Synthesis and Biological Evaluations of Novel Human Parathyroid Hormone 1 Receptor (hPTHR1) Agonists Bearing Bicyclic Aromatic Moiety.

We have previously shown that the small molecule hPTHR1 agonist PCO371 (1) orally and dose-dependently induces PTH-like calcemic and hypophostemic activity in thyroparathyroidectomized rats. Compound 2a, bearing a bicyclic aromatic ring, was identified as a novel hPTHR1 agonist during hit to lead modification. It showed moderate PTHR1 agonistic activity with an EC20 value of 15 µM, and its metabolic stability in human liver microsome (hLM) as well as its solubility in phosphate buffer (PPb) and Fasted state simulated intestinal fluid (FaSSIF) were found to be poor. As results of the initial derivatization of 2a, we identified the indole derivatives as another scaffold. In this article, we report on the structure-activity relationship (SAR), structure-metabolism relationship (SMR), and structure-solubility relationship (SSR) of bicyclic aromatic derivatives, and the in vivo efficacy of 2j.

Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022.

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.

A concept for emotion recognition systems for children with profound intellectual and multiple disabilities based on artificial intelligence using physiological and motion signals.

PURPOSE: This study proposes a concept for emotion recognition systems for children with profound intellectual and multiple disabilities (PIMD) based on artificial intelligence (AI) using physiological and motion signals. METHODS: First, the heartbeat interval (R-R interval, RRI) of a child with PIMD was measured, and the correlation between the RRI and emotion was briefly tested in a preliminary experiment. Then, a concept based on AI for emotion recognition systems for children with PIMD was created using physiological and motion signals, and an emotion recognition system based on the proposed concept was developed using a random forest classifier taking as inputs the RRI, eye gaze, and other data acquired using low physical burden sensors. Subsequently, the developed emotion recognition system was evaluated, validating the proposed concept. Finally, we proposed a validated concept for emotion recognition systems. RESULTS: A correlation was found between the RRI and emotion. The emotion recognition system was created based on the proposed concept and tested. According to the results, the recognition rate of "negative" and "not negative" of 70.4% ± 6.1% (Mean ± S.D.) of the developed emotion recognition system was higher than 48.5% ± 5.0% of an unfamiliar person used as a control. CONCLUSION: The results indicate that the proposed concept for emotion recognition systems is useful for communicating with children with PIMD.

A new concept based on artificial intelligence for emotion recognition systems for children with profound intellectual and multiple disabilities (PIMD) using physiological and motion signals is proposed.An emotion recognition system based on the proposed concept developed using a random forest classifier taking as inputs the heartbeat interval, eye gaze, and other data acquired using low physical burden sensors were tested in terms of the emotion recognition rate.The recognition rate of "negative" and "not negative" of the developed system (i.e., 70.4% ± 6.1%) is higher than that of an unfamiliar person (i.e., 48.5% ± 5.0%).The proposed concept for emotion recognition systems may be useful for communicating with children with PIMD.

A patient with ketosis-prone type 2 diabetes showing nearly normalized glucose tolerance after recovery from severe diabetic ketoacidosis.

Unprovoked A-ß+ ketosis-prone type 2 diabetes (KPD) is characterized by the sudden onset of diabetic ketosis/ketoacidosis (DK/DKA) without precipitating factors, negative anti-islet autoantibodies ("A- "), and preservation of ß-cell function ("ß+ ") after recovery from DKA using insulin therapy. However, there have been few reports on glucose tolerance after recovery. We present a case of KPD with nearly normalized glucose tolerance after recovery from severe DKA. A 41-year-old obese woman first presented with unprovoked severe DKA, i.e., ketonuria, plasma glucose 570 mg/dL, pH 7.18, and HCO3 - 5.2 mmol/L, without anti-islet autoantibodies. She achieved insulin-free glycemic remission after recovery from DKA, leading to the diagnosis of KPD. Thereafter, 75 g oral glucose tolerance test showed impaired fasting glucose and time-in-range using intermittently scanned continuous glucose monitoring was 97% without medication. These findings suggest that, despite the initial severe DKA, some patients with KPD might achieve normalized glucose tolerance after recovery. The similar onset patterns of DKA necessitates appropriately distinguishing KPD from acute-onset type 1B (idiopathic) diabetes. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-022-00599-6.

Use of the reliable change index to evaluate the effect of a multicomponent exercise program on physical functions.

AIMS: Using the reliable change index (RCI), we aimed to examine the effect of a multicomponent exercise program on the individual level. METHODS: Overall, 270 adults (mean age, 78 years) completed a multicomponent physical exercise program (strength, aerobic, gait, and balance) for 40 min, 1-2 times per week, continued up to 1 year at a daycare center. Effectiveness was assessed using grip, ankle, knee, and hip strength; Timed Up & Go (TUG); Berg Balance Scale (BBS); gait speed; and 6-min walking distance. These were measured at baseline and every 3 months thereafter. We calculated the RCI using the data between two-time points (baseline and at 3, 6, 9, or 12 months) in each participant and then calculated the mean RCI value across the participants. A paired t-test was also employed to evaluate the effect of the intervention as an average-based statistics. RESULTS: The highest mean RCI values were on ankle plantar-flexion strength, followed by gait speed, hip abduction strength, BBS, knee extensor strength, 6-min walk distance, grip strength, and finally TUG. Paired t-test also revealed significant improvement with moderate effect sizes for ankle plantar-flexion strength (0.504), gait speed (0.413), hip abduction strength (0.374), BBS (0.334), knee extensor strength (0.264), and 6-min walk distance (0.248). Significant but small effect size was seen on TUG (0.183). CONCLUSION: The RCI is a convenient method of comparing the effect between different assessments, especially at an individual level. This index can be applied to the use of personal feedback.

The Effects of Neighborhood Physical and Social Environment on Physical Function among Japanese Community-Dwelling Older Adults: A One-Year Longitudinal Study.

Previous studies have shown a relationship between physical and social aspects of the neighborhood environment (e.g., built environment, safety) and physical function in older adults. However, these associations are unclear in older Asian adults because longitudinal studies are lacking. This study examined the effects of neighborhood physical and social environment on longitudinal changes in physical function among Japanese older adults. We analyzed 299 Japanese community-dwelling adults aged ≥65 years. Neighborhood environment was assessed using the International Physical Activity Questionnaire Environment Module. Physical function was assessed using handgrip strength, knee extension muscle strength, 5-m walking time, and a timed up-and-go test (TUG) in baseline and follow-up surveys. Changes in physical function over one year were calculated and classified into decline or maintenance groups based on minimal detectable changes. Multiple logistic regression analysis showed that even after adjusting for confounding factors, good access to recreational facilities affected the maintenance of 5-m walking time (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.02-5.21) and good crime safety affected the maintenance of TUG (OR = 1.87, 95%CI: 1.06-3.33). Therefore, it is important to assess both physical and social environmental neighborhood resources in predicting decline in physical function among Japanese older adults.

Relationship between static balance and gait parameters in preschool children.

BACKGROUND: Postural sway while standing reflects the degree of sensory integration function. The relationship between static balance and gait parameters in preschool children is essential for understanding which component of gait function is linked to the sensory integration function. RESEARCH QUESTION: We aimed to clarify the relationship between static balance and gait in children, aged 2-6 years, with typical development METHODS: A total of 105 children (48 girls, 57 boys) participated in this study. Static balance parameters were computed using positions at the center of pressure (COP) while standing (COP length, velocity, and sway area). Spatiotemporal parameters during gait were analyzed for stride length, step width, stance time, cadence, coefficient of variation (CV) of step length, and CV of stance time as gait variability. Pearson correlation coefficients were estimated to explore the relationship between age and static balance or gait parameters. Partial correlation analysis controlling for age was also performed to examine the relationship between static balance and gait parameters. RESULTS: A moderate association between age and static balance parameters and between age and gait parameters was found. Partial correlation analysis revealed that the variability parameters of gait were associated with the static balance parameters. No relationship was found between both spatial and temporal gait parameters and static balance parameters. SIGNIFICANCE: Among the gait parameters that are considered to develop in early childhood, gait variability was associated with COP sway while standing, whereas stride length with increasing age was independent of any static balance parameters. Of the spatial, temporal, and variability parameters of gait, only gait variability maybe associated with the development of sensory integration function.

Social isolation is associated with future decline of physical performance in community-dwelling older adults: a 1-year longitudinal study.

BACKGROUND: Social isolation and decline of physical function, such as muscle strength and physical performance, are known to be associated with deterioration of functional capacity. However, the relationship between social isolation and physical function has not been sufficiently clarified by a longitudinal observational study. AIMS: The aim of this study was to examine whether social isolation is associated with a future decline in physical function in older people. METHODS: The participants were 166 community-dwelling older people (aged ≥ 65 years). Social isolation and physical function were assessed using the 6-item Lubben Social Network Scale and handgrip strength, knee extensor strength, usual walking time, and the Timed Up and Go (TUG) test in both the baseline and follow-up surveys. To define the presence or absence of physical function decline over time, we used the minimal detectable change. The associations between social isolation and physical function were analyzed using logistic regression analysis adjusted for confounding factors. Further, to examine the possibility of drop-out bias, inverse probability weighting (IPW) was performed. RESULTS: The results of the logistic regression analysis adjusted for confounding factors showed social isolation at baseline was significantly associated with future TUG decline (OR 2.88, 95% CI 1.15-7.22). Social isolation was not associated with a decline in other physical functions. Similar results were found in an analysis using IPW. CONCLUSIONS: Social isolation was an independent risk factor for future TUG decline in community-dwelling older people. Our results indicated that assessment of social isolation may be necessary to assess the risk of physical performance decline.

Longitudinal effects of physical exercise on health-related outcomes based on frailty status in community-dwelling older adults.

AIM: To clarify the difference in the longitudinal effects of physical exercise on health-related outcomes according to the baseline frailty status (frail or non-frail) in community-dwelling older adults. METHODS: Participants included 177 adults aged ≥65 years who carried out multicomponent physical exercises (strength, aerobic, gait and balance) for 40 min, one to three times per week, for 1 year at a day-care center. Bodyweight, comfortable walking speed, 6-min walking distance and Mini-Mental State Examination were measured at baseline and every 3 months. For longitudinal trend, we analyzed the change in scores from baseline for each outcome using the linear mixed effects model. Fixed effects included "group" (frail or non-frail), "time" (4 time points every 3 months, from 3 to 12 months) and "interaction between group and time." RESULTS: The effect sizes from baseline showed almost all positive values for each outcome. The linear mixed effects model showed significant effects on "interaction between group and time" in changes in bodyweight (P = 0.033), "group" in changes in walking speed (P = 0.013) and "time" in changes in the Mini-Mental State Examination (P < 0.001). Bodyweight showed a decreasing trend in the non-frail group after 3 months, unlike in the frail group. For walking speed, moderate effect sizes (d = 0.67-0.74) were sustained over time in the frail group, as did lesser effect sizes (d = 0.26-0.40) in the non-frail group. CONCLUSIONS: Exercise-based multicomponent interventions were effective for both groups. The longitudinal effects on walking speed and bodyweight were greater in the frail group. Geriatr Gerontol Int 2022; 22: 213-218.

Association Between Physical Function and Neighborhood Environment in Healthy, Older Adults: An Exploratory Study Using Regression Tree Analysis.

The aim of this study was to perform an exploratory investigation of the individual characteristics of older adults that affect the relationships between physical function and neighborhood environment. A total of 624 community-dwelling older adults living independently, aged ≥65 years, participated in this cross-sectional study. Physical function was assessed by muscle strength (grip strength and knee extension strength) and physical performance (5-m walking time and Timed Up and Go Test). The neighborhood environment was assessed using the International Physical Activity Questionnaire Environmental Module. The individual characteristics that affect the association between both were analyzed using multiple regression analysis and Classification and Regression tree (CaRT) analysis. In both older men and women, multiple regression analysis showed that neighborhood environment was significantly associated with physical function. On the other hand, on CaRT analyses, older men ≤80 years of age without low back pain and depressive symptoms and perceived good access to recreational facilities had the shortest 5-m walking time. However, CaRT analyses found no relationship between physical function and neighborhood environment in older women. The relationships between physical function and neighborhood environment may be altered by sex, age, and physical and mental health conditions.

Characteristics Associated with Early Worsening of Retinopathy in Patients with Type 2 Diabetes Diagnosed with Retinopathy at Their First Visit: A Retrospective Observational Study.

MATERIALS AND METHODS: Our study design was a retrospective observational study. Subjects with type 2 diabetes diagnosed with either simple or preproliferative diabetic retinopathy by ophthalmologists at their first visit and followed up for 6-18 months thereafter were included and divided into worsening and nonworsening groups. Thereafter, baseline characteristics and changes in HbA1c and therapy over a year were investigated. RESULTS: Among the 88 subjects with simple diabetic retinopathy, 16% improved to no retinopathy, 65% retained their simple diabetic retinopathy, 18% worsened to preproliferative diabetic retinopathy, and 1% worsened to proliferative diabetic retinopathy. Among the 47 subjects with preproliferative diabetic retinopathy, 9% improved to simple diabetic retinopathy, 72% retained their preproliferative diabetic retinopathy, and 19% worsened to proliferative diabetic retinopathy. Patients with simple diabetic retinopathy had an odds ratio of 1.44 for worsening retinopathy with a 1% increase in baseline HbA1c. Meanwhile, the odds ratios for worsening retinopathy with a 1% decrease in HbA1c from baseline at 3, 6, and 12 months were 1.34, 1.31, and 1.38, respectively. Among patients with simple diabetic retinopathy, significantly more new interventions were introduced in the worsening group than in the nonworsening group. CONCLUSIONS: Increased baseline HbA1c, a substantial decrease in HbA1c, and intensified therapy were identified as risk factors for early worsening of diabetic retinopathy in patients with simple diabetic retinopathy at the first visit. Patients should therefore be intimately followed for retinopathy after their first visit.

Acute Subdural Hematoma in High School Rugby Players in Japan: The Importance of Playing Experience for Injury Prevention.

OBJECTIVES: Acute subdural hematoma (ASDH) is known to be devasting sport-related head injury but it is relatively rare in rugby compared with other contact sports. Certain cases of ASDH have happened in high school rugby players in Japan. To prevent them from the injury we report a background of the players. METHODS: Data of high school rugby players who suffered ASDH were extracted from injury reports in the Japan Rugby Football Union between April 2004 and March 2020. The number of injured players, diagnosis on the report, school year, phase of play where the injury occurred, and playing career were analyzed. RESULTS: There were 30 cases of ASDH including 16 cases in the first year, 9 in the second year, and 5 in the third year of playing. Phase of play was mainly being tackled in 11 (37%), and tackling in 13 (43%). Novice players, defined as a player having less playing experience of rugby during junior high school, accounted for 77% of phase of tackling, 82% of being tackled. First year novice players accounted for 100% of phase of being tackled. Outcome within 6 months after injury was recovery in 14, morbidity in 6, mortality in 2, and unknown in 8. CONCLUSIONS: Playing experience in high school rugby players should be considered as an important factor for prevention of ASDH-in particular, phase of being tackled is riskier than that of tackling for first year novice players.

The effect of the interaction between fall-related self-efficacy and gait function on the occurrence of falls in community-dwelling older people.

BACKGROUND: Fall-related self-efficacy and gait function are known to be associated. However, whether the interaction between fall-related self-efficacy and gait function affects future falls has not been investigated. AIM: The aim of this study was to investigate the effect of the interaction between fall-related self-efficacy and spatiotemporal gait parameters on the occurrence of falls in community-dwelling older people. METHODS: A total of 265 elderly persons (age ≥ 65 years) living independently in the community were recruited. For gait function, spatiotemporal gait parameters at usual and maximum effort paces were measured using a 2.4-m walkway system with embedded pressure sensors. Furthermore, changes in gait parameters between usual and maximum paces were calculated (Δgait parameters). Fall-related self-efficacy was assessed using the short version of the Falls Efficacy Scale International (Short FES-I). The occurrence of falls was prospectively investigated 6 months later. The effect of the interaction between short FES-I and gait parameters on falls was analyzed using logistic regression analysis adjusted for confounding factors. RESULTS: Several gait parameters were significantly different by self-efficacy level. As for the effect of the interaction of fall-related self-efficacy and gait parameters on falls, smaller Δgait parameters in those with high efficacy were associated with higher odds ratios of falls, whereas Δgait parameters in those with low efficacy were not associated with falls. DISCUSSION AND CONCLUSIONS: The interaction between fall-related self-efficacy and gait function appeared to affect future falls. Assessments combining fall-related self-efficacy and gait function may improve the accuracy of prediction of future falls.

A Cross-Sectional Study on the Association between Body Mass Index and Frailty According to Sex in Elderly Patients with Disabilities from an Elderly Day-Care Center.

The association between body mass index (BMI) and frailty in elderly patients with disabilities is unclear. We aimed to investigate the association between BMI and frailty in the elderly with disabilities according to sex. This cross-sectional study included 280 elderly patients with disabilities from an elderly daycare center. BMI classification for the Asian population was used to categorize the patients into four groups: underweight, normal, overweight, and obese. Frailty score was based on the phenotypic definition of frailty and consisted of five criteria derived from the revised Japanese version of the Cardiovascular Health Study. Those who had three or more criteria were considered frail. Logistic regression models were constructed to investigate the associations between frailty and BMI in each group (males and females). In females, being underweight was significantly associated with frailty after adjusting for confounders (age and Mini-Mental State Examination score); after adding medical history as a confounder, the aforementioned association was not significant. In males, BMI was not significantly associated with frailty. The association between BMI and frailty differed according to sex among the elderly with disabilities. This finding provides important information regarding frailty risk to workers in daycare facilities.

A Case of Acute Embolism of the Accessory Middle Cerebral Artery Treated Using ADAPT Thrombectomy without Lesion Passing.

An accessory middle cerebral artery (AMCA) is a variant vessel that branches from the anterior cerebral artery (ACA) and runs through the Sylvian fissure along the middle cerebral artery (MCA). We report a case of acute embolic occlusion of the AMCA that was treated with thrombectomy using direct aspiration first pass technique (ADAPT). An 88-year-old woman with a history of atrial fibrillation, loss of consciousness, and right hemiparesis was referred to our hospital. Diffusion-weighted magnetic resonance imaging (MRI) showed high signal intensity in the left frontal lobe, insular cortex, and deep white matter, and magnetic resonance angiography (MRA) demonstrated left internal carotid artery (ICA) occlusion. Mechanical thrombectomy using the ADAPT technique was performed with complete recanalization. Final angiography revealed left ACA and AMCA because of the thrombus located at the origin of the left ACA and AMCA. In the case of an acute ischemic stroke associated with AMCA, it is difficult to understand and recognize the anatomy of the vessel before thrombectomy. Therefore, the ADAPT technique, which can treat acute embolic occlusion without lesion passing, is recommended due to its safety. If there is a mismatch between the perfusion area of the occluded artery and the ischemic area or the neurological findings before thrombectomy, it is extremely important to keep in mind the presence of vessel variation in the MCA.

Spectator medicine at an international mega sports event: Rugby World Cup 2019 in Japan.

BACKGROUND: The Rugby World Cup (RWC) is one of the biggest international mega sports events in the world. This study was conducted to identify and evaluate the volume, nature, and severity of spectator medical care in the stadiums of 12 venues across Japan during RWC 2019. METHOD: This was a retrospective review of medical records from spectator medical rooms of 45 official matches of RWC 2019 between September 20 and November 2, 2019. All patients in the stadium who visited the spectator medical room and were transferred to a hospital were included. The wet bulb globe temperature (WBGT) value at the kick-off time of each match, the number of visits to the spectator medical room, and the number of transfers to a hospital were reviewed and analyzed. The patient presentation rate (PPR) was calculated per 10,000 attendees. Severity categories were defined as mild or severe. Mild cases were considered non-life threatening requiring minimal medical intervention, and severe cases required transport to a hospital. RESULT: The total number of visits to the spectator medical room was 449 with a PPR of 2.63. Most cases (91.5%) were mild in severity. The PPR was significantly higher for the matches held with a WBGT over 25 °C than for the matches under 21 °C (PPR 4.27 vs 2.04, p = 0.04). Thirty-eight cases were transferred to a hospital by ambulance; the PPR was 0.22. The most common reasons for transfer to the hospital were heat illness and fracture/dislocation, at a rate of 15.8% each. The incidence rate of cardiopulmonary arrest per 10,000 attendees was 0.0059 during RWC 2019. CONCLUSION: Preparation and provision of appropriate medical service for spectators is a key factor for mass-gathering events. During RWC 2019, the majority (91.5%) of patients who sought medical attention did so for minor complaints, which were easily assessed and managed. On the other hand, a higher WBGT situation contributes significantly to an increased PPR (< 21 versus > 25, 2.04 versus 4.27, p = 0.04). Careful medical preparation, management, and development of public education programs for higher WBGT situations will be required in the future for similar international mega sports events.

[Fall-related efficacy is associated with the progression of frailty in community-dwelling older people].

AIM: The goal of this study was to verify the association between frailty and fall-related efficacy in community-dwelling older people by performing a cross-sectional and longitudinal data analysis. METHODS: In this study, 339 people aged 65 years and older participated in a baseline survey. Furthermore, people who were not identified as frail in the baseline survey participated in a follow-up survey 6 months later. Frailty was assessed in the baseline and follow-up surveys after 6 months using the Kihon checklist. Fall-related efficacy was assessed at baseline using the short Falls Efficacy Scale International (short FES-I). Potential confounding factors, such as the lower limb functions and psychological functions, were also investigated at baseline. The association between frailty and short FES-I was analyzed using a logistic regression analysis adjusted for potential confounding factors. RESULTS: At baseline and the follow-up survey, 10.1% and 6.3% of the participants were judged to demonstrate frailty, respectively. The results of the baseline and follow-up data analysis showed that even if potential confounding factors were adjusted for, the short FES-I was significantly associated with frailty. Furthermore, the ability to distinguish the onset of frailty using the short FES-I was analyzed using a receiver operating characteristic curve, and the area under curve, sensitivity, and specificity values were 0.78, 0.92 and 0.56, respectively. CONCLUSIONS: A clear association between frailty and fall-related efficacy was thus observed, as indicated in the cross-sectional and longitudinal data analysis. Furthermore, based on the results of the longitudinal data analysis, the short FES-I was found to be able to predict the progression of frailty and it can thus be a useful screening tool for assessing frailty.

Postural deformity in children with cerebral palsy: Why it occurs and how is it managed.

Despite the fact that children with cerebral palsy may not have any deformities at the time of birth, postural deformities, such as scoliosis, pelvic obliquity, and windswept hip deformity, can appear with increasing age. This may lead to respiratory function deterioration and, in more severe cases, affects survival. To date, postural care is believed to help improve the health and quality of life of children with cerebral palsy. This review provides an overview of the cause and clinical management of postural deformity that is seen in children with cerebral palsy.

Cortical and Internal Watershed Infarcts Might Be Key Signs for Predicting Neurological Deterioration in Patients with Internal Carotid Artery Occlusion with Mild Symptoms.

BACKGROUND: Treatment for acute ischemic stroke due to large vessel occlusion (LVO) with mild symptoms is under discussion. Although most patients have good outcomes, some patients deteriorate and have unfavorable results. Imaging findings that predict the prognosis of LVO with mild symptoms are needed to identify patients who require treatment. In this study, we focused on watershed infarctions (WSIs), because this clinical phenomenon quite sensitively reflects changes in cerebral blood flow. The purpose of this study was to assess positive rates of WSI on MRI findings in patients with internal carotid artery (ICA) occlusion, and compare WSI-positive rates between patients divided according to their clinical course. METHODS: We retrospectively collected data of 1,531 patients who presented with acute ischemic stroke between June 2006 and July 2019. Among them, we chose symptomatic ICA occlusion patients with a past history of atrial fibrillation who were treated conservatively. We divided these patients into two groups, those with maintenance or improvement in their NIHSS score after hospitalization, and those whose NIHSS score worsened. We compared WSI-positive rates between these two groups. RESULTS: Thirty-seven of the 1,531 patients were included in this study. Of them, total NIHSS score was maintained or improved in 8 patients (group A), 3 of whom (37.5%) had internal watershed infarctions (IWIs). In group B, consisting of patients whose NIHSS score worsened by >2 at 7 days from symptom onset, 24 (82.8%) had IWIs. Group A thus had statistically lower IWI positivity rates than group B (p = 0.02). Three patients (37.5%) in group A had cortical watershed infarctions (CWIs), while 27 patients in group B (93.1%) had CWIs. Group A thus had a significantly lower CWI positivity rate than group B (p = 0.002). CONCLUSION: In patients with mildly symptomatic ICA occlusion, CWIs and IWIs might be key signs for predicting neurological deterioration after hospitalization.

Clarifying the structure of serious head and spine injury in youth Rugby Union players.

This study aimed to clarify the cause of rugby head and spinal cord injuries through a network centrality analysis of 14-year (2004-2018) longitudinal data in Japan. The study hypothesis is that understanding the causal relationship among the occurrence of serious injuries, the quality of player experience and play situation as a network structure could be possible to obtain practical knowledge on injury prevention. In this study, bipartite graphs are used to make it easier to understand the situation of players and injuries. This would also help to elucidate more characteristic subgroup. A network bipartite graph and subgroup (cluster) analyses were performed to clarify the injured players' experience and the cause of injury. We used the algorithm of R program, IGRAPH, clustering edge betweenness. For subgroup extraction, the modularity Q value was used to determine which step to cut. The Japanese rugby population was 93,873 (2014-2018 average), and 27% were high school students. The data showed that careful attention would be particularly needed for groups of inexperienced Japanese high school players. Our study suggests that we should consider introducing rules that prohibit "head-on collisions" in youth rugby.