Juntendo University

With the advent of disease-modifying therapies for Alzheimer's disease, there is a growing demand for more cost-effective methods that predict amyloid PET positivity. In Japan, the combination of structural brain MRI and regional cerebral blood flow (rCBF) single-photon emission computed tomography (rCBF SPECT) is routinely used in clinical practice for neuroimaging. The present study investigated the utility of this imaging approach for amyloid PET positivity in real-world clinical settings. A retrospective analysis of 101 patients who visited the Memory Clinic at Juntendo University Hospital between April 2019 and September 2023 was performed. All patients had undergone amyloid PET imaging at their own expense, in addition to a neuropsychological assessment, structural brain MRI and rCBF SPECT. Among 58 cases that underwent a voxel-based specific regional analysis system for Alzheimer's disease (VSRAD), volumetric differences between the amyloid-positive and -negative groups were assessed using Statistical Parametric Mapping (SPM) version 12. Among the 101 patients analysed, 68 were positive and 33 were negative for amyloid. Twenty-nine patients had a change in clinical diagnosis after amyloid PET imaging, which affected subsequent management. Using VSRAD, VOI severity (continuous value) was set to 0.95 based on Youden's index and AUC (95% CI) was 0.72 (0.572-0.867), with a sensitivity of 90%, specificity of 52% and accuracy of 78%. In the visual assessment, MRI and rCBF SPECT were combined, and AUC (95% CI) was 0.767 (0.629-0.905), with a sensitivity decrease to 21% and specificity increase to 95%. The SPM12 analysis revealed clusters in the right medial temporal lobe at an uncorrected threshold (p < 0.001). However, no voxels survived family-wise error (FWE) correction (p < 0.05). A VSRAD analysis of brain MRI has moderate discriminatory ability as a screening tool for predicting amyloid PET positivity. The addition of SPECT to MRI was not associated with a statistically significant improvement compared with MRI alone. SPECT may contribute to the differential diagnosis of non-Alzheimer's disease. MRI alone could be considered an option to increase the pre-test probability of amyloid PET positivity.

Exercise therapy is important for exercise tolerance, for the prevention of frailty or sarcopenia, and to improve quality of life (QOL). Previous studies, including systematic reviews, have shown the efficacy of exercise therapy for kidney transplant recipients (KTRs), but the optimal types of exercise remain unclear. Therefore, we aimed to synthesize the published evidence and compare the efficacy of types of exercise. We systematically searched for randomized controlled trials of the efficacy of exercise therapy in KTRs on PubMed and Ichushi, then performed a meta-analysis. Exercise was categorized as aerobic training (AT), resistance training (RT), or AT + RT. The risk of bias was assessed using ROB2 and the certainty of the evidence was evaluated using the GRADE approach. Twenty-five studies were included in the study and 18 in the meta-analysis. Exercise was associated with significant improvements in QOL (SF-36 physical functioning score), cardiorespiratory function (VO2peak), physical function (performance in the 6-min walk test (6MWT) and sit/stand test (STS)), and a metabolic index (triglyceride concentration). Kidney function tended to be superior in the exercise group, but the difference was not significant. Other indices of glucose and lipid metabolism and the incidence of hospitalization did not differ between the Exercise and Control groups. AT + RT significantly improved VO2peak, 6MWT performance, and the triglyceride concentration, whereas AT alone did not improve VO2peak and RT alone did not improve 6MWT performance or the triglyceride concentration. The certainty of the evidence was generally "low" or "very low". Exercise therapy improved the QOL, cardiorespiratory function, physical function, and triglyceride concentration of KTRs. The AT + RT combination may be the most effective exercise therapy for such patients.

• Eye-tracking identifies gaze patterns linked to judgment and situational awareness. • This review clarifies how gaze metrics inform design, assessment, and skill learning. • Findings guide simulation design and feedback to strengthen clinical reasoning skills. To synthesize how eye-tracking technology has been applied in nursing simulation and identify its contributions to educational design, learner assessment, and skill development. A scoping review following the Arksey and O’Malley framework and PRISMA-ScR guidelines. PubMed, EBSCOhost, Scopus, and Web of Science were searched (September 2025), supplemented by manual screening. Eligible studies involved nursing participants, used eye-tracking as a primary method, and were conducted in simulation-based learning settings. Fourteen studies met the inclusion criteria. Three themes emerged: (1) expert-novice gaze pattern differences, showing broader AOI coverage and more efficient scanning among experts; (2) cognitive-load indicators such as pupil dilation and fixation duration that varied by task complexity and experience; and (3) gaze-based feedback that enhanced reflective learning using visualizations, including heatmaps and gaze replays. Eye-tracking provides objective insight into learners’ cognitive processes, supporting improved simulation design, assessment of clinical judgment and situational awareness, and the extraction of teachable visual-scanning strategies. Standardization and multimodal approaches are needed to advance future research.

Platelet-rich plasma (PRP) is plasma with a high platelet concentration, prepared from whole blood. PRP can suppress disuse muscle atrophy, enhance muscle function, and promote muscle recovery. This study aimed to evaluate the effects of PRP on the recovery process following hindlimb unloading (HU)-induced muscle atrophy in mice. Fourteen-week-old male C57BL/6J mice (n = 18) underwent HU for two weeks. The mice were then randomly divided into three groups: HU (n = 5), saline (SA, n = 7), and PRP (n = 6). In the HU group, the gastrocnemius muscles were excised immediately after HU. In the SA and PRP groups, the gastrocnemius muscles were excised after a one-week recovery period following HU. Additionally, in the cage control (CON) group (n = 9), the gastrocnemius muscles were excised without HU procedure. After two weeks of HU, saline or PRP was injected into the gastrocnemius muscle of the right leg (treated side) in the SA or PRP groups, respectively, whereas a sham injection was administered into the left leg (sham side). Only the PRP group showed significantly higher muscle weights and larger cross-sectional areas of type IIA and IIX muscle fibers on the treated side than on the sham side after recovery. These findings suggest that a single injection of PRP can enhance the recovery of fast-twitch muscle fibers following HU-induced disuse atrophy.