Obstructive sleep apnea syndrome is a common disorder characterized by repeated upper airway obstruction during sleep. Oral appliance therapy is a noninvasive treatment option commonly recommended for patients who are intolerant to continuous positive airway pressure. This study aimed to evaluate the treatment outcomes of oral appliance therapy in patients with obstructive sleep apnea syndrome and to examine the relationship between therapeutic effectiveness and patient characteristics, including age, disease severity, and body mass index.

COVID-19 pandemic-related changes have increased mental health problems of essential workers. However, little is known about its impact on direct support professionals (DSPs) working at facilities for people with disabilities. This study examined the resilience and related factors, including psychological distress, burnout, depression, among DSPs working during the COVID-19 pandemic, including those in facility with cluster occurrences in Japan.

A shared sense of professionalism among healthcare professionals enhances team-based care through interprofessional collaboration. This study aimed to develop a reliable and valid scale for assessing healthcare professionals' professionalism.

In Indonesia, stunting remains a health issue among children aged < 5 years, with a prevalence of 36.8% in 2021, the highest prevalence of malnutrition in the said age group, and the quality of drinking water consumed being one of the main causes. This study aimed to identify the quality of drinking water and determine the risk factors for stunting.

Paroxysmal sympathetic hyperactivity (PSH) is a clinical syndrome characterized by recurrent episodes of sympathetic overactivity, including hypertonia, tachycardia, hypertension, and hyperthermia, typically following severe brain injury. While PSH is well documented in adult populations, reports on pediatric patients, particularly those with severe motor and intellectual disabilities (SMID), remain limited. Here, we report three pediatric patients with SMID due to neonatal hypoxic-ischemic encephalopathy (NHIE) who developed PSH. All patients presented with characteristic PSH symptoms and were diagnosed according to the Pediatric Clinical Practice Guidelines based on the 2014 consensus criteria. Gabapentin (GBP) was initiated at low doses (5-10 mg/kg/day) in all patients, resulting in the rapid resolution of PSH symptoms. In two patients, symptoms partially recurred within several months but were controlled through GBP dose adjustment and the addition of clonidine or other agents. No severe adverse events were observed. To our knowledge, this is the first report describing the short-term efficacy of GBP in pediatric patients who developed PSH with SMID status due to NHIE. Our findings suggest that GBP is a valuable and well-tolerated therapeutic option for the management of PSH in children with these conditions.

Burn wounds cause pain through various mechanisms, making pain management challenging. Although treatment and management strategies for healing burns have been developed, clear guidelines for analgesia in burn injuries are lacking. Opioids are commonly used for pain relief, but regional anesthesia performed by anesthesiologists has shown effectiveness in some cases. We encountered a case in which epidural anesthesia was effective for analgesia of a lower-extremity burn injury in a 19-year-old man. The patient with burn injuries to his lower extremities was transferred to the emergency department. On the day of the injury, an epidural catheter was administered for burn pain. The epidural anesthesia was removed during hospitalization, but the pain worsened, so it was placed again to provide adequate analgesia. In this case, epidural anesthesia proved effective for managing the lower-extremity burn pain and facilitated patient rehabilitation. Epidural anesthesia should be actively considered for the management of burn pain.

Urosepsis is defined as sepsis caused by an infection of the urogenital tract and is a systemic response to infection. Urosepsis is commonly treated in the intensive care unit (ICU) because of its acute and potentially lethal nature. Acute kidney injury (AKI) is a common complication of septic shock in ICU patients. This study predicted cases in which patients required renal replacement therapy (RRT) during the early stages of hospitalization. We also examined the relationship between the clinical information obtained at admission and the subsequent need for RRT.

Accurate assessment of pressure injuries is critical in clinical settings, especially when evaluating necrotic tissue using the DESIGN-R® scale widely adopted in Japan. This study aimed to integrate artificial intelligence (AI) into the evaluation process to enhance diagnostic consistency and accuracy. By leveraging deep learning and convolutional neural networks, we explored the potential of AI models in classifying necrotic tissue from wound images.

Extensive burns induce systemic inflammation and increase vascular permeability, resulting in dehydration and edema. During burn injury, the release of high-mobility group box 1 (HMGB1) from damaged cells may promote an inflammatory response. In this study, we examined the relationship between changes in blood HMGB1 levels, vascular permeability, and lung tissue damage following burn injury.

Allogeneic hematopoietic stem cell transplantation (allo-HCT) has been established as a curative treatment for hematological malignancies such as acute myeloid leukemia and myelodysplastic syndrome. Patients aged ≥ 70 years have traditionally been considered ineligible for this procedure, because of concerns over high transplant-related mortality rates and difficulties managing post-transplant complications. However, recent advances in supportive care, expanded donor availability, and the development of reduced-intensity conditioning (RIC) regimens have increased the availability of allo-HCT for older patients. Notably, the number of allo-HCT procedures performed in patients aged ≥ 70 has been steadily increasing in Japan and Western countries, reflecting a re-evaluation of transplant eligibility in older patients. When assessing transplant eligibility in older patients, it is crucial to consider not only disease risk stratification and treatment response, but also comprehensive evaluations of general health status, comorbidities, cognitive function, and social backgrounds. In particular, indexes such as the Hematopoietic Cell Transplantation-Comorbidity Index and Comprehensive Geriatric Assessment have proven useful for predicting patient prognoses and non-relapse mortality. Donor selection and the intensity of the conditioning regimen used can both significantly influence transplant outcomes. RIC or non-myeloablative regimens are generally recommended for patients aged ≥ 70 years. Human leukocyte antigen-matched related or younger unrelated donors are preferred, while haploidentical donors or cord blood may be considered when matched donors are unavailable, although evidence in older patients is limited. This review provides a comprehensive overview of the current status of and challenges related to allo-HCT in patients aged ≥ 70 years. Patient eligibility, conditioning strategies, donor selection, and transplant outcomes are discussed in detail, based on the latest available evidence.

Polycythemia vera is a chronic myeloproliferative neoplasm characterized by a marked increase in circulating erythrocyte volume in middle-aged and elderly patients; it is associated with increased white blood cell and platelet counts and splenomegaly. There is a high risk of conflicting complications during surgical treatment, such as thrombosis and hemorrhage, with thrombosis being the leading cause of death. Hence, it is important to take measures against both in the perioperative management. We report a case of perioperative management of a patient with polycythemia vera and resection of an intraepithelial carcinoma of the tongue. The patient, a 46-year-old man, had been under observation at our hospital's Department of Internal Medicine for 10 years with a diagnosis of polycythemia vera. He came to our department with a complaint of white spots on the left tongue margin. Phlebotomy was performed when his blood count, hemoglobin, and hematocrit levels were elevated. The biopsy showed intraepithelial carcinoma. Preoperative examination revealed no abnormality, and a partial left-sided tongue resection was performed under general anesthesia. To prevent thromboembolism, the patient wore an elastic stocking from the time he entered the operating room. The patient underwent local hemostasis to prevent bleeding and systemic management centered on infusion therapy to prevent blood concentration. Four years and three months have passed since the surgery without recurrence.

Survival rates improve significantly if basic life support (BLS) is administered for an out-of-hospital cardiac arrest (OHCA); however, it has a low rate of implementation. Even though bystanders' low willingness to administer BLS may be a contributing factor, the factors influencing their willingness have not been sufficiently elucidated. Therefore, this study investigated the relationship between personality traits and the willingness to administer BLS in a large cohort.

Brain injury accompanied by hemorrhage, such as cerebral contusion or intracerebral hemorrhage, leads to the accumulation of activated microglia around the lesion. In addition, microglia at the site of injury can act either damagingly or protectively, depending on the time; for instance, it is damaging in the acute phase and protective in the chronic phase. Moreover, during brain injury, glutamate-induced excitotoxicity leads to secondary damage to neurons. However, the source of glutamate released from cells remains largely unknown. Our previous studies have revealed that cystine/glutamate antiporter system x (xc-) in microglia is an important source of glutamate release and that the induction of expression of xCT, a component molecule of xc-, is vital.

A survey was conducted to determine the demand for the use of digital health content for health promotion, both among those interested in using digital tools and those interested in health promotion.

Children with autism spectrum disorder frequently experience persistent sleep difficulties that persist into adulthood. These issues are linked to adverse outcomes like behavioral issues, poor academic performance, and increased parental stress, highlighting the importance of early interventions. We assessed an internet-based sleep education program for parents of children with autism spectrum disorder and conducted a preliminary examination of its potential to improve sleep quality and behavioral outcomes.

We designed a single-center retrospective study comparing the performance of commercially explainable artificial intelligence (XAI)-powered computer-aided detection (CAD) system of abnormal findings on chest X-rays (CXR) with that of non-experts, and pulmonology experts.

Amyloidosis is a group of disorders in which specific precursor proteins form insoluble amyloid fibrils are deposited in various organs and extracellular spaces. Sjögren's syndrome (SS) is a chronic inflammatory disease in which lymphocytes infiltrate the exocrine glands, such as the salivary and lacrimal glands, through an autoimmune mechanism. At advanced stages of SS, localized nodular amyloidosis has been reported in specific organs outside the glands. Herein, we report a case of localized nodular amyloidosis associated with SS. An 80-year-old woman, who had been biting her buccal mucosa for several years and was aware of the presence of a mass, which had increased in size since approximately 6 months, was referred to our hospital. The patient had a history of SS and systemic lupus erythematosus since her 50s. A needle biopsy was performed because malignancy was suspected by magnetic resonance imaging. The pathological diagnosis was ATTR-type amyloidosis. The patient underwent excision of the lesion to improve the swelling. The pathological findings showed plasma cell infiltration in some areas, which required differentiation from AL amyloidosis; therefore, the patient was referred to a facility specializing in amyloidosis. The pathological diagnosis was AL amyloidosis. Various clinical findings ruled out systemic involvement and the final pathological diagnosis was localized nodular amyloidosis. It has been reported that it may occur in the advanced stages of SS, and our patient had SS for 30 years. One year after the surgery, the patient's prognosis was good.

The objective of this study is to devise a simplified approach for estimating respiratory particle trajectory to avoid infection in gathering places of emergency departments.

The Coronavirus disease 2019 global pandemic is transmitted through respiratory droplets from infected people. We aim to determine the risk factors for COVID-19 reinfection, and the degree of its severity in patients reinfected with it.

The number of reports of robotic surgery for rectal cancer with combined resection of other organs is increasing gradually, with most procedures performed using the da Vinci Surgical System. The hinotori Surgical Robot System, developed in Japan, was approved for gastrointestinal surgery and gynecology in 2022. Here, we report the first case of en-bloc rectal resection with hysterectomy using the hinotori Surgical Robot System. A 77-year-old woman was referred to our institution with a diagnosis of rectal cancer (cT4bN1bM1a), with uterine invasion and a resectable liver metastasis. We performed rectal resection with total hysterectomy and bilateral salpingo-oophorectomy using the hinotori Surgical Robot System. Two surgical teams, a gastroenterological team and a gynecological team, performed en-bloc resection of the rectum and uterus. Because of in-depth consultation between the teams, the operation was performed safely with no unplanned additional ports, robotic arm interference or arm collision with the assistant surgeon. Including the preceding stoma closure, the operative time was 473 minutes, and blood loss was 60 mL. The patient experienced no complications ≥ Clavien-Dindo classification grade III. Robot-assisted extended surgery for locally advanced rectal cancer using the hinotori Surgical Robot System can be performed safely, which may lead to an expanded treatment option in the future.

Sleep disordered breathing, represented by sleep apnea syndrome, not only significantly reduces the quality of daily life but is also known to contribute to the development of various cardiovascular diseases. Since 2000, sleep apnea syndrome has become widely recognized by the general public. However, the number of suspected patients who seek medical consultation remains low, and even fewer receive a proper diagnosis and treatment. One reason for this is the lack of information that apnea is linked to cardiovascular disease, even among individuals experiencing typical sleep apnea syndrome symptoms such as daytime sleepiness and general fatigue. Additionally, healthcare providers may not be effectively guiding patients while providing sleep hygiene education. Furthermore, the limited number of medical facilities and technicians capable of conducting overnight polysomnography tests for diagnosing sleep disordered breathing is another factor preventing more patients from benefiting from treatment. This article explores the relationship between sleep disordered breathing and the onset of cardiovascular diseases, as well as the latest treatment approaches.