Background: Self-perceived voice disorders (PVD) are common in later life and may affect psychological, social, and physical well-being. However, longitudinal evidence in community settings remains limited. This study sought to examine whether PVD predicted changes in well-being among community-dwelling older adults. Methods: Data were obtained from a community cohort in Kasama City, Japan. Older adults (n=273; aged 76.5 years; 57.1% female) were classified based on baseline Voice Handicap Index-10 scores (0, no; 1–4, mild; and ≥5, PVD). Outcomes were assessed annually through 2025 using the Geriatric Depression Scale (GDS), Lubben Social Network Scale (LSNS), Physical Activity Scale for the Elderly, and physical performance measures (handgrip strength, single-leg balance with eyes open, sit-and-reach, and 5-m habitual walk). Linear mixed models analyzed the fixed effects of group, time, and their interaction while adjusting for selected covariates. Results: Significant group effects were observed for the GDS, total LSNS scores, and the LSNS family scale, indicating that participants with PVD had weakened psychological and social well-being and smaller family networks. Additionally, a notable group effect was observed in sit-and-reach, with PVD participants showing less flexibility than those without it in the physical performance measures. Conclusion Among community-dwelling older adults, PVD was prospectively associated with increased depressive symptoms, diminished social networks, particularly smaller family networks, and reduced physical flexibility. These findings suggest that PVD preceding medical diagnosis may signal broader declines in psychological, social, and physical well-being, highlighting the importance of early identification and support.

Background: Poor hand dexterity may increase the risk of functional disability; however, few studies have examined the relationship between hand dexterity and incident functional disability. The aim of this study was to prospectively investigate the dose-response association of hand dexterity with incident functional disability in community-dwelling older adults. Methods: This study included 1,069 older adults aged ≥65 years in Kasama City, Japan. Peg-moving and circle-drawing tasks were used to evaluate hand dexterity. Functional disability was identified using the Japanese Long-Term Care Insurance System database. Restricted cubic spline analysis was performed to investigate the dose-response association between hand dexterity and incident functional disability. Results: During a mean follow-up of 8.5 years (maximum 14.0 years), 248 participants (23.2%) developed functional disability. The lowest performance group in each hand dexterity test had a significantly higher risk of functional disability than the highest performance group—peg-moving (hazard ratio [HR]=1.92, 95% confidence interval [CI] 1.29–2.87) and circle drawing (HR=1.66, 95% CI 1.15–2.41). Spline analysis confirmed curvilinear dose-response associations between hand dexterity and incident functional disability. Increased risk was observed when participants performed worse than the cut points (peg-moving, 37.9/38.0 seconds; circle drawing, 21/20 points), and no decreased risk was observed for those who performed better than these cut points. Conclusion Easily evaluated hand dexterity tests may be valuable for predicting functional disability in older adults. Curvilinear dose-response associations suggest that maintaining adequate hand dexterity could be a key strategy to support functional independence.

Purpose: To investigate the efficacy of aflibercept for the treatment of diabetic macular edema via a treat-and-extend regimen. Methods: This prospective, single-center, open-label, interventional study involved 30 patients with a best-corrected visual acuity (BCVA) ≤0.6 and a central retinal thickness (CRT) ≥300 μm. The enrolled eyes each received a monthly intravitreal aflibercept injection until the CRT decreased below 300 μm, upon which the administration interval was extended for 1 month until the CRT once again increased to ≥300 μm. Main outcome measures were median BCVA and CRT at 6 and 12 months after initiation of treatment via last observation carried forward analysis, the median number of injections over the 12 months, and the effects on the diabetic retinopathy severity scale (DRSS) score of the patients who completed the 12-month follow-up period. Results: Of the 30 enrolled patients, 29 and 25 respectively completed the 6- and 12-month follow-up examinations. From baseline to 6 and 12 months after treatment initiation, the median BCVA (logarithm of the minimum angle of resolution) significantly improved from 0.52 to 0.30 and 0.35, respectively, and the median CRT significantly decreased from 439.5 to 268.5 and 249.0 μm, respectively. The median number of injections over the 12-month follow-up period was 6.0. Compared to baseline, the DRSS score at 12 months was improved by 2 steps in 16% of patients; in no cases did the DRSS score worsen or improve by three steps or more. Conclusions When administered in a treat-and-extend regimen, aflibercept is an effective treatment option for diabetic macular edema.

Background  The number of foreign tourists visiting Japan has increased to about 30 million people per year. 1.5% of them were injured or became sick during their travelin Japan and had to undergo medical treatment. Among the foreign tourists, 27% were not covered by travel health insurance.Case  A 40-year-old man from Southeast Asia who was visiting his relative in Japan experienced sudden hemiparesis and was diagnosed with cerebral infarction. During the initial treatment, it was found that the patient did not have health insurance and the relatives could not afford to pay the treatment costs. No other source of financial support was available to him During our consultations with the patient and his relatives about the medical treatment including medical expenses, he continued to be treated as an outpatient and it was aimed at an early return to his home country.Discussion  Foreigners, who are not covered under travel health insurance, could fall ill or sustain an injury during their stay in Japan. Appropriate medical care should be provided regardless of their ability to pay. However, a situation that could lead them to incur huge medical expenses from availing medical care should be avoided. For medical consultations of non-insured foreigners, it is better to consult the available systems and pay attention about feasible medical expenses. There is a need for a long-term vision of medical care to make a smooth transition from medical treatment in Japan to treatment in their home country.Conclusion  Although medical institutions can offer only a limited response, it is necessary to accumulate case examples from across the nation and prepare specific countermeasures and counselors.

No abstract available.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Amino Acid Sequence ; Calreticulin/*genetics ; Child ; DNA/chemistry/genetics/metabolism ; Exons ; Female ; Humans ; Janus Kinase 2/*genetics ; Male ; Middle Aged ; Molecular Sequence Data ; Polymorphism, Single Nucleotide ; Receptors, Thrombopoietin/genetics ; Sequence Analysis, DNA ; Sex Factors ; Thrombocythemia, Essential/*diagnosis/genetics ; Young Adult

In 4 children (2.4-10.9 y.o) with mitral valve regurgitation, prosthetic valve replacement was done using warm heart surgery. Three of them had previously received 1-3 times valve repair operations and the other one was accompanied by endocarditis. The condition of 3 children were in NYHA grade 4 and received dopamine preoperatively. At the esophageal temperature of 34 degree, aorta was cross clamped for 79-216min. with continuous coronary perfusion of 3ml/kg/min, however, no child showed postoperative low output syndrome, and the maximum use of dopamine was 2-6μg/kg/min and the CK-MB at 1POD was within the normal range in all cases. Warm heart surgery showed better myocardial protection for pediatric mitral valve replacement.