Background: Appetite loss in older adults raises the risk of malnutrition and frailty. The recent emphasis on psychological and social support for appetite loss reveals the importance of robust social networks. Depression is linked to a decline in appetite and social networks. Social networks may influence appetite directly and indirectly through depression. This exploratory cross-sectional study categorizes social networks into family and friend networks to elucidate their direct and indirect effects. Methods: The study analyzed 193 community-dwelling older adults (women 78.2%; mean age 77.1±5.3 years) who participated in health-checkup events in two cities in Japan. Appetite was assessed using the Japanese version of the Simplified Nutritional Appetite Questionnaire, and family and friend networks were assessed using the Lubben Social Network Scale-6. Depression was assessed using the Geriatric Depression Scale-15. Based on previous research, we constructed a causal model examining the impacts of family and friend social networks and depression on appetite and calculated the direct and indirect effects through structural equation modeling. Results: The family network had a direct effect on appetite (path coefficient=0.18) and an indirect effect via depression (path coefficient=0.0608). Conversely, the friend network was not directly associated with appetite but had an indirect effect through depression (path coefficient=0.095). The model exhibited a good fit. The mechanism of influence on appetite varied between the networks. Conclusion To prevent appetite loss, social networks with family and friends should be assessed separately, and tailored support should be provided for each.

Methods: Forty-nine adults who underwent single-level L4/5 interbody fusion for degenerative spondylolisthesis were divided into BE-ELIF (n=27) and OLIF (n=22) groups based on the surgical approach used. Clinical outcomes were assessed using the Visual Analog Scale and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Radiographic parameters, including distance of spondylolisthesis, disc height, segmental lordosis, lumbar lordosis, pelvic tilt, and sagittal vertical axis, were evaluated preoperatively and at final follow-up. Results: OLIF provided significantly better relief of pain in lower limbs and buttocks at 1-year follow-up. No significant between-group differences were observed in JOABPEQ domains. BE-ELIF resulted in greater improvements in spondylolisthesis distance and disc height, while other parameters did not differ significantly between the two groups. Conclusions For L4/5 degenerative spondylolisthesis, BE-ELIF demonstrated superior spondylolisthesis reduction and disc height improvement than OLIF. Although BE-ELIF was associated with some inferior clinical outcomes, it provided satisfactory results, effective realignment, and a low complication risk.

Background: Appetite loss in older adults raises the risk of malnutrition and frailty. The recent emphasis on psychological and social support for appetite loss reveals the importance of robust social networks. Depression is linked to a decline in appetite and social networks. Social networks may influence appetite directly and indirectly through depression. This exploratory cross-sectional study categorizes social networks into family and friend networks to elucidate their direct and indirect effects. Methods: The study analyzed 193 community-dwelling older adults (women 78.2%; mean age 77.1±5.3 years) who participated in health-checkup events in two cities in Japan. Appetite was assessed using the Japanese version of the Simplified Nutritional Appetite Questionnaire, and family and friend networks were assessed using the Lubben Social Network Scale-6. Depression was assessed using the Geriatric Depression Scale-15. Based on previous research, we constructed a causal model examining the impacts of family and friend social networks and depression on appetite and calculated the direct and indirect effects through structural equation modeling. Results: The family network had a direct effect on appetite (path coefficient=0.18) and an indirect effect via depression (path coefficient=0.0608). Conversely, the friend network was not directly associated with appetite but had an indirect effect through depression (path coefficient=0.095). The model exhibited a good fit. The mechanism of influence on appetite varied between the networks. Conclusion To prevent appetite loss, social networks with family and friends should be assessed separately, and tailored support should be provided for each.

Methods: Forty-nine adults who underwent single-level L4/5 interbody fusion for degenerative spondylolisthesis were divided into BE-ELIF (n=27) and OLIF (n=22) groups based on the surgical approach used. Clinical outcomes were assessed using the Visual Analog Scale and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Radiographic parameters, including distance of spondylolisthesis, disc height, segmental lordosis, lumbar lordosis, pelvic tilt, and sagittal vertical axis, were evaluated preoperatively and at final follow-up. Results: OLIF provided significantly better relief of pain in lower limbs and buttocks at 1-year follow-up. No significant between-group differences were observed in JOABPEQ domains. BE-ELIF resulted in greater improvements in spondylolisthesis distance and disc height, while other parameters did not differ significantly between the two groups. Conclusions For L4/5 degenerative spondylolisthesis, BE-ELIF demonstrated superior spondylolisthesis reduction and disc height improvement than OLIF. Although BE-ELIF was associated with some inferior clinical outcomes, it provided satisfactory results, effective realignment, and a low complication risk.

Background: Appetite loss in older adults raises the risk of malnutrition and frailty. The recent emphasis on psychological and social support for appetite loss reveals the importance of robust social networks. Depression is linked to a decline in appetite and social networks. Social networks may influence appetite directly and indirectly through depression. This exploratory cross-sectional study categorizes social networks into family and friend networks to elucidate their direct and indirect effects. Methods: The study analyzed 193 community-dwelling older adults (women 78.2%; mean age 77.1±5.3 years) who participated in health-checkup events in two cities in Japan. Appetite was assessed using the Japanese version of the Simplified Nutritional Appetite Questionnaire, and family and friend networks were assessed using the Lubben Social Network Scale-6. Depression was assessed using the Geriatric Depression Scale-15. Based on previous research, we constructed a causal model examining the impacts of family and friend social networks and depression on appetite and calculated the direct and indirect effects through structural equation modeling. Results: The family network had a direct effect on appetite (path coefficient=0.18) and an indirect effect via depression (path coefficient=0.0608). Conversely, the friend network was not directly associated with appetite but had an indirect effect through depression (path coefficient=0.095). The model exhibited a good fit. The mechanism of influence on appetite varied between the networks. Conclusion To prevent appetite loss, social networks with family and friends should be assessed separately, and tailored support should be provided for each.

Methods: Forty-nine adults who underwent single-level L4/5 interbody fusion for degenerative spondylolisthesis were divided into BE-ELIF (n=27) and OLIF (n=22) groups based on the surgical approach used. Clinical outcomes were assessed using the Visual Analog Scale and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Radiographic parameters, including distance of spondylolisthesis, disc height, segmental lordosis, lumbar lordosis, pelvic tilt, and sagittal vertical axis, were evaluated preoperatively and at final follow-up. Results: OLIF provided significantly better relief of pain in lower limbs and buttocks at 1-year follow-up. No significant between-group differences were observed in JOABPEQ domains. BE-ELIF resulted in greater improvements in spondylolisthesis distance and disc height, while other parameters did not differ significantly between the two groups. Conclusions For L4/5 degenerative spondylolisthesis, BE-ELIF demonstrated superior spondylolisthesis reduction and disc height improvement than OLIF. Although BE-ELIF was associated with some inferior clinical outcomes, it provided satisfactory results, effective realignment, and a low complication risk.

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML). Methods: Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles. Results: Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group. Conclusions Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.

Objective: To investigate the effect on early mobilization in patients undergoing extra-corporeal membrane oxygenation (ECMO) and acute blood purification therapy in the intensive care unit (ICU). Methods: We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU, aged ≥18 years, and received mechanical ventilation for >48 hours were eligible. The analyzed were divided into two groups: ECMO/blood purification or control group. Clinical outcomes; time to first mobilization, number of total ICU rehabilitations, mean and highest ICU mobility scale (IMS); and daily barrier changes were also investigated. Results: A total of 204 patients were included in the analysis, 43 in the ECMO/blood purification group and 161 in the control group. In comparison of clinical outcome, the ECMO/blood purification group had a significantly longer time to first mobilization: ECMO/blood purification group 6 vs. control group 4 (p=0.003), higher number of total ICU rehabilitations: 6 vs. 5 (p=0.042), lower mean: 0 vs. 1 (p=0.043) and highest IMS: 2 vs. 3 (p=0.039) during ICU stay. Circulatory factor were most frequently described as barriers to early mobilization on days 1 (51%), 2 (47%), and 3 (26%). On days 4 to 7, the most frequently described barrier was consciousness factors (21%, 16%, 19%, and 21%, respectively) Conclusion The results of this study comparing the ECMO/blood purification group and the untreated group in the ICU showed that the ECMO/blood purification group had significantly longer days to mobilization and significantly lower mean and highest IMS.

Objective: To examine the association between the mobilization level during intensive care unit (ICU) admission and independence in activity of daily living (ADL), defined as Barthel Index (BI)≥70. Methods: This was a post-hoc analysis of the EMPICS study involving nine hospitals. Consecutive patients who spend >48 hours in the ICU were eligible for inclusion. Mobilization was performed at each hospital according to the shared protocol and the highest ICU mobility score (IMS) during the ICU stay, baseline characteristics, and BI at hospital discharge. Multiple logistic regression analysis, adjusted for baseline characteristics, was used to deter-mine the association between the highest IMS (using the receiver operating characteristic [ROC]) and ADL. Results: Of the 203 patients, 143 were assigned to the ADL independence group and 60 to the ADL dependence group. The highest IMS score was significantly higher in the ADL independence group than in the dependence group and was a predictor of ADL independence at hospital discharge (odds ratio, 1.22; 95% confidence interval, 1.07–1.38; adjusted p=0.002). The ROC cutoff value for the highest IMS was 6 (specificity, 0.67; sensitivity, 0.70; area under the curve, 0.69). Conclusion These results indicate that, in patients who were in the ICU for more than 48 hours, that patients with good function in the ICU also exhibit good function upon discharge. However, prospective, multicenter trials are needed to confirm this conclusion.

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.