Transient Regional Wall Motion Abnormality and Increased Wall Thickness of the Left Ventricle in Acute Myopericarditis Occurring in the Puerperium

An unusual sequence of echocardiographic abnormalities of a 25-year-old female with acute myopericarditis was described. She presented with shortness of breath and a high body temperature after the birth of her first child. Regional asynergy and increased thickness of the left ventricle were transiently observed by echocardiography. It is considered that these abnormalities resulted from inflammatory changes in heart muscle such as edema, which was ascribable to acute myopericarditis in the puerperium

Providing Brief Personalized Therapies for Insomnia Among Workers Using a Sleep Prompt App: Randomized Controlled Trial

スマートフォンアプリによる睡眠改善の効果を実証 --ショート・メッセージによる行動変容技術の有効性--. 京都大学プレスリリース. 2022-07-26.[Background:] Insomnia is the most common sleep disorder and the foremost health concern among workers. We developed a new sleep prompt app (SPA) for smartphones to positively alter the users' consciousness and behavior by sending timely short messages for mild sleep problems at an early stage. [Objective:] The aim of this study is to investigate the effectiveness of the SPA in providing brief personalized therapy for insomnia among workers. [Methods:] We conducted a 2-arm parallel randomized controlled trial. The intervention group used the SPA, and the control group received no intervention. Participants were recruited between November 2020 and January 2021. The researcher sent emails for recruitment to more than 3000 workers of 2 companies and 1 university in Japan. The SPA provided personalized prompt messages, sleep diaries, sleep hygiene education, stimulus control therapy, and sleep restriction therapy. The prompt messages were sent automatically to the participants to encourage them to improve their sleep habits and sleep status and were optimized to the individual's daily rhythm. The intervention program duration was 4 weeks. The primary outcome was a change in the Insomnia Severity Index (ISI) for the study period. The ISI was obtained weekly using a web questionnaire. [Results:] A total of 116 Japanese workers (intervention group n=60, control group n=56) with sleep disorders were recruited. Two participants in the intervention group were excluded from the analyses because of challenges in installing the SPA. The mean ISI scores at baseline were 9.2 for both groups; however, after 4 weeks, the mean ISI scores declined to 6.8 and 8.0 for the intervention and control groups, respectively. Primary analysis using a linear mixed model showed a significant improvement in the temporal trends of the ISI in the SPA group and in the total population (P=.03). Subgroup analyses of ISI-8-insomniacs revealed a significant improvement in the temporal trends of ISI in the SPA group (P=.01), and the CFS score for physical condition significantly improved following the intervention (P=.02). [Conclusions:] This study demonstrates the effectiveness of the SPA in providing brief personalized therapy for insomnia among Japanese workers with mild insomnia. The physical fatigue score significantly improved in ISI-8-insomniacs. Thus, SPA could play an important role in reducing the adverse effects of sleep disorders in workers. To promote the wide use of the SPA in the future, further studies are required to examine its effectiveness in other age groups and individuals with health problems. [Trial Registration:] University Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042263; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R00004629

Temporal Trend in an Initial Treatment, Survival, and Medical Costs Among Patients With Lung Cancer Between 2013 and 2018 in Kyoto City, Japan

2013年から2018年にかけた京都市における肺がん患者の初期治療、医療費及び生存割合の変化. 京都大学プレスリリース. 2022-07-28.OBJECTIVES: This study aimed to identify the variation of treatment contents and outcomes and economic burden of lung cancer among the elderly population in Japan. METHODS: New-onset primary lung cancer from April 2013 to March 2019 were identified by using the Kyoto City administrative database for National Health Insurance and Advanced Elderly Medical Service System. Patient characteristics, initial treatment, medical costs, and deaths were analyzed. Continuous variables were calculated using standard descriptive statistical methods. RESULTS: A total of 4845 people who were diagnosed as having lung cancer and received any treatment between 2013 and 2018 were included in the study. The average age of patients was 73 to 74 years for a 6-year study period. The proportion of patients who received surgery, drug therapy, and radiation therapy as initial treatment was 31% to 42%, 36% to 44%, and 21% to 24%, respectively. Healthcare costs increased between fiscal year (FY) 2014 and FY 2018, with a particularly significant increase of 340 million for drug therapy, whereas the mortality rate in <2-year follow-up decreased from 42.7% in FY 2013 to 368% in FY 2016. CONCLUSIONS: This cross-sectional study demonstrated that the improvement in the survival rate and proportion of surgery as an initial treatment was increased whereas drug therapy decreased and medical costs increased among patients with lung cancer over time. Based on these results, it is necessary to implement sustainable healthcare measures with a consideration of cost-effectiveness

Efficacy of sleep extension therapy using a remote support system in university students with increased social jetlag: a parallel, single-blind, randomized controlled trial

[Purpose] The efficacy of sleep extension therapy using a remote support system (SET-R) was investigated in university students with increased social jetlag (SJL). [Methods] For this two-arm parallel randomized controlled trial, we recruited Japanese university students with SJL ≥ 60 min. The SET-R provided an individualized sleep schedule for gradual sleep extension using email and sleep hygiene education, stimulus control therapy, and progressive muscle relaxation as web content. The control group was sent an email that encouraged them to record their sleep. The duration of the intervention program was two weeks. The primary outcome was the mean change in SJL two weeks later, assessed using the Munich ChronoType Questionnaire (MCTQ). The other outcomes included Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Patient Health Questionnaire-9 (PHQ-9), and sleep quiz. A follow-up survey was conducted 6 months after the intervention. [Results] Of 54 students, 26 were assigned to an intervention group and 28 to a control group. The difference in the mean change in SJL between the two groups (n = 26, n = 27) at two weeks was statistically significant (27.7 min, P = 0.048). The scores for the ESS, PHQ-9, and sleep quiz were improved in the intervention group relative to the control group. At the 6-month follow-up point, the difference in the mean change in SJL between the two groups (n = 22, n = 27) was not statistically significant, but scores for the PHQ-9, and sleep quiz remained significant. [Conclusions] This study demonstrated the efficacy of the SET-R among university students with increased SJL. [Trial Registration] The study was registered with the UMIN Clinical Trials Registry (UMIN000042634, 2021/02/01)

Seihai-to (TJ-90)-Induced Activation of Airway Ciliary Beatings of Mice: Ca2+ Modulation of cAMP-Stimulated Ciliary Beatings via PDE1

Sei-hai-to (TJ-90, Qing Fei Tang), a Chinese traditional medicine, increases ciliary beat frequency (CBF) and ciliary bend angle (CBA) mediated via cAMP (3′,5′-cyclic adenosine monophosphate) accumulation modulated by Ca2+-activated phosphodiesterase 1 (PDE1A). A high concentration of TJ-90 (≥40 μg/mL) induced two types of CBF increases, a transient increase (an initial increase, followed by a decrease) and a sustained increase without any decline, while it only sustained the CBA increase. Upon inhibiting increases in intracellular Ca2+ concentration ([Ca2+]i) by 10 μM BAPTA-AM (Ca2+-chelator, 1,2-Bis(2-aminophenoxy)ethane-N,N,N′,N′-tetraacetic acid tetrakis(acetoxymethyl ester) or Ca2+/calmodulin-dependent PDE1 by 8MmIBMX (a selective PDE1 inhibitor), TJ-90 (400 μg/mL) induced only the sustained CBF increase without any transient CBF increase. The two types of the CBF increase (the transient increase and the sustained increase) induced by TJ-90 (≥40 μg/mL) were mimicked by the stimulation with both procaterol (100 pM) and ionomycin (500 nM). Thus, TJ-90 stimulates small increases in the intracellular cAMP concentration ([cAMP]i) and [Ca2+]i in airway ciliary cells of mice. These small increases in [cAMP]i and [Ca2+]i cause inducing a transient CBF increase or a sustained CBF increase in an airway ciliary cells, depending on the dominant signal, Ca2+-signal, or cAMP-signal

Survival and medical costs of non‐small cell lung cancer patients according to the first‐line treatment: An observational study using the Kyoto City Integrated Database

Abstract Background Lung cancer is the primary cause of cancer mortality and non‐small cell lung cancer (NSCLC) accounts for the majority of lung cancer cases. New drug treatments have been developed since 2010 but there are concerns about the increase in medical costs. This study aimed to compare survival and medical costs among patients with NSCLC according to their initial treatment to estimate the impact of early NSCLC detection. Methods Patients with primary NSCLC who filed insurance claims between April 2013 and March 2019 were identified using the Kyoto City Integrated Database. Patients were divided into two groups depending on their initial treatment: the resection group and drug or radiation group. The survival and medical costs were calculated. Results A total of 2609 patients with primary NSCLC were identified. Among them, 1035 patients underwent resection. The 5‐year survival was 75% for the resection group while below 25% for the drug or radiation group. At 6 months of survival, the median cumulative total cost was 2409 thousand yen (interquartile range [IQR] 1947–4012 thousand yen) in the resection group and 2951 thousand yen (IQR 1600–4706 thousand yen) in the drug or radiation group. At 4 years of survival, the cumulative median total cost was 5257 thousand yen (IQR 3808–8243 thousand yen) in the resection group and 10 202 thousand yen (IQR 4845–20 450 thousand yen) in the drug or radiation group. Conclusions As a first‐line therapy in newly diagnosed patients with NSCLC, surgical resection is associated with longer survival and lower medical costs than pharmacotherapy or radiotherapy