Toho University

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.

The number of patients with transthyretin amyloid cardiomyopathy (ATTR-CM) has been increasing recently, and the early diagnosis and treatment of it are important. 99mTc pyrophosphate scintigraphy (99mTc-PYP) plays a key role in the early diagnosis of ATTR-CM. In patients who underwent 99mTc-PYP, the early diagnosis of ATTR-CM by echocardiography was evaluated, focusing on left ventricular myocardial form and left ventricular wall thickness. The present study was conducted on 144 patients who underwent 99mTc-PYP between February 2020 and March 2024. A comparison was made between the 99mTc-PYP positive (P) and negative (N) groups, and significant factors were subjected to multivariate analysis. 17 of 144 patients were positive (14.9%), and 15 patients were diagnosed with ATTR-CM by myocardial or skin (fat) biopsy. Other positive patients were also clinically considered to have ATTR-CM based on findings such as poor cardiac function and cerebral hemorrhage. 99mTc-PYP positive had a significantly larger CTR (60.3% in the P group vs. 53.9% in the N group, p = 0.007) and a larger left atrial diameter (42.8 mm in the P group vs. 40.0 mm in the N group, p = 0.047). On the other hand, the mean LV wall thickness was significantly thicker (15.7 mm in the P group vs. 12.8 mm in the N group, p < 0.001); however the LV end-diastolic diameter was smaller (41.9 mm in the P group vs. 48.4 mm in the P group, p < 0.001). The LV mass was similar in both groups, thus the relative left ventricular wall thickness (RWT), which indicates relative wall thickening, was significantly higher in the P group (0.85 in the P group vs. 0.52 mm in the N group, p < 0.001). The receiver operating characteristic curve of RWT for assessing 99mTc-PYP positivity had a cut-off value of 0.717 (area under the curve 0.862, 95%CI 0.763-0.961). The evaluation of wall thickness and RWT on echocardiography is important for diagnosing ATTR-CM.

The use of dietary supplements (DSs) can lead to an excessive intake of certain nutrients, posing potential health risks. However, studies are scarce on whether DS users adhere to recommended doses provided by the manufacturer and what factors are associated with overconsumption of DS. By leveraging purchase history data to estimate DS use precisely, this study aimed to investigate the factors associated with DS consumption exceeding manufacturer-recommended doses and examine the prevalence of excess nutrient intake among DS users. An online survey was conducted from November to December 2024 among 2002 adults (aged 18-74 years) with a history of buying one of the 25 major DS products and who had used it in the previous month or regularly. Self-reported daily DS consumption was assessed using a questionnaire and compared to the manufacturer-recommended doses indicated in the package. Using multivariate logistic regression analysis, the associations between DS consumption exceeding the manufacturer-recommended doses and sociodemographic factors were examined. The prevalence of DS users exceeding tolerable upper intake levels (ULs), defined according to the Dietary Reference Intakes for Japanese, was calculated based on vitamin and mineral intake from DS only. Consequently, 371 (18.5%) of the 2002 participants consumed DS above the manufacturer-recommended dose. Consumption of DS above the recommended dose was associated with middle-aged, part-time or full-time employment, use of tablet-form DS, especially single water-soluble vitamin tablets, use of DS for 6 months or more, and intentional consumption above the recommended dose. For 1705 individuals consuming DS with UL nutrients, 17.4% (n=297) exceeded the manufacturer-recommended dose. Of these, 61.9% (184/297) surpassed UL by ≥1 nutrient. Middle-aged, part-time or full-time jobs, using tablet-form DS, and using DS for 6 months or more were associated with DS consumption exceeding the manufacturer-recommended dose, which may lead to excessive nutrient intake.

To examine the impact of socioenvironmental factors on the severity of menopausal symptoms among perimenopausal Japanese women from a life-course perspective. This cross-sectional study was conducted using an internet panel survey in August 2023 among 1,980 Japanese women aged 45-56 years. Women hospitalized for depression or gynecologic disorders at the time of the study were excluded. Data on sociodemographic and lifestyle factors and employment details were collected using Japanese-validated versions, including the World Health Organization Health and Work Performance Questionnaire and Kupperman Menopause Index. Multivariate logistic regression was used to identify factors associated with moderate or severe menopausal symptoms. Over half of the participants reported mild (26.8%), moderate (16.1%), or severe menopausal symptoms (7.8%). The median absolute presenteeism, where lower scores reflect greater performance impairment and consequently poorer job performance, was 60% in severe cases, 70% in moderate cases, and 80% in mild cases. After adjusting for age and body mass index, caregiving for an elderly family member, and those experiencing absolute presenteeism were associated with increased odds of moderate or severe symptoms. Conversely, women who received social support from their surrounding community were less likely to experience severe symptoms. Socioenvironmental factors significantly impact the severity of menopausal symptoms. Supportive workplace policies and community may help mitigate these symptoms.

Amikacin liposomal inhalation suspension (ALIS), an inhaled aminoglycoside, can effectively treat refractory or relapsed Mycobacterium avium complex lung disease (MAC-LD). However, ALIS is associated with interstitial lung disease (ILD), and underlying pathological mechanisms are unclear. This study aimed to determine the pathophysiological insights of ALIS-associated ILD (A-ILD). This retrospective cohort study included 25 patients with MAC-LD who received ALIS treatment between September 2021 and October 2024. Clinical data, laboratory findings, high-resolution chest computed tomography results and pathological findings from transbronchial lung biopsy, surgical lung resection and bronchoalveolar lavage were evaluated. Of the 25 patients, 8 developed A-ILD after a mean duration of 98.5 ± 159.8 days following ALIS initiation. Histopathological evaluation showed infiltration of enlarged foamy macrophages containing lipid deposits in patients with and without A-ILD. In patients with A-ILD, bronchoalveolar lavage fluid exhibited inflammatory cell infiltration; however, these findings were not diagnostic for a specific entity. Serum Krebs von den Lungen-6 levels increased modestly from baseline to the time of A-ILD diagnosis (407 ± 231 vs. 434 ± 250 U/mL), whereas eosinophil count, C-reactive protein, and lactate dehydrogenase levels showed no significant changes. Seven of eight patients with A-ILD exhibited clinical improvement following discontinuation or dose reduction of ALIS; one patient required corticosteroid therapy. Of these eight patients, five continued inhalation therapy on an every-other-day dosing schedule. The sputum culture conversion rate was maintained even among patients with A-ILD (63% vs. 47%; P = 0.673). Lipid deposition in the lungs was observed regardless of the A-ILD status, and no pathognomonic findings specific to A-ILD were identified. A-ILD may occur more often in patients with renal function decline and/or poorer baseline pulmonary function; therefore, closer clinical monitoring for A-ILD may be warranted in this subgroup.

Background/Objectives: This study aimed to evaluate macular choroidal blood flow dynamics and structural alterations in children with hyperopic anisometropic amblyopia and compare these findings with those of the fellow eyes. Methods: This retrospective observational study included 36 eyes from 18 children (mean age: 4.9 years) with unilateral hyperopic anisometropic amblyopia. Central choroidal thickness (CCT) was measured using enhanced depth imaging optical coherence tomography. Macular choroidal hemodynamics were assessed using laser speckle flowgraphy. Mean blur rate (MBR) was used as an index of blood flow, whereas beat strength (BS) was used as a measure of pulsatility. Ocular perfusion pressure (OPP) was also calculated. All parameters were compared between amblyopic and fellow eyes. Results: Amblyopic eyes demonstrated significantly greater CCT compared with fellow eyes (407.6 ± 84.9 µm vs. 326.4 ± 79.1 µm). Conversely, macular MBR was significantly lower in amblyopic eyes (9.28 ± 3.60 AU vs. 10.94 ± 4.68 AU), as was BS (5.73 ± 3.07 AU vs. 7.28 ± 3.59 AU). No significant differences were observed in central retinal thickness or OPP between amblyopic and fellow eyes. In amblyopic eyes, CCT was not significantly correlated with macular MBR or BS. Conclusions: Amblyopic eyes exhibited significant central choroidal thickening accompanied by reduced macular blood flow and pulsatility. These findings suggest that localized macular hemodynamic dysregulation may contribute to the pathophysiology of hyperopic anisometropic amblyopia.