Kisarazu Hospital

Background: cardiopulmonary resuscitation (CPR) is crucial for survival in patients with out-of-hospital cardiac arrest (OHCA). Therefore, it is imperative to study factors that may modify the effectiveness of CPR. Bystander CPR is one of the most powerful first-aid techniques, and many have debated the factors that hinder its initiation. Female gender has been associated with a reduced likelihood of receiving CPR in public; however, no studies have investigated how gender may influence the effectiveness of CPR. Hypothesis: gender modifies the survival benefit of bystander CPR in OHCA. Methods: this multicenter prospective cohort study collected data from September 2019 through March 2021. Information on OHCA characteristics and patient care was gathered by 42 facilities located in the Kanto region of Japan. Terminology and definitions followed the Utstein templates and relevant international guidelines. Adult patients aged 18 and older were included, while those with missing information on gender, witness status, or bystander CPR were excluded. The primary outcome was 30-day survival. Crude statistics were used to compare survival rates by gender (women and men) between patients who did and did not receive bystander CPR. Cox proportional hazards regression was employed to adjust for potential confounders, including age, location of OHCA by prefecture, time of OHCA occurrence, witnessed arrest, initial rhythm, cause of cardiac arrest, and the use of therapeutic hypothermia. Results: out of a total of 9,909 patients, 9,081 were included in the analysis. Of these, 3,459 were women and 5,622 were men. A higher proportion of women received bystander CPR (n = 1,582; 45.5%) compared to men (n = 2,399; 42.7%; p = 0.004). Among women, the survival rate was 5.4% for those who received bystander CPR and 3.4% for those who did not, yielding a risk ratio of 1.6. In men, the corresponding survival rates were 11.0% with bystander CPR and 4.5% without, with a risk ratio of 2.4. The hazard ratio (HR) of bystander CPR for 30-day survival was 1.3 in women (95% CI: 0.9–1.9; p = 0.124) and 1.5 in men (95% CI: 1.2–1.9; p < 0.001). Conclusions: in this study setting in Japan, women received bystander CPR in numbers similar to those of men when OHCA occurred. However, the increase in the chance of survival from bystander CPR for women appeared to be not as high as that for men.

Conventional methods for diagnosing dysphagia often involve invasive procedures, limiting both their accessibility and ease of use. As a result, there is an increasing demand for simple, noninvasive screening techniques. In recent years, automatic classification methods that use machine learning to analyze acoustic features of swallowing sounds have gained attention due to their low burden on patients. However, traditional approaches using support vector machines (SVMs) or 2D convolutional neural networks (2D-CNNs) have yet to achieve sufficient classification accuracy. In this study, we propose a dysphagia classification method based on a 1D convolutional neural network (1D-CNN), considering the limited availability of training data. A binary classification was performed to distinguish between patients with dysphagia, primarily elderly individuals, and healthy elderly participants. By combining log-scalograms with a 1D-CNN architecture, the proposed method outperformed existing techniques in classification performance. Moreover, Grad-CAM visualization revealed that the model focused on the second swallowing sound, which aligns with previous medical findings that emphasize its clinical significance.

To ensure a consistent supply of high-quality agricultural products, managing environmental factors like temperature, humidity, and light is crucial. Plant factories are emerging as practical solutions for creating controlled environments. Our laboratory has developed a system to manage temperature and vapour pressure deficit (VPD), enabling precise control of mist cooling. Understanding the relationship between plants and water is vital, especially in adapting to regional conditions and quality targets. This study introduces an IoT system that measures VPD and weight changes due to transpiration, allowing for calculating transpiration rates and vapour conductance without damaging the plants. We measured leaf area using both destructive and nondestructive methods. Results indicated that leaf area could be estimated through destructive inspection by applying a derived equation from nondestructive methods. Additionally, we tracked weight changes from transpiration over time and derived growth rate curves. When VPD increased by 1.19 to 1.68 times compared to normal, water vapour conductance decreased by 0.42 to 0.77 times. This study highlights that transpiration is active at moderate VPD levels, but excessive VPD may trigger stomatal closure, indicating a complex interplay between environmental conditions and plant physiology.

Adjuvant anti-PD-1 (adj PD-1) antibodies are extensively used to improve survival in patients with resected melanoma. Clinical trials on adj PD-1 antibodies have revealed significant improvements in recurrence-free survival (RFS); however, few of these trials have included patients with acral melanoma (AM). Clinical data were retrospectively collected from Japanese patients who underwent resection of stage III sole AM between 2014 and 2021. Survival outcomes, including RFS, distant metastasis-free survival (DMFS), and overall survival (OS), were compared between patients without adjuvant therapy (OBS group) and those receiving adj PD-1 group. This study included 139 patients (OBS: 79; adj PD-1: 60), with a median follow-up of 2.6 years. The baseline characteristics were comparable, except for age and nodal metastasis. No significant differences in survival were observed between the OBS and adj PD-1 groups (3-year RFS: 36.7% v 27.5%, P = .13; 3-year DMFS: 51.0% v 45.3%, P = .51; 3-year OS: 65.3% v 67.4%, P = .45). Multivariate analysis showed no survival benefit of adj PD-1 (RFS: hazard ratio [HR], 1.25, P = .29; DMFS: HR, 1.03, P = .89; and OS: HR, 0.69, P = .23). Each survival outcome after propensity score matching confirmed no significant difference between the matched OBS group (n = 52) and adj PD-1 group (n = 52; 3-year RFS: 34.3% v 25.9%, P = .22; 3-year DMFS: 45.6% v 46.5%, P = .85; 3-year OS: 60.7% v 68.9%, P = .29). Adj PD-1 did not improve the prognosis in sole AM. However, further studies are essential to evaluate the efficacy of the adj anti-PD-1 antibody in AM.

Bone marrow examination is essential for the definitive diagnosis of myelodysplastic neoplasms (MDS). However, non-invasive diagnostic approaches are needed for patients who cannot tolerate the procedure, especially elderly patients. This study aimed to validate the diagnostic accuracy of non-invasive gradient-boosted models (GBMs) in Japanese patients with MDS. When used alone, GBMs had sensitivity of 63.2% and specificity of 43.9% for diagnosis of MDS. When combined with WT1 mRNA expression levels (WT1 levels)(cutoff: 150 copies/µg RNA), specificity remained similar at 50.0%, while sensitivity improved to 81.6%. MDS was correctly diagnosed in 87.2% of patients with probable or indeterminate MDS by GBMs who had WT1 levels higher than 150 copies/µg RNA. When patients with vitamin B12 deficiency were excluded from analysis, this percentage increased to 91.9%. These findings suggest that the combination of GBMs, WT1 levels, and vitamin B12 deficiency could non-invasively identify patients likely to have MDS.

Acute myeloid leukemia (AML) is an aggressive hematological malignancy with genetic alterations. The FMS-like tyrosine kinase 3 (FLT3) gene is frequently mutated in adult de novo AML, with two types of mutations: internal tandem duplication (ITD) and point mutations in the tyrosine kinase domain. This study aimed to investigate the impact of FLT3 inhibitors and hematopoietic cell transplantation (HCT) on survival outcomes in patients with FLT3-ITD AML in a real-world setting. We retrospectively analyzed 139 patients with FLT3-ITD-positive AML between 2012 and 2021. The median age was 63 years. In the propensity score-matched cohort, FLT3 inhibitors improved overall survival (OS) compared with patients treated without FLT3 inhibitors (3-year OS: 33.7% vs. 25.8%, p = 0.021). Patients who underwent HCT had superior outcomes to those without HCT (3-year OS: 45.3% vs. 2.2%, p < 0.0001). The combination of FLT3 inhibitors and HCT resulted in the highest OS and relapse-free survival (RFS) rates (3-year OS: 62.4%; 3-year RFS: 44.4%). Disease status before transplantation did not predict the prognosis, but use of FLT3 inhibitors increased survival in patients without complete remission before HCT. These results demonstrate the clinical impact of FLT3 inhibitors on survival outcomes in patients with FLT3-ITD-positive AML, particularly when combined with HCT. FLT3 inhibitors can improve the prognosis of AML with FLT3 mutations, especially in patients who undergo HCT.