Haneda Clinic

Uterine fibroids (UFs), the most common tumors in women of reproductive age, are characterized by sex steroid-dependent growth and excessive deposition of extracellular matrix (ECM) surrounding UF smooth muscle cells. Women with symptomatic UFs experience heavy menstrual bleeding and consequent iron-deficiency anemia. They also have a risk of recurrent pregnancy loss, preterm birth, and cesarean delivery, indicating that UFs can negatively affect reproductive outcomes. Various types of immune cells, including innate and adaptive cells, are observed in UFs; however, the impact of these cells on the pathophysiology of UFs remains unclear. Inflammation may play important roles in the growth of UFs, and expression levels of proinflammatory and inflammatory cytokines, such as interleukin (IL)-1, IL-6, IL-10, TNF-α, and TGF-β, are upregulated in UFs. These cytokines play important roles in the interaction between growth factors and ECM that is regulated by the sex steroids estrogen and progesterone. Furthermore, proinflammatory mediators are upregulated in females with UFs, with higher expression levels in the endometrium with submucosal and intramural UFs than in the endometrium without UFs, indicating that these proinflammatory cytokines may impair endometrial receptivity, leading to implantation failure in in vitro fertilization programs. Hormonal treatments using gonadotropin releasing hormone analogs and the selective progesterone receptor modulator ulipristal acetate significantly shrink UFs and improve UF-related symptoms. These compounds can regulate local inflammation in UFs and adjacent myometrium. Controlling and improving local inflammation caused by UFs may represent a novel therapeutic strategy for UFs and potentially improve reproductive outcomes in women with symptomatic UFs.

Research and development of artificial intelligence (AI) in the field of gastrointestinal endoscopy is progressing rapidly. In Japan alone, there are more than 10 AI-assisted endoscopic medical devices that have received regulatory approval, and numerous randomized controlled trials have been published both domestically and internationally. However, the adoption of AI in clinical practice has not been smooth due to factors such as insufficient evaluation of the balance between clinical benefits and harms, unclear cost-effectiveness, the lack of reliable guidelines, and the absence of established reimbursement systems for medical fees. Considering this situation, the Japan Gastroenterological Endoscopy Society (JGES) presents its perspective on the status of AI in endoscopic practice in the form of the following position statements. This comprises nine statements developed by the JGES AI Committee in collaboration with a diverse panel of members. These statements comprehensively address issues related to the quality of endoscopic examinations, cost-effectiveness, clinical disadvantages, preparatory knowledge, medical safety, and legal responsibilities. They have been developed to be practical and useful in actual endoscopy settings.

Estrogen is synthesized throughout various tissues in the body, and its production is regulated by the rate-limiting enzyme aromatase (encoded by the Cyp19a1 gene). Notably, aromatase is also expressed in central nervous system cells, allowing for localized estrogen synthesis in regions such as the hypothalamus. Estrogens produced within these neurons are referred to as neuroestrogens. In this study, we investigated the role of neuroestrogens in the regulation of appetite through modulation of hypothalamic pathways in OVX, ArKO, and aromatase-restored mice. Estrogen suppresses appetite by influencing the expression of appetite-regulating peptides, including POMC and NPY, via MC4R. We explored the direct effects of neuroestrogens, independent from ovarian estrogen, on appetite suppression and the underlying molecular mechanisms. We monitored body weight and food intake and evaluated the expression of Cyp19a1, Mc4r, and other appetite-related genes. Our findings indicate that OVX and ArKO mice exhibited increased body weight and food consumption, which correlated with altered expression of Mc4r and Cyp19a1. Conversely, restoration of Cyp19a1 expression in a neuron specific manner significantly decreased food intake and increased Mc4r expression in the hypothalamus. Furthermore, neuroestrogens enhanced leptin responsiveness. Our results imply that neuroestrogens likely contribute to appetite regulation and may be relevant for body weight reduction.

Patient systemic and ocular data based on optical coherence tomography (OCT) and OCT angiography images were analyzed (n = 45; control and diabetic eyes with or without diabetic retinopathy [DR]; mean age, 49.6 ± 8.1 years). All participants had best-corrected visual acuity < 0.05 in logMAR. The choriocapillaris flow area (CCFA) ratio was lower and the coefficient of variation (CV) of CCFA ratio was higher in diabetic eyes with or without DR than in control eyes. CCFA ratio of DR eyes was lower than that of diabetic eyes without DR. Superficial retinal vessel length density (VLD) was reduced only in DR eyes. CCFA ratio correlated with retinal VLD, photoreceptor outer segment (PROS) length, and retinal pigment epithelium (RPE) volume in the study population; mean PROS decreased in diabetic eyes with or without DR, and RPE volume increased in DR eyes. CCFA ratio < 65.9% and CV of CCFA ratio ≥ 0.140 were more frequently found in diabetic eyes (odds ratio [OR], 13.333; P = 0.001), and related to HbA1c ≥ 7.0% (OR, 4.992; 95% confidence interval [CI] 1.164-21.412; P = 0.030) or systolic blood pressure ≥ 135 mmHg (OR, 5.572; 95% CI 1.156-26.863; P = 0.032). These findings could help understand diabetic pathogenesis in the choriocapillaris and outer retina, and remind clinicians to manage both diabetes and hypertension.

The OperA (Optimising Colorectal Cancer Prevention through Personalized Treatment with Artificial Intelligence) project aims to transform colorectal cancer care through artificial intelligence (AI) innovations. Recognizing that legal and ethical challenges remain key obstacles to clinical integration, this Delphi study sought to identify and prioritize such concerns in the context of gastrointestinal (GI) endoscopy. Fourteen international experts participated in a 2-round Delphi process. In round 1, the steering committee, with feedback from participants, proposed legal and ethical issues pertaining to AI in endoscopy. Round 2 involved iterative rating and refinement of these issues to achieve consensus on their importance. Consensus was reached on 10 key statements spanning 3 thematic domains: data governance, medicolegal implications, and equity and bias. Experts emphasized the need for robust data protection, transparent algorithmic development, and institutional clarity on data ownership. Liability concerns related to AI-assisted diagnosis and automated reporting were highlighted, alongside calls for guidance from legal and professional bodies. Finally, participants underscored the importance of demographic diversity in training data sets and transparent reporting practices to mitigate bias and ensure equitable AI deployment. As AI tools become increasingly integrated into the clinical practice of gastroenterology, addressing legal, ethical, and equity-related challenges is essential. This expert consensus provides a foundation for developing guidelines and regulatory frameworks to support responsible AI adoption in GI endoscopy.

BACKGROUND: Retinal migraine is a diagnosis of exclusion and is characterized by repeated episodes of transient monocular blindness associated with migraine. We report a case of systemic lupus erythematosus with acute episodes mimicking retinal migraines. CASE REPORT: A 46-year-old woman with a history of migraine with aura since her 20s and Evans syndrome presented with episodic transient monocular blindness. Retinal migraine was considered as the cause, and migraine prophylaxis initially reduced its frequency. After 5 months, the frequency increased, with chilblain-like lupus lesions on her extremities. Laboratory testing revealed lymphopenia and hypocomplementemia, fulfilling the diagnostic criteria for systemic lupus erythematosus, which may have caused Evans syndrome and transient monocular blindness, mimicking retinal migraines. After intravenous methylprednisolone and rituximab therapy, the transient monocular blindness episodes did not recur. CONCLUSION: Given the clinical presentation, systemic lupus erythematosus should be considered as a cause of transient monocular blindness and should be distinguished from retinal migraine.

Background/Aim: Slow eating is recommended for obese individuals. We aimed to determine the associations between meal duration and various factors (sex, numbers of chews and bites, eating tempo (including forced rhythm with a metronome) and BMI). Methods: Using a test meal (a quarter slice of pizza), we tested the sex difference of the meal duration, numbers of chews and bites, and eating tempo for thirty three healthy subjects (M: 15; F: 18) aged 37.2 ± 11.1 years via unpaired t tests. Next, factors influencing meal duration were identified via multivariate analysis (adjusted for sex), with meal duration as the dependent variable. Results: The meal duration and numbers of chews and bites differed significantly between sexes (63.1 ± 20.7 vs. 87.4 ± 22.8, p = 0.003; 80.3 ± 28.7 vs. 107.0 ± 36.1, p = 0.02; 2.1 ± 1.1 vs. 4.5 ± 2.6, p = 0.001, respectively), but the chewing tempo was similar (p = 0.32). Meal duration was associated with the number of chews (β = 0.6 [0.4, 0.7], p &lt; 0.001) and bites (5.8 [2.5, 9.2], p = 0.001) but not with BMI (p = 0.52) or chewing tempo (p = 0.99). Finally, when a metronome was used to force rhythmic stimulation (0/40/80/160 bpm), compared with 0 bpm, slow stimulation (40 bpm) resulted in increased meal duration (mean difference [95% CI] = −47.0 [−66.4, −27.7], p &lt; 0.0001), chews (−28.6 [−44.5, 12.8], p = 0.0003), and bites (−4.9 [−7.9, 1.9] p = 0.001) and delayed tempo (10.4 [4.5, 16.3], p = 0.0004). Conclusions: Meal duration was positively associated with the numbers of chews and bites and negatively associated with chewing tempo. Thus, increasing the numbers of bites and chews and slowing the eating tempo may prolong meal duration.

BACKGROUND: Hypoxic-ischemic (HI) insult in infants induces brain injury and results in motor coordination impairments associated with cerebral palsy; however, preventive measures for HI brain injury in preterm infants remain unclear. We investigated the impact of progesterone (P4) in a rat HI insult model that mimics HI brain injury in preterm infants. METHODS: Neonatal male rats with their right common carotid artery coagulated were exposed to a 1-h hypoxia (6% oxygen) on postnatal day (PND) 3. P4 (0.2 mg) was subcutaneously administered daily from PND4-12. Motor coordination function and muscular strength were evaluated on PND50 using rotarod and grip strength tests, respectively. Brain histology was evaluated via immunohistochemistry using anti-NeuN, anti-Olig2, and anti-IbaI antibodies on PND15 and PND50. RESULTS: In male rats, P4 significantly improved the latency-to-fall off on the rotarod test in the insult rats to the levels of the sham-operation rats. Neither the insult nor P4 administration impacted the grip strength results. No significant differences were observed in the number of neurons, oligodendrocyte progenitor cells (OPCs), and microglia in the motor and somatosensory area of the cortex between the insult and insult followed by P4-administered rats on PND50. The number of OPCs in the corpus callosum was significantly increased in the ipsilateral side compared with the contralateral side of the insult in the P4-administered rats, indicating that P4 facilitates recruitment of OPCs to the corpus callosum. HI insult accelerated neuronal differentiation in rats on PND15, which was abrogated in the P4-administerd group, suggesting that P4 suppresses transient neuronal differentiation caused by the insult. CONCLUSION: P4 administration restored motor coordination impairments caused by postnatal HI insult in male rats. The insult timing corresponds to that of human preterm infants, indicating P4's potential for protecting HI brain injury in preterm male infants.

BACKGROUND: Osteoporosis is a common complication in patients with primary biliary cholangitis (PBC). This study aimed to compare the efficacy and safety of denosumab and zoledronic acid (ZOL) in treating osteoporosis in PBC patients. METHODS: This multicenter, randomized, open-label trial enrolled Japanese patients with PBC and osteoporosis. Patients were randomized to receive either subcutaneous denosumab 60 mg every 6 months (denosumab group) or i.v. zoledronic acid 5 mg yearly (ZOL group). The primary endpoint was the mean percent change in bone mineral density (BMD) at the lumbar spine and total hip from baseline to 12 months. RESULTS: Of 47 enrolled patients, 41 (87.2%) completed the study (denosumab: n=21; ZOL: n=20). At 12 months, lumbar spine BMD increased by 7.5% in the denosumab group and 6.4% in the ZOL group, demonstrating the non-inferiority of denosumab (95% CI: -1.6% to 3.8%). Although the total hip BMD increased more in the denosumab group than in the ZOL group (5.0% vs. 2.6%, p<0.01), the difference did not meet the predefined non-inferiority margin (95% CI: -1.3% to 6.2%). Serum ALP to upper limit of normal ratio and bone turnover markers significantly decreased in both groups; however, the rates of change were not significantly different between them. The incidence of adverse events was significantly lower in the denosumab group compared with the ZOL group (14.3% vs. 50.0%, p=0.013). CONCLUSIONS: Denosumab is a safe and effective treatment option for osteoporosis in patients with PBC.

Purpose To evaluate the OCT images of eyes with fovea-involved complete retinal pigment epithelial and outer retinal atrophy (cRORA) as well as best-corrected visual acuity (BCVA) to explore the pathogenesis of visual impairment and atrophy. Design Retrospective observational study. Subjects Data of eyes with cRORA associated with age-related macular degeneration with foveal center involvement were collected from 10 hospitals in Japan. Methods Ophthalmic examination data, BCVA, and extents of retinal pigment epithelial and outer retinal atrophy (RORA), represented by choroidal hyper-transmission, and outer plexiform layer (OPL) deterioration, central retinal thickness (CRT), and central choroidal thickness (CCT) measured using built-in software on the sectional OCT images were evaluated. Main Outcome Measures Relationship between BCVA and extents of RORA and OPL deterioration. Results Of the 64 eyes of 64 patients (mean age: 76.8 ± 9.5 years old), 38 eyes (59.4%) belonged to men. Mean BCVA was 0.602 ± 0.475 (median: 0.523; range, −0.079 to 1.523) in logarithm of the minimum angle of resolution (logMAR). Mean extent of RORA was 2921 ± 1291 (median: 3172; range: 479–5985) μm. BCVA in logMAR positively correlated with extents of RORA ( P = 0.004) and OPL deterioration ( P = 0.004) and negatively correlated with CRT ( P = 0.022). Best-corrected visual acuity ≥0.5 was associated with extents of RORA ≥3000 μm (odds ratio [OR], 4.227; 95% confidence interval [CI], 1.440–12.408; P = 0.009) and OPL deterioration ≥1700 μm (OR, 2.984; 95% CI, 1.034–8.609; P = 0.043), and presence of complete central outer plexiform layer defect (cCOD) (OR, 12.700; 95% CI, 2.439–66.132; P = 0.003), after adjusting for age and sex. The extent of RORA ≥3000 μm was associated with BCVA ≥0.5 (OR, 4.213; 95% CI, 1.437–12.356; P = 0.009), extent of OPL deterioration ≥1700 μm (OR, 58.682; 95% CI, 6.865–501.592; P < 0.001), and presence of cCOD (OR, 4.107; 95% CI, 1.339–12.604; P = 0.014), after adjusting for age and sex. The extent of RORA positively correlated with that of OPL deterioration ( P < 0.001), CRT ( P = 0.001), and CCT ( P = 0.041). Conclusions A longer extent of cRORA in the OCT images with foveal center involvement was associated with a longer extent of OPL deterioration and the presence of cCOD and worse BCVA. Further studies focusing on OPL changes are warranted for understanding the pathogenesis of RORA and vision loss. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Retinal thickness measured using optical coherence tomography (OCT) is a major parameter to evaluate retinal diseases. However, it may be influenced by systemic factors. We retrospectively analyzed OCT images and blood sample data from 266 participants (49.1 ± 10.5 years) including 181 (68.0%) males who underwent medical checkups at Fujita Medical Innovation Center, Tokyo. Those with retinal pathological findings were excluded. Males had thicker retinas in the center and inner circles of Early Treatment Diabetic Retinopathy Study grid (P < 0.01 for all). Mean thicknesses of the superior areas were greater than those of the inferior areas in inner and outer circles (P < 0.01 for both). However, there were eyes with thicker inner inferior areas (72 eyes, 27.1%), which was observed more frequently in males (P = 0.018). Thicker retinas were associated with lower hemoglobin A1c levels in the center (P = 0.012), and inner temporal (P = 0.042) and inferior (P = 0.047) areas; lower creatinine levels in the inner temporal (P = 0.002), superior (P = 0.026), and inferior (P < 0.001) areas; and higher high-density lipoprotein cholesterol levels in the inner nasal (P = 0.029) and inferior (P = 0.029) areas after adjusting for age and sex. These results may be kept in mind in evaluating OCT data during clinical practice and future clinical trials, although further studies are warranted.

Background/Aim: Obese individuals are often said to eat fast. Given that obese individuals are often reported to consume fast food more frequently, we hypothesized that fast food can be eaten more quickly. This study aimed to examine the effects of meal type on meal duration, considering meal sequence. Methods: Meal duration, number of chews and bites, and chewing tempo were measured among 41 participants (18 males, 23 females; average age, 41.1 years) using two meals: pizza (301 kcal) and hamburger steak bento (hamburger, rice and broccoli, 304 kcal; two eating sequences: vegetables first or last). Results: Compared with pizza, bento meals (vegetables first or last) were associated with longer meal durations (sec) (mean differences in pizza-bento (vegetable first): −182 [−245.6, −118.9], p &lt; 0.0001; pizza-bento (vegetables last): −216.0 [−273.3, −158.7], p &lt; 0.0001). In contrast, no differences in meal duration (sec) were observed regardless of the order of vegetable consumption (p = 0.14). These findings were consistent with the number of chews and chewing tempos across both sexes. The number of bites was similar among pizza, bento (vegetable fast), and bento (vegetable last). Meal duration was positively associated with the number of chews and bites and meal type and negatively associated with age and sex. BMI was not associated with meal duration. Conclusions: Meal type affected meal duration, the number of chews, and the chewing tempo, independent of meal sequence. To eat more slowly, it is important to pay attention to the meal type.

PURPOSE: To identify time-specific factors associated with loss to follow-up (LTFU) in the early to medium term after initiating anti-vascular endothelial growth factor (VEGF) treatment in patients with neovascular age-related macular degeneration (nAMD) in Japan. METHODS: The study had a retrospective multicenter case-control design and was performed across 16 specialist retinal facilities in Japan. Patients diagnosed with nAMD at their initial visit who initiated treatment between January 2017 and December 2020 were included. Patient characteristics were analyzed to identify factors associated with LTFU within 3 months (very early), 3 months to 1 year (early), and 1 year to 2 years (medium term) after starting treatment. RESULTS: Data for 2389 patients with nAMD were analyzed. The very early, early, and medium-term LTFU rates were 6.8%, 13.8%, and 21.2%, respectively. Stepwise regression analysis identified factors that were significantly associated with LTFU at a very early stage to be greater central retinal thickness at baseline and a prior treatment history, those associated with early LTFU to be worse baseline best-corrected visual acuity (BCVA), anti-VEGF treatment combined with photodynamic therapy, and a follow-up period that overlapped with the COVID-19 pandemic, and that associated with medium-term LTFU to be worse BCVA at 3 months. LTFU in any period within 3 months to 2 years was more likely in patients aged >80 years, and LTFU very early within 3 months was more likely in those aged <60 years. A poor baseline BCVA (logMAR) of >1 was a risk factor for LTFU within 3 months and 1 year, whereas LTFU was significantly less likely in patients with good baseline BCVA (<0.1). CONCLUSION: The LTFU rate in patients with nAMD increased over time. Factors contributing to LTFU vary depending on the time since initiation of treatment.

Purpose: To evaluate the clinical course of retinal pigment epithelial and outer retinal atrophy (RORA) with best-corrected visual acuity (BCVA) and risk factors for rapid progression to explore the pathogenesis. Design: Retrospective observational study. Subjects: Data on eyes with fovea-involved RORA associated with age-related macular degeneration were collected over time from 10 hospitals in Japan. Methods: Data on ophthalmic examination, BCVA, and OCT images were analyzed. Main Outcome Measures: Relationships between changes in BCVA and extents of RORA and outer plexiform layer (OPL) deterioration and their associations with central choroidal thickness (CCT) and pachychoroid characteristics at baseline were evaluated. Results: = 0.010) at baseline after adjusting for age and baseline extent of RORA; similar risks for greater vertical extension of RORA were observed. Conclusions: The change in BCVA paralleled the changes in the extents of RORA and OPL deterioration. Rapid BCVA impairment was observed in eyes with longer RORA at baseline. A thinner choroid, SDD, and drusen were risk factors, and pachychoroid characteristics were protective factors against RORA progression. Further studies are warranted to better understand the progression of RORA and vision loss. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

OBJECTIVES: This study aimed to compare 3-min delayed phase images with 5-min delayed phase images for quantifying hepatic extracellular volume fraction (ECV) using dual-energy CT. METHODS: Between January 2020 and July 2022, 80 consecutive patients with chronic liver disease (45 men and 35 women, mean age: 69.3 ± 10.4 years) were included in this study cohort. All patients underwent both 3- and 5-min delayed phase CT scans for assessing focal liver lesions. Extracellular volume fraction value was calculated by the iodine densities of the hepatic parenchyma and aorta and compared between in each phase. Correlations between ECV values in each phase with the albumin-bilirubin (ALBI) score and grade, fibrosis-4 index (Fib-4), and clinical fibrosis stage were statistically analysed. RESULTS: No significant difference was found in ECV values between the 3- and 5-min delayed phase images (P = 0.056). The ratio of ECV values for 3- to 5-min delayed phase images was 0.984 ± 0.078, ranging from 0.85 to 1.16. The ECV calculated on 3- and 5-min delayed phase images showed strong and moderate correlations with ALBI grade (Spearman's ρ; 0.763 and 0.724, respectively) and ALBI score (Spearman's ρ; 0.707 and 0.668, respectively) and also showed moderate correlations with Fib-4 (Spearman's ρ; 0.548 and 0.543, respectively) and clinical fibrosis stage (Spearman's ρ; 0.468 and 0.435, respectively). CONCLUSION: Three-minute delayed phase images were found to be equivalent to 5-min delayed phase images for the calculation of ECV. ADVANCES IN KNOWLEDGE: Three-minute delayed phase images were found to be equivalent to 5-min delayed phase images for calculating ECV in the same patients, and both 3- and 5-min delayed phase CT scans showed strong and moderate correlation with serum fibrous makers, including ALBI score and grade and fibrosis-4 index. This could facilitate the clinical use of hepatic ECV in daily practice.

Background/Objectives: The aim of this study is to investigate the association between physical and chemical digestion and nutrition markers (serum albumin (ALB), prealbumin (PAB), and vitamin B12 (B12) levels). Methods: During a detailed checkup at Fujita Health University, we examined the associations of physical (occlusal force, masticatory performance, and swallowing ability (via the 10-item Eating Assessment Tool, EAT-10)) and chemical (Helicobacter pylori (HP) eradication history, HP antibody levels, and oral antacid (proton pump inhibitors) use) digestion parameters with serum ALB, PAB, and B12 levels in 92 individuals (M:67, F:25). Results: Forty-eight percent of the participants were older than 65 years of age, 19% had decreased occlusal force, 3.2% had decreased masticatory strength, 3.2% had decreased swallowing function, 24% had a history of HP eradication, 23% were HP antibody positive, and 16% were taking oral antacid medication. Additionally, 14% and 11% of the patients had low serum ALB and PAB levels, respectively, and 14% of the patients had B12 deficiency. Multivariate analysis adjusted for age, sex, body mass index, and C-reactive protein levels revealed that there were no significant associations between the physical digestion parameters and the serum PAB, ALB, or B12 levels. On the other hand, there was a significant association between oral antacid use and PAB levels (β = −3.3, p = 0.04). Independent of physical or chemical digestion parameters, serum PAB and B12 levels were significantly associated with protein and B12 intake, respectively. Conclusions: Oral antacid use may decrease serum PAB levels, indicating protein synthesis.

Background: The clinical utility of electron density (ED), obtained by non-contrast dual-energy computed tomography, has been demonstrated for the diagnosis of brain tumors and bone lesions; however, the clinical utility of ED in the liver has not been adequately reported. This study aimed to compare ED between hepatocellular carcinomas (HCCs), liver metastases, hepatic hemangiomas, and hepatic cysts and assess the differential diagnostic performance of ED between malignant tumors and benign lesions. Methods: Eighty-nine patients (53 men and 36 women; mean age, 67.2±13.2 years) were included. EDs were measured for 24 HCCs, 19 liver metastases, 28 hepatic hemangiomas, and 18 hepatic cysts. The relative ED (rED), normalized by the ED of the background liver parenchyma, was calculated. The ED and rED of the focal hepatic lesions (FHLs) were statistically analyzed. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance of ED and rED in differentiating malignant tumors from benign lesions. Results: 0.80, P<0.05). Conclusions: ED aids in the differential diagnosis of FHLs. The use of rED further improves diagnostic performance.

Background/Aim: To date, there have been no data regarding the reproducibility or agreement of meal duration when a test meal is eaten. To confirm the reproducibility and agreement of the meal duration, number of chews, chewing tempo, and number of bites of a test meal, we performed a prospective observation study. Methods: We measured the duration, number of chews, chewing tempo, and number of bites of a test meal (salmon bento) among 33 participants (male: 15; female: 18) aged 20–60 years who ate twice at 2-week intervals to verify the agreement (by Bland-Altman (BA) analysis) and reproducibility (intraclass correlation coefficient (ICC)) by sex. Results: The meal duration (s) and number of bites (times) were significantly greater in the female group (560.4 (128.7) and 731.9 (266.3), p = 0.023; 17.1 (9.9) vs. 26.4 (13.7), p = 0.036), and the number of chews tended to be greater in the female group (752.5 (203.3) vs. 938.1 (375.9), p = 0.083). Meal duration was positively associated with the number of chews (0.64 [0.53, 0.74], p &lt; 0.001) and bites (10.4 [5.1, 15.8], p &lt; 0.001). For both sexes, the % error calculated via BA analysis was high for meal duration, the number of chews, and the chewing tempo (21.4 and 13.4%; 16.5 and 18.5%; and 6.8 and 5.3%, respectively) and low for the number of bites (37.9 and 68.9%). The ICCs were high for meal duration (0.73 and 0.90), the number of chews (0.76 and 0.89), and the chewing tempo (0.76 and 0.90), and low for the number of bites (0.84 and 0.69). Moreover, systematic and proportional errors were found only for the number of bites in the female group (median_difference with 95% CI: −9.00 (−13.00, −2.00); −0.320 (−0.45, −0.093)). Conclusions: Although the sample size was small due to the exploratory nature of the study, meal duration, number of chews, and chewing tempo had high reproducibility and agreement, at least when this test meal was consumed. These measures may indicate individual-specific eating behavior.

This retrospective study evaluated whether sperm DNA fragmentation (SDF), measured by DNA fragmentation index (DFI), predicts IVF outcomes in 124 couples undergoing IVF with PGT-A (Preimplantation Genetic Testing for Aneuploidy) between 2015 and 2023. SDF was assessed using the Halosperm kit and categorized into low (≤ 15%, n = 81), medium (15-30%, n = 34), and high (≥ 30%, n = 9) DFI groups. Fertilization was performed via IVF or ICSI, and embryos were analyzed with PGT-A using next-generation sequencing. High DFI was associated with advanced paternal age, reduced motility, lower fertilization rates (in ICSI), and fewer good-quality blastocysts. However, PGT-A outcomes showed no significant differences in euploidy, mosaicism, or aneuploidy rates across DFI groups. Similarly, despite the methodological limitations of a retrospective design and a highly selected cohort, implantation, pregnancy, and live birth rates following euploid embryo transfer were unaffected by DFI level. SDF testing can help identify male infertility factors and guide IVF strategy, particularly regarding sperm selection. These findings suggest that early developmental impairment from sperm DNA damage may possibly be mitigated by embryonic repair mechanisms at later stages.

BACKGROUND: Gait-a frequently performed activity of daily living-is thought to reflect multiple dimensions of an individual's physical and cognitive status. Individuals with frailty or mild cognitive impairment (MCI) show decreased gait speed. However, previous studies have not simultaneously considered both statuses, although they frequently co-occur and may act as confounders. The direct association between frailty and gait is well-understood. In contrast, the association between cognitive decline-independent of physical function-and decreased gait speed, as well as the relationship among these three factors (frailty, cognitive decline, and gait speed), is not fully understood. METHODS: This study examined the effect of MCI on gait speed after accounting for frailty. Older individuals were categorized as (1) frailty with MCI, (2) frailty without MCI, (3) pre-frailty with MCI, (4) pre-frailty without MCI, (5) non-frailty with MCI, and (6) non-frailty without MCI. Frailty was assessed using the Kihon checklist and MCI using the Montreal Cognitive Assessment. Participants completed a 10-m walk test under two conditions: comfortable walking and fast walking. Two types of analyses were conducted: mediation analysis and two-way analysis of covariance (ANCOVA). RESULTS: Mediation analysis supported independent relationships between frailty and MCI status and gait speed, suggesting a direct association between MCI and gait speed, even when accounting for frailty. In addition, two-way analysis of covariance indicated significant main effects of both frailty and MCI on gait speed, with no significant interaction between them under the two walking conditions. CONCLUSIONS: These findings suggest that the observed association between MCI and gait speed is largely independent from frailty status, providing additional evidence supporting the association between cognitive function and gait performance.