Sakai Municipal Hospital

Generalized seizures in heatstroke have traditionally been interpreted as a clinical sign of severe central nervous system involvement. However, it remains uncertain whether seizures documented early in the disease course uniformly reflect irreversible injury or may be observed in patients with preserved short-interval physiologic responsiveness. We aimed to characterize early physiologic trajectories associated with early seizures and to explore their association with in-hospital mortality. We conducted a retrospective nationwide cohort study of adults hospitalized with heat-related illness in the Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance (JAAM-HsS) registry from 2017 to 2024. Early seizures were defined as generalized seizures observed or documented during prehospital transport or the initial emergency department assessment. The primary objective was to compare Day 1-Day 2 short-interval trajectories of key metabolic, electrolyte, and fluid-balance markers by early seizure status using linear mixed-effects models, focusing on seizure-by-time interactions. In-hospital mortality was evaluated as a secondary observational outcome using prespecified multivariable logistic regression (with vs. without lactate) and 1:1 propensity score matching, with attention to negative confounding and survivorship-related bias. Of 3,859 patients, 408 (10.6%) had early seizures. Patients with early seizures exhibited greater initial derangement (higher body temperature and lactate and lower base excess) yet showed more rapid short-interval normalization of base excess, lactate, glucose, and serum sodium by Day 2 (all interaction p < 0.05). In-hospital mortality was 180/3,451 (5.2%) without early seizures and 27/408 (6.6%) with early seizures. In multivariable models adjusting for measured covariates, early seizures were inversely associated with mortality (lactate-included: aOR 0.48, 95% CI 0.27-0.86; lactate-excluded: aOR 0.57, 95% CI 0.33-0.99). This inverse association was directionally consistent after propensity score matching. Early seizures in heat-related illness were associated with a distinct short-interval trajectory phenotype that may help calibrate early prognostication. An inverse association with in-hospital mortality was observed in adjusted and covariate-balanced analyses; however, this should be interpreted as a secondary marker-outcome association and may reflect residual or negative confounding, including differential seizure ascertainment among the most moribund patients. These findings are hypothesis-generating and warrant prospective validation with higher-granularity neurologic and treatment data.

<title>Abstract</title> <bold>Objectives:</bold> To develop a revised version of the Professional Identity Scale for Physiotherapists and clarify core elements of professional identity among Japanese physiotherapists. <bold>Design:</bold> A nationwide cross-sectional web-based survey. <bold>Setting:</bold> The survey was conducted across 499 institutions employing physiotherapists in Japan. <bold>Participants:</bold> A total of 1 <bold/> 037 physiotherapists participated in the study (mean age = 32.3 years; 68.5% male, 31.0% female, and 0.5% unspecified gender). <bold>Main outcome measures:</bold> Primary outcome measures were the factor structure and internal consistency of the newly developed Professional Identity Scale for Physiotherapists. Secondary outcome measure included correlations between this scale and the Burnout Scale to assess criterion-related validity. <bold>Results:</bold> Exploratory factor analysis yielded a five-factor structure (“Development of and Contribution to the Professional Group,” “Practical Skills,” “Client-Centered Support,” “Sense of Adaptability,” and “Orientation Toward Contributing to Interprofessional Collaboration”) comprising 28 items, after excluding 9 items from the original 37-item version. Cronbach’s α coefficient ranged from 0.85 to 0.92 for the five factors, with an overall value of 0.96. Criterion-related validity was evidenced by significant correlations with the Burnout Scale: the total identity score was negatively correlated with emotional exhaustion ( <italic>r</italic> = -0.322, <italic>p</italic> &lt; 0.001) and depersonalization ( <italic>r</italic> = -0.281, <italic>p</italic> &lt; 0.001) and positively correlated with personal accomplishment ( <italic>r</italic> = 0.498, <italic>p</italic> &lt; 0.001). <bold>Conclusions:</bold> The revised Professional Identity Scale for Physiotherapists is a reliable and valid instrument for assessing professional identity among physiotherapists. It provides a practical framework for research and educational initiatives aimed at fostering professional identity and mitigating burnout. In addition, the scale may contribute to curriculum development, competency-based training, and international comparative studies focused on professional identity within the health professions.

Almost 10% of all pregnant women are diagnosed with placental location abnormalities (PLA), including placenta previa and low-lying placenta; however, most of PLA resolve as pregnancy process. Despite of placental migration, postpartum hemorrhage (PPH) is often experienced in those cases. The association between the timing of placental migration and the risk of PPH has remained unclear. The aim of this study is to investigate the relationship between the timing of placental migration and the PPH, and to establish a cutoff value to accurately predict the risk of PPH in cases who underwent the placental migration during course of pregnancy. This was a retrospective cohort study using electronic medical records in Osaka University Hospital (Japan). Patients diagnosed with PLA after 22 gestational weeks using transvaginal ultrasonography were eligible for inclusion. All patients delivered at our hospital between 2009 and 2022. Focusing on the cases in which placental migration (more than 2 cm away from the internal cervical os) were observed, the association between the timing of placental migration and the PPH was investigated only in vaginal delivery using the multivariate analyses with collecting covariates that could affect the PPH. Based on the results, receiver operating characteristic curves were generated to determine the optimal cutoff for the number of weeks of placental migration to predict PPH. One hundred and forty-five patients were diagnosed with PLA after 22 gestational weeks and delivered at our hospital between 2009 and 2022. Seventy-six after-placental migration cases with successful vaginal delivery were analyzed. The median gestational age of placental migration was 32 weeks, and the median amount of hemorrhage during delivery was 777 mL. PPH (500-1000 mL) occurred in 34 cases (44.7%), >1000 mL in 26 (34.2%). In the univariate analysis, a positive correlation was observed between the timing of placental migration and the amount of hemorrhage (r=0.365, P<.01). Furthermore, multivariate analysis showed that the timing of placental migration is the most strongly influential covariate (standardized partial regression coefficient: 0.31, P=.0036) for predicting the amount of hemorrhage. In addition, the timing of placental migration was a significant risk for PPH (more than 500 mL) (adjusted unit OR 1.26 [95% CI: 1.07-1.49]). The receiver operating characteristic curve indicated that the moderate cutoff of the timing of placental migration to predict the risk of PPH (more than 500 mL) was 29 gestational weeks. In comparison between the groups in which placental migration was confirmed before 29 gestational weeks (n=19) and after 30 gestational weeks (n=57), the incidences of PPH (more than 500 mL) were significantly higher in the group in which placental migration was confirmed after 30 gestational weeks (52.6% vs 87.7%, P=.0012). The timing of placental migration is positively correlated with the occurrence of PPH. In particular, cases in which placental migration is confirmed after 30 gestational weeks should be monitored carefully as high risk for PPH, as the risk of PPH is not eliminated.

Background/AimImmune checkpoint inhibitors (ICIs) have become central in the treatment of non-small cell lung cancer (NSCLC). The occurrence of immune-related adverse events (irAEs) is a critical issue in the management of patients with NSCLC receiving ICIs. Recent studies have suggested that patients who develop irAEs may have a better prognosis than those who do not. However, the most problematic cases involved the development of severe irAEs. This study aimed to investigate the clinical impact of severe irAEs (grade ≥3) in patients with NSCLC treated with ICIs.Patients and MethodsWe analyzed 122 patients from a prospective database of consecutive patients with NSCLC who received first-line ICI-containing treatment between November 2018 and October 2024. Patients were classified into two groups: 48 treated with anti-programmed death-ligand 1 (anti-PD-L1) therapy and 74 treated with anti-programmed death-1 (anti-PD-1) therapy. We retrospectively compared the incidence of severe irAEs between the two groups and evaluated the clinical outcomes of severe irAEs on the survival.ResultsAmong 122 patients, 24 (19.7%) experienced severe irAEs. The incidence of severe irAEs was significantly higher among patients treated with anti-PD-1 than among those treated with anti-PD-L1. The incidence of irAE-related death was also higher in the anti-PD-1 group than in the anti-PD-L1 group, with pneumonitis accounting for most of these fatalities (87.5%). There were no significant differences in the progression-free or overall survival between patients with and without severe irAEs. A multivariable analysis showed that the use of anti-PD-1 therapy was associated with a worse overall survival.ConclusionTreatment with anti-PD-1 was associated with an increased risk of severe irAEs. The incidence of severe irAEs was not associated with an improved survival rate.

Abstract We analyzed the differences in bacterial composition between 475 Japanese patients with advanced gastric cancer (median age 70 years, median BMI 20.0) and 106 healthy individuals using a comprehensive metagenome shotgun analysis. Among the patients with advanced gastric cancer, 71% were male, 37.% patients had relapsed, and 55.5% previously underwent gastrectomy. Bifidobacterium , Anaerostipes , and Parabacteroides were predominant in healthy individuals, whereas Streptococcus , Lactobacillus , and Odoribacter were predominant in patients with advanced gastric cancer. Additionally, Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that butanoate and pyruvate metabolism was enriched in healthy individuals, whereas factors such as ABC transporters and ribosomes were enriched in patients with advanced gastric cancer. Clustering analysis broadly classified patients with advanced gastric cancer and healthy individuals into two clusters; however, clustering using pathway data enabled a clearer classification of patients with advanced gastric cancer and healthy individuals than clustering using flora analysis. Moreover, healthy individuals showed higher bacterial flora diversity than patients with advanced gastric cancer. Thus, we successfully identified the molecular characteristics of microbial genera and functional pathways in the gut of patients with advanced gastric cancer. Our results suggest that fecal metagenomic shotgun sequencing analysis can be used to detect gastric cancer.

ABSTRACTSmall cell neuroendocrine carcinoma of the cervix (SCNEC) is classified as a high‐grade neuroendocrine carcinoma with a worse prognosis than other major histological types of cervical cancer. Identifying novel therapeutic targets based on its molecular characteristics is highly desirable but challenging due to the rarity of SCNEC and the resulting lack of research resources. In this study, we identified vaccinia‐related kinase 1 (VRK1) as a potential therapeutic target for SCNEC. VRK1 was prioritized based on our previously reported proteomic analysis of patient‐derived organoids. Immunohistochemistry of patient samples consistently revealed high VRK1 expression in SCNEC, as opposed to its variable expression in other cervical carcinomas. Although VRK1 knockdown in SCNEC had only a limited effect on cell proliferation in two‐dimensional cultures, it significantly suppressed cell proliferation in three‐dimensional cultures and inhibited xenograft tumor growth in vivo. Gene set enrichment analysis of RNA‐sequencing data from mouse xenograft models demonstrated that VRK1 is associated with mitochondrial‐related pathways. Furthermore, under oxidative stress conditions, VRK1 knockdown resulted in a reduction of mitochondrial membrane potential, an indicator of mitochondrial integrity, and decreased expression of cytochrome c oxidase subunit IV (COX IV), a nuclear‐encoded subunit of cytochrome c oxidase, the terminal enzyme complex of the mitochondrial respiratory chain. These findings suggest that VRK1 knockdown indirectly impaired mitochondrial function. Collectively, these anti‐tumor effects highlight VRK1 as a promising therapeutic target for SCNEC.

Retrospective study of the prospectively collected data. To assess the ability of three artificial intelligence (AI) models to predict attainment of clinically important differences (CIDs) in the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Accurate prediction of postoperative functional improvement is essential for surgical planning, yet patient-reported outcome-based predictive tools have not been established. We retrospectively analyzed 1149 patients from three spine centers. Outcomes were five JOABPEQ domain scores and three visual analog scale (VAS) scores. Three AI models-TabNet, a deep neural network (DNN), and elastic-net penalized logistic regression (ENLR)-were trained and validated on 981 patients from two centers using stratified five-fold cross-validation. External validation was performed on an independent cohort of 168 patients from the third center. Input features included age, sex, preoperative JOABPEQ item responses, domain scores, and VAS scores. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) and accuracy. In external validation for JOABPEQ domains, TabNet achieved a mean AUC of 0.79 and accuracy of 0.74; DNN, AUC 0.77 and accuracy 0.73; and ENLR, AUC 0.78 and accuracy 0.74. For VAS outcomes, TabNet yielded a mean AUC of 0.80 and accuracy of 0.74; DNN, AUC 0.77 and accuracy 0.72; and ENLR, AUC 0.78 and accuracy 0.72. All three AI models reliably predicted postoperative improvements. Such AI-based prediction models may enhance clinical decision-making and patient counseling in lumbar spine surgery.