Tohoku Medical and Pharmaceutical University Wakabayashi Hospital

In rehabilitation research, machine learning (ML) algorithms are being increasingly applied to predict the ability of patients with stroke and other acquired brain injuries to perform activities of daily living (ADL). However, many previous studies have relied on complex data, such as imaging or blood tests, which require advanced equipment and specialized expertise and are difficult to apply in general clinical settings. We aimed to predict ADL independence in patients with stroke and other acquired brain injuries at the start of rehabilitation using routine assessment data. This retrospective study involved 379 patients with stroke or other acquired brain injuries who received rehabilitation at our hospital between September 2008 and August 2022. Three ML models - support vector machine (SVM), random forest (RF), and Light Gradient-Boosting Machine (LightGBM) - were used to classify Functional Independence Measure scores. Predictors included age, sex, Japan Coma Scale score, and Brunnstrom recovery stage. All models performed above chance, with SVM achieving the highest F1 score (0.862), followed by RF (0.857) and LightGBM (0.838). Analysis of variance revealed a significant effect of the classifier on performance (P < .001), with SVM and RF significantly outperforming LightGBM. SHapley Additive exPlanations analysis identified lower- and upper-limb Brunnstrom recovery stage, impaired consciousness, and age as key predictive features. ML algorithms can accurately predict ADL independence using initial rehabilitation assessment data without reliance on advanced medical technologies. The use of these algorithms may enhance clinical decision-making, and they may be particularly valuable in resource-limited settings.

Podocyte infolding (PI) in a thickened glomerular basement membrane (GBM) is a rare pathological finding in electron microscopy (EM). We histopathologically evaluated a 57-year-old Japanese male patient with clustering microspheres and PI in the GBM. EM showed clustering microspheres in irregularly thickened GBM and PI into the GBM. Endothelial cells also invaded the GBM on EM. Low-vacuum scanning EM revealed numerous openings or holes in the GBM. Careful examination by EM is needed to identify further cases of clustering microspheres and PI. It is also important to explore these cases using new approaches such as low-vacuum scanning EM.

Systemic sclerosis (SSc) is characterised by ischaemic skin ulcers on the fingertips, and low-energy shock wave therapy is suggested as a novel treatment for ischaemic lesions with angiogenic effects. We aimed to investigate the efficacy and safety of shock wave therapy for skin ulcers in patients with SSc. In this Phase 3 pivotal study, we analysed 60 SSc patients with digital ulcers that did not disappear after >4 weeks of existing treatment: 30 patients were treated with extracorporeal shock wave therapy and 30 with conventional treatment. The ulcer count reduction observed after an 8-week treatment period was compared between the shock wave therapy and conventional treatment groups. After an 8-week treatment period, the mean reduction in the number of ulcers was 0.83 (SD 2.79) in the conventional treatment group compared to a more pronounced reduction of 4.47 (SD 2.65) in the shock wave therapy group. The study findings indicate the efficacy of extracorporeal shock wave therapy for refractory digital ulcers associated with SSc, which has limited therapeutic options. This therapy is non-invasive and safe and can be used without restriction in combination with other therapies, thus serving as a novel therapeutic method.

Background/Aims Sitting balance training is an important therapeutic tool used by physical and occupational therapists who work with patients with hemiparesis, many of whom have difficulty shifting their weight while sitting. This study assessed the immediate effects of circular trunk movements on the maximum reach distance and the centre of pressure distance that could be achieved during a multidirectional reach task in participants with post-stroke hemiparesis and healthy individuals as a control group. Methods This non-randomised controlled study included 26 participants with hemiparesis and 10 age-matched control participants. A functional reach apparatus, body pressure distribution measuring system and digital video camera were used to measure multidirectional reach, centre of pressure trajectories and circular trunk movements. The participants completed the assessments in the following order: multidirectional reach, circular trunk movements and repeat multidirectional reach. The authors classified the centre of pressure trajectories into type A (oval) and type B (non-oval) tracings according to the shape displayed by the circular trunk movements, which corresponded to the level of trunk function. The reach distance and centre of pressure distance before and after the circular trunk movements were compared. Results The reach distance and centre of pressure distance values in the front direction of participants with hemiparesis who exhibited type A tracings and had higher trunk function were significantly greater after completing circular trunk movements. In contrast, the reach distance and centre of pressure distance values of participants in all directions who exhibited type B tracings and had lower trunk function were significantly greater after completing circular trunk movements. Conclusions Circular trunk movements appeared to affect both reach distance and centre of pressure distance, particularly in participants with hemiparesis with type B tracings and lower trunk function. Implications for practice Physical and occupational therapists could incorporate circular trunk movements into rehabilitation programmes to help individuals with post-stroke hemiparesis improve their reach distance, trunk function and ability to shift their weight while sitting.

The effectiveness of ischemic postconditioning (iPoC) in patients with ST-elevation myocardial infarction (STEMI) without ischemic preconditioning has not been determined. Therefore, we investigated the impact of iPoC and its potential mechanism related to heat shock protein 72 (HSP72) induction on myocardial salvage in patients with STEMI without prodromal angina (PA).We retrospectively analyzed data from 102 patients with STEMI with successful reperfusion among 323 consecutive patients with acute coronary syndrome. Among these, 55 patients with iPoC (iPoC (+) ) underwent 4 cycles of 60-second inflation and 30-second deflation of the angioplasty balloon. Both the iPoC (+) and iPoC (-) groups were divided into 2 further subgroups: patients with PA (PA (+) ) and those without (PA (-) ). We analyzed HSP72 levels in neutrophils, which were measured until 48 hours after reperfusion. I-123 β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) scintigraphy was performed within a week of reperfusion therapy. In 64% of patients, thallium-201 (TL) scintigraphy was performed 6-8 months after STEMI onset.Using BMIPP and TL, in the PA (-) subgroups, the iPoC (+) group had a significantly greater myocardial salvage ratio than the iPoC (-) group. iPoC was identified as an independent predictor of the myocardial salvage ratio. The HSP72 increase ratio was significantly elevated in the iPoC (+) PA (-) group. Importantly, the myocardial salvage effect in patients without PA was significantly correlated with the HSP72 increase ratio, which was greater in patients with iPoC.These results suggest the potential impact of iPoC via HSP72 induction on myocardial salvage; however, the effects may be limited to patients with STEMI without PA.

Introduction: Asthma is an inflammatory reaction mediated by type 2 helper T (Th2) cells and is known to increase eosinophil levels. Our previous study showed that stress-related asthma can cause neutrophilic and eosinophilic airway inflammation by suppressing immune tolerance. However, the mechanism of stress-induced neutrophilic and eosinophilic airway inflammation remains unclear. Therefore, to elucidate the cause of neutrophilic and eosinophilic inflammation, we investigated the immune response during the induction of airway inflammation. In addition, we focused on the relationship between immune response modulation immediately after stress exposure and the development of airway inflammation. Methods: Asthmatic mice were induced by three phases using female BALB/c mice. During the first phase, the mice were made to inhale ovalbumin (OVA) to induce immune tolerance before sensitization. Some mice were exposed to restraint stress during the induction of immune tolerance. In the second phase, the mice were sensitized with OVA/alum intraperitoneal injections. In the final phase, onset of asthma was induced through OVA exposure. Asthma development was evaluated based on airway inflammation and T-cell differentiation. Microarray and qPCR analyses were used to enumerate candidate factors to investigate the starting point of immunological modification immediately after stress exposure. Furthermore, we focused on interleukin-1β (IL-1β), which initiates these immune modifications, and performed experiments using its receptor blocker interleukin-1 receptor antagonist (IL-1RA). Results: Stress exposure during immune tolerance induction increased eosinophil and neutrophil airway infiltration. This inflammation was associated with decreased T regulatory cell levels and increased Th2 and Th17 levels in bronchial lymph node cells. Microarray and qPCR analyses showed that the initiation of Th17 differentiation might be triggered by stress exposure during tolerance induction. IL-1RA administration during stress exposure suppressed neutrophilic and eosinophilic airway inflammation via Th17 reduction and Treg increase. Conclusions: Our results show that psychological stress causes both eosinophilic and neutrophilic inflammatory responses due to the breakdown of immune tolerance. Furthermore, stress-induced inflammation can be abolished using IL-1RA.

PurposePatients with chronic obstructive pulmonary disease (COPD) have decreased physical activity (PA) compared with healthy adults. As lower PA is associated with increased mortality, improving PA is an important objective for COPD management. This large-scale, multicenter, non-interventional, cross-sectional study examined the activity status of COPD patients in Japan and explored factors related to PA.Patients and MethodsOutpatients aged ≥40 years with confirmed COPD diagnosis and pulmonary function test data were enrolled. Primary study outcomes were measurement of daily steps (over 14 consecutive days, using an activity monitor), assessment of activity time by activity intensity (using metabolic equivalents [METs]), and evaluation of correlation between PA and patient characteristics. Secondary outcomes included further investigation of the influence of patient characteristics on PA.ResultsData from 417 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I (29.5%), II (43.9%), III (23.5%), and IV (3.1%) were evaluated. Median (Q1, Q3) daily step count was 3440.8 (1831.3, 5709.3). Median (Q1, Q3) durations of PA at ≥3 (moderate-to-vigorous) and ≥2 METs (light-to-vigorous) were 18.7 (6.5, 41.3) and 186.9 (126.9, 259.2) minutes, respectively. For >30% of patients, time spent in ≥3 METs activity was ≤10 minutes. Unemployment was significantly correlated with reduced activity time (≥3 and ≥2 METs) and step count. Severe GOLD stage was significantly correlated with reduced activity time (≥3 and ≥2 METs). High modified Medical Research Council (mMRC) dyspnea score was significantly correlated with reduced activity time (≥3 METs) and step count. Patients tended to overestimate the time spent in activities requiring ≥2 METs in their subjective reports compared with activity monitor measurements.ConclusionReduced PA was observed in the Japanese COPD patients with the majority of them being GOLD stage I/II. Employment status, GOLD stage, and mMRC dyspnea score could help identify patients at risk of reduced PA.Clinical Trial RegistrationNCT03642613 (ClinicalTrials.gov); UMIN000032962 (UMIN-CTR, umin.ac.jp).

A 61-year-old Japanese man had a gradually growing, red-colored nodule in his umbilicus from 3years ago. He had no symptoms such as hot flush, diarrhea or wheezing. Computed tomography detected a 3.0cm×3.0cm enhanced nodule on the umbilical portion, inguinal and axillary lymph node swelling, and peritoneal nodules. Upper and lower gastrointestinal endoscopy and cystoscopy did not show any other tumor. We resected the umbilical nodule and subjected the inguinal lymph node and peritoneal nodule to biopsy. Histopathological findings indicated that the cutaneous lesion was composed of variously sized nests that included small, monomorphic, round to polygonal cells, mainly in the dermis to the peritoneum. Mitotic figures were scant. The inguinal lymph node and peritoneal nodule were positive for metastasis. Immunohistochemistry was diffusely positive for cytokeratin (CK)-7, CD56, chromogranin A, synaptophysin, estrogen receptor-α, progesterone receptor, GATA3 and carcinoembryonic antigen, and focally positive for mammaglobin and gross cystic disease fluid protein 15. The Ki-67 labeling index was 1.5%. The patient was diagnosed with a case of low-grade neuroendocrine carcinoma of the skin (LGNECS) occurring on the umbilicus. This case exhibited distant peritoneal metastasis, as well as inguinal and axillary lymph node metastases; however, the patient is alive without chemotherapy at 23months after the first visit. LGNECS is a newly proposed, extremely rare entity that has been reported under various names, including primary cutaneous carcinoid tumor. In the present case, this tumor shows a slow-growing nature and favorable prognosis, even though it harbors metastatic potential.

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the “Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake” under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata‐Chuetsu Earthquakes, the current “Manual for Disaster Diabetes Care” has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.

Objective: To report our experience with the management of two cases of chronic tubal pregnancy by laparoscopic surgery.