VOLUME 88 NUMBER 3 August 2026
ORIGINAL PAPERS
Initial development and psychometric evaluation of the Dementia Worry Assessment Scale for middle-aged and older adults in Japan
Kaori Saeki, Junko Hoshino, Rika Usami, Mika Sakurai and Naomi Furukawa
pg(s) 375 - 388
Dementia worry is an emotional response to the perceived threat of developing dementia. This study aimed to develop Dementia Worry Assessment Scale (DWAS) for middle-aged and older adults in Japan, evaluating its reliability and validity through a cross-sectional survey. A 30-item preliminary DWAS was developed based on existing scales related to dementia worry, as well as Japanese middle-aged and older adults’ specific emotional responses regarding dementia onset. Participants were over 40 years of age and were recruited from community health promotion groups and residents’ association activities. There were 152 valid responses from 182 participants. Data were analyzed through item analysis, exploratory factor analysis, internal consistency, reliability testing, and criterion-related validity assessment. The number of responses was 152 (valid response rate = 83.5%), of whom 71.1% were women and 28.9% were men. The mean age and standard deviation were 59.4 ± 10.9 years. The finalized 16-item DWAS comprises two domains: “Threat from having dementia” (7 items) and “Apprehension about developing dementia” (9 items). The internal consistency reliability estimated by Cronbach’s alpha was 0.952 for the overall scale, and 0.956 and 0.940 for the two subscales, respectively. Significant positive correlations were observed between the DWAS total score and the Japanese version of the Beck Depression Inventory score (r = 0.342, p < 0.001). The DWAS demonstrated robustness, reliability, and validity. This new scale is a suitable tool for assessing dementia worry levels among middle-aged and older adults in Japan. It may facilitate the development of tailored support for individuals with varying levels of dementia worry.
Flavopiridol protects against oxidative stress in Schwann cells and maintains their myelin structure during peripheral nerve degeneration: pharmaco-neuroanatomical approaches
Hyung-Joo Chung, Jung Sig Cho, Won Woo Moon, Na Young Jeong and Junyang Jung
pg(s) 389 - 400
Flavopiridol (Flavo) is a synthetic flavonoid analog and a broad cyclin-dependent kinase (CDK) inhibitor based on an extract of Dysoxylum binectariferum that effectively decreases the activity of CDK1, CDK2, CDK6, CDK7, and CDK9 in living cells. This property has allowed Flavo to be tested in clinical trials for acute myeloid leukemia and for the suppression of cancer cell proliferation. The proliferation of Schwann cells, unique glia in the peripheral nervous system, is the main morphological phenotype during peripheral nerve degeneration. We determined that Flavo induced Schwann cell proliferation during peripheral nerve degeneration. Flavo also protected other phenotypes, such as demyelination, axonal degeneration, transcriptional regulation, and Schwann cell trans-dedifferentiation. One of the causes of peripheral nerve degeneration is oxidative stress. A variety of cellular events in oxidatively damaged Schwann cells induce the onset of neurodegeneration, resulting in irreversible neurodegenerative conditions. In Schwann cells, hydrogen sulfide (H2S) increases the protective response to oxidative stress and several signaling pathways involved downstream of H2S. Flavo significantly inhibited the H2S/CDK pathway in Schwann cells during peripheral nerve degeneration. Thus, our study suggests that Flavo is an effective inhibitor for peripheral neurodegeneration and could be a candidate to develop a therapeutic drug for peripheral neurodegenerative diseases.
Nurses’ perceptions of the interaction process between parents and nurses in a pediatric ward: nurses’ feelings
Yurika Usami, Yuki Takahashi, Akiko Yamada and Miho Narama
pg(s) 401 - 413
Pediatric nurses are expected to involve parents in the care of hospitalized children. However, parent–nurse interactions are among the most challenging aspects of their practice. This study aimed to explore nurses’ perceptions of the nurse–parent interaction process in detail in pediatric wards. Individual semi-structured interviews were conducted with 14 nurses from six hospitals: three from children’s hospitals, three from university hospitals, and eight from general hospitals. The nurses had worked in pediatric wards for at least 1 year in Japan from June to September 2019 and November 2022 to January 2023. A grounded theory approach was used to capture the interaction processes with parents. The phenomenon of “nurse’s feelings” was extracted from all participants through the analysis of interview data. This phenomenon comprised 23 categories, with the category “nurse’s feelings” at the center. Pediatric nurses perceived the process of interaction with parents through their feelings. Nurses use their feelings as sensors to understand parents’ psychological states and respond appropriately. Building relationships with parents involves listening to parents’ concerns and being flexible in meeting their needs.
Long-term outcomes of double-balloon endoscopy–assisted endoscopic balloon dilation for small bowel strictures in Crohn’s disease: a retrospective cohort study
Yusuke Hatta, Takeshi Yamamura, Keiko Maeda, Tsunaki Sawada, Eri Ishikawa, Kentaro Murate, Takashi Hirose, Tadashi Iida, Yasuyuki Mizutani, Kentaro Yamao, Takuya Ishikawa, Yoji Ishizu, Kazuhiro Furukawa, Takashi Honda, Masanao Nakamura and Hiroki Kawashima
pg(s) 414 - 429
Crohn’s disease (CD) is a chronic, relapsing inflammatory disorder of the gastrointestinal tract characterized by transmural inflammation, often resulting in small bowel strictures. Although surgical resection remains the standard treatment, repeated surgeries increase the risk of short bowel syndrome. Endoscopic balloon dilation (EBD) has emerged as a less invasive alternative to surgery; however, its long-term efficacy and surgical predictors remain understudied. This study aimed to evaluate the long-term outcomes, safety, and risk factors of surgery following double-balloon endoscopy (DBE)–assisted EBD (DBE-EBD) in patients with CD. This study retrospectively analyzed 177 patients with CD who underwent DBE for small-bowel strictures at Nagoya University Hospital between March 2004 and January 2024. Among the 120 eligible patients, EBD was attempted in 68. Technical success (passage of a 9.4-mm endoscope) was achieved in 55 (80.9%) of them. The cumulative surgery-free rates were 89.7% at 1 year and 79.8% at 3 years, whereas the redilation-free rates were 72.4% and 43.4%, respectively. Patients who underwent successful EBD showed significantly higher surgery-free survival than those who underwent unsuccessful EBD (1-year rate, 94.5% vs 69.2%, p = 0.002). Multivariate analysis identified unsuccessful EBD as the sole independent risk factor for subsequent surgery. No significant predictors of redilation or emergency hospitalization were identified. DBE-EBD for small-bowel strictures in CD demonstrates high rates of technical success and long-term surgery-free survival. Unsuccessful EBD was the strongest predictor of subsequent surgery, highlighting the importance of procedural success. Therefore, DBE-EBD appears to be a valuable bowel-preserving strategy in appropriately selected patients.
Risk factors associated with knee and wrist injuries in Chinese male breakdancers
Lu Bai, Huiye Jia and Bo Wang
pg(s) 430 - 450
This study aimed to identify the potential risk factors associated with knee and wrist injuries in Chinese male breakdancers. A cross-sectional study was conducted from May to August 2023 using a self-administered online questionnaire distributed to 689 male breakdancers with at least two years of training experience. The questionnaire covered demographics, training patterns, injury protection knowledge, and injury characteristics in the preceding 24 months. Among the participants, 621 dancers (90.1%) reported at least one injury, totaling 1,056 injuries. Wrist injuries (247 cases, 23.3%) and knee injuries (205 cases, 19.4%) were the most common injuries. Regression analysis indicated that being a self-identified beginner (OR = 0.176, 95% CI, 0.046–0.681) and performing warm-ups of 10–20 minutes (OR = 0.259, 95% CI, 0.092–0.728) or 20–30 minutes (OR = 0.162, 95% CI, 0.05–0.529) were protective against knee injuries. For wrist injuries, longer training duration (OR = 0.958, 95% CI, 0.921–0.997) was protective, while specialization in footwork (OR = 1.591, 95% CI, 1.078–2.349) and having basic (OR = 1.808, 95% CI, 1.101–3.189) or some knowledge (OR = 1.885, 95% CI, 1.115–3.189) of injury prevention were associated with higher injury risk. Most injuries occurred during training, with fatigue and technical errors as the primary causes. Variables with a univariate association of P < 0.05 with the injury outcome were considered eligible for inclusion as covariates in the final multivariate logistic regression models to adjust for potential confounding factors. Longer training duration and adequate warm-up demonstrated protective effects against wrist injuries, underscoring the importance of professional instruction and injury prevention knowledge.
Improved breast cancer characterization with high-resolution 3D T2-weighted image at equivalent scan times to conventional 2D fast spin echo T2-weighted image
Kazushige Ichikawa, Hiroko Satake, Mami Iima, Satoko Ishigaki, Yutaka Kato and Shinji Naganawa
pg(s) 451 - 464
This study aimed to optimize three-dimensional T2-weighted image (3D T2WI) to match 2D T2WI scan times in a phantom study and compare their image quality and diagnostic potential in clinical breast magnetic resonance imaging (MRI). A phantom study evaluated contrast-to-noise ratio (CNR) and spatial resolution using four spheres mimicking cyst, benign tumor, malignant tumor, and fibroglandular tissue (FGT). CNR was compared between variable refocusing flip angle (VRFA) and constant FA approaches across equivalent echo times (TE) of 80–120 millisecond (msec). Optimal resolution was assessed using voxel sizes of 1.1 × 0.8 × 2.0 (2D) and 1.0 × 0.8 × 1.4, 0.8 × 0.6 × 1.4, 0.7 × 0.5 × 1.4 mm3 (3D) with equivalent TEs of 100–120 msec. Seventy female patients were included in this Nagoya University Hospital Institutional Review Board (IRB)-approved retrospective study. Signal-to-noise ratio (SNR) and CNR between lesions and FGT were calculated. Two radiologists independently evaluated all T2WIs using a 5-point Likert scale. 3D T2WI with VRFA consistently provided higher CNR than constant FA. CNR between malignant tumor- and FGT-mimicking spheres, and between benign tumor- and FGT-mimicking spheres peaked at equivalent TE of 100 msec. Optimal balance between resolution and equivalent TE was achieved with 0.8 × 0.6 × 1.4 mm3 and 100 msec. Lesion SNR showed no significant difference between 2D and optimized 3D T2WI (6.23 ± 2.83 vs 5.96 ± 2.84, p > 0.05), nor did FGT SNR (6.59 ± 3.00 vs 6.33 ± 3.38, p > 0.05). However, optimized 3D T2WI demonstrated significantly higher CNR (4.15 ± 3.11 vs 3.62 ± 2.74, p < 0.05) and superior radiologist scores across all criteria (p < 0.01). Optimized 3D T2WI significantly improved image quality, supporting its clinical feasibility as a valuable adjunct to contrast-enhanced breast MRI for lesion characterization and morphological assessment.
Clinicopathological features and long-term outcomes of pleural solitary fibrous tumors
Elçin Ersöz Köse, Aysun Kosif, Serda Kanbur Metin, Meltem Ağca, Abidin Levent Alpay and Volkan Baysungur
pg(s) 465 - 476
Pleural solitary fibrous tumors (PSFT) are rare mesenchymal neoplasms with heterogeneous biological behavior. Although most tumors are histologically benign, recurrence and distant metastasis may occur, complicating prognostic stratification. This retrospective study evaluated the clinicopathological characteristics and long-term outcomes of 47 patients who underwent surgical resection for PSFT between January 2008 and June 2023, with particular focus on tumor size, positron emission tomography–computed tomography (PET-CT)–derived maximum standardized uptake value (SUVmax), and Ki-67 proliferation index. The mean tumor diameter was 8.4 cm, with 31.9% of the cases presenting a tumor size of ≥10 cm. Malignant histology was identified in 14 patients (29.7%). PET-CT was available in 28 patients; SUVmax ≥2.5 was observed in all malignant tumors and in 35.0% of benign tumors (p = 0.004). Ki-67 data were available in 18 patients, and Ki-67 ≥10% was significantly more frequent in malignant tumors than in benign tumors (p = 0.005). Complete R0 resection was achieved in all patients. The 5-year overall survival rate was 89.3%, with lower survival in malignant tumors compared with benign tumors (78.6% vs 93.9%). Local recurrence was observed in one patient with benign histology, while brain metastasis occurred in a patient with malignant histology. These findings suggest that the clinical behavior of PSFT cannot be reliably predicted based solely on histopathological features or tumor size. Instead, they indicate that metabolic and proliferative markers may provide valuable prognostic insights, highlighting the necessity for long-term, risk-stratified follow-up for all patients.
Analysis of risk factors for acute kidney injury during extracorporeal membrane oxygenation in children
Jiaqi Li, Liting Hou, Qianqian Liu, Bin Yan and Weikai Wang
pg(s) 477 - 486
This study aimed to identify the risk factors for acute kidney injury (AKI) in children receiving extracorporeal membrane oxygenation (ECMO) treatment. We retrospectively analyzed data of 76 children who were treated with ECMO. The analysis factors included sex, age, primary disease type, ECMO treatment mode and flow, the vasoactive–inotropic score (VIS) after ECMO initiation, and relevant laboratory data before and after ECMO initiation. Patients who developed AKI were assigned to the observation group, while those who did not develop AKI were assigned to the control group. We compared relevant indicators between the two groups. Binary logistic regression was used to determine independent risk factors for AKI during ECMO treatment. AKI occurred in 43 patients (56.6%). Univariate analysis revealed significant differences in the intensive care unit (ICU) stay length, mechanical ventilation duration, combined continuous renal replacement therapy (CRRT) time, ECMO treatment duration, lactate level before ECMO initiation, VIS after ECMO initiation, and output within 24 hours after ECMO initiation. Multivariate analysis revealed that high lactate levels before ECMO initiation (OR = 1.828; 95% CI, 1.163–2.874; P = 0.009), a high VIS after ECMO initiation (OR = 1.038; 95% CI, 1.000–1.077; P = 0.047), and a prolonged ECMO duration (OR = 1.022; 95% CI, 1.005–1.039; P = 0.012) were independent risk factors for AKI. The incidence of AKI during ECMO treatment is high. A high VIS, an elevated lactate level before ECMO initiation, and an extended ECMO duration are independent risk factors for AKI in these patients.
Longitudinal association between body mass index-adjusted skeletal muscle mass and domain-specific progression of locomotive syndrome in community-dwelling adults aged 50 years and older
Koji Ono, Shingo Taki, Junji Nishimoto, Minoru Toriyama, Hajime Ito and Ryo Tanaka
pg(s) 487 - 499
Locomotive syndrome (LS) is characterized by mobility decline in older adults and is associated with future long-term care needs and reduced independence. Skeletal muscle mass plays a crucial role in maintaining mobility. However, the longitudinal association between appendicular skeletal muscle mass adjusted for body mass index (ASM/BMI) and LS progression remains insufficiently examined. This study examined the association between baseline ASM/BMI and LS progression by each LS assessment component. This prospective cohort study followed community-dwelling adults aged ≥50 years for 1 year. LS progression was evaluated using changes in the two-step test, stand-up test, and the 25-question geriatric locomotive function scale (GLFS-25). ASM was assessed using bioelectrical impedance analysis, and ASM/BMI was calculated as ASM divided by body mass index. Associations were examined using multivariable logistic regression models adjusting for age, sex, and baseline LS stage. Incidence of LS progression differed across components. Higher baseline ASM/BMI was significantly associated with a lower risk of LS progression assessed by the two-step test (adjusted odds ratio per 0.01-unit increase, 0.94; 95% confidence interval, 0.90–0.98). Baseline ASM/BMI was not significantly associated with LS progression based on the stand-up test or GLFS-25. Among community-dwelling adults aged ≥50 years, lower baseline ASM/BMI was associated with a higher likelihood of LS progression in dynamic mobility capacity assessed by the two-step test, but not with overall LS progression based on the stand-up test or GLFS-25. These results suggest that ASM/BMI is a domain-specific predictor for declines in walking-related mobility.
Association between physique at age 20 and body weight gain from age 20: a cross-sectional study of the Shizuoka-Sakuragaoka Japan Multi-Institutional Collaborative Cohort (J-MICC) Study
Kazuto Tozuka, Rie Kawata, Kana Higuchi, Rion Suzuki, Mayuko Shibuya, Kanako Nakajima and Kiyonori Kuriki
pg(s) 500 - 516
Body weight gain from age 20 (BWG_20yr) is a significant risk factor for lifestyle-related diseases; however, its association with self-perceived physique at age 20 (Physique_20yr) remains unexplored. This study aimed to examine the relationship between self-perceived Physique_20yr and BWG_20yr. This study included 3,068 males and 2,312 females aged 35–79 years. Participants self-reported their body weight at age 20 and categorized their physique as either “muscular” or “obese,” followed by selection of one of five levels (Physique_20yr). BWG_20yr was defined as the difference in body mass index between approximately age 20 and baseline. A directed acyclic graph was used to visualize relationships with adjusted factors, and multivariable logistic regression analysis was conducted to assess odds ratio trends and interactions between groups. Differences in trends from “strongly disagree” to “strongly agree” between the muscular and obese groups were observed (p for interaction <0.05 for both sexes). For BWG_20yr ≥2.5 kg/m2, trends were positive in the muscular group and negative in the obese group in males. In females, no significant trend was observed in the muscular group, whereas a negative trend was observed in the obese group. Similar trends and interactions were noted for BWG_20yr ≥3.5 kg/m2 (p for interaction <0.05 in males; 0.074 in females). To address potential recall bias, analyses were repeated using two cutoff values exceeding the expected range of recall error, yielding consistent results. These findings suggest that self-perceived Physique_20yr may be associated with BWG_20yr.
Validation of the Japanese version of the Spiritual Health and Life-Orientation Measure (SHALOM) among nursing students
Iraka Kambe, Kazuki Sato, Mika Onodera, Naoki Ozawa, Shoko Ando, Shigeyoshi Maki and Ayumi Sugimura
pg(s) 517 - 528
The Spiritual Health and Life-Orientation Measure (SHALOM) assesses spiritual well-being (SWB) across four relational domains by comparing ideal and lived states. The aim of this study was to develop and validate the Japanese version of SHALOM among university nursing students. A cross-sectional survey was conducted among 213 undergraduate nursing students at two universities in Japan. Reliability was evaluated using Cronbach’s α and test–retest reliability with intraclass correlation coefficients (ICCs). Construct validity was examined through exploratory factor analysis, concurrent validity through correlations with the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp-Non-Illness), and known-groups validity by comparing SHALOM scores between students with high and low self-esteem based on the Rosenberg Self-Esteem Scale–Japanese version. Cronbach’s α ranged from 0.79 to 0.90, and ICCs ranged from 0.67 to 0.78. Exploratory factor analysis supported a four-domain structure, although one environmental item (“magic in the environment”) loaded on the transcendental domain, and one personal item (“inner peace”) loaded on the communal domain. Correlations with the FACIT-Sp-Non-Illness were as follows: total r = 0.45, personal r = 0.59, communal r = 0.45, environmental r = 0.25, and transcendental r = 0.09. Students with higher self-esteem showed significantly higher personal and communal SHALOM scores. These findings provide preliminary support for the reliability and validity of the Japanese SHALOM. The measure may offer a culturally adaptable, non-religious framework for assessing SWB in nursing education and practice.
Characteristics of cage migration cases following combined anterior-posterior spinal reconstruction surgery using an adjustable wide footprint plate cage
Kazuma Ohshima, Naoki Segi, Yuya Okada, Sadayuki Ito, Jun Ouchida, Ippei Yamauchi, Yukihito Ode, Tetsuya Urasaki, Shiro Imagama and Hiroaki Nakashima
pg(s) 529 - 541
Anterior-posterior vertebral reconstruction is indicated for unstable spinal fractures, but cage subsidence and migration remain concerns. Adjustable wide footprint plate (AWFP) cages were developed to enhance anterior column stability; however, postoperative migration and breakage have been reported. This study evaluated the radiographic characteristics of AWFP cage migration. We retrospectively reviewed 21 patients with single-level AO type A2-A4 or B4 fractures who underwent combined anterior-posterior reconstruction using an AWFP cage and pedicle screw-rod fixation between 2019 and 2024, with ≥6 months of follow-up. Demographics, vertebral computed tomography (CT) values, cage lift-up, subsidence, screw loosening, bone fusion, coronal AWFP angle, and hardware failure were assessed. Patients were classified into migration (≥3 mm displacement) and non-migration groups. Eleven patients showed cage migration. Demographics, CT values, and posterior fixation levels did not differ between groups. Anterior and posterior cage lift-up were significantly greater in the migration group (6.2 vs 2.1 mm, p = 0.03; 3.2 vs 0.7 mm, p = 0.04). Migration was associated with higher rates of subsidence and screw loosening. Progressive increases in the coronal AWFP angle were observed at 1 week (4.6° vs 1.5°, p = 0.001) and 6 months (7.3° vs 2.1°, p = 0.001). Plate breakage occurred in two cases, including one requiring revision surgery. AWFP cage migration is associated with excessive lift-up, subsidence, and progressive coronal angle changes. Monitoring coronal angle changes may facilitate early detection of mechanical failure.
CASE REPORT
Initial experience with deceased-donor lung transplantation at a newly established lung transplant center: a report of three cases
Taiki Ryo, Heng Huang, Minoru Sugihara, Tatsuya Masuda, Yasuhisa Ichikawa, Yoshito Imamura, Hirofumi Takenaka, Hiroki Watanabe, Yuta Kawasumi, Keita Nakanishi, Yuka Kadomatsu, Harushi Ueno, Taketo Kato, Shota Nakamura, Tetsuya Mizuno and Toyofumi Fengshi Chen-Yoshikawa
pg(s) 542 - 549
Deceased-donor lung transplantation (DDLT) is an established therapeutic option for patients with end-stage lung disease; however, the number of certified lung transplant centers in Japan remains limited. Our institution was certified as the 11th lung transplant center in Japan in March 2023, and lung transplant registration was subsequently initiated. We report our initial experience with three consecutive DDLTs performed at our institution. The patients included two men with idiopathic pulmonary fibrosis and one man with diffuse panbronchiolitis. Right single-lung, bilateral lung, and left single-lung transplantation were performed, respectively. One patient developed postoperative aspiration pneumonia, which was successfully treated with antibiotics. Another patient required methylprednisolone pulse therapy for suspected acute rejection and transient renal replacement therapy for acute renal dysfunction. All patients showed favorable postoperative recovery, with substantial improvement in functional status. Donor lung procurement, surgery, and postoperative management were conducted through close collaboration with an experienced transplant center and a multidisciplinary team. This experience suggests that DDLT can be safely introduced at a newly established lung transplant center through interinstitutional cooperation and comprehensive multidisciplinary perioperative management.