Toyota Memorial Hospital

The growing recognition of the importance of interpregnancy care to reduce gestational diabetes mellitus (GDM) risk underscores the importance of effective preventive strategies. However, developing effective systems is still challenging. We aimed to bridge this gap by developing a weight management specific prediction model. This study retrospectively analyzed the data of women who underwent two childbirths across 15 medical facilities, including both primary and tertiary facilities. A derivation cohort was constructed using data from 2009 to 2019 (n = 1,640). Data between 2020 and 2024 was used to construct a separate temporal-validation cohort (n = 293). Using the data from another tertiary center between 2017 and 2023, the geographical-validation cohort was constructed (n = 339). A prediction model for GDM development in the second pregnancy was developed by applying logistic regression analysis using 5 key clinical information. GDM in the second pregnancy occurred in 9.5% (156 of 1,640, derivation), 16.7% (49 of 293, temporal-validation), and 7.7% (26 of 339, geographical-validation). The prediction model demonstrated consistent discrimination across cohorts, with c-statistics of 0.75, 0.80, and 0.79, respectively. Precision–recall analyses, accounting for the low prevalence of GDM, further confirmed performance well above the baseline (0.095 in the derivation cohort), with AUC-PRs of 0.43, 0.47, and 0.41 for the three cohorts. Calibration showed alignment with slopes of 1.04, 0.87, and 0.59 for each cohort. This simple and accurate model supports personalized weight management goals, offering a practical tool to reduce GDM risk in future pregnancies through inter-pregnancy weight management.

Diabetes mellitus represents a major public health challenge worldwide, with type 2 diabetes mellitus (T2DM) accounting for the majority of cases. Urbanization and lifestyle changes are reportedly contributing to the increasing incidence of T2DM worldwide. The prevalence of T2DM is also increasing among women who wish to become pregnant, owing to the growing overall proportion of women with T2DM, the increasing prevalence of obesity, and the rising average age of childbirth. Preconception care is warranted in this demographicto optimize glycemic control, improve pregnancy outcomes, and reduce the risk of congenital anomalies and perinatal complications.Educational support that includes not only glycemic control but also increased physical activity (PA) and lifestyle modifications is important to delivering effective preconception care. Herein, we report the case of a woman in her 30s with T2DM, hypertension, and dyslipidemia. Her early glycemic control was suboptimal (glycated hemoglobin: 8.9%, time in range (TIR): 36.6%), her pregnancy preparation was delayed, and a personalized PA program was eventually introduced that included continuous glucose monitoring (CGM) reviewed by a physical therapist.The intervention lasted four months and included continuous feedback and adjustments to the timing, intensity, and activity goals of the patient's exercise regimenbased on her CGM trends. A specific PA target of 8,000-10,000 steps per day was established to promote increased daily movement. The intervention also incorporated a combination of aerobic exercise (walking) and resistance training tailored to the patient's condition and lifestyle. This intervention led to improvements in her blood glucose markers, treatment satisfaction related to diabetes, health-related quality of life, and independence. The patient's TIR increased from 36.6% to 77%, and her PA increased from 2500 to 9500 steps/day. This case study highlights the potential of CGM to promote real-time feedback and behavior modification in patients with T2DM, particularly those attempting pregnancy.PA support combined with CGM can effectively manage blood glucose levels, increase motivation, and improve overall health in ways that are highly beneficial to integrate into preconception care regimens. This study emphasizes that PA support combined with CGM is effective for increasing glycemic control and PA levels, thus improving lifestyle habits and preparing women with T2DM for pregnancy. We advocate for the wider adoption of PA support interventions combined with CGM by physical therapists as a standard practice in preconception careand emphasize the role of this approach in terms of improving long-term metabolic health prior to conception.Further research is warranted to validate these findings and optimize intervention protocols.

ABSTRACTSince the COVID-19 pandemic, it has been found that SARS-CoV-2 antecedent infection can cause multisystem inflammatory syndrome in children. However, the frequency of SARS-CoV-2 antecedent infection in Kawasaki disease (KD) is unknown. The purpose of this study was to investigate the frequency of SARS-CoV-2 infection that preceded the onset of KD. This study is a multi-center observational study. The subjects were patients who were diagnosed with KD at 4 hospitals from April 1, 2020 to August 31, 2022. Serum SARS-CoV-2 IgM and total antibody including IgG levels were measured by the chemiluminescence immunoassay method before and after treatment for KD. A total of 55 patients participated in the study. The first antibody measurement before the initial treatment was performed on a median of 4th days of illness and the second antibody measurement was performed after the initial treatment on a median of 12th days of illness. No patient had a significant increase in SARS-CoV-2 IgM levels in two measurements. Only one patient (1.8%) had elevated total antibodies including IgG, and the patient had a history of COVID-19 6 months before the onset of KD. SARS-CoV-2 antecedent infection before the onset of KD was not observed in this study, and strong association between development of KD and SARS-CoV-2 infection was not suggested.

BackgroundAtraumatic localized convexity subarachnoid hemorrhage (cSAH) is an uncommon form of nonaneurysmal subarachnoid hemorrhage characterized by bleeding limited to the cerebral convexities. Ipsilateral cSAH can result from a variety of causes, such as internal carotid artery stenosis, obstruction, and dissection, although concomitant contralateral cSAH is exceptionally rare. In this case, the initial findings of cSAH led us to discovering contralateral internal carotid artery dissection (ICAD) and an elongated styloid process (ESP). ESP is recognized as a risk factor for ICAD, which is a hallmark of Eagle syndrome. This sequence of findings led to the diagnosis of Eagle syndrome, illustrating a complex and intriguing interplay between cerebrovascular conditions and anatomical variations.Case presentationA 47-year-old Japanese woman experienced acute onset of headache radiating to her neck, reaching its zenith approximately two hours after onset. Given the intractable nature of the headache and its persistence for three days, she presented to the emergency department. Neurological examination revealed no abnormalities, and the coagulation screening parameters were within normal ranges. Brain computed tomography (CT) revealed right parietal cSAH, while CT angiography (CTA) revealed ICAD and an ESP measuring 30.1 mm on the left side, positioned only 1.4 mm from the dissected artery. The unusual occurrence of contralateral cSAH prompted extensive and repeated imaging reviews that excluded reversible cerebral vasoconstriction syndrome (RCVS), leading to a diagnosis of left ICAD secondary to Eagle syndrome. The patient underwent conservative management, and the dissected ICA spontaneously resolved. The patient has remained recurrence-free for two and a half years.ConclusionsManaging cSAH requires diligent investigation for ICAD, extending beyond its identification to explore underlying causes. Recognizing Eagle syndrome, though rare, as a potential etiology of ICAD necessitates the importance of evaluating ESPs. The method for preventing recurrent cervical artery dissection due to Eagle syndrome is controversial; however, conservative management is a viable option.

BackgroundAtrial fibrillation (AF) and heart failure (HF) often coexist, leading to increased mortality. A cryoballoon-based approach is a potential treatment for patients with HF because of its safety and efficacy. ObjectivesThe authors sought to evaluate the optimal timing of cryoballoon ablation after the first clinical diagnosis of AF and its prognosis for patients with HF. MethodsThis large-scale multicenter study retrospectively collected data of patients with HF who underwent cryoballoon ablation for AF from 17 Japanese institutions. Patients were divided into 2 groups depending on the duration between the first diagnosis and ablation using a median time of 0.5 year (IQR: 0.3-2.0 years). Clinical endpoints of recurrence, mortality, and HF hospitalization were compared between the 2 groups. ResultsAmong 3,655 patients, 543 with HF were included for analysis. During a median follow-up period of 21.3 months (IQR: 12.0-36.8 months), 151 of 520 patients (29%) had a recurrence. The AF recurrence rate was significantly lower in the early-ablation group (≤0.5 year) than in the delayed-ablation group (>0.5 year) (24% [65/266] vs 34% [86/254], respectively; P = 0.018). In the multivariable analysis, early ablation ≤ 0.5 year was independently associated with an absence of recurrence (HR: 0.581; 95% CI: 0.401-0.842; P = 0.004). Delayed time for cryoballoon ablation incrementally increased the risk of postablation recurrence. Antiarrhythmic drug use was independently associated with delayed ablation. No significant differences in mortality or HF hospitalization were observed between the 2 groups. ConclusionsEarly cryoablation reduced the risk of recurrence in patients with HF, which may help improve clinical management.

Dysuria is caused by bladder outlet obstruction (BOO) and detrusor underactivity. Female BOO is often overlooked because it is difficult to diagnose a condition from history and symptoms alone. Fowler's syndrome is seen in young women and causes urinary retention due to a primary disorder of urethral sphincter relaxation. Although the level of evidence is still low, sacral neuromodulation or intra-sphincteric Botulinum toxin injection has been applied to Fowler's syndrome. A 44-year-old woman with a chief complaint of dysuria started clean intermittent catheterization because of urinary retention. Videourodynamics showed BOO, open bladder neck, and narrowing of the middle urethra during voiding, and MRI showed thickening of the urethral sphincter. A neurological examination was performed with no neurologic features, so the diagnosis of Fowler's syndrome was suggested. The possibility of a diagnosis of female BOO should always be kept in mind when a woman has dysuria, and urodynamic study or Videourodynamics should be considered.

The outcome of total hip arthroplasty (THA) in patients with end-stage arthritis of the hip is associated with preoperative physical status. This study was performed to examine the relationship between the preoperative severity of sarcopenia and clinical outcomes after THA. This retrospective cohort study was performed among 306 consecutive patients (mean age: 63.7 ± 12.9 years, 222 women) undergoing THA at a university hospital. The severity of sarcopenia was determined based on the skeletal muscle mass index (SMI), handgrip strength, and gait speed according to the criteria of the Asian Working Group for Sarcopenia 2019. The severe sarcopenia prevalence rate was 10.6%. Severe sarcopenia was significantly associated with the risk of delayed functional recovery (adjusted odds ratio, 2.82; 95% confidence interval, 1.03-7.72; p = 0.043) compared with the non-sarcopenia group after adjusting for pre-existing risk factors, including preoperative hip function and physical activity. The addition of SMI, handgrip strength, and gait speed to the model for risk of functional recovery delay significantly increased the area under the receiver operating characteristic curve (p = 0.038). Severe sarcopenia was significantly associated with poorer hip function and patient-reported outcomes at 6 months after surgery compared with the non-sarcopenia group. Severe sarcopenia was adversely associated with postoperative clinical outcomes in patients undergoing THA.