Association of the 24-hour movement behaviours composition with workers’ chronic musculoskeletal pain

by Aino Kitayama, Yu-Tai Liu, Ai Shibata, Sayaka Kurosawa, Koichiro Oka

Background

Chronic musculoskeletal pain is a significant symptom among workers. 24-hour movement behaviours comprising sleep, sedentary behaviour, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity are associated factors. However, the relationships between these behaviours and workers’ chronic musculoskeletal pain, considering the interrelationship between the behaviours, are still unclear. This study aimed to investigate the associations of 24-hour movement behaviours with workers’ low-back and neck/shoulder pain.

Methods

In 2023, cross-sectional survey was conducted targeting adults who registered for a Japanese Internet survey system. Time for 24-hour movement behaviours and other demographic characteristics (age, gender, marital status, education, household income, height, weight, smoking, alcohol, chronic disease, work hours, and job activity) were self-reported. The intensity of low-back and neck/shoulder pain was evaluated using the numerical rating scale and a score of ≥4 was considered as moderate-to-severe pain. Compositional logistic regression and isotemporal substitution were performed to examine the associations of 24-hour movement behaviours and time reallocations between the behaviours with moderate-to-severe low-back and neck/shoulder pain, adjusted for all the demographic variables.

Results

1,665 full-time workers (women: 35.8%, mean age: 42.1 ± 10.2 years) were analysed. Increased sleep and decreased light-intensity or moderate-to-vigorous-intensity physical activity were associated with lower odds of moderate-to-severe low-back (adjusted odds ratio [AOR] = 0.54, 95% confidence interval [CI] = 0.40–0.72; 1.45, 1.25–1.69; 1.17, 1.06–1.30, respectively) and neck/shoulder pain (AOR = 0.60, 95% CI = 0.45–0.80; 1.37, 1.19–1.60; 1.12, 1.01–1.24, respectively). Reallocating sleep from the other behaviours was associated with decreased probabilities of low-back and neck/shoulder pain, whereas replacing sedentary behaviour or light-intensity physical activity with more intense activity was associated with increased probabilities. However, the results of moderate-to-vigorous-intensity physical activity reallocation were no longer significant when restricted to complete cases.

Conclusions

Considering the interrelationship of 24-hour movement behaviours, sleep was favourably associated with workers’ low-back and neck/shoulder pain.

EpCAM silencing suppresses aggressive phenotypes and induces partial redifferentiation in anaplastic thyroid cancer cells

by Teruo Nakamura, Tomohiro Shibata, Ken-ichi Ito

Anaplastic thyroid cancer (ATC) is a rare but highly aggressive malignancy with a dismal prognosis. Although recent advances in targeted therapies have modestly improved survival, the molecular mechanisms driving ATC progression remain incompletely elucidated. Epithelial cell adhesion molecule (EpCAM), a multifunctional cell-surface protein, is implicated in proliferation, migration, and stemness in various cancers. However, its role in thyroid cancer progression remains unclear. In this study, we investigated the function of EpCAM in thyroid cancer cell lines of varying differentiation status. EpCAM expression was significantly elevated in ATC cell lines compared with differentiated thyroid cancer (DTC) lines. EpCAM knockdown by siRNA suppressed proliferation, adhesion, motility, and invasion in ATC cells, but had minimal effects on DTC cells. Morphological analyses revealed that EpCAM silencing induced differentiation features, including follicle-like structure formation and increased expression of thyroid differentiation markers such as thyroglobulin and PAX8 in ATC cells. Furthermore, EpCAM inhibition decreased mesenchymal marker expression, reduced filopodia formation, and suppressed extravasation of cancer cells into the lung in an in vivo mouse model. Mechanistically, EpCAM knockdown attenuated epithelial–mesenchymal transition (EMT)-related pathways but did not affect major proliferation signaling cascades in ATC cells. These findings suggest that EpCAM promotes dedifferentiation and metastatic potential in ATC through EMT modulation. Our results provide new insights into the role of EpCAM in thyroid cancer biology and highlight its potential as a therapeutic target in ATC. Further studies are warranted to elucidate the mechanisms linking EpCAM to anaplastic transformation and to explore the therapeutic efficacy of EpCAM-targeting strategies in aggressive thyroid cancers.

Relationship Between Weight Loss and Problems With Oral Intake in Institutionalised Older Adults: A Japanese Multi‐Institutional 1‐Year Follow‐Up Study

ABSTRACT

Aim

To examine the relationship between weight loss and problems with oral intake in institutionalised older adults.

Design

A 1-year longitudinal observational study.

Methods

Data were obtained from a prospective study conducted in three nursing homes and two long-term care facilities in Japan. Participants' problems with oral intake were assessed using items published in 2021 by the Japanese Ministry of Health, Labour and Welfare. Baseline and follow-up factors were compared between individuals who experienced a weight loss of 5% or more and those who did not. Separate multivariable logistic regression models were constructed for each oral intake assessment item to examine its independent association with weight loss of 5% or more, accounting for transitions in each item between baseline and the 1-year follow-up.

Results

In total, 172 institutionalised older adults were included in the analysis. Among them, 57 (33.1%) participants experienced a weight decrease of 5% or more. The emergence of somnolence or clouding of consciousness during meals at the 1-year follow-up in participants without these signs at baseline was independently associated with a weight loss of 5% or more, after adjustment for baseline characteristics.

Conclusion

Recognising signs of somnolence or clouding of consciousness during meals may be useful for the early detection and prevention of weight loss in institutionalised older adults.

Implications for the Profession and/or Patient Care

Early detection of individuals at risk is essential to prevent significant weight loss and its associated adverse outcomes. Recognising somnolence or clouding of consciousness during meals may enable earlier detection and intervention to prevent weight loss and improve the quality of care for older adults.

Reporting Method

Strengthening the Reporting of Observational Studies in Epidemiology.

Patient or Public Contribution

No patient or public contribution.

Triple-drug therapy with Goreisan, tranexamic acid and carbazochrome sodium sulfonate hydrate to prevent recurrence after chronic subdural haematoma surgery: a multicentre, randomised, controlled trial protocol

Introduction

Chronic subdural haematoma (CSDH) is a common neurosurgical condition in older adults, with a recurrence rate of approximately 7.1–13% after burr-hole drainage. Although surgical adjuncts such as subdural drains and middle meningeal artery embolisation may reduce recurrence, these are not suitable for all patients. Pharmacological strategies, including tranexamic acid, Goreisan and carbazochrome sodium sulfonate hydrate, have shown potential, but high-level evidence remains lacking. A prior retrospective study suggested that a triple oral regimen combining these agents may reduce recurrence. This randomised controlled trial aims to evaluate its efficacy and safety.

Methods and analysis

This is a prospective, multicentre, open-label, randomised controlled trial conducted across six hospitals in Ibaraki, Japan. A total of 180 patients undergoing first-time burr-hole surgery for CSDH will be randomised 1:1 to receive either triple therapy (Goreisan 7.5 g/day, carbazochrome sodium sulfonate hydrate 90 mg/day and tranexamic acid 750 mg/day for up to 90 days) or standard postoperative care. The primary outcome is recurrence requiring reoperation within 90 days. Secondary outcomes include time to recurrence and haematoma volume reduction on serial CT imaging. All analyses will follow the intention-to-treat principle, using logistic regression, Cox proportional hazards models and mixed-effects models.

Ethics and dissemination

Written, informed consent will be obtained from all participants at each participating hospital by trained staff from that hospital. The trial protocol has been approved by the ethics committee of the University of Tsukuba Hospital (approval no. TCRB23-025) and the Institutional Review Boards of all participating centres. Study findings will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals. A summary of the results will also be provided to participating institutions and made publicly available in accordance with the BMJ Open data sharing policy.

Trial registration number

jRCTs031240007.