Search Results (8)

Background/Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2is), by elevating urinary glucose levels, may predispose patients to urinary tract infections (UTI). However, limited evidence is available regarding the association between SGLT2is and postoperative outcomes after transurethral resection of bladder tumors (TURBT). We evaluated the impact of SGLT2is on post-TURBT pyuria and febrile UTI (fUTI), as well as oncological outcomes. Methods: We retrospectively reviewed the data of 812 patients with and without diabetes mellitus (DM) who underwent TURBT between January 2019 and May 2024. The patients were categorized into three groups: non-DM (Nara Medical University cohort, n = 344), DM non-SGLT2i (multi-institutional cohort, n = 363), and DM SGLT2i (multi-institutional cohort, n = 105). We compared fUTI-free survival, fUTI-related hospitalization-free survival, and persistent pyuria duration as well as oncological outcomes using the inverse probability of treatment weighting (IPTW)-adjusted Kaplan–Meier method and Cox regression analysis. Results: No significant differences in fUTI-free or hospitalization-free survival were observed between the non-DM and DM groups, whereas the DM group had prolonged pyuria compared to the non-DM group (1-year pyuria rate: 36.6% vs. 18.2%; p < 0.001). In contrast, the DM SGLT2i group had significantly shorter fUTI-free survival (1-year fUTI-free survival: 83.0% vs. 90.0%; p = 0.013) and longer pyuria persistence (1-year pyuria rate: 70.6% vs. 28.9%; p < 0.001) than the DM non-SGLT2i group. Additionally, the DM SGLT2i group was significantly associated with shorter UTUC-free survival than the DM non-SGLT2i group (p = 0.0072). SGLT2i was an independent prognostic factor for fUTI and prolonged pyuria in IPTW-adjusted Cox regression analysis. No significant differences were observed in fUTI-free survival, hospitalization-free survival, or persistent pyuria duration among the different SGLT2i types. Conclusions: Temporal discontinuation of SGLT2i in the peri-TURBT period may prevent persistent postoperative pyuria and the risk of fUTI. Full article

Globally, groundwater resources are experiencing a decline in hydraulic heads resulting from the dual effects of urbanization and climate change, highlighting the need for integrated and sustainable water resources management. Urban development in the cities of Kansai region, western Japan, presents a significant challenge to the sustainability of groundwater resources. This study aims to assess the combined influence of urbanization and climate change on the groundwater resources of the Nara Basin using MODFLOW 6 for two distinct periods: The Pre-Urbanization Period (PreUP: 1980–1988), and the Post-Urbanization Period (PostUP, 2000–2008) with an emphasis on spatiotemporal distribution of recharge in a multi-layer aquifer system. Simulated hydraulic heads were evaluated under three different recharge scenarios: uniformly, spatiotemporally and spatially distributed. The uniform recharge scenario both overestimates and underestimates hydraulic heads, while the spatially distributed scenario produced a simulated heads distribution similar to the spatiotemporally distributed recharge scenario, underscoring the importance of incorporating spatiotemporal variability in recharge input for accurate groundwater flow simulation. Moreover, our results highlight the relevance of spatial distribution of recharge input than temporal distribution. Our findings indicate a significant decrease in hydraulic heads of approximately 5 m from the PreUP to PostUP in the unconfined aquifer, primarily driven by changes in land use and climate. In contrast, the average head decline in deep confined aquifers is about 4 m and is mainly influenced by long-term climatic variations. The impervious land use types experienced more decline in hydraulic heads than the permeable areas under changing climate because of the impedance to infiltration and percolation exacerbating the climate variability effect. These changes in hydraulic heads were particularly evident in the interactions between surface and groundwater. The cumulative volume of groundwater discharge to the river decreased by 27%, while the river seepage into the aquifer increased by 16%. Sustainable groundwater resources management under conditions of urbanization and climate change necessitates a holistic and integrated approach. Full article

The Shisong lü 十誦律, translated in the early 5th century, remains the only complete version of this Buddhist Vinaya text preserved to date and represents the first Vinaya text translated into Chinese. This Vinaya text introduced standardized terminology that significantly influenced subsequent translations of Vinaya texts and profoundly impacted Chinese Buddhism during the Six Dynasties period. Due to its complex translation history, the text is bifurcated into two lineages: the Northern lineage, featuring an initial 58-scroll version (without a preface), and the Southern lineage, with an expanded 61-scroll version (including a preface). This study examines the two oldest extant manuscripts of the Lüxu 律序 (Preface to the Shisong lü) from the Southern lineage—one from the Dunhuang collection currently preserved in Japan and the other from the Nara Japan. Through intensive comparisons with woodblock editions, these manuscripts from Dunhuang, and ancient Japanese manuscript Buddhist canons, this study not only traces the textual evolution of the Southern lineage of the Shisong lü from the 6th to the 13th centuries but also offers new insights into both the historical development and the relationship between these two lineages of the text. Methodologically, this paper provides inspiration for textual criticism of the Vinaya in particular and Buddhist studies in general. Full article

The set of eighth-century objects known as the “Tōdaiji Golden Hall Platform Pacifying Objects” (Tōdaiji Kondō chindangu 東大寺金堂鎮壇具; “Tōdaiji objects”) is among the earliest concrete evidence of ritual practice in the Nara period. This study reveals how the Tōdaiji objects transformed the space inside the temple’s colossal central statue of the Vairocana Buddha into a symbolic heavenly realm where the deceased would traverse to arrive at Vairocana’s Pure Land. Close analysis of the Tōdaiji objects within Sovereigns Shōmu’s and Kōken’s religiopolitical applications of the Kegon teaching strengthens Okumura Hideo’s argument that Kōken orchestrated the emplacement of these objects in the year 757 as part of commemorating the one-year anniversary of Shōmu’s death. I argue that the Tōdaiji objects encapsulated Kōken’s filial piety towards her father, Shōmu, by praying for his swift ascension to Vairocana’s Pure Land. The objects furthermore served as a reenactment of Buddhist repentance that not only ensured Shōmu’s salvation, but also the prosperity of Kōken’s new reign. Full article

Contrary to the widespread assumption in the study of Japanese religions that Kagura is historically the main genre of performing arts at Shintō festivals, something dating back to the beginning of Japanese history, in this article I focus instead on Gagaku (and its Bugaku dance repertory) as a central component of rituals, ceremonies, and festivals not only at the imperial court but also and especially at many temples and shrines across the country. While Gagaku and Bugaku were deeply rooted in the Kansai area, with guilds of hereditary professional musicians affiliated with, respectively, the imperial court in Kyoto, Kasuga-Kōfukuji in Nara, and Shitennōji in Osaka, and with the most lavish performances being held at temples and shrines in the region, those art forms had already spread to the provinces by the end of the Heian period. This article investigates some of the connections between religious ideas, rituals, and musical performances in relation to Kuroda Toshio’s concept of the exo-esoteric system (kenmitsu taisei) and the creative use of Buddhist canonical sources that such connections originated. Full article

Aminoglycosides (AGs) in combination with β-lactams play an important role in antimicrobial therapy in severe infections. Pan-resistance to clinically relevant AGs increasingly arises from the production of 16S rRNA methylases (RMTases) that are mostly encoded by plasmids in Gram-negative bacteria. The recent emergence and spread of isolates encoding RMTases is worrisome, considering that they often co-produce extended-spectrum β-lactamases (ESBLs) or carbapenemases. Our study aimed to retrospectively analyze and characterize the association of carbapenem- and aminoglycoside-resistant clinical isolates in Switzerland during a 3.5-year period between January 2017 and June 2020. A total of 103 pan-aminoglycoside- and carbapenem-resistant clinical isolates were recovered at the NARA (Swiss National Reference Center for Emerging Antibiotic Resistance) during the 2017–2020 period. Carbapenemase and RMTase determinants were identified by PCR and sequencing. The characterization of plasmids bearing resistance determinants was performed by a mating-out assay followed by PCR-based replicon typing (PBRT). Clonality of the isolates was investigated by multilocus sequence typing (MLST). Over the 991 Enterobacterales collected at the NARA during this period, 103 (10.4%) of them were resistant to both carbapenems and all aminoglycosides. Among these 103 isolates, 35 isolates produced NDM-like carbapenemases, followed by OXA-48-like (n = 23), KPC-like (n = 21), or no carbapenemase (n = 13), OXA-48-like and NDM-like co-production (n = 7), and VIM-like enzymes (n = 4). The RMTases ArmA, RmtB, RmtC, RmtF, RmtG, and RmtB + RmtF were identified among 51.4%, 13.6%, 4.9%, 24.3%, 1%, and 1%, respectively. Plasmid co-localization of the carbapenemase and the RMTase encoding genes was found among ca. 20% of the isolates. A high diversity was identified in terms of the nature of associations between RMTase and carbapenemase-encoding genes, of incompatibility groups of the corresponding plasmids, and of strain genetic backgrounds, highlighting heterogeneous importations rather than clonal dissemination. Full article

A close reading of the cosmogony found in the preface to Ō no Yasumaro 太安萬侶’s Kojiki 古事記 (Record of Ancient Matters, 712 CE) reveals the ways in which Japan’s early Nara period elites appropriated aspects of China’s Daoist traditions for their own literary, mythological, and political purposes. This debt to Daoism on the part of the oldest Shintō 神道 scripture, in turn, reveals the extent to which Daoist traditions were eclectically mined for content that early Japanese elites found useful, rather than transmitted as intact lineages. This also raises questions about whether and how “Daoism” has functioned as a systematic body of doctrines and practices, whether in China or overseas. The essay argues that Ō no Yasumaro’s appropriation of the Daoist cosmogonic repertoire is consistent with Daoist traditions as they developed during China’s Six Dynasties and Tang periods—that is, with Daoism as it existed contemporaneously with the early Nara period, when the Kojiki was compiled. Full article

This study aimed to analyze population flow using global positioning system (GPS) location data and evaluate influenza infection pathways by determining the relationship between population flow and the number of drugs sold at pharmacies. Neural collective graphical models (NCGMs; Iwata and Shimizu 2019) were applied for 25 cell areas, each measuring 10 × 10 km², in Osaka, Kyoto, Nara, and Hyogo prefectures to estimate population flow. An NCGM uses a neural network to incorporate the spatiotemporal dependency issue and reduce the estimated parameters. The prescription peaks between several cells with high population flow showed a high correlation with a delay of one to two days or with a seven-day time-lag. It was observed that not much population flows from one cell to the outside area on weekdays. This observation may have been due to geographical features and undeveloped transportation networks. The number of prescriptions for anti-influenza drugs in that cell remained low during the observation period. The present results indicate that influenza did not spread to areas with undeveloped traffic networks, and the peak number of drug prescriptions arrived with a time lag of several days in areas with a high amount of area-to-area movement due to commuting. Full article