Changes in the place of death before and during the COVID-19 pandemic in Japan.

BACKGROUND: In the global aging, the coronavirus disease 2019 (COVID-19) pandemic may have affected the place of death (PoD) in Japan, where hospital deaths have dominated for decades. We analyzed the PoD trends before and during the COVID-19 pandemic in Japan. METHODS: This nationwide observational study used vital statistics based on death certificates from Japan between 1951 and 2021. The proportion of PoD; deaths at home, hospitals, and nursing homes; and annual percentage change (APC) were estimated using joinpoint regression analysis. Analyses were stratified by age groups and causes of death. RESULTS: After 2019, home deaths exhibited upward trends, while hospital death turned into downward trends. By age, no significant trend change was seen in the 0-19 age group, while hospital deaths decreased in the 20-64 age group in 2019. The trend change in home death in the ≥65 age group significantly increased since 2019 with an APC of 12.3% (95% confidence interval [CI]: 9.0 to 15.7), while their hospital death trends decreased by -4.0% (95% CI: -4.9 to -3.1) in 2019-2021. By cause of death, home death due to cancer and the old age increased since 2019 with an APC of 29.3% (95% CI: 25.4 to 33.2) and 8.8% (95% CI: 5.5 to 12.2), respectively. CONCLUSION: PoD has shifted from hospital to home during the COVID-19 pandemic in Japan. The majority of whom were older population with cancer or old age.

Mechanical Properties and Friction Dynamics of Organogels Solidified with Rice Paraffin.

Raw materials suitable for a sustainable society have attracted interest in the cosmetics industry. We focused on rice bran as a sustainable material and evaluated the gelation behavior of paraffin extracted from rice bran (rice paraffin) against liquid paraffin, squalane, jojoba oil, and silicone oil. In addition, the frictional properties of the prepared organogel on an artificial skin surface were evaluated using a sinusoidal motion friction evaluation system. Rice paraffin solidified all oils even at the lowest wax concentration of 5 wt%. The hardness and kinetic friction coefficient µ k increased with an increase in the wax composition. The hardness and µ k of organogels solidified with rice paraffin were smaller than those of gels solidified with petroleum-derived paraffin. These differences are caused by the smaller carbon amount of rice paraffin. The friction parameters depended on the type of oil: the µ k of RLG composed of rice and liquid paraffin was greater than that of the other three oils (R, L, and G denote rice paraffin, liquid paraffin, and gel, respectively). These findings promote the development of lipsticks and cleansing gels consisting of sustainable development goal-responsive raw materials.

Surfactant-Free Pickering Emulsification Using Chinese Quince Fruit Fiber.

Quince fruit powder can be obtained from the waste of the edible product. In this study, we modified the powder with various solvents and investigated its application in Pickering emulsification. The crushed Chinese quince fruit possessed excellent Pickering emulsifying abilities when the water-soluble components were removed. In addition to cellulose, the powder contains hydrophilic pectin and hydrophobic lignin fibers. Similarly, a powder consisting of cellulose and a small amount of lignin without pectin, which was obtained by further solvent treatment, also showed high emulsification performance. Although these two powders had different fiber compositions, their water contact angles were almost equal, and their surface hydrophilicity was lower than that of the cellulose-only powder without emulsification ability.

Friction Dynamics of Organogels on Artificial Skin Surfaces.

Organogels are attractive formulations in cosmetics, food, and pharmaceuticals. They exhibit characteristic frictional and mechanical responses during the collapse of a mesostructure. In this study, the friction dynamics of organogels composed of five different waxes (paraffin wax, microcrystalline wax, ceresin, candelilla wax, and carnauba wax) and liquid paraffin were evaluated using a sinusoidal motion friction evaluation system. All organogels exhibited a velocity dependence of friction coefficient that increased with the acceleration of the contact probe. Depending on the ease of the crystal formation of the waxes in liquid paraffin, hydrocarbon-based waxes formed soft organogels with a low-friction coefficient, whereas ester-based, highly polar waxes formed organogels that were hard and had a high-friction coefficient.

Magnetic resonance-guided focused ultrasound thalamotomy restored distinctive resting-state networks in patients with essential tremor.

OBJECTIVE: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy ameliorates symptoms in patients with essential tremor (ET). How this treatment affects canonical brain networks has not been elucidated. The purpose of this study was to clarify changes of brain networks after MRgFUS thalamotomy in ET patients by analyzing resting-state networks (RSNs). METHODS: Fifteen patients with ET were included in this study. Left MRgFUS thalamotomy was performed in all cases, and MR images, including resting-state functional MRI (rsfMRI), were taken before and after surgery. MR images of 15 age- and sex-matched healthy controls (HCs) were also used for analysis. Using rsfMRI data, canonical RSNs were extracted by performing dual regression analysis, and the functional connectivity (FC) within respective networks was compared among pre-MRgFUS patients, post-MRgFUS patients, and HCs. The severity of tremor was evaluated using the Clinical Rating Scale for Tremor (CRST) score pre- and postoperatively, and its correlation with RSNs was examined. RESULTS: Preoperatively, ET patients showed a significant decrease in FC in the sensorimotor network (SMN), primary visual network (VN), and visuospatial network (VSN) compared with HCs. The decrease in FC in the SMN correlated with the severity of tremor. After MRgFUS thalamotomy, ET patients still exhibited a significant decrease in FC in a small area of the SMN, but they exhibited an increase in the cerebellar network (CN). In comparison between pre- and post-MRgFUS patients, the FC in the SMN and the VSN significantly increased after treatment. Quantitative evaluation of the FCs in these three groups showed that the SMN and VSN increased postoperatively and demonstrated a trend toward those of HCs. CONCLUSIONS: The SMN and CN, which are considered to be associated with the cerebello-thalamo-cortical loop, exhibited increased connectivity after MRgFUS thalamotomy. In addition, the FC of the visual network, which declined in ET patients compared with HCs, tended to normalize postoperatively. This could be related to the hypothesis that visual feedback is involved in tremor severity in ET patients. Overall, the analysis of the RSNs by rsfMRI reflected the pathophysiology with the intervention of MRgFUS thalamotomy in ET patients and demonstrated a possibility of a biomarker for successful treatment.

Enhancement of the Gel Hardness of Candelilla Wax through the Addition of Long-chain Ester Wax Behenyl Behenate.

Candelilla wax (CW) is used as an oil-gelling agent in cosmetic sticks. However, its hardness is inadequate compared to those of hydrocarbon waxes such as paraffin. In this study, behenyl behenate (BB), an additive plant-derived wax ester with a high melting point, was shown to improve the oil-gel hardness of CW.Although the gel with BB alone had a relatively low gel hardness, when BB was mixed with CW at a ratio of 70:30 (CW:BB), the gel hardness significantly increased to four times that of the CW gel. The hardness of the CW and BB mixtures was higher than that of paraffin wax, which is used to solidify cosmetic oils. An increase in gel hardness was not observed when additives with chemical structures similar to those of BB, such as stearyl stearate (which has a lower molecular weight than BB) and behenic acid or behenyl alcohol (which are components of BB), were blended.Scanning electron microscopy indicated the presence of many spherical clusters comprising fine crystallites in the CW gel. This morphology was in contrast to that of paraffin wax gel, in which only plate crystals were observed. It was concluded that this heterogeneous structure led to the low gel hardness of CW. When BB was added to CW, the spherical clusters disappeared, and the internal structure changed to a homogeneous card-house structure composed of plate crystals.

Cutoff values for the best management strategy for magnetic resonance-guided focused ultrasound ablation for essential tremor.

OBJECTIVE: The efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) ablation for essential tremor (ET) is well known; however, no prognostic factors have been established. The authors aimed to retrospectively investigate MRgFUS ablation outcomes and associated factors and to define the cutoff values for each prognostic factor. METHODS: Sixty-four Japanese patients who underwent unilateral ventral intermediate nucleus thalamotomy with MRgFUS for ET were included. Follow-up evaluations were performed at 1 week and 1, 3, 6, 12, and 24 months postoperatively. Tremor suppression was evaluated using the Clinical Rating Scale for Tremor (CRST), and adverse effects were recorded postoperatively. Outcome-associated factors were examined preoperatively, intraoperatively, and postoperatively using multivariate analyses. The cutoff values for the prognostic factors were calculated using receiver operating characteristics. RESULTS: Percentage improvements in the CRST scores of the affected upper limb were 82.4%, 72.2%, 68.6%, and 65.9% at 1, 3, 6, and 12 months, respectively. Preoperatively, a high skull density ratio (SDR) (p ≤ 0.047), low CRST part B score (used to assess tremors during several tasks) (cutoff value 25, p ≤ 0.041), and nonoccurrence of resting tremors (p = 0.027) were significantly associated with improved tremor control. An intraoperatively high maximum mean temperature (cutoff value 52.5°C, p ≤ 0.047), postoperatively large lesion (cutoff value 3.9 mm in the anterior-posterior direction, p ≤ 0.002; cutoff value 5.0-5.55 mm in the superior-inferior direction, p ≤ 0.026), and small transducer focus correction (p ≤ 0.015) were also associated with improved tremor control. No valid cutoff value was found for SDR. Adverse effects (limb weakness, sensory disturbance, ataxia/walking disturbance, dysgeusia, dysarthria, and facial swelling) occurred transiently and were associated with high SDR, high temperature, high number of sonication sessions, large lesion, and occurrence of resting tremor. Patients who developed leg weakness experienced greater percentage improvement in tremors at 3 months postoperatively than those who did not. CONCLUSIONS: MRgFUS ablation could be used to achieve good tremor control with acceptable adverse effects in Japanese patients with ET. The relatively low SDR in Asian ethnic groups as compared with that of Western populations makes treatment difficult; however, the cutoff values obtained in this study may be useful for achieving good treatment outcomes even in such patients. Clinical trial registration no.: UMIN000026952 (University Hospital Medical Information Network). ABBREVIATIONS: ACPC = anterior commissure-posterior commissure; AP = anterior to posterior; CRST = Clinical Rating Scale for Tremor; ET = essential tremor; MRgFUS = magnetic resonance-guided focused ultrasound; PC = posterior commissure; PSA = posterior subthalamic area; RL = right to left; ROC = receiver operating characteristic; SDR = skull density ratio; SI = superior to inferior; T2WI = T2-weighted imaging; VIM = ventral intermediate nucleus.

Multitier Network Analysis Using Resting-state Functional MRI for Epilepsy Surgery.

Resting-state functional MRI (rs-fMRI) has been utilized to visualize large-scale brain networks. We evaluated the usefulness of multitier network analysis using rs-fMRI in patients with focal epilepsy. Structural and rs-fMRI data were retrospectively evaluated in 20 cases with medically refractory focal epilepsy, who subsequently underwent surgery. First, structural changes were examined using voxel-based morphometry analysis. Second, alterations in large-scale networks were evaluated using dual-regression analysis. Third, changes in cortical hubs were analyzed and the relationship between aberrant hubs and the epileptogenic zone (EZ) was evaluated. Finally, the relationship between the hubs and the default mode network (DMN) was examined using spectral dynamic causal modeling (spDCM). Dual-regression analysis revealed significant decrease in functional connectivity in several networks including DMN in patients, although no structural difference was seen between groups. Aberrant cortical hubs were observed in and around the EZ (EZ hubs) in 85% of the patients, and a strong degree of EZ hubs correlated to good seizure outcomes postoperatively. In spDCM analysis, facilitation was often seen from the EZ hub to the contralateral side, while inhibition was seen from the EZ hub to nodes of the DMN. Some cognition-related networks were impaired in patients with focal epilepsy. The EZ hub appeared in the vicinity of EZ facilitating connections to distant regions in the early phase, which may eventually generate secondary focus, while inhibiting connections to the DMN, which may cause cognitive deterioration. Our results demonstrate pathological network alterations in epilepsy and suggest that earlier surgical intervention may be more effective.

Techniques, Indications, and Outcomes in Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Tremor.

Magnetic resonance (MR)-guided focused ultrasound surgery (MRgFUS) is the latest minimally invasive stereotactic procedure, and thalamotomy using this novel modality has demonstrated its effectiveness and safety, especially for patients with essential tremor (ET) and Parkinson's disease (PD). In Japan, the application of MRgFUS to treat ET and PD has recently been covered by health insurance. Technically, the transducer with 1024 elements emits ultrasound beams, which are then focused on the target with a phase control, resulting in optimal ablation by thermal coagulation. The technical advantages of MRgFUS are continuous intraoperative monitoring of clinical symptoms and MR images and fine adjustment of the target by the steering function. Postoperative tremor control is compatible with other modalities, although long-term follow-up is necessary. The adverse effects are usually transient and acceptable. Prognostic factors for good tremor control include high temperature and large lesion size. A high skull density ratio is a factor to achieve high temperature and large lesioning, but it may not be necessary and sufficient for clinical outcomes. For patients with advanced symptoms such as bilateral tremor or head/neck tremor, deep brain stimulation may be recommended because of the adjustability of stimulation and the possibility of bilateral treatment. Patients have high expectations of MRgFUS because of its non-invasiveness. To perform this treatment safely and effectively, physicians need to understand the technological aspects, the physiological principles. To choose the appropriate modality, physicians also should recognize the clinical advantages and disadvantages of MRgFUS compared to other modalities.

[Magnetic Resonance-guided Focused Ultrasound Ablation:Techniques and Neurological Applications].

Magnetic resonance(MR)-guided focused ultrasound ablation(FUS)is a minimally invasive technique for targeted tissue thermo-ablation and is promising for neuromodulation in various neurological disorders. The effectiveness and safety of this technique have been recognized worldwide. In Japan, the applications of FUS for the treatment of essential tremors and Parkinson's disease have recently been covered under health insurance. The FUS system is composed of a phased-array transducer with 1024 elements, with a beam of ultrasound emerging from each element. The phase and amplitude of the beam are computed and controlled to focus on the target with the calculation of computed tomography(CT)profiles, resulting in optimal thermo-ablation. To utilize FUS safely and effectively, a deep understanding of the physics of this technology is necessary. Furthermore, the technique should be compared with other options including deep brain stimulation(DBS)and radiofrequency thermo-ablation. Although FUS has received attention because of minimally invasive characteristics and a possibility of procedural target refinement, DBS has some advantages on bilateral implantation, a potential of postoperative adjustment, and control of head/leg tremors. In this article, we first reviewed the physics of FUS and demonstrated the typical treatment protocols. Second, we reviewed the outcomes from the existing literature, and revealed the advantages and disadvantages of this procedure, with the evaluation of the optimal condition for FUS.

Distributed source analysis of magnetoencephalography using a volume head model combined with statistical methods improves focus diagnosis in epilepsy surgery.

Deep-seated epileptic focus estimation using magnetoencephalography is challenging because of its low signal-to-noise ratio and the ambiguity of current sources estimated by interictal epileptiform discharge (IED). We developed a distributed source (DS) analysis method using a volume head model as the source space of the forward model and standardized low-resolution brain electromagnetic tomography combined with statistical methods (permutation tests between IEDs and baselines and false discovery rate between voxels to reduce variation). We aimed to evaluate the efficacy of the combined DS (cDS) analysis in surgical cases. In total, 19 surgical cases with adult and pediatric focal epilepsy were evaluated. Both cDS and equivalent current dipole (ECD) analyses were performed in all cases. The concordance rates of the two methods with surgically identified epileptic foci were calculated and compared with surgical outcomes. Concordance rates from the cDS analysis were significantly higher than those from the ECD analysis (68.4% vs. 26.3%), especially in cases with deep-seated lesions, such as in the interhemispheric, fronto-temporal base, and mesial temporal structures (81.8% vs. 9.1%). Furthermore, the concordance rate correlated well with surgical outcomes. In conclusion, cDS analysis has better diagnostic performance in focal epilepsy, especially with deep-seated epileptic focus, and potentially leads to good surgical outcomes.

Oil Gelation Ability of a Rice Bran Wax and Botanical High-Melting-Point Alcohol Mixture.

Due to its availability and relatively high melting point, rice bran wax can be used in foods and cosmetics as an oil solidifying agent. The addition of high-melting-point alcohols to the wax to optimize its performance was investigated. Such alcohols were prepared by the hydrolyzation of rice bran wax or carnauba wax. These alcohols had melting points of ～80°C, higher than that of rice bran wax, and consisted of hydrocarbons with alkyl chain lengths ranging from C24 to C34, much longer than the alkyl chains found in commercially available higher alcohols. Oil gel made with only rice bran wax as a solidifying agent has lower hardness than the conventional hydrocarbon wax gel, too low for practical usage in stick cosmetics such as lipsticks and lip creams. Blending high-melting-point alcohols with rice bran wax at 10-20% led to marked increase in gel hardness, equivalent to the gel hardness of the hydrocarbon wax. This effect on rice bran wax was not observed in commercially available higher alcohols and esters with lower melting points. Based upon the change in microstructure observed with SEM, the improved gel hardness of the rice bran wax upon addition of high-melting-point alcohols was probably induced by the disappearance of spherical clusters, originally presented in the gel, resulting in close to uniform morphology.

Anatomo-electro-clinical correlations of hypermotor seizures with amygdala enlargement: Hippocampal seizure origin identified using stereoelectroencephalography.

•A drug-resistant epilepsy case showed hypermotor seizures and amygdala enlargement.•Seizure onset zone was the hippocampus, not amygdala, as revealed by SEEG.•The enlarged amygdala pathology was classified as FCD type I.•Selective amygdalohippocampectomy led to good outcomes.

Application of Awake Surgery for Epilepsy in Clinical Practice.

Epilepsy surgery aims to control epilepsy by resecting the epileptogenic region while preserving function. In some patients with epileptogenic foci in and around functionally eloquent areas, awake surgery is implemented. We analyzed the surgical outcomes of such patients and discuss the clinical application of awake surgery for epilepsy. We examined five consecutive patients, in whom we performed lesionectomy for epilepsy with awake craniotomy, with postoperative follow-up > 2 years. All patients showed clear lesions on magnetic resonance imaging (MRI) in the right frontal (n = 1), left temporal (n = 1), and left parietal lobe (n = 3). Intraoperatively, under awake conditions, sensorimotor mapping was performed; primary motor and/or sensory areas were successfully identified in four cases, but not in one case of temporal craniotomy. Language mapping was performed in four cases, and language areas were identified in three cases. In one case with a left parietal arteriovenous malformation (AVM) scar, language centers were not identified, probably because of a functional shift. Electrocorticograms (ECoGs) were recorded in all cases, before and after resection. ECoG information changed surgical strategy during surgery in two of five cases. Postoperatively, no patient demonstrated neurological deterioration. Seizure disappeared in four of five cases (Engel class 1), but recurred after 2 years in the remaining patient due to tumor recurrence. Thus, for patients with epileptogenic foci in and around functionally eloquent areas, awake surgery allows maximal resection of the foci; intraoperative ECoG evaluation and functional mapping allow functional preservation. This leads to improved seizure control and functional outcomes.

Functional Movements in Japanese Mini-Basketball Players.

Functional movement screen (FMS) has been used to establish normative data and determine potential injury risk for young adults and athletes, but there are few data in elementary school-age children. The purpose of this study was to establish fundamental values for the FMS in elementary school-age mini-basketball players. Secondary purposes were to examine relationships between functional movement patterns and age, peak height velocity (PHV), and body mass index (BMI), and to compare functional movement patterns between boys and girls and between individuals with and without a history of injury. The mean composite FMS score was 16.5 ± 2.2 (16.5 ± 2.4 for boys, 16.5 ± 1.7 for girls). The composite FMS score was positively correlated with age (r = .312) and negatively correlated with the BMI (r = - .371). However, the FMS score was not correlated with PHV or with PHV age. The FMS score was not different between boys and girls or between individuals who reported a previous injury and those who did not. However, boys in the mini-basketball teams performed better than girls on the trunk stability push-up and rotary stability tests. Age and the body mass index were significantly associated with better and poorer functional movement, respectively.

Injuries in Japanese Junior Soccer Players During Games and Practices.

CONTEXT: Soccer is the most popular junior sport in the world. In junior sports, injury analysis and injury-prevention measures for players, especially those under 12 years of age, are urgently needed. OBJECTIVE: To prospectively study the incidence, sites, types, and mechanisms of injuries in elementary school-aged junior soccer players during games and practices. DESIGN: Descriptive epidemiology study. SETTING: Elementary school-aged junior soccer teams in Nagoya, Japan. PATIENTS OR OTHER PARTICIPANTS: Eighty-nine players in 5 community-based club teams of junior soccer (U-12, age range = 11-12 years; U-11, age range = 10-11 years; U-10, age ≤10 years). MAIN OUTCOME MEASURE(S): Data on all game and practice injuries for the 2013-2014 season were collected using an injury report form. Injury rates were calculated according to injury site, type, and mechanism. RESULTS: The overall injury rate was 2.59/1000 athlete-hours (AHs). The game injury rate (GIR; 6.43/1000 AHs) was higher than the practice injury rate (PIR; 1.49/1000 AHs; P < .05). The most common anatomical areas of injury during games and practices were the lower limbs (62.5% and 4.02/1000 AHs versus 38.5% and 0.57/1000 AHs, respectively). Contusions (27.6%, n = 8) were the most frequent type of overall injuries. Most game injuries resulted from body contact (43.8%, 2.81/1000 AHs), whereas most practice injuries resulted from other types of contact (53.8%, 0.83/1000 AHs). CONCLUSIONS: The GIRs were higher than the PIRs in Japanese junior soccer players. A lower overall PIR suggested that players in the U-12 age group practiced under appropriate conditions. However, the higher GIR in this age category needs to be decreased.

Highly functional T-cell receptor repertoires are abundant in stem memory T cells and highly shared among individuals.

To expand our knowledge of the ontogeny of the T-cell receptor (TCR) repertoire of antigen-specific T-cell subsets, we combined next-generation deep sequencing and single-cell multiplex clonotype analysis to evaluate the diversity and frequency of paired TCRs, their functions and whether clonotypic TCRs are shared among different individuals. Using an HLA-A*02-restricted cytomegalovirus (CMV) pp65-derived immunogenic peptide, we found that the more dominant pp65-specific TCR clonotypes in the blood of healthy donors have higher binding affinities for the CMV peptide and arise from clonotypes that are highly shared among individuals. Interestingly, these highly shared HLA-A*02-restricted CMV-specific TCRs were detected in a CMV-seronegative individual as well as in HLA-A*02-negative donors albeit at lower frequency. More intriguingly, these shared TCR clonotypes were abundant in the stem memory T-cell subset, and TCR diversity of the stem memory T-cell repertoire was significantly lower than in the central memory and effector memory T-cell repertoires. These results suggest that the stem memory T-cell subset may serve as a reservoir of highly shared and highly functional memory T-cells.

Injuries in Japanese Mini-Basketball Players During Practices and Games.

CONTEXT: Mini-basketball is one of the most popular junior sports in Japan. Mini-basketball-related injuries may increase because of early specialization. However, no reports have been published to date concerning basketball injuries in children younger than 12 years of age. OBJECTIVE: To prospectively study the incidence, sites, types, and mechanisms of injuries in mini-basketball teams. DESIGN: Descriptive epidemiology study. SETTING: Mini-basketball teams in Kobe, Japan. PATIENTS OR OTHER PARTICIPANTS: A total of 95 players in 7 community-based mini-basketball club teams (age range, 9 through 12 years). MAIN OUTCOME MEASURE(S): Data on all practice and game injuries for the 2013-2014 season were collected using an injury report form. Injury rates were calculated according to site, type, and mechanism. RESULTS: The overall injury rate was 3.83 per 1000 athlete-hours (AHs). The game injury rate ( 12.92/1000 AHs) was higher than the practice injury rate (3.13/1000 AHs; P < .05). The most common anatomical areas of injury during games and practices were the head and neck (36.4%, 4.70/1000 AHs) and the upper limbs (47.8%, 1.50/1000 AHs). Sprains (42.9%, n = 39) were the most common type of injuries overall, followed by contusions (29.7%, n = 27). Most game injuries resulted from body contact (45.5%, 5.87/1000 AHs), whereas most practice injuries resulted from other contact (56.5%, 1.77/1000 AHs). CONCLUSIONS: Game injury rates were higher than practice injury rates in Japanese mini-basketball players. The high practice injury rate in this study may be due to specific factors related to growth, such as individual differences in height, or to skills, such as inexperience in ball handling.