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[This corrects the article DOI: 10.31662/jmaj.2024-0331.].
To evaluate the clinical efficacy of prostheses designed using mandibular motion analysis in maxillary full-arch implant rehabilitation. Twenty patients were assigned to a study group (n = 10), receiving prostheses designed with dynamic occlusal data from an electronic jaw motion analyzer (JMA), or a control group (n = 10) using conventional static digital workflows. Between-group differences in occlusal adjustment depth (MAE), area, and chairside time were analyzed by independent t-tests. Within the study group, the stability of mandibular movement paths (provisional vs. post-restoration) was assessed using paired t-tests. Oral health-related quality of life (OHRQoL) was evaluated using the OHIP-14 questionnaire. Effect sizes were calculated as Hedges' g. The study group exhibited significantly lower occlusal adjustment depth (163.26 ± 31.42 μm vs. 213.99 ± 56.38 μm; p = 0.030, Hedges' g = 1.06) and adjustment area (95.93 ± 30.27 mm2 vs. 129.86 ± 25.82 mm2; p = 0.020, g = 1.16) compared to the control group. Chairside adjustment time was reduced by approximately 30% (23.8 ± 7.8 min vs. 33.8 ± 8.0 min; p = 0.074, g = 1.15). No significant changes in parameters of mandibular movement paths were observed within the study group post-restoration (all p > 0.05). OHIP-14 scores were significantly better in the study group for "Meal interruption", "Relaxation difficulty" (p = 0.041), reflecting improved OHRQoL. Integrating dynamic mandibular motion data into prosthesis design reduces clinical adjustments, improves OHRQoL, and preserves inherent movement patterns, demonstrating a promising approach to optimize functional outcomes in full-arch implant rehabilitation. Integrating dynamic mandibular motion data into digital prosthesis design offers a clinically valuable strategy that minimizes occlusal adjustments, supports functional stability, and enhances patient-reported quality of life in full-arch implant rehabilitation.
This study aimed to evaluate and compare the condylar distraction potential and joint space dimensions between patients with unilateral disc displacement without reduction (DDwoR) and asymptomatic individuals, using dynamic jaw tracking and MRI imaging. A total of 47 participants were included: 34 patients diagnosed with unilateral DDwoR and 11 asymptomatic volunteers. Dynamic mandibular movements were recorded using the Zebris JMA 3D ultrasonic jaw tracking system. The amount of condylar distraction was measured using the Electronic Position Analysis (EPA) module. Additionally, MRI scans were performed to assess joint space distances. Statistical comparisons were conducted using appropriate parametric and non-parametric tests, with significance set at p < 0.05. The findings provide insight into the differences in condylar distraction between patients with unilateral DDwoR and healthy volunteers. Patients with DDwoR showed significantly reduced condylar distraction potential an on the affected side compared to controls (p < 0.05). MRI analysis revealed a narrower anterior joint space and limited increase in superior joint space in the DDwoR group. No significant differences were found on the non-affected side compared to the control group. Patients with unilateral DDwoR demonstrate limited condylar distraction capacity and altered joint space dynamics compared to asymptomatic individuals. These findings highlight the mechanical constraints associated with disc displacement and emphasize the importance of functional and morphological evaluation in temporomandibular joint disorders.
Antigen-specific immunoglobulin-G (IgG) antibodies cause or contribute to the pathogenesis of a wide spectrum of human diseases and conditions. Multiple therapeutic approaches have been developed, yet they are limited by variable safety and efficacy, patient inconvenience, and cost. IdeS, a cysteine protease derived from S. pyogenes, specifically cleaves IgG antibodies, representing a unique opportunity for the treatment of IgG-mediated diseases. However, clinical utilization of IdeS is limited by the immunogenic nature of bacterial proteases and short half-life. Using Seismic's IMPACT platform, we engineered S-1117, an IgG cleaving enzyme fused to a human effectorless IgG1 Fc domain for an extended half-life. S-1117 is being developed to address the limitations of existing therapies in IgG-mediated diseases. In vitro and in vivo pharmacology studies demonstrate that S-1117 exhibits reduced B and T cell immunogenicity, a superior pharmacokinetic profile, and manufacturability and developability properties resembling those of monoclonal antibodies. S-1117 cleavage of IgG reduces circulating levels of IgG, including pathogenic IgG autoantibodies and IgG immune-complexes, and reduces IgG antibody effector functions, such as complement fixation, antibody-dependent cellular cytotoxicity, and antibody-dependent cell phagocytosis. The polypharmacology of S-1117 further extends to cleaving the antigen receptor on IgG-positive memory B cells, thereby modulating activation of memory B cells.
Japan, the world's third-largest pharmaceutical market, introduced new guidelines in 2019 to address ethical concerns in pharmaceutical company-physician relationships. This study aimed to analyze Japanese physicians' attitudes toward these strengthened regulations. An online survey of 1,203 Japanese physicians was conducted in November 2019. Respondents were categorized based on their frequency of interaction with pharmaceutical companies: frequent (82, 6.8%), moderate (930, 77.3%), or rare (191, 15.9%). The survey assessed awareness of the new guidelines, perceived changes in promotional activities, and attitudes toward stricter regulations. Multivariable modified Poisson regression was used to identify factors associated with opposition to the regulations. A total of 640 (53.3%) respondents opposed stricter regulations, while 325 (27.1%) were in favor. Physicians with frequent (adjusted Incidence Rate Ratio [aIRR] 1.61, 95% confidence interval [CI] 1.24-2.10) or moderate (aIRR 1.53, 95% CI 1.24-1.89) interactions were more likely to oppose regulations compared with those with rare interactions. Hospital directors/managers, those affiliated with private institutions, and recent graduates also showed higher opposition. The main reason for favoring regulations was to promote healthy industry relationships (38, 9.3%), while the primary concern among those opposed was related to information gathering or potential patient disadvantages (88, 21.6%). The study reveals diverse views on industry-physician relations in Japan. Frequent interactions and leadership roles correlate with opposition to stricter regulations. The results suggest a need for balanced policies that consider varied perspectives.
New insecticides for indoor residual spraying (IRS) are being developed to manage resistance. Chlorfenapyr (Sylando® 240SC), a pro-insecticide, is metabolized by active mosquitoes into the toxic metabolite tralopyril. This mode of action requires adapted "free flying" bioassays (because chlorfenapyr is converted to its toxic metabolite tralopyril when mosquitoes are metabolically active). A miniature-experimental hut (MEH) assay was developed within the Ifakara Ambient Chamber Test (I-ACT) with a rabbit as a host to measure residual efficacy under controlled conditions. Sylando® 240SC was compared with SumiShield® 50WG (clothianidin) for 12-month residual efficacy against malaria and arbovirus vectors. Residual activity was assessed on mud, wood and concrete with two huts per substrate treated with Sylando® 240SC, one with SumiShield® 50WG, and one with untreated control. Five replicates of 20 mosquitoes per strain (malaria vectors: pyrethroid-susceptible Anopheles gambiae and -resistant An. arabiensis and An. funestus; culicines Aedes aegypti and Culex quinquefasciatus) were exposed overnight at one-week post spraying and monthly thereafter. Multivariable mixed-effect logistic regression with binomial errors and log link function assessed non-inferiority with a 7% margin on mosquito mortality as the primary outcome for malaria vectors. Both products induced delayed mortality, with higher effects on malaria vectors than culicines. Across all substrates and malaria species combined over the full 12 months of observation, Sylando® 240SC was non-inferior to SumiShield® 50WG on mortality measured at 72 h (76% vs. 67%, OR = 0.86, 95% CI: 0.77-0.97) and 168 h (89% vs. 82%, OR = 0.74, 95% CI: 0.63-0.87). Sylando® 240SC performed comparably to SumiShield® 50WG, supporting its use as an IRS additional option. The new I-ACT mini-experimental-hut assay provides a practical tool for evaluating pro-insecticides. The importance of free-flight evaluation methods for pro-insecticides is discussed.
Dpep is a cell-penetrating peptide that targets transcription factors ATF5, CEBPB and CEBPD to selectively suppress growth and survival of diverse tumor cell types in vitro and in vivo. Due to these actions and its apparent safety, the peptide has potential as a cancer therapeutic. How Dpep might be combined with other anti-cancer agents to achieve synergistic efficacy and to overcome possible peptide resistance has not been assessed in depth. Based on prior work indicating that Dpep promotes apoptotic cancer cell death and up-regulates multiple pro-apoptotic and tumor suppressor genes, we studied combinations of Dpep with ABT-263, a pro-apoptotic BCL2 family inhibitor, and decitabine, a hypomethylating drug. Combining Dpep with each agent alone or together synergistically suppressed the growth of a range of solid and liquid tumor cell types. Moreover, the combinations synergistically inhibited the growth of cells lines that were selected either in vivo or in vitro for Dpep resistance. Finally, we tested the combination of Dpep with ABT-263 in a mouse melanoma xenograft model. The combination more effectively inhibited tumor growth than either agent alone and, in contrast to vehicle or ABT-263, produced a 40% durable survival rate. Taken together, these observations highlight potential drug partners for the therapeutic development of Dpep.
Recent advances in medical care have increased the number of children with medical complexity (CMC) requiring daily support, yet their opportunities for social participation remain limited. We involved a 6-year-old CMC in circus performances held in three Japanese cities. Despite medical challenges, the child safely participated and experienced psychological growth through nervousness, ambition, and communication. This initiative required close interdisciplinary collaboration and highlighted the importance of trust between families and healthcare providers. Our experience illustrates how creative, community-based efforts can reduce barriers and promote inclusion for CMCs, contributing to a more equitable and supportive society.
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Arrhythmogenic cardiomyopathy (ACM) is an inherited disease that is characterized by lethal ventricular arrhythmias stemming from myocyte dysfunction. ACM is associated with considerable subepicardial fibrosis and inflammation with right ventricle predominance. Most cases of gene-positive ACM are caused by a desmosome protein mutation, with plakophilin-2 (Pkp2) mutations being the most common. We hypothesized that Pkp2-deficiency in epicardium-derived cells (EPDCs) contributes to fibro-inflammatory signaling and ACM pathogenesis. We developed transgenic mice that lack Pkp2 in cardiomyocytes (Pkp2-cKO), in EPDC (Pkp2-eKO), or in both cardiomyocyte and EPDC (Pkp2-ceKO) via the tissue-specific expression of tamoxifen-inducible Cre recombinase. Nonmyocyte populations were isolated 21 days posttamoxifen injection for single-cell RNA-sequencing. Immunohistochemistry, flow cytometry, quantitative reverse transcription polymerase chain reaction, and echocardiography were used to interrogate cardiac physiology and cellular composition. We identified a population of epicardium-derived fibroblasts characterized by the expression of Ccl2, Ccl7, Thbs1, and Ptx3 that accumulated on Pkp2 deletion in both cardiomyocytes and EPDC. Pkp2 deletion in cardiomyocytes induced a moderate fibro-inflammatory EPDC phenotype, while deletion in EPDC did not elicit a pathological phenotype, suggesting cardiomyocyte involvement is necessary for ACM pathogenesis. Proinflammatory fibroblasts acquired the senescence-associated secretory phenotype, correlating with elevated senescence associated-βgal staining in the right ventricle. Gene expression, flow cytometry, and histological data also revealed an exaggerated inflammatory response in Pkp2-ceKO mice, which progresses from right to left ventricular predominance. Importantly, macrophages and B cells accumulate in both Pkp2-cKO and Pkp2-ceKO mice compared with controls. Although B-cell depletion delays the early inflammatory and fibrosis response, it did not alter end-stage cardiac physiology. Pkp2 deletion in EPDC facilitates the emergence of a fibro-inflammatory phenotype that may contribute to ACM pathogenesis.
The European Working Group on Sarcopenia in Older People 2 revised its diagnostic criteria for sarcopenia, highlighting the importance of evaluating not only skeletal muscle mass but also muscle quality. Recently, the extracellular water-to-total body water ratio (ECW/TBW) has gained attention as an indicator of muscle quality. The aim of this study was to investigate the sex differences in the effect of aging on ECW/TBW in community-dwelling individuals. This cross-sectional study was conducted among community-dwelling males and females (aged ≥20 years). A total of 824 participants (345 males, 479 females) were included. ECW/TBW was measured using bioelectrical impedance analysis. Associations between age and ECW/TBW were analyzed separately for males and females using Spearman's correlation coefficient. Participants were categorized into three age groups: 20-39 years, 40-64 years, and ≥65 years. Among males (n = 345), the age groups 20-39, 40-64, and ≥ 65 years comprised 124, 128, and 93 participants, respectively. Among females (n = 479), the corresponding numbers were 94, 164, and 221 participants, respectively. The Kruskal-Wallis test was used to compare ECW/TBW among the three groups for both males and females. Bonferroni's post hoc test was used to determine the significance when the main effect was confirmed in the Kruskal-Wallis test. In addition, a two-way analysis of variance was performed on ECW/TBW with age group and sex as factors. Correlation analyses revealed a significant positive association between age and ECW/TBW in both males (ρ = 0.733, p < 0.001) and females (ρ = 0.684, p < 0.001). For both males and females, a main effect of age on ECW/TBW was observed among the three groups. In addition, for both males and females, the ECW/TBW in the ≥65-year group was significantly higher than in the 20-39 and 40-64-year groups. ECW/TBW showed a significant interaction between age group and sex (p < 0.001). The results of this study indicated that age is positively related to ECW/TBW in community-dwelling males and females. Additionally, the influence of aging on ECW/TBW was more pronounced in males than in females. Based on our findings, assessing ECW/TBW is important for capturing age-related changes.
Accurate identification of pathological complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) remains a key clinical challenge. Clinical complete response is an imperfect surrogate, and pCR can only be definitively established after surgery. We developed a fully automated, segmentation-free deep learning model to support post-treatment response assessment using routine T2-weighted MRI. A longitudinal three-dimensional (3D) siamese convolutional neural network was trained using paired pre- and post-nCRT axial T2-weighted MRI volumes and a normalized signed voxel-wise difference map. The multitask framework simultaneously predicted rectal wall response (good response: modified Ryan score 0-1 vs poor response ≥ 2) and nodal status (ypN0 vs ypN +), from which pCR probability (ypT0N0) was derived. A retrospective single-center cohort of 195 patients was divided into training and independent test sets stratified by pCR status. Performance was evaluated using AUC-ROC and standard classification metrics with bootstrap-derived 95% confidence intervals. In the independent test set (n = 49; pCR prevalence 18.5%), the model achieved an AUC-ROC of 0.71 (95% CI: 0.55-0.85) for pCR prediction. At the selected operating threshold, sensitivity was 100% (95% CI: 70.1-100) and negative predictive value (NPV) was 100% (95% CI: 81.6-100), with a specificity of 42.5% (95% CI: 28.5-57.8). The high NPV reflects the low prevalence of pCR in the study cohort and may vary across external populations. This fully automated longitudinal deep learning model demonstrated moderate discrimination and a high-sensitivity profile for pCR detection. Its performance suggests potential utility as a screening or triage tool to support multidisciplinary assessment, rather than to directly guide organ-preserving strategies. External multicenter validation is required before clinical implementation.
Children with severe motor and intellectual disabilities (SMIDs) require complex care involving both technical skill and emotional presence. Pediatric residents often lack meaningful exposure to such patients, and little is known about how they make sense of these learning experiences. We conducted a qualitative study using an interpretative phenomenological analysis to explore how pediatric residents experienced a three-month rotation at a facility for children with SMID in Japan. Four residents were interviewed twice during their rotations. Interviews were transcribed verbatim and analyzed through iterative coding and thematic development. Three main themes emerged: (1) bewilderment at the unfamiliar and its overcoming, (2) confrontation with complex, ambiguous, and unstable medical conditions, and (3) psychological barriers to communication and their resolution. Initially, residents felt discomfort and emotional distance owing to unfamiliar devices, patients who were non-verbal, and the ambiguity of symptoms. However, through repeated contact, observational learning, and active participation in daily care, residents gradually developed intuitive judgment, comfort with uncertainty, and emotional connection. These experiences shifted their perceptions of children with SMID from passive and unknowable to responsive and relational. Residents also began to reconceptualize their role-not merely as problem-solvers but as care companions who tolerate ambiguity and foster connection. Pediatric residents initially struggled with unfamiliarity and uncertainty in caring for children with SMID. However, sustained exposure and interprofessional learning fostered emotional growth, intuitive competence, and epistemic humility. Training programs should provide longitudinal, hands-on experiences with patients with SMID and support reflective learning to cultivate more compassionate and capable pediatricians.
Nitrous oxide (N2O) is a strong greenhouse gas that contributes significantly to global warming and causes depletion of ozone in the stratosphere. Recent observational records show an unprecedented acceleration in atmospheric N₂O growth, reaching 1.15 ppb yr- 1 in 2019-2023, a significant increase compared to 0.68 ppb yr- 1 in 2001-2005. This surge in growth rate is particularly pronounced over tropical regions, and has been measured most prominently at the southern-most island of Japan (Hateruma). In this study, we use N2O observations from globally distributed multi-institutional networks and the MIROC4-ACTM inversion framework to quantify N2O emissions and identify key regions that are driving the recent acceleration. Our results suggest that the major Asian countries, Brazil, Central and Northern Africa, and the Contiguous United States have increased emission sources in the recent 2.5 decades (1998-2023). Further, there has been an increase in land N2O emissions, at a rate of 106 GgN yr- 1 per year during 1998-2002 to 2019-2023 (1Gg = 109g). The inversion inferred trends are consistent with increased fertiliser use and manure production to support extensive agriculture, and terrestrial ecosystem model results. The emissions from oceanic regions did not show significant increases in N2O (rate: 7 ± 2 GgN yr- 1 per year) in our inverse model setup. Our results underscore the importance for improved climate mitigation strategies and emissions reduction policies by increasing nitrogen-fertiliser use efficiency in agricultural land. The online version contains supplementary material available at 10.1186/s40562-026-00476-z.
Influenza vaccines are formulated each year to prevent serious illness in at-risk individuals, including elderly people. Healthcare decision-making is mainly based on the economic evaluations (EEs) (i.e., cost-effectiveness analysis [CEA]) of vaccines; however, understanding the limitations of these models and correctly interpreting the results may be challenging. Here, we provide a practical Guide that will help readers who are not experts in the field of health economics or influenza to critically review influenza vaccine EEs. This Guide is based on the findings of a systematic review of the literature, a critical analysis of the available EEs published for influenza vaccines for older adults in Spain, and applicable national and international guidelines on EE and influenza modeling. It has been developed by a multidisciplinary board of experts in influenza, vaccines, and health economics. The guide provides tips to help the reader assess whether an EE design is fit for its purpose in terms of comparators, time horizon, perspective of the analysis, population analyzed, and whether appropriate modeling methods were applied. It detects the uncertainty arising from input data and the implications of this uncertainty on the results. Ultimately, this resource aims to empower decision-makers, particularly those without expertise in health economics or vaccinology, to critically read and interpret EEs, thus favoring evidence-based informed decisions that will improve the efficiency of influenza vaccination programs.
Time elapsed since trauma onset is a critical determinant of prognosis in trauma patients. However, factors behind prolonged prehospital on-site time remain unclear. This study aimed to identify associated factors in trauma cases. Using a nationwide Japanese database, adults who experienced trauma and were treated between January 2004 and May 2019 were identified. Multivariable logistic regression with multiple imputations for missing data was performed to compare characteristics of patients with shorter and longer prehospital on-site times. Data from 150,215 patients were included. Multivariable logistic regression with multiple imputations for missing data revealed that longer prehospital on-site time was associated with younger age, male sex (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.11-1.16), weekends and holidays (OR, 1.06; 95% CI, 1.03-1.08), alcohol consumption (OR, 1.31; 95% CI, 1.26-1.36), fall (OR, 1.07; 95% CI, 1.05-1.10), other blunt trauma (OR, 1.12; 95% CI, 1.07-1.18), suicide (OR, 1.20; 95% CI, 1.13-1.27), violence (OR, 1.33; 95% CI, 1.20-1.46), hypotension (OR, 1.15; 95% CI, 1.09-1.22), higher Revised Trauma Score (OR, 1.21; 95% CI, 1.20-1.23), Abbreviated Injury Scale (AIS) category 6 (spine) ≥ 3 (OR, 1.21; 95% CI, 1.17-1.25), AIS category 7 (upper extremities) ≥ 3 (OR, 1.15; 95% CI, 1.10-1.21), immobilization (OR, 1.25; 95% CI, 1.22-1.28), intravenous line placement (OR, 1.27; 95% CI, 1.17-1.37), intubation (OR, 1.44; 95% CI, 1.26-1.64), mental disease (OR, 1.07; 95% CI, 1.02-1.13), chronic kidney disease undergoing hemodialysis (OR, 1.12; 95% CI, 1.03-1.22), and malignancy (OR, 1.11; 95% CI, 1.04-1.18). Several factors associated with prolonged prehospital on-site time were identified. Interventions targeting these factors may help shorten prehospital on-site time.
To demonstrate the step-by-step application of intraluminal indocyanine green (ICG) in endometriosis and adenomyosis surgery, including mucosa-sparing shaving of deep bladder and rectal nodules and excision of superficial tubal endometriosis. Description of surgical technique with narrated video footage. First case was a 36-year-old patient with chronic pelvic pain, urinary frequency, and dysuria. Preoperative magnetic resonance imaging revealed a bladder endometriosis nodule measuring 1.7 cm × 1.5 cm. The patient underwent robotic-assisted excision of endometriosis with total hysterectomy. Second case was a 34-year-old patient with chronic pelvic pain and dyschezia. Preoperative magnetic resonance imaging revealed a rectal endometriosis nodule measuring 2.7 cm × 1.8 cm, located 8 cm from the anal verge. The patient underwent robotic-assisted excision of endometriosis with total hysterectomy. Additional applications of intraluminal ICG highlighted in the video include superficial tubal endometriosis and intrauterine ICG use during adenomyosis excision. In the first case, cystoscopy was performed to exclude bladder mucosal involvement. The bladder was backfilled with diluted ICG, and mucosa-sparing shaving of the bladder nodule was performed under fluorescence guidance. In the second case, ICG was administered transrectally, and the rectal nodule was shaved using monopolar energy under fluorescence guidance. In the third case, ICG was used for real-time identification of the tubal lumen during excision of tubal endometriosis. In the fourth case, intrauterine ICG was used to guide the depth of excision during adenomyosis resection. Demonstration of robotic-assisted excision of endometriosis and adenomyosis using intraluminal ICG guidance. All procedures were completed without intraoperative or postoperative complications, and patients were discharged on the same day of surgery. Bladder mucosal integrity was preserved, allowing avoidance of prolonged catheterization. A voiding trial was successfully completed before discharge. At 6-week follow-up, patients reported no complaints. Intravenous ICG is well established for assessing bowel perfusion and anastomotic viability (1). Its use for ureteral perfusion has been described in limited reports, whereas pelvic nerve visualization has only been reported in isolated case reports (2, 3). Intraluminal injection of ICG into the ureters is commonly used to aid ureteral identification (4). In this video, we highlight intraluminal ICG as a valuable adjunct in advanced endometriosis and adenomyosis surgery. When combined with the advantages of robotic surgery, it enables precise mucosa-sparing excision of deep endometriotic lesions and may reduce surgical morbidity.
Japan's cancer screening programs have expanded widely in recent decades, with local governments and workplaces offering screenings beyond national recommendations. Although this flexibility has improved access to screening, it has also contributed to overscreening and the practice of conducting tests beyond evidence-based age ranges, intervals, and methods. The underlying principles of organized screening, which emphasize evidence-based methods and quality assurance, have often been overshadowed by administrative and institutional momentum rather than by deliberate, evidence-based planning. In 2024, Miyazaki City initiated a comprehensive review of its cancer screening system under the new medical leadership. The process identified several deviations from national guidelines in target populations and screening methods, leading to a reform policy that discontinued non-evidence-based tests, such as the ABC method (a combination of serum pepsinogen and Helicobacter pylori antibody testing) for gastric cancer, breast ultrasound, and prostate-specific antigen testing. Although implementation is ongoing, this initiative demonstrates how municipalities can begin realigning screening practices with scientific standards. The Japanese case, exemplified by Miyazaki City's initiative, highlights the importance of local leadership and an organizational understanding of the principles of organized screening. Reforming overscreening requires sustained collaboration between policymakers, healthcare providers, and citizens to balance accessibility with evidence-based practices.
Workplace social capital (WSC), defined as the features of social organization that promote coordination and cooperation for mutual benefit, is a relevant construct that contributes positively to employee and organizational wellness, and has recently attracted wide attention. However, factors associated with WSC in the field of medical education have not been investigated, including regarding the effect of physician working hour restrictions. Thus, the aim of the study was to investigate differences in the WSC of resident physicians before and after the April 2024 introduction of restrictions on physician working hours in Japan. We conducted a nationwide repeated cross-sectional survey in 25 hospitals across Japan. Pre- and post-restriction data were obtained in July and August 2022 and in December 2024, respectively. We evaluated WSC using the Japanese medical resident version of the WSC Scale, which comprises horizontal trust (i.e., trust in co-workers) and vertical trust (i.e., trust in supervisors) subscales. We used the total score and its domain scores, all of which range from 1 to 5, with higher scores indicating greater WSC, as outcome variables. We created a dummy variable (1 = post-restriction data [December 2024], 0 = pre-restriction data [July-August 2022]) and used it as the explanatory variable. We used a linear mixed-effects model to adjust clustering within hospitals and individual covariates. We analyzed data for 428 respondents (pre-restriction, 246; post-restriction, 182 participants; man, 272). After adjusting possible confounders and clustering within hospitals, physician working hour restrictions were significantly associated with greater vertical trust (adjusted mean difference, 0.17; 95% confidence interval, 0.02 to 0.32). No clear trend was observed in the association among restrictions, total WSC score (adjusted mean difference, 0.13; 95% confidence interval, -0.01 to 0.26), and horizontal trust score (adjusted mean difference, 0.10; 95% confidence interval, -0.05 to 0.24). This nationwide multicenter study revealed significant vertical trust score differences between pre- and post-physician working hour restrictions. The implementation of physician working hour restrictions has improved vertical trust. These findings contribute to the literature on potential benefits of working hour restrictions on the organization of physician life and enhancement of patient care quality.
Ophthalmic viscosurgical devices (OVDs) are essential in cataract surgery for maintaining anterior chamber stability and protecting intraocular tissues. This study evaluated the physicochemical and rheological properties of three hyaluronic acid-based OVDs (OpHLINE® 1.4%, 2%, and 3%) and assessed their clinical performance. A two-phase investigation was conducted: (1) characterization of OpHLINE formulations versus four commercial comparators, including cohesive-dispersive analysis and viscosity-shear profiling; and (2) a prospective clinical trial in 68 patients undergoing phacoemulsification with intraocular lens implantation. Primary endpoint was workspace maintenance; secondary endpoints included ease of OVD removal, endothelial cell density (ECD) loss, and intraocular pressure (IOP) changes. By varying HA concentration at constant molecular weight, we achieved direct control of rheological properties and CDI, generating distinct functional profiles: OpHLINE 1.4% behaved cohesively with rapid aspiration, OpHLINE 3% exhibited dispersive-like retention while maintaining space, and OpHLINE 2% combined cohesive handling with the highest shear-resistant viscosity. Clinically, OpHLINE 2% maintained an intermediate behaviour regarding space maintenance, ease of removal, ECD and IOP, while OpHLINE 3% provided the highest full chamber maintenance during all surgical steps. OpHLINE 1.4% enabled the easiest removal (95% adequate) and the lowest ECD loss (12.9%). IOP spikes ≥ 30 mmHg occurred in 13.6%, 20.8%, and 30.4% of eyes at 6 h for 1.4%, 2%, and 3%, respectively, resolving without sequelae. This study demonstrates that cohesive-dispersive behaviour and shear-dependent viscosity can be predictably tuned by HA concentration alone, enabling a modular, evidence-based approach to OVD selection. OpHLINE series provide evidence for three distinct behaviours: 1.4% showed optimal removal and endothelial protection; 2% offered balanced rheological and clinical properties; 3% provided the most consistent anterior chamber stability during surgery. These results allow surgeons to tailor intraoperative performance without altering polymer chain length. This study was retrospectively registered (OpHLINE-PIC01-2020), approved on 8 February 2021 by the Ethics Committee for Research with Medicines of Euskadi (CEIm-E, Spain, code PS2020065). ClinicalTrials.gov, NCT ID Number NCT07343973, Registered on 07 January 2026.