Background: This study aimed to evaluate the differences in common types of epidermal growthfactor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) with brain metastasis (BM) treated using linear accelerator-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT). Methods: Between January 2011–December 2023, among 294 consecutive patients with BMfrom NSCLC, 84 patients with EGFR-mutated NSCLC were enrolled in this study. Results: The median follow-up time after SRS/fSRT was 20.1 months (range: 0.6–109.7months), while the median overall survival (mOS) after SRS/fSRT was 25.1 months (95% confidence interval [CI]: 18.4–33.5 months). The mOS after initial treatment for NSCLC was 56.2 months (95% CI:41.7–77.0 months). The mOS after SRS/fSRT in 34 patients with exon 19 deletions and 45 patients with exon 21 mutations with L858R was 20.4 months (95% CI: 13.6–55.9 months) and 28.5 months (95% CI: 16.2–33.5). The two groups showed no difference in the mOS. In univariate analyses using the Cox proportional hazards model, no prognostic factors associated with prolonged survival were identified except for good pretreatment Karnofsky Performance Status score and no prior tyrosine kinase inhibitor use before SRS/fSRT in EGFR-mutated NSCLC. There was no difference in both distant failure and local control in the two groups. Conclusion The difference in survival between EGFR subtypes (exon 21 L858R mutations vs.exon 19 deletion) was not observed after SRS/fSRT in NSCLC.

The importance of addressing social determinants of health (SDH) in clinical practice is widely acknowledged. However, managing SDH becomes particularly challenging when patients exhibit psychological deficits and behavioral disorders. The present case involved a woman in her 80s who lived on public assistance and exhibited multiple co-morbidities. Following the initiation of home medical care, her condition deteriorated due to an interruption in necessary medical treatment after the electricity in her house was disconnected for nonpayment. The patient had strained relationships with the public assistance officer and other support personnel. As her primary physician, I convened all relevant parties to address the situation, evaluated her psychological and behavioral issues, and provided financial management support. Within six months, she paid her overdue electricity bill, following which her symptoms showed notable improvement. This report details the challenges healthcare workers face while addressing multiple SDHs such as the patient's financial hardship and severed connections with social resources. Our findings suggest that interventions tailored to a patient's psychological and behavioral needs improve their health.

[Objective] In the past, we reported results focusing on the immediate effect of psychosocial factors that influence the effects of acupuncture on patients with chronic low back pain. In the present study, we conducted a retrospective analysis of the data before and after four weeks of acupuncture therapy.[Materials and Methods] Fifty-three patients with an initial diagnosis of chronic low back pain who visited the Acupuncture Department of the Center for Integrative Medicine, Tsukuba University of Technology between August and December 2019 and showed baseline lumbar pain intensity by Visual Analogue Scale (VAS) > 30 mm, were subjects of this study. Psychosocial scales viz, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), Roland-Morris Disability Questionnaire (RDQ), and impression of acupuncture were recorded using a self-administered questionnaire at the first visit and at four weeks after the first acupuncture therapy. Based on VAS, RDQ, and anchor questions about low back pain before and four weeks after the acupuncture therapy, patients were classified into "effective group" and "non-effective group"; then, the logistic regression analysis was performed using this classification as a dependent variable. In addition, r repeated measures analysis of variance (rANOVA) was performed on the data before and after four weeks of acupuncture therapy.[Results and Discussion] The number of patients in the "effective group" and "non-effective group" were 24 and 29, respectively. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.924, P = 0.037) and age (OR: 0.418, P = 0.005) showed statistical significance. In the rANOVA, all the evaluated items showed statistically significant differences before and after four weeks; only VAS in motion showed a statistically significant difference (P = 0.046) regarding the presence or absence of an immediate effect. Therefore, it was suggested that it is important to focus on psychosocial factors from an early stage of therapy, and to make appropriate evaluations and judgments based on both physical and psychosocial aspects of patients to treat them effectively.

Introduction: This study used a meta-analysis to investigate factors related to dizziness/vertigo and their effect size in community-dwelling elderly people.Methods: The search terms "elderly," "dizzy," "community dwelling," and others were used, and a database search was conducted using Ichushi Web and PubMed.Result: In total, 10 studies were extracted. Meta-analysis calculated 28 items as significantly related factors: anxiety, fatigue, taking nitric acid drugs, taking anxiolytics, low self-rated health, memory impairment, depression, sleep disorder, dementia, cancer, balance failure, gait disturbance, physical dysfunction, taking diuretics, living alone, heart disease, fall history, rheumatoid arthritis, stroke, taking sleeping pills, taking multiple drugs, visual impairment, female, ADL impairment, osteoporosis, taking antihypertensive drugs, hypertension, and low education level.Conclusion: The above items may be key variables for investigating dizziness/vertigo in the future.

  Objective: Various psychosocial factors were exploratively investigated in order to specify items that influence on immediate effect of acupuncture among patients with chronic low back pain.  Method: Fifty-six outpatients with initial diagnosis of chronic low back pain, visiting the Acupuncture Department of Center for Integrative Medicine, Tsukuba University of Technology between August to December 2019 were included in the study. The baseline lumbar pain intensity of the patients evaluated using the Visual Analogue Scale (VAS) was >30 mm. Psychological scales viz., Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), lumbar dysfunction, and impression on acupuncture were recorded using a self-administered questionnaire during the first visit. Patients showing decreased VAS scale (≦30 mm) after the first acupuncture treatment as well as self-recognition of improvement in pain were classified as “high responders” while the others were treated as “low responders”. Physical and psychosocial factors were exploratively compared between high and low responders and logistic regression analysis of the two groups was performed using a dichotomous dependent variable.   Results and Discussion: The number of high and low responders were 22 and 34, respectively. On comparing these groups exploratively, positive (P＝0.001) and negative (P＝0.004) impression on acupuncture were the only items that showed statistical significance. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.886 (95% CI: 0.808 to 0.971); P＝0.010), positive impression on acupuncture (OR: 5.085 (95% CI: 1.724 to 15.002); P＝0.003), and number of people living together (OR: 0.355 (95% CI: 0.149 to 0.844); P＝0.019) showed statistical significance. Hence, it may be suggested that psychosocial factors influence the immediate effect of acupuncture among patients with chronic low back pain.

Utility of heart rate (HR)-oxygen consumption (VO₂) method to estimate energy expenditure (EE) was studied for 5 main apple working days based on 24 hour HR recording and EE by this method partially was compared with RMR (relative metabolic rate) method currently used in Japan. Results were as follows:
1. Heart rate during the apple cultivating work were 90-110 beats per minute, that were ranked with moderate work classified by Rodahl.
2. The values of EE estimated by HR-VO₂ method in every apple working days were almost suited for that of previous reports by RMR method.
3. Comparing EE by HR-VO₂ and RMR method for an example in harvesting work, 2, 654 kcal in former was 376 kcal (16.5%) higher than latter. Correlation coefficient was 0.987 (p<0.001) between both method with EE estimated in every working contents.
4. The intense of activity in a working day from view point of daily activity index (1-EE/basal metabolism) followed the order of harvesting putting sack on≅pluking flower>thinning apple> pruning.
Consequently, estimation of EE by HR-VO₂ method was precisely reflected metabolic state in human by comparison in spite of some defects. After this it was expected to use the HR-VO₂ method instead of RMR method.