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Sorbic acid and its salts, listed as Sorbic Acid (SOA) and Potassium Sorbate (SOK) in the current Japan's Standard and Specification for Food Additives (JSFA), are widely used as food additive preservatives. In the JSFA monographs, titration is used as a quantitative method, and the SOA or SOK contents are quantified as sorbic acid or its salt, including their stereoisomers. Although sorbic acid can be converted into its stereoisomers under certain conditions, the actual isomer content in food additive products has not been accurately analyzed on the JSFA titration assay. In this study, we used a previously developed single-reference high-performance liquid chromatography (SR-HPLC) method to accurately analyze sorbic acid and its three isomers, enabling the individual quantification of these components in commercial SOA and SOK products used as food additives. Analysis of five lots of the SOA products and eight lots of the SOK products revealed that the 2E,4Z-isomer was the predominant stereoisomer, with contents ranging up to 0.011% in SOA and up to 0.15% in SOK. Thus, the stereoisomer content was extremely low compared with that of sorbic acid or potassium sorbate. The total contents of sorbic acid and the isomers in SOA or those of potassium sorbate and the isomers in SOK obtained using SR-HPLC were equivalent to those determined using the JSFA titration method. This suggests that the SR-HPLC method is a viable alternative to the titration-based quantitative method, enabling simultaneous quantification of stereoisomers in food additives. These findings demonstrate the utility of SR-HPLC as an alternative assay for regulatory and quality-control purposes, offering improved chemical specificity and stereoisomeric profiles compared with conventional titration methods.

The interactions between four compounds used as influenza neuraminidase inhibitors-oseltamivir, zanamivir, laninamivir, and peramivir- and influenza virus neuraminidase were analyzed using pair interaction energy decomposition analysis based on fragment molecular orbital (FMO) method, quantitatively elucidating binding characteristics of each inhibitor. Our calculations revealed that structures with common functional groups showed similar binding characteristics, whereas structures with functional groups differing in hydrophilicity/hydrophobicity showed different types of intermolecular interactions for the same amino acid residues. Such analysis is expected to be effective for precise molecular design in structure-based drug design.

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A 70-year-old female patient was diagnosed with autoimmune hepatitis (AIH) at the age of 58 years based on antinuclear antibodies (1:1280) and liver biopsy findings. She received prednisolone (PSL). Over time, elevated levels of liver enzymes and alkaline phosphatase were observed, and 12 years later, a repeat liver biopsy revealed no signs of AIH but showed characteristics of primary biliary cholangitis (PBC). After reducing the PSL dose and starting ursodeoxycholic acid and pemafibrate, the blood test results improved. A liver biopsy is useful if a change in the condition is suspected, even in a patient undergoing follow-up for AIH or PBC.

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This study aimed to evaluate metal artifacts in cardiac magnetic resonance imaging using four pacing leads and four defibrillation leads and to clarify the effects of lead differences on image quality. Each lead was fixed in a phantom and aligned parallel to the X-, Y-, and Z-axis. Short-axis images were acquired using balanced steady-state free precession (balanced SSFP) and fast gradient echo (FGRE). Artifact area (S0) and increase rate (ΔS) were calculated. For each lead, the maximum value among the three axes was used to perform inter-lead comparisons. Visual assessment was also performed using short-axis images. In the physical evaluation, both S0 and ΔS tended to be greater with FGRE than with balanced SSFP for all leads. The median (range) of the maximum S0 and ΔS values among the three axes for each lead were 152.02 mm2 (119.17-183.49) and 5024.27% (4562.10-6956.83), respectively, for pacing leads, and 114.43 mm2 (79.51-148.11) and 2073.16% (1398.30-3561.46), respectively, for defibrillation leads. In the visual assessment, metal artifacts were significantly larger in some defibrillation leads in both balanced SSFP and FGRE. Pacing leads showed relatively small inter-lead differences, whereas some defibrillation leads exhibited inter-lead variability, suggesting the involvement of structural factors.

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Objective　To identify barriers to psychological safety in long-term care insurance facilities through a qualitative descriptive analysis of verbatim transcripts obtained from facility directors.Methods　Directors of long-term care insurance facilities in the Kinki region of Japan were recruited using snowball sampling. Semi-structured interviews were conducted between August and September 2023. Verbatim transcripts were analyzed qualitatively and inductively to generate codes representing statements that impede psychological safety. Codes were iteratively grouped to increase abstraction, forming subcategories and higher-order categories. Findings were further organized according to three antecedent domains: individual, structural/system, and interpersonal factors, to examine how these barriers manifest within facilities.Results　A total of 11 directors participated (9 male; age distribution: 40s, n=5; 50s, n=5). Mean age was 50.0 years (SD=6.44), and mean tenure in the current role was 10.4 years (SD=5.12). Three categories of individual factors were identified: "Position of new employees and junior employees," "Trait of being overly conscious of others and defensive of oneself," and "Difficult work performance among employees suspected of having psychological issues." Three structural/system categories were identified: "Limited understanding and capability regarding managerial duties," "Difficulties in managing, supporting, and training staff," and "Burden due to staff shortages and challenges in appropriate staffing." Five interpersonal categories were identified: "Self-centered and dismissive behavior toward others," "Self-righteous and pressure-generating behavior from superiors," "Intolerance and low flexibility associated with excessive righteousness," "Misunderstandings and concerns arising from insufficient ethical knowledge and rumors," and "Emotionally complex relationships that are difficult to reconcile." Interpersonal factors were prominent and interacted with individual factors. The findings suggested that the lack of effective organizational and workplace structures and systems to address these issues hinders psychological safety in long-term care facilities.Conclusion　Individual, interpersonal, and structural/system factors directly and indirectly inhibit open work-related communication among employees in long-term care insurance facilities. Persistent staffing shortages in Japan further exacerbate these barriers. Enhancing psychological safety requires targeted interventions addressing structural/system factors, particularly leadership practices within management.

Benzoic acid (BA),widely used as a food preservative, occurs naturally in various natural foods. Therefore, distinguishing between added and naturally occurring BA is essential in the administrative testing of food preservatives. To elucidate the naturally derived BA levels, we analyzed 180 samples, including fruits, nuts, vegetables, beans, and mushrooms, using steam distillation and dialysis. The distillation method successfully detected BA in 60 samples, with concentrations ranging from 2.3 to 471.2 μg/g. Particularly high levels were detected in cranberry and red perilla. In contrast, the dialysis method could not detect BA in 21 fruit samples with low BA concentrations and detected only trace amounts of BA in four samples. These findings indicated that BA might be generated in fruit samples during the distillation process. This study provides valuable reference data for administrative assessments when determining whether BA detected in food is naturally derived or added as a preservative.

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Immune checkpoint inhibitors (ICIs) have significantly advanced cancer treatment, and their clinical indications continue to expand. At the same time, the importance of managing immune-related adverse events (irAEs) has been increasing, along with growing expectations for pharmacist involvement. Herein, we report a case in which prompt pharmacist intervention prevented the progression of cytokine release syndrome (CRS) following ICI therapy. A patient with lung adenocarcinoma received 4 cycles of carboplatin, pemetrexed, and pembrolizumab, followed by maintenance therapy with pemetrexed and pembrolizumab. During the first cycle of maintenance therapy, the patient presented with fever, chills, and fatigue. Despite antibiotic administration, the symptoms persisted. Given the low likelihood of infection and elevated laboratory markers such as ferritin and interleukin-6, CRS was suspected, and the patient was urgently admitted for corticosteroid therapy. However, the patient's respiratory condition deteriorated despite steroid administration. The attending pharmacist actively intervened by recommending additional laboratory tests, performing physical assessments, and suggesting therapeutic options. Following these interventions, the patient's symptoms improved, no further exacerbations occurred, and the patient was discharged. This case highlights the clinical significance of pharmacist intervention in managing ICI-related CRS.

This study aimed to visualize patient waiting times in general radiography using a data-driven approach and to evaluate operational strategies for congestion mitigation in a high-volume clinical setting. General radiography examination data collected over a 3-year period were retrospectively analyzed. Waiting time was defined as the interval between patient reception and examination start. The overall distribution and characteristics of waiting times were evaluated using inverse cumulative distribution analysis. Factors influencing waiting time were assessed using random forest regression, incorporating examination-related and operational variables. Based on the identified key factors, a discrete-event simulation model was constructed to evaluate the effects of different operational conditions, including staffing levels, on patient waiting time. Inverse cumulative distribution analysis revealed substantial variability in waiting time across examinations. Random forest analysis identified examination type, imaging region, and operator as major contributing factors to waiting time. Discrete-event simulation demonstrated that increasing staffing levels effectively reduced waiting time; however, the magnitude of improvement diminished beyond a certain staffing threshold, indicating limited returns from simple workforce expansion. Data-driven visualization and machine learning-based analysis are effective for understanding waiting time characteristics in general radiography. The findings suggest that congestion mitigation cannot be achieved solely through staffing increases and requires optimized workflow design and operational planning based on empirical data.

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This single-arm before-after study examined short-term changes in body weight following a 28-day self-selected, type-tailored lifestyle modification program implemented before workplace health checkups. Participants self-identified one of the seven types based on brief descriptions and created a personalized program. Employees aged 35-64 years from Kao Group corporations who met body mass index (BMI) &#x2265; 25 kg/m2 or waist circumference criteria (men &#x2265; 85 cm, women &#x2265; 90 cm) were eligible. Participants self-selected either a "supported" (daily prompts for record entry and weekly automated feedback) or "self-managed" (booklet only) course and followed the 28-day program. The primary outcome was the change in self-measured body weight from pre- to post-program. Secondary outcomes included changes in annual health checkup parameters (body weight, BMI, waist circumference, blood pressure, blood glucose, and lipid profiles), specific health guidance levels, and metabolic syndrome (MetS) classification. Among 162 analyzed participants (supported: 108, self-managed: 54), the mean change in body weight was -1.75 kg (95% confidence interval [CI], -2.01 to -1.43, p < .001). Mean changes by course were -1.67 kg (supported) and -1.93 kg (self-managed) (both p < .001). The adjusted estimate (controlling for sex, age, and baseline weight) was similar (-1.75 kg, 95% CI; -2.07 to -1.42, p < .001). Waist circumference decreased significantly. The proportion of participants requiring specific health guidance and those classified as having MetS or pre-MetS decreased by approximately 15% and 8%, respectively. No significant changes were observed in blood pressure, blood glucose levels, or lipid profiles. Short-term decreases in self-measured body weight and waist circumference were observed after the 28-day program, along with decreased proportions requiring health guidance or classified as having MetS or pre-MetS. However, owing to the single-arm design and potential confounding factors, causal attribution to the intervention could not be made. Randomized controlled trials and longer-term follow-up are required to confirm its effectiveness and sustainability.

Abstract&#x3000;In rapidly aging Japan, supporting older adults in maintaining meaningful social roles is an important public health priority for extending healthy life expectancy and preventing the need for long-term care. In response, the Work-like Activity (Shuro-teki Katsudo) Support Coordinator Placement Program was introduced in 2020 to promote role-based social participation among older adults. Within this policy framework, this paper clarifies the concepts of work-like activities and work-like activity support. By reviewing diverse definitions and practices and examining their alignment with documents issued by the Ministry of Health, Labour and Welfare, we identify key conceptual issues related to work-like activities and emphasize their significance as meaningful forms of social participation, particularly regarding paid activities outside formal employment. Two central perspectives on work-like activity support are highlighted: (1) aligning activities with older adults' preferences and functional conditions and (2) developing and expanding opportunities that accommodate diverse health and functional states. This conceptual framework may support the planning and implementation of municipal programs while providing a common foundation for future research on the prevalence and effects of work-like activities.