of the mitochondrial cytochrome c oxidase subunit 1 (COI) gene (658 bp), mitochondrial 16S rRNA gene (482 bp), and nuclear 18S rRNA (724 bp) as a DNA barcode for the species. We show by molecular phylogenetic analysis that the present species is distinct from A. takanoshimensis.

Recent studies have demonstrated that breast pathological complete response (pCR) can be accurately diagnosed preoperatively using image-guided needle biopsy after neoadjuvant chemotherapy (NAC), underscoring the value of incorporating ypT stage into prediction models for axillary response (ypN0). Based on this evidence, we developed and externally validated a nomogram to predict ypN0 in patients with clinically node-positive (cN+) breast cancer treated with NAC. This retrospective, multicenter study included 609 patients with cN + breast cancer who underwent NAC followed by surgery. A nomogram was developed using a training cohort (n = 330) and validated in an independent cohort (n = 279). Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and positive predictive value (PPV). The nomogram incorporated five predictors: ypT stage, cN stage, hormone receptor status, HER2 status, and post-NAC cN stage. It showed strong discriminative ability, with bias-corrected AUCs of 0.858 in the training cohort and 0.855 in the validation cohort. Calibration and DCA confirmed good model performance. PPV exceeded 0.90 when the nomogram-predicted probability was ≥ 0.7 in both cohorts. This nomogram demonstrated high diagnostic accuracy for predicting ypN0 and may support the selection of candidates for axillary surgery de-escalation based on post-NAC biopsy findings. Prospective validation using biopsy-confirmed pCR is warranted.

Background: Artificial Intelligence (AI) has the potential to revolutionize healthcare by enhancing diagnostic accuracy, streamlining administrative tasks, and improving patient care. However, the integration of AI into clinical practice faces significant barriers, particularly in nursing. Nurses, like frontline healthcare providers, are uniquely positioned to observe and experience these challenges. Understanding their perspectives can offer valuable insights into the obstacles hindering AI adoption in nursing practice, especially within acute care settings. Aims: This study aimed to explore the perceptions of nurses regarding the barriers to integrating AI technologies into clinical practice. Design: A qualitative design. Methods: A qualitative phenomenological approach was employed to capture nurses lived experiences. Twenty nurses were recruited through purposive sampling from 20 healthcare institutions (eight tertiary care hospitals, eleven general hospitals, and one district hospital) in Dhaka, Bangladesh. Data were collected over a three-month period (April to June 2025) using semi-structured interviews and focus group discussions. Transcripts were analyzed using van Manen’s reflective methodology. The conceptual framework incorporated the Technology Acceptance Model, emphasizing perceived usefulness and ease of use, while also considering the cultural and infrastructural context. Results: The study identified three major themes: (i) knowledge and awareness gaps, (ii) organizational barriers, and (iii) ethical and interpersonal concerns. Nurses highlighted a lack of AI-focused education, inadequate institutional support, and concerns about privacy and dehumanization of care. Misconceptions about AI's capabilities and exclusion from AI-related decision-making processes further contributed to resistance and skepticism. Conclusions: The study underscores the need for targeted reforms in nursing education to include comprehensive AI training. Addressing organizational and ethical barriers, such as providing adequate resources, robust privacy measures, and inclusive policies, is crucial. By empowering nurses and fostering interdisciplinary collaboration, healthcare systems can leverage AI effectively while preserving human-centered care.

<bold>Background:</bold> Drug-induced lung injury associated with lung cancer chemotherapy is a serious adverse event that can complicate treatment management and worsen prognosis. However, there are limited reports on the usefulness of serum SP-D and KL-6 in drug-induced lung injury related to lung cancer drug therapy. We aimed to investigate the clinical significance of serum SP-D and KL-6 in this condition. <bold>Method:</bold> We conducted a retrospective study of 121 patients who had serum SP-D and KL-6 measured at the time of diagnosis of drug-induced lung injury at our hospital and collaborating institutions. SP-D and KL-6 levels at disease onset were analyzed using descriptive statistics. We defined the differences between the values at onset and those at the initiation of lung cancer drug therapy as ⊿SP-D and ⊿KL-6, respectively. ROC analysis and multivariate analysis were performed to assess their association with disease severity, comparing CTCAE pneumonitis severity Grade 1–2 and Grade 3–5 groups. <bold>Results:</bold> In ROC analysis, the AUC for ⊿SP-D and ⊿KL-6 were 0.66 and 0.50, respectively. The optimal cutoff values were 108 for ⊿SP-D and 141 for ⊿KL-6. In multivariate analysis, the odds ratios of ⊿SP-D and ⊿KL-6 above the cutoff values were 3.8 and 0.9, respectively, with ⊿SP-D showing a statistically significant difference. <bold>Conclusion:</bold> SP-D and KL-6 may be useful biomarkers for diagnosing drug-induced lung injury and can be detected with high sensitivity when used in combination. We also report on its potentially important role in disease assessment, and severity prediction.

<bold>Background and Aim:</bold> The role of airway mucus plugging in asthma pathophysiology is well-established. However, its relationship with infectious episodes and type 2 inflammation remains unclear in refractory asthma with bronchiectasis. As part of the BEXAS study (Nomura N, et al. <italic>Respir Res</italic> 2022; 23: 365), this study aimed to clarify the association between mucus plugging, infectious episodes, and type 2 inflammation, with a specific focus on plug location. <bold>Methods:</bold> Patients with refractory asthma complicated by bronchiectasis, but not with allergic bronchopulmonary aspergillosis, were included, if they had high-resolution CT images suitable for mucus score evaluation. Mucus plugging was scored separately for bilateral upper and lower lobes, as well as for the total lung. Cluster analysis was performed using mucus scores in the upper and lower lobes and the number of lobes affected by bronchiolitis. <bold>Results:</bold> Forty-two patients were included, and three distinct clusters were identified. CL 1 (n = 14) was characterized by lower-lobe-dominant mucus plugs, the highest number of bronchiolitis-affected lobes, frequent detection of Pseudomonas, systemic corticosteroid-requiring exacerbations, and bronchopneumonia. This cluster also exhibited the lowest FeNO and %FEV1. CL 2 (n = 6) showed high mucus scores in both lower and upper lobes, along with the highest FeNO levels. CL 3 (n = 22) had the lowest mucus scores overall. The degree of bronchiectasis was comparable among the three clusters. <bold>Conclusions:</bold> Lower-lobe-dominant mucus plugs may reflect the severest phenotype, characterized by frequent bronchiolitis involvement and infectious episodes. The location of mucus plugs may be clinically important.

The process of intelligent library construction is advancing, and readers' demand for personalized information services is growing.Traditional recommender systems do not fully consider the temporal characteristics of users' borrowing behavior, resulting in limited recommendation accuracy.Meanwhile, challenges such as user interest evolution and cold-start problem constrain the improvement of library service quality.OBJECTIVE: To construct an intelligent library personalized information recommendation system based on temporal data analysis in response to the problem of underutilization of temporal features in library personalized recommendation systems.Methods: Adopt convolutional neural network for local characterization of time-series data, and extract local features of user-item scoring matrix through normalization and similarity calculation; design personalized recommendation model based on BiLSTM, integrate Embedding layer and multilayer perceptron, and extract features of readers' borrowing preference using bidirectional long and short-term memory network; construct recommendation system with B/S architecture, adopt MVC three-layer architecture and J2EE technology to realize the system functions.RESULTS: The experiments show that in the sparsity interval of 0.7-0.9, the accuracy of CNN local similarity prediction is higher than the Euclidean distance and Pearson correlation coefficient methods; the BiLSTM model achieves the optimal performance at the learning rate of 0.001, 2-layer network, and batch size of 256, with the MAE value of 0.787; compared with the UserCF, ItemCF and ConvMF algorithms, the proposed algorithm performs optimally in 10 experiments.CONCLUSION: The recommender system based on temporal data analysis effectively improves book recommendation accuracy and provides technical support for personalized library services.

Rationale: Patients with noncavitary nodular bronchiectatic (NB) Mycobacterium avium complex pulmonary disease (MAC-PD) are treated intermittently three times per week, although no randomized controlled trials have been conducted comparing three times weekly with daily therapy. Objectives: To assess the tolerability, safety, and efficacy of intermittent versus daily treatment in patients with previously untreated noncavitary NB MAC-PD. Methods: In an open-label study, patients were randomly assigned to the intermittent therapy group receiving clarithromycin 1,000 mg, rifampicin 600 mg, and ethambutol 25 mg/kg (maximum 1,000 mg) three days per week or the daily therapy group receiving clarithromycin 800 mg, rifampicin 450 mg, and ethambutol 15 mg/kg (maximum 750 mg) daily for 1 year. The primary endpoint was the proportion of patients requiring modification of the initial treatment regimen. Results: Twenty-one Japanese hospitals participated in the study, enrolling 141 patients between May 2019 and December 2021. The full analysis set included 138 participants (intermittent therapy = 70; daily therapy = 68). There were no significant differences between the intermittent and daily therapy groups in terms of the regimen modification rate (20.0% [14 of 70] vs. 33.8% [23 of 68]; adjusted odds ratio, 0.48; 95% confidence interval, 0.22 to 1.05; P = 0.06) or culture conversion (70.3% vs. 80.0%; P = 0.53), time to culture conversion (28.0 vs. 28.5 d; P = 0.89), improvement in chest CT findings (60.9% vs. 71.0%; P = 0.30), or clarithromycin resistance development (1.4% vs. 0%; P = 1.00). Elevated aspartate aminotransferase (16.9% vs. 41.2%; P = 0.003) and alanine aminotransferase (18.3% vs. 44.1%; P = 0.002) were more common in the daily treatment group, whereas elevated bilirubin (11.3% vs. 1.5%; P = 0.04) and dysgeusia (14.1% vs. 1.5%; P = 0.01) were more common in the intermittent treatment group. The daily treatment group exhibited a greater absolute change in the 36-Item Short Form Health Survey physical aspect score (-2.5 points) than the intermittent treatment group (2.1 points) (P = 0.01). Conclusions: Intermittent treatment was not significantly better tolerated than daily treatment for noncavitary NB MAC-PD. However, further studies with larger numbers of patients are needed. Clinical trial registered with https://jrct.mhlw.go.jp/en-top (jRCTs031190008).

Background/Objectives: We define severe postpartum hemorrhage (PPH) with macroscopic hematuria as clinical disseminated intravascular coagulation (DIC), a life-threatening condition. We also report a methodology using machine learning, a subtype of artificial intelligence, for developing the boundary criterion for predicting hematuria on the fibrinogen-fibrin/fibrinogen degradation product (FDP) plane. A positive FDP-fibrinogen/3-60 (mg/dL) value indicates hematuria; otherwise, non-hematuria is observed. We aimed to validate this criterion using severe placental abruption (PA), and to examine the activation of the coagulation-fibrinolytic system in clinical DIC. Methods: Of 17,285 deliveries across nine perinatal centers in Japan between 2020 and 2024, 13 had severe PA without hematuria, 18 had severe PPH without hematuria, and 3 had severe PPH with hematuria, i.e., clinical DIC. We calculated the values of the criterion formula for 13 cases of severe PA to validate the boundary criterion and compared the laboratory tests for coagulation-fibrinolytic activation among the three groups. Results: The calculated values using the criterion for the 13 PA without hematuria ranged from -108.91 to -5.87 and all were negative. In cases of clinical DIC, fibrinogen levels (median, 62 mg/dL) were lower (p < 0.05), while levels of FDP (96 mg/dL), the thrombin-antithrombin complex (120 ng/mL), and the plasmin-α2-plasmin inhibitor complex (28.4 μg/mL) were significantly higher than in the other two groups. Conclusions: This study demonstrated the validity of the boundary criterion for predicting hematuria using severe PA. The coagulation-fibrinolytic test results suggested that PPH cases with hematuria were assumed to have clinical DIC, indicating that this criterion may be considered for diagnosing DIC during delivery. However, further additional patient data are needed to confirm the usefulness of this criterion because of the very low number of hematuria cases.

Elevated serum IgG4 is a key diagnostic marker for type 1 autoimmune pancreatitis (AIP), but some patients lack IgG4 elevation, complicating diagnosis. This study investigated the clinicopathological features of AIP without elevated serum IgG4 levels. A total of 323 patients diagnosed with AIP at Hiroshima University Hospital and affiliated institutions were analyzed. Patients were categorized into IgG4-positive (≥ 135 mg/dL), IgG4-negative (< 135 mg/dL with “definite” or “probable” diagnosis), and possible (with “possible” diagnosis) groups. Comparative analysis was performed between the IgG4-positive (n = 281) and IgG4-negative (n = 20) groups. Segmental or focal narrowing of the main pancreatic duct (MPD) and retroperitoneal fibrosis were significantly more common in the IgG4-negative group (90.0% vs. 58.7%, P = 0.011; and 35.0% vs. 12.5%, P = 0.012, respectively). Although the number of pathological findings was comparable, the rate of surgical intervention was significantly higher in the IgG4-negative group (P < 0.001). No significant differences were observed in relapse rates or relapse sites between the two groups. These findings suggest that MPD narrowing and retroperitoneal fibrosis may be characteristic of AIP without elevated IgG4. Vigilant monitoring for relapse is warranted, regardless of serum IgG4 levels.