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Intravascular large B‐cell lymphoma can induce central nervous system manifestations, including strokes, due to small‐vessel occlusion caused by lymphoma cells. However, involvement in large‐sized vessels is rare. Here, we present an unusual autopsy case of an 88‐year‐old man showing a rapid transition from multiple strokes due to small vessel occlusion, typical of intravascular lymphoma, to progressive embolic strokes caused by the occlusion of major cerebral arteries. Magnetic resonance angiography demonstrated the major cerebral arteries associated with those multiple progressive strokes, including the right posterior cerebral artery, left anterior cerebral artery, and right middle cerebral artery, but the detectability was poor. A random skin biopsy at the abdomen confirmed the diagnosis of intravascular large B‐cell lymphoma. The patient died 106 days after hospitalization despite intensive treatment. An autopsy revealed broad liquefactive necrosis in the area governed by the major cerebral arteries and multiple small infarctions caused by intravascular lymphoma cells in the small‐sized vessels. In addition, the major cerebral arteries showed multiple thromboembolism with partial organization and clusters of intravascular lymphoma cells. Notably, those cells were shown aggregated and attached along the vascular wall of the basilar artery, which might have caused focal hypercoagulation in the near vessels. This aggregation might have disseminated widely in the other major cerebral arteries. Moreover, the cluster of intravascular lymphoma cells in the basilar artery was positive for tumor necrosis factor α, and similar histopathology findings were observed in the splenic veins. However, the pathogenesis of this rare phenomenon involving these cells remains unknown. From a clinical perspective, we should consider the possibility that intravascular lymphoma cells may provoke similar progressive embolic strokes. [ABSTRACT FROM AUTHOR]

Objectives: Thiamine deficiency (TD) presents with various physical and psychiatric symptoms, but no cases with depression-like symptoms have been reported. Methods: We report a patient with cancer who appeared to attempt suicide as a consequence of depressive mood likely related to TD. Results: The patient was a 58-year-old woman diagnosed with recurrent endometrial cancer, with lung metastasis and pelvic dissemination. The patient apparently attempted suicide was referred to the psycho-oncology department. At the time of the examination, major depressive disorder was suspected based on her mental symptoms, but when thiamine was administered intravenously in response to her poor dietary intake, her palpitations, dyspnea, anorexia, and insomnia improved, and her suicidal ideation disappeared at her reexamination 1 hour later after thiamine administration. Significance of results: It is likely that the observed palpitations, dyspnea, anorexia, and insomnia, as well as the severe depression and the attempted suicide, which were thought to be physical symptoms associated with depression, were actually related to TD. Suicidal ideation and attempted suicide are conspicuous as psychiatric symptoms. However, in such cases, rather than simply starting treatment for depression, it is necessary to consider reversible TD as a cause of these symptoms and perform differential diagnosis to confirm the physical illness. [ABSTRACT FROM AUTHOR]

Marchiafava–Bignami disease (MBD) is a very rare disorder characterized by demyelination and necrosis of the corpus callosum. A 53‐year‐old male was transported to the emergency room with impaired consciousness. On his arrival, he was quite emaciated. CT examination revealed no hemorrhagic lesions whereas MR images showed hyperintense areas throughout the corpus callosum, leading to a diagnosis of MBD. His impaired consciousness improved with treatment, including parenteral thiamine administration. When examining patients with impaired consciousness because of malnutrition, MBD should be taken in consideration and the incorporation of head MR imaging into the examination protocol enables early diagnosis and treatment, and may improve the prognosis. [ABSTRACT FROM AUTHOR]

Background: Despite increasing reports of thiamine deficiency (TD) among cancer patients, there remain some patients with borderline thiamine concentrations (BTC). However, it is unclear whether such patients subsequently develop TD. Methods: Here, we report cases of cancer patients progressing to TD within a short time period after presentation with BTC (24–28 ng/ml). Results: Case 1: A 49-year-old female with lung cancer. During treatment for depression, the patient showed a decreased appetite, and a blood sample revealed BTC (25 ng/ml). Fourteen days later, she reported a continued loss of appetite, and despite the absence of the 3 classical signs of Wernicke encephalopathy (WE), additional testing showed a thiamine level of 23 ng/ml, leading to a diagnosis of TD. Case 2: A 65-year-old female developed depression during chemotherapy for angiosarcoma. Her blood sample revealed BTC (25 ng/ml). Seven days later, despite the absence of the classical signs of WE, a further testing revealed a thiamine level of 20 ng/ml. Case 3: A 41-year-old female developed depression during chemotherapy for ovarian cancer. No loss of appetite was observed, but a blood sample revealed BTC (25 ng/ml). Seven days later, despite the absence of the classical signs of WE or decreased appetite, further testing revealed a thiamine level of 19 ng/ml. Significance of results: Depressed cancer patients with BTC may develop TD within a short time frame. To prevent TD, health-care professionals should maintain an awareness of its potential and the need for regular testing of thiamine level or prophylactic replacement therapy. [ABSTRACT FROM AUTHOR]

Background: Although thiamine deficiency (TD) can lead to Wernicke encephalopathy, the characteristics associated with TD in the elderly have not yet been clarified. We sought to clarify the frequency of TD among an institutionalized elderly population with a controlled dietary intake and to identify possible factors related to TD. Method: We undertook a cross‐sectional study of residents in three nursing homes for the elderly as of June 2020. Blood thiamine concentrations were measured using a high‐performance liquid chromatography method, with TD defined as a concentration of <21.3 ng/mL. Basic data (age, sex, height, weight, and BMI), dietary intake for the previous 3 weeks, degree of care (DOC), degree of independence in daily life for elderly with dementia (DIDLED), and comorbidities were analyzed using descriptive statistical methods. Results: The mean age (±SD) was 86.9 years (±8.29), with 84 residents (70.0%) being female. The DIDLED varied from total independence to long‐term care level 5 (full assistance), with 89.2% suffering dementia. The mean whole blood thiamine value was 36.18 (±17.58) ng/ml, with TD confirmed in 7 (5.8%) of the 120 residents. All TD patients suffered from dementia. No TD was observed in patients with a near‐normal food intake, and no related factors were observed among the other items. Conclusion: Reduced food intake may at increase the risk of TD and symptoms of TD may be overlooked in those displaying symptoms of dementia; thus, it is important for clinicians working with the elderly to remain aware of the potential for TD. [ABSTRACT FROM AUTHOR]

Planning adaptations to climate change require an understanding of how climate-related impacts cascade across sectors of society. Equally important is the need to engage stakeholders in discussions of climate-related impacts, risks, vulnerabilities, and adaptation issues. The impact chain (IC) approach, which emerged about a decade ago, can be used to reveal potential climate risks and vulnerabilities and to visualize how climate-related impacts may propagate as cascades. Here, we discuss the composition, key features, and potentials of the IC approach. Drawing from actual experience, we discuss some important factors that must be considered in the development of ICs via stakeholder participation. Such considerations are centered on the need for clarity with respect to the conceptual framing of relevant ICs, the need to allocate ample time for the development of ICs, and the need for stakeholders to be representative of the relevant sectors and sub-sectors. The insights presented in this article should facilitate the implementation of this relatively simple, practical, and useful approach for understanding climate-related impacts, risks, vulnerabilities, and adaptation issues. [ABSTRACT FROM AUTHOR]

Climate change may disrupt species–species interactions via phenological changes in one or both species. To predict and evaluate the influence of climate change on these interactions, long-term monitoring and sampling over large spatial areas are required; however, funding and labor constraints limit data collection. In this study, we predict and evaluate the plant–insect interactions with limited data sets. We examined plant–insect interaction using observational data for development of the crop plant rice (Oryza sativa) and an effective accumulated temperature (EAT) model of two mirid bugs (Stenotus rubrovittatus and Trigonotylus caelestialium). We combined 11 years of records monitoring rice phenology and the predicted phenology of mirid bugs using spatially–explicit EAT models based on both spatially and temporally high resolutions temperature data sets, then evaluated their accuracy using actual pest damage records. Our results showed that the predicted interactions between rice and mirid bugs explained rice damage to some degree. Our approach may apply predicting changes to plant–insect interactions under climate change. As such, combining plant monitoring records and theoretical predictions of insect phenology may be effective for predicting species–species interactions when available data are limited. [ABSTRACT FROM AUTHOR]

The mirid bugs Stenotus rubrovittatus and Trigonotylus caelestialium, which cause pecky rice, have become a threat to rice cultivation in Asia. Damage caused by these pests has rapidly become frequent since around 2000 in Japan. Their expansion pattern is not simple, and predicting their future spread remains challenging. Some insects with wide ranges have locally adapted variations in life‐history traits. We performed laboratory rearing experiments to assess the geographical scale of intraspecific variations in life‐history traits of S. rubrovittatus and T. caelestialium. The experiments were aimed at increasing the accuracy of occurrence estimates and the number of generations per year. These results were compared with previous research, and differences in development rates were observed between populations of different latitudes, but not of the same latitude. Finally, plotting the timing of adult emergence and the potential number of generations per year on maps with a 5‐km grid revealed that they differed greatly locally at the same latitude. These maps can be used for developing more efficient methods of managing mirid bugs in integrated pest management. [ABSTRACT FROM AUTHOR]

Background: In recent years, the use of both molecular targeting agents (MTAs) and immune-checkpoint inhibitors (ICIs) tend to occupy important positions in systemic anticancer therapy (SACT). The objective of this study is to describe the predictors of SACT include both MTAs and ICIs near the end of life (EOL) and the effect on EOL care in patients with advanced cancer.Methods: We analyzed all patients who died of advanced cancer from August 2016 to August 2019, and we analyzed the survival time of patients who underwent anticancer agents excluded due to the loss of information about the last administration of SACT. The primary endpoint of this study was to identify predictors during the last administration of SACT near EOL.Results: In a multivariate analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS) (ORs 33.781) was significantly related factors within 14 days of death from the last administration of SACT. Age (ORs 0.412), ECOG-PS (ORs 11.533), primary cancer site of upper GI cancers (ORs 2.205), the number of comorbidities (ORs 0.207), MTAs (ORs 3.139), and ICIs (ORs 3.592) were significantly related factors within 30 days of death. The median survival time (MST) of patients with PS 3-4 was 29 days, while that of patients with both PS 0-2 was 76 days. The prevalence rate of delirium with MTAs was 17.5%, which was significantly lower than that of patients without it (31.8%). The prevalence rate of the mean dose of opioids in patients with ICIs was 97.9 mg/day, which was significantly higher than that of patients without it (44.9 mg/day).Conclusions: Age, ECOG-PS, primary cancer site, the number of comorbidities, MTAs, and ICIs use were significant associated with SACT near EOL. Information on these factors may aid clinical decision making in referral to palliative care institutes. [ABSTRACT FROM AUTHOR]

Objective: It is well known that the burden on the families of cancer patient extends across many aspects, but there have been no reports of family members developing delirium due to the burden of caring for a cancer patient.Methods: We reported a caregiver who developed Wernicke encephalopathy (WE) while caring for a family member with advanced cancer.Results: The subject was a 71-year-old woman who had been caring for her husband, diagnosed with gastric cancer and liver metastases, for 5 months. She visited the "caregivers' clinic" after referral by an oncologist who was worried about a deterioration in her mental condition that had appeared several weeks previously. The woman had a history of diabetes mellitus. Some giddiness was observed and, based on her inability to answer questions, her level of consciousness was checked and some disorientation was observed. She was diagnosed with delirium. A blood sample was collected to investigate the cause of the delirium, but the test data showed no hypoglycemia. Her appetite had declined since her husband was diagnosed with cancer. Thiamine deficiency was suspected as thiamine stores in the body are depleted within about 18 days and her loss of appetite had continued for 5 months. On intravenous injection of 100 mg of thiamine, her consciousness level was returned to normal in 1 h. A diagnosis of WE was supported by the patient's abnormally low serum thiamine level.Significance Of the Results: The family members of cancer patients may develop a loss of appetite due to the burden of caring, resulting in WE. When providing care for signs of distress in family members, it is necessary to pay attention not only to the psychological aspects but also to their level of consciousness and physical aspects, particularly the possibility of serious illness resulting from reduced nutritional status. [ABSTRACT FROM AUTHOR]

Background/objectives: Recent studies have revealed thiamine deficiency (TD) as a cause of delirium in cancer patients. However, the extent to which Wernicke encephalopathy is present and in what patients is not well understood.Subjects/methods: In this retrospective descriptive study, we investigated referred cancer patients who were diagnosed with delirium by a psycho-oncologist to clarify the proportion of TD, the therapeutic effect of thiamine administration, and the factors involved in its onset.Results: Among 71 patients diagnosed with delirium by a psycho-oncologist, TD was found in 45% of the patients. Intravenous administration of thiamine led to a recovery in about 60% of these patients. We explored the factors associated with TD using a multivariable regression model with a Markov chain Monte Carlo imputation procedure. We found an association between TD and chemotherapy (adjusted odds ratio, 1.98 [95% confidence interval, 1.04-3.77]); however, there were no significant associations between TD and the other factors we considered.Conclusions: TD is not particularly rare in delirium patients undergoing psychiatric consultation. The delirium was resolved in more than half of these patients by intravenous administration of thiamine. Oncologists should consider TD as a cause of delirium in cancer patients. Further prospective study is needed to clarify the relationship between TD and delirium in cancer patients. [ABSTRACT FROM AUTHOR]

A long‐term study was conducted in Japanese patients with primary axillary hyperhidrosis who completed the preceding 6‐week phase III, confirmatory study of 5% sofpironium bromide gel (hereinafter referred to as sofpironium) to evaluate the safety and efficacy of 52‐week treatment with sofpironium. In the long‐term study, 185 patients who completed the confirmatory study (94 and 91 patients in the vehicle and sofpironium groups, respectively) started to receive sofpironium (switching and extension groups, respectively), and all these patients were included in both the full analysis set (FAS) and the safety analysis set (SAF). In the FAS, there were more females than males (73.0% vs. 27.0%), and median age was 38.0 years. A total of 161 patients (86 and 75 patients in the switching and extension groups, respectively) completed the study at week 52. The proportions of patients with hyperhidrosis disease severity score of 1 or 2 and a 50% or more reduction in total gravimetric weight of sweat were 57.4% in the switching group and 58.2% in the extension group at week 52. The proportions of patients who achieved this efficacy end‐point in the long‐term study were similar to that (53.9%) in the sofpironium group in the confirmatory study. In the SAF, the incidences of adverse events (AEs) were 80.9% in the switching group and 83.5% in the extension group, and the incidences of adverse drug reactions were 39.4% and 45.1%, respectively. AEs that occurred in at least 20% of patients in both treatment groups were application site dermatitis (25.5% and 33.0%, respectively) and nasopharyngitis (31.9% and 23.1%, respectively). Reported AEs were generally mild, and there were no deaths. Serious AEs occurred in three patients, but none were considered related to the study drug. In this study, the efficacy of sofpironium was maintained during 52‐week treatment, and no new safety risk was observed. [ABSTRACT FROM AUTHOR]

The patient was an 83‐year‐old male who, after being hospitalized for 70 days for suffocation due to aspiration, was provided with home medical care (HMC) as his physical condition did not allow him to climb stairs. Wernicke encephalopathy (WE) was suspected based on his disorientation and a continued loss of appetite. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after thiamine administration. In addition, he became able to use stairs. Patients who receive HMC should undergo active screening and receive treatment with WE in mind. We identified Wernicke encephalopathy (WE) in a patient receiving home medical care. This is the first reported case of WE in a noncancer patient receiving home medical care. Patients receiving home medical care should receive active screening and treatment with WE in mind. [ABSTRACT FROM AUTHOR]

Station-type one-way carsharing systems (OWCS) using electric vehicles (EV) are expected to equip all dedicated stations with chargers to prevent opportunity loss caused by a drivable-distance shortage. However, it is not cost-efficient for an OWCS operator to install chargers at all stations. Therefore, they need a method for finding the optimal stations to be equipped with chargers while also staying within their budget limit. We propose a search method that evaluates the result of a two-step simulation that accounts for state transition. As a case study using practical operational data for Tokyo, we searched for candidate stations to be augmented by chargers. [ABSTRACT FROM AUTHOR]

A phase 3 study was conducted to verify the efficacy and safety of 5% sofpironium bromide (BBI‐4000) gel (hereinafter referred to as sofpironium) administrated for 6 weeks in Japanese patients with primary axillary hyperhidrosis. The primary efficacy end‐point was the proportion of patients who satisfied both criteria of a Hyperhidrosis Disease Severity Score (HDSS) of 1 or 2 at the end of 6‐week treatment and a 50% or more reduction in total gravimetric weight of sweat at the end of treatment relative to baseline. A total of 281 patients were randomized to receive 5% sofpironium (141 patients) or vehicle (140 patients), and all patients were included in the full analysis set (FAS). In the FAS, 70.1% of patients were female, and the median age was 35.0 years. The proportion of patients who achieved the primary efficacy end‐point was 53.9% in the sofpironium group and 36.4% in the vehicle group, with a statistically significant difference of 17.5% (95% confidence interval, 6.02–28.93) between these two groups (P = 0.003). The incidence of adverse events was 44.0% in the sofpironium group and 30.7% in the vehicle group, and the incidence of adverse drug reactions was 16.3% in the sofpironium group and 5.0% in the vehicle group. Reported adverse events were generally mild or moderate in severity. In the sofpironium group, common events (incidence, ≥5%) were nasopharyngitis (14.2%) and dermatitis/erythema at the application site (8.5%/5.7%), with no serious adverse events reported. This study demonstrated the efficacy and safety of 5% sofpironium. [ABSTRACT FROM AUTHOR]

A 63‐year‐old woman had started caring for her mother with dementia 6 months previously. A loss of appetite had appeared 2 months prior to her visit. Neurologically, she experienced mild unsteadiness, but she was fully conscious and had no ocular symptoms. MRI examination of her head did not reveal any notable findings. From these symptoms, the possibility of thiamine deficiency was considered, and her unsteadiness disappeared within a few days after an intravenous injection of thiamine. The burden of caring for a dementia patient may affect the nutritional status of the family caregiver. [ABSTRACT FROM AUTHOR]

The Fukushima Daiichi power plant accident led to large‐scale and long‐term evacuation zones in which usual land‐use activities such as farming have been stopped. In particular, the loss of irrigated rice paddies is hypothesized to have seriously impacted freshwater biodiversity. In 2014, we started acoustic monitoring of frogs by using digital voice recorders in and around the evacuation zone. For the monitoring project, 52 and 57 monitoring sites were located within schoolyards (including those that had been converted into community centers) to examine the frog assemblages in the urban and rural landscapes of the region in 2014 and 2015, respectively. At each site, a digital voice recorder was installed during the period from May to July, and we recorded 10 min a day at night using a timed‐recording mode. We divided the audio data into 20‐s segments and identified species recorded in segments sampled from late May to late June (partly in early July). We identified eight frog species from 1,962 audio segments in total (correspond to 4 days per year in principal). For each species, intensity of calling at four levels was also recorded as an index of abundance. We are continuing to monitor and intend to update the dataset with new observations hereafter. Our dataset will support scientists and experts in recognizing the status and dynamics of anuran assemblages in and around the evacuation zone and will contribute to the promotion of open science. The complete data set for this abstract published in the Data Paper section of the journal is available in electronic format in MetaCat in JaLTER at http://db.cger.nies.go.jp/JaLTER/metacat/metacat/ERDP-2020-12.1/jalter-en. [ABSTRACT FROM AUTHOR]

Background: Tumor fever and infection are common febrile etiologies among advanced cancer patients. To date, only few studies have been conducted to differentiate between tumor fever and infections. Objective: This study aimed to identify discriminating factors that provide rapid results and are feasible and minimally invasive for discriminating between tumor fever and infection in advanced cancer patients. Methods: This is a retrospective cohort study. Advanced cancer patients with clinically diagnosed tumor fever or infection, who received medical treatment from palliative care specialists in 10 nationwide Japanese hospitals, were consecutively identified during August 2012 and November 2014. The symptoms, physical findings, blood test results at baseline and during fever, imaging findings, and sociodemographic factors of these patients were retrospectively extracted. Results: Thirty-three patients with tumor fever and 72 patients with infection were identified. Their mean age was 68.8 years, 68 (64.8%) were men, and the median palliative performance status (PPS) was 50. Statistically significant factors predicting tumor fever by logistic regression analysis were as follows: deterioration of PPS (odds ratio, 0.078), shaking chills during fever (0.067), and change from baseline data of neutrophil/lymphocyte ratio of ≥5 (0.14). Conclusions: Shaking chills during fever, and changes from baseline of performance status and white blood cell differentiation can be useful to differentiate between tumor fever and infection among advanced cancer patients. Further confirmatory studies are needed. [ABSTRACT FROM AUTHOR]

Objective: Cancer patients often want to spend their final days at home, and it is essential that general practitioners have knowledge of and technical skills related to cancer medicine and symptom relief. Recent clinical studies have revealed that Wernicke encephalopathy (WE) is quite common in cancer patients. However, there have been no reports to date on WE in cancer patients undergoing home medical care.Methods: From a series of cancer patient undergoing home medical care, we reported a patient with lung cancer who developed WE.Results: An 84-year-old female with lung cancer undergoing home medical care developed an impaired mental state and an attention deficit. Her symptoms fulfilled the diagnostic criteria for delirium. WE was suspected as the patient's food intake had fallen from normal a month previously to somewhere between 50% or just a few mouthfuls. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after thiamine administration.Significance Of the Results: When delirium occurs in cancer patients undergoing home treatment, it is necessary to suspect thiamine deficiency as a potential cause, as appropriate diagnosis and treatment can prevent irreversible brain-related sequelae. [ABSTRACT FROM AUTHOR]

Objective: Cognitive dysfunction has a negative effect on cancer treatment; however, in a cancer setting, specific treatments can restore cognitive function. Such conditions are known as reversible dementia, with one of these being vitamin B12 (VB12) deficiency. However, there have been no reports of VB12 deficiency identified by preoperative evaluation in cancer patients.Method: We studied a patient who was referred to the Department of Psycho-oncology on suspicion of cognitive decline prior to lung cancer surgery. Preoperative evaluation revealed VB12 deficiency.Results: The patient was an 82-year-old woman diagnosed with lung cancer. She also presented with cognitive decline and, therefore, was referred to the Department of Psycho-oncology for preoperative evaluation. The patient scored 19 points on a Mini-Mental State Examination (MMSE), which is indicative of cognitive decline. As the onset of symptoms occurred several months previously and they were subacute, the possibility of reversible dementia was considered. Extensive examination revealed VB12 deficiency, and VB12 replacement therapy normalized the MMSE score to 25 points before surgery.Significance Of the Results: When cognitive decline is observed in cancer patients, it is necessary to actively evaluate the serum levels of some B vitamins, including VB12. [ABSTRACT FROM AUTHOR]

Background: Clinical efficacy of aggressive end-of-life (EOL) chemotherapy remains unclear. Method: Medical records of patients with advanced cancer between August 2011 and August 2016 were retrospectively analyzed. The primary endpoint was to identify prognostic factors at the last administration of chemotherapy. The secondary endpoint was to analyze the relationship between EOL symptoms and EOL treatment details. Results: Among 300 evaluated patients, the number of patients who died within 14 and 30 days from the last administration of chemotherapy were 16 (5.3%) and 50 (16.7%), respectively. Multivariate analysis revealed that ECOG-PS (OR 3.698, p < 0.001) and GPS2 (OR 3.791, p = 0.028) were significant prognostic factors. The MST of patients with both PS 2–4 and GPS2 (+) was 38 days, while that in patients with both PS 0–1 and GPS2 (−) was 134.5 days. The prevalence rate of nausea and vomiting (25.0%) and the mean hydration volume (0.50 L/day) in patients who died within 30 days from the chemotherapy was significantly higher than others (7.4%) (0.20 L/day). Conclusion: ECOG-PS and GPS were significant prognostic factors for aggressive EOL chemotherapy. Information on these factors may aid clinical decision-making in terms of risk–benefit balance, particularly in patients with poor prognosis. [ABSTRACT FROM AUTHOR]

Rurioctocog alfa (recombinant factor VIII: Advate®) is available for the control of bleeding in patients with hemophilia A in Japan. To evaluate the inhibitor development, safety, and efficacy of rurioctocog alfa, a non-interventional and observational postmarketing surveillance was conducted on 352 previously treated Japanese patients aged 1-76 years with ≥ 4 exposure days under the conditions of routine clinical practice. A post-hoc comparison of the mean annualized bleeding rates which required treatment with rurioctocog alfa detected a statistically significant difference (P < 0.0001) between patients treated on regular prophylaxis (8.5 bleeds/year) and patients treated on an on-demand basis (36.6 bleeds/year). Favorable prophylactic and on-demand hemostatic efficacy ("excellent" or "good") were shown in 88.5-100% of patients across all treatment regimens. A total of 22 events of adverse drug reactions were reported in 13 male patients. Of the 352 patients, 3 (0.9%) patients, all of whom had ≤ 50 exposure days before enrollment, developed de novo FVIII inhibitor. No deaths or allergic reactions were reported. Rurioctocog alfa was found to be well-tolerated and effective among patients with hemophilia A in a postmarketing routine clinical practice. [ABSTRACT FROM AUTHOR]

Rurioctocog alfa (recombinant Factor VIII: AdvateⓇ) is available for the control of bleeding in patients with hemophilia A in Japan. To evaluate the immunogenicity, safety, and efficacy of prophylactic and on-demand use of rurioctocog alfa, postmarketing surveillance was conducted on 114 previously untreated Japanese patients aged 0-82 years with ≤ 3 exposure days under the conditions of routine clinical practice. A post-hoc comparison of mean annualized bleeding rates between patients in the regular prophylaxis group (7.4 bleeds/year) and in the on-demand treatment group (15.7 bleeds/year) using a negative binomial model found a statistically significant difference (P = 0.0164) in the subset of patients with severe hemophilia A. Favorable prophylactic and on-demand hemostatic efficacy ("excellent" or "good") was shown in 71.4-88.5% across all treatment regimens. A total of 31 events of adverse drug reactions were reported. Of 114 patients, 21 (18.4%) developed de novo FVIII inhibitor; of these, 17 occurred within 50 exposures. One death was reported. A family history of positive inhibitors was significantly associated with inhibitor development (Fisher exact P value = 0.0004); no other risk factors were identified. Rurioctocog alfa was found to be well-tolerated and effective in previously untreated Japanese patients with hemophilia A in this postmarketing surveillance of routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: Bleeding and obstruction are common localized symptoms in patients with unresectable gastric cancer. Although there are several reports about surgical and endoscopic therapies for gastric cancer, there are few regarding palliative radiation therapy.Methods: We retrospectively analyzed data for 23 gastric cancer patients who underwent palliative radiation between April 2006 and March 2014, with either localized bleeding (n = 18) or upper gastric obstruction (n = 10).Results: The median (range) total dose and fraction (Fr) of radiotherapy (RT) were 42 (18-60) Gy and 20 (9-30) Fr, respectively. The response rates were 88.8% (bleeding) and 80% (obstruction). The median event-free survival times of the bleeding and obstruction groups from the start of radiation were 103 and 104 days, respectively. Adverse events with RT and chemo-radiotherapy (CRT) were grade 2 nausea (n = 4) and grade 2 esophagitis (n = 3) and grade 2 neutropenia (n = 3). In univariate analysis, the antrum as the gastric primary site (p = 0.063) and peritoneal metastasis (p = 0.054) occurred more frequently in the non-responders (n = 4) than the responders (n = 19). [ABSTRACT FROM AUTHOR]

Detecting dispersal pathways is important both for understanding species range expansion and for managing nuisance species. However, direct detection is difficult. Here, we propose detecting these crucial pathways using a virtual ecology approach, simulating species dynamics using models, and virtual observations. As a case study, we developed a dispersal model based on cellular automata for the pest insect Stenotus rubrovittatus and simulated its expansion. We tested models for species expansion based on four landscape parameters as candidate pathways; these are river density, road density, area of paddy fields, and area of abandoned farmland, and validated their accuracy. We found that both road density and abandoned area models had prediction accuracy. The simulation requires simple data only to have predictive power, allowing for fast modeling and swift establishment of management plans. [ABSTRACT FROM AUTHOR]

Despite the fact that both thiamine deficiency (TD) and Wernicke encephalopathy (WE) have been observed to some degree in cancer patients, such cases of TD and/or WE reported to date have all been diagnosed after the initiation of treatment. We here report a case of TD that presented without the commonly accepted triad of WE symptoms based on a total nutritional evaluation prior to the onset of treatment for cancer. The patient was a 71-year-old man with esophageal cancer who was referred to the oncology outpatient clinic for evaluation to determine the treatment plan. Although he did not present with delirium, cerebellar signs, or ocular symptoms, TD was suspected based on a reduction in appetite lasting 2 months as thiamine stores in the body are depleted in as few as 18 days. Blood findings showed a marked decline in serum thiamine level supported, which the diagnosis of TD. This case revealed the existence of a cancer patient with subclinical TD prior to the onset of treatment for cancer. Due to the fact that TD can occur without the characteristic symptoms as in this case, we believe it is important that total nutritional evaluation of cancer patients always be considered. [ABSTRACT FROM AUTHOR]

Although there have been recent reports of nonalcoholic thiamine deficiency (TD), no association has been reported between the exacerbation of the psychiatric symptoms of Alzheimer's disease patient and TD. An 89‐year‐old woman with dementia visited our hospital because of acute deterioration in behavioral and psychological symptoms of dementia (BPSD). Her medical history revealed a decrease in oral food intake lasting more than 2 weeks, so that TD was suspected and abnormal behavior improved significantly after thiamine administration. Thiamine deficiency should be suspected in patients with dementia who demonstrate acute deterioration in BPSD possibly related to poor oral food intake. [ABSTRACT FROM AUTHOR]

Rurioctocog alfa (recombinant factor VIII: Advate®) is available for the control of bleeding among patients with hemophilia A in Japan. To evaluate the perioperative safety and hemostatic efficacy of Advate®, a postmarketing surveillance was conducted in Japanese patients undergoing surgery in a real-world setting. A total of 74 surgical procedures performed in 58 subjects aged 0-75 years, including three females, were studied. A hemostatic efficacy rating of "excellent" or "good" was reported in 73/74 surgical procedures (98.6%). Perioperative bleeding was successfully controlled by Advate® in five subjects with positive FVIII inhibitors (2.4-9.1 BU/mL). Advate® was administered at higher initial bolus doses (114-385 IU/kg) and at higher rates by subsequent initial continuous infusion (8.3-15 IU/kg/hour) in the five subjects with inhibitor than in the subjects without inhibitor (n = 47; mean initial bolus dose: 53.4 IU/kg; subsequent mean initial continuous infusion: 3.8 IU/kg/h). Adverse drug reactions were reported in 7/74 (9.5%) procedures, two of which were the development of de novo FVIII inhibitors. Overall, the perioperative use of Advate® in a real-world setting was found to be safe and effective among Japanese patients with hemophilia A. [ABSTRACT FROM AUTHOR]

Plasma‐damage during the dry‐etch process often induces degradation of the electric performance in GaN high electron mobility transistor (HEMT) devices. In this paper, the effects of wet‐etch processing on plasma‐damaged AlGaN films using various chemical solutions and propose the best chemical formulation are reported. Three chemical solutions are selected by a combinatorial method. A MIS‐capacitor TEG is fabricated on an AlGaN/GaN structure, and each surface is evaluated by XPS, SIMS, TEM, and AFM. From the results of C–V measurements of wet‐etched samples, the study reveals that the wet chemicals successfully remove charge traps at ≈−2.3 eV induced by the dry‐etch process. Moreover, these C–V results show excellent agreement with simulated trap models. The XPS results show that O/Ga ratios increase from 0.32 to 1.00 after the dry‐etch process, whereas after the wet‐etch process, the ratios return to less than 0.31. Moreover, the TEM observations reveal that an amorphous layer is only detected in the dry‐etched sample. Therefore, this amorphous layer should be an oxidized AlGaN layer. Thus, the selected chemical formulation can successfully remove the damaged‐layer induced by the dry‐etch process. The increase of surface roughness by the wet‐etch process is suppressed less than 0.1 nm. [ABSTRACT FROM AUTHOR]

Land-use/land-cover heterogeneity is among the most important factors influencing biodiversity in agricultural landscapes and is the key to the conservation of multi-habitat dwellers that use both terrestrial and aquatic habitats. Heterogeneity indices based on land-use/land-cover maps typically do not integrate ecological dissimilarity between land-use/land-cover types. Here, we applied the concept of functional diversity to an existing land-use/land-cover diversity index (Satoyama index) to incorporate ecological dissimilarity and proposed a new index called the dissimilarity-based Satoyama index (DSI). Using Japan as a case study, we calculated the DSI for three land-use/land-cover maps with different spatial resolutions and derived similarity information from normalized difference vegetation index values. The DSI showed better performance in the prediction of Japanese damselfly species richness than that of the existing index, and a higher correlation between the index and species richness was obtained for higher resolution maps. Thus, our approach to improve the land-use/land-cover diversity index holds promise for future development and can be effective for conservation and monitoring efforts. [ABSTRACT FROM AUTHOR]

Background: We aimed to develop an adaptable prognosis prediction model that could be applied at any time point during the treatment course for patients with cancer receiving chemotherapy, by applying time-series real-world big data. Methods: Between April 2004 and September 2014, 4,997 patients with cancer who had received systemic chemotherapy were registered in a prospective cohort database at the Kyoto University Hospital. Of these, 2,693 patients with a death record were eligible for inclusion and divided into training (n = 1,341) and test (n = 1,352) cohorts. In total, 3,471,521 laboratory data at 115,738 time points, representing 40 laboratory items [e.g., white blood cell counts and albumin (Alb) levels] that were monitored for 1 year before the death event were applied for constructing prognosis prediction models. All possible prediction models comprising three different items from 40 laboratory items (40C3 = 9,880) were generated in the training cohort, and the model selection was performed in the test cohort. The fitness of the selected models was externally validated in the validation cohort from three independent settings. Results: A prognosis prediction model utilizing Alb, lactate dehydrogenase, and neutrophils was selected based on a strong ability to predict death events within 1–6 months and a set of six prediction models corresponding to 1,2, 3, 4, 5, and 6 months was developed. The area under the curve (AUC) ranged from 0.852 for the 1 month model to 0.713 for the 6 month model. External validation supported the performance of these models. Conclusion: By applying time-series real-world big data, we successfully developed a set of six adaptable prognosis prediction models for patients with cancer receiving chemotherapy. [ABSTRACT FROM AUTHOR]

Invasions of some areas of Japan by the exotic redback spider Latrodectus hasseltii Thorell (Araneae: Theridiidae) have been reported. While most of these invasions have occurred in urban areas, anthropogenic habitat modifications may provide an opportunity for L. hasseltii to invade semi-natural ecosystems, but the ecological impacts of L. hasseltii have only rarely been studied. We therefore examined the distribution of L. hasseltii in sand dune ecosystems and its potential impacts on other animals. In addition, we surveyed the occurrence of spiders on the exotic yucca Yucca gloriosa L. (Asparagaceae), another invader of sand dune ecosystems. Latrodectus hasseltii was observed in six of 18 sand dunes in the Chita Peninsula, central Japan, and was the dominant web-building spider at one site. The web contents of L. hasseltii consisted of various arthropod species, including the threatened ground beetle Scarites sulcatus Olivier (Carabidae). In all, 24 of 172 patches of exotic yucca were occupied by L. hasseltii, suggesting that colonization by exotic plants may facilitate the invasion of L. hasseltii into sand dunes. This is the first report of the invasion of L. hasseltii into semi-natural habitats in Japan, and these results suggest that L. hasseltii poses a threat to the conservation of coastal insects inhabiting human-modified sand dune ecosystems. [ABSTRACT FROM AUTHOR]

Following the accident at the Fukushima Daiichi nuclear power plants in 2011, a large evacuation zone was imposed in an area where residents had historically managed forests and farmlands. Thus, the human activities that had maintained biodiversity and ecosystem services in the zone were discontinued. Such change can affect insects, a biodiversity component that is relatively tolerant to radiation exposure. In this study, we investigated flying insects, including pollinators, important ecosystem providers inside and outside the zone, using Malaise traps. The results showed that the number of individuals of Xylocopa appendiculata, the largest Apidae species in the region, was significantly lower inside the evacuation zone than outside it, whereas those of other insects were not lower significantly. Although we suggest that flying insects and their ecosystem services (i.e., benefits from them such as pollination) 3 years after the disaster were not critically impacted, it is important to monitor the long-term effects of the evacuation in the future. [ABSTRACT FROM AUTHOR]

We read the paper by Gomes I et al i . with great interest.1 They showed the existence of patients with thiamine deficiency unrelated to alcohol consumption even in high-income countries, and that alerting healthcare professionals working in clinical practice to this fact contributed to improving the quality of medical care. Wernicke encephalopathy presented in the form of postoperative delirium in a patient with hepatocellular carcinoma and liver cirrhosis: a case report and review of the literature. Early detection and successful treatment of Wernicke encephalopathy in a patient with advanced carcinoma of the external genitalia during chemotherapy. [Extracted from the article]

The International Immune Tolerance Induction (I-ITI) Study in hemophilia A patients with inhibitors included 16 Japanese patients among a total of 115 test subjects. The results within this group of Japanese patients were 11 cases of I-ITI off-study, three cases of I-ITI on-study, and two cases of tolerance on prophylaxis. There was no significant difference in success rate between the low-dose and high-dose groups (Study I). Successively, independent follow-up survey in Japan was conducted in 14 cases, with consent (Study II). Ten cases were off-study at the end of the I-ITI Study. Of these 10 cases, seven of seven successful cases remained clinical successes at the end of the follow-up study, one partial success became a full success while a second relapsed, and one failure was subsequently evaluated as a partial success. Four cases that were on-study at the end of I-ITI Study were classified as three successes and one failure at the end of the follow-up study. As a result, the status at the end of follow-up study was: 11 ITI successes (78.6 %); one partial success; one failure; and one relapse. Thus, the ITI follow-up study was helpful in providing a long-term prognostic determination of inhibitors. [ABSTRACT FROM AUTHOR]

Abstract: Unidirectional water flow results in the downstream‐biased, asymmetric dispersal of many riverine organisms. However, little is known of how asymmetric dispersal influences riverine population structure and dynamics, limiting our ability to properly manage riverine organisms. A metapopulation of the freshwater pearl mussel Margaritifera laevis may be sensitive to river currents because mussels are repeatedly exposed to downstream drift during floods—a parasitic life stage is the only, limited period (~40 days) during which larvae (glochidia) can move upstream with the aid of host fish. We hypothesized that water‐mediated dispersal would overwhelm upstream dispersal via host fish, and therefore, that upstream subpopulations play a critical role as immigrant sources. To test this hypothesis, we examined the effects of both up‐ and downstream immigrant sources on the size of target subpopulations in the Shubuto River system, Hokkaido, Japan. We found that target subpopulation size was dependent on the upstream distribution range of reproductive subpopulations and the number of upstream tributaries, which are proxies for the number of potential immigrants moving downstream. In contrast, little influence was observed of downstream immigrant sources (proximity to downstream reproductive subpopulations). These results were consistent even after accounting for local environments and stream size. Our finding suggests that upstream subpopulations can be disproportionately important as immigrant sources when dispersal is strongly asymmetric. [ABSTRACT FROM AUTHOR]

Local aggregations of unionoids (mussel beds) represent subpopulations constituting a riverine metapopulation and are presumed to be linked by dispersal of parasitic mussel larvae (glochidia) on host fishes. We examined movement patterns of Masu Salmon ( Oncorhynchus masou masou), the obligate host fish for the freshwater pearl mussel Margaritifera laevis, during the mussel's parasitic period to determine the dispersal potential of glochidia via host fish in the Shubuto River system, Hokkaido, Japan. We conducted a mark-recapture study in a 650-m river section to describe the distance and directionality of host fish movement, and we used fyke net sampling to quantify the number of host fish moving from mainstem rivers to tributaries. Most individuals of Masu Salmon captured in the study were infected with glochidia of M. laevis. The displacement distance of infected fishes ranged from 37.5 m downstream to 512.5 m upstream (mean = 36.5 m upstream from marking location). The dispersal kernel based on a diffusion-advection model represented a leptokurtic distribution with a fat-tailed upstream bias, but most recaptured fish remained near the initial capture location. Movement of fish from mainstem rivers to tributaries was strongly affected by differences in water temperature among tributaries. Most individuals moved to cooler tributaries, but tributaries did not support populations of M. laevis. These results suggest that glochidial dispersal via host fish is important for local recruitment and upstream dispersal, but dispersal to tributaries may be a source of mortality for M. laevis. [ABSTRACT FROM AUTHOR]

The spatial prioritization of biodiversity restoration sites on a national scale lags behind that of protected areas. We present a simple framework for spatial restoration prioritization using complementarity analysis based on the differences between past and present species distributions and restoration feasibility. In the framework, sites that were not only diverse or unique in the past (high restoration potential), but also have high restoration feasibility (e.g. low anthropogenic pressures) are ranked higher. We applied the framework to endangered bird species that breed in Japan for which distribution data were available from nationwide distribution censuses conducted in 1978 and 1998. The data were compiled in a 20-km grid resolution across Japan. We incorporated the degree of urbanization and number of farmers as a cost to optimize the sets of cells with regard to restoration feasibility. We successfully identified candidate sets of restoration cells, in which at most six can be allocated for each species under the constraint that the total area selected does not exceed 15% of the degraded cells. At most, 11 cells were allocated for each species under the constraint that restoration cells were within 15% of all ecosystem types. Comparison with the distribution of existing nature restoration sites revealed that only 9.3 or 9.7% (depended on the constraint) of high-priority cells overlapped cells including existing restoration sites. Our framework provides an objective, efficient method to obtain a testable plan for biodiversity restoration, which might contribute to the attainment of the 2020 target set by the Convention on Biological Diversity. [ABSTRACT FROM AUTHOR]

We show that the MIC-Kepler probrem is simply solved via the phase-space formulation of non-relativistic quantum mechanics. The MIC-Kepler problem is the Hamiltonian system behind the hydrogen atom subjected to the influence of the Dirac's magnetic monopole field and the square inverse centrifugal potential force besides the Coulomb's potential force. We get the energy spectrum of the bound states explicitly and construct the Green's functions for E < 0 by means of the Moyal product, which is one of the 'star' products denoted by '*'. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the new Japanese School Absentees Reporting System for Infectious Disease (SARSID) for pandemic influenza A/H1N1 2009 infection in comparison with the National epidemiological Surveillance of Infectious Disease (NESID). Methods: We used data of 53,223 students (97.7%) in Takamatsu city Japan. Data regarding school absentees in SARSID was compared with that in NESID from Oct 13, 2009 to Jan 12, 2010. Results: Similar trends were observed both in SARSID and NESID. However, the epidemic trend for influenza in SARSID was thought to be more sensitive than that in NESID. Conclusion: The epidemic trend for influenza among school-aged children could be easily and rapidly assessed by SARSID compared to NESID. SARSID might be useful for detecting the epidemic trend of influenza. [ABSTRACT FROM AUTHOR]

Only a limited number of case reports documenting the off-label use of recombinant factor VIIa (rFVIIa) in Japanese patients with postpartum haemorrhage (PPH) have been published. Data on Japanese cases with severe PPH in which rFVIIa was administered were collected. Data of obstetric haemorrhage patients treated with rFVIIa between 2005 and 2010 were retrospectively collected throughout Japan. The data included patients' background information, blood product requirements, dose/timing of rFVIIa, and adverse effects. Treating clinicians subjectively assessed the effect of rFVIIa on bleeding at each administration using four categories: "Stopped", "Decreased", "Unchanged", and "Increased". A total of 25 women received rFVIIa for the treatment of obstetric haemorrhage in 18 institutions. After the final administration, bleeding was "stopped" in 16 patients (64%), "decreased" in eight patients (32%), and "unchanged" in one patient (4%). A significant reduction in blood product requirement was observed following the first rFVIIa administration. Hysterectomy was required in two patients (15.4%) after rFVIIa administration. Four asymptomatic thrombotic events were reported in three patients. These results suggest that rFVIIa can be a beneficial therapeutic option that can reduce blood loss and prevent hysterectomy in Japanese patients with massive obstetric bleeding. [ABSTRACT FROM AUTHOR]

Only a limited number of case reports documenting the off-label use of recombinant factor VIIa (rFVIIa) in Japanese patients with postpartum haemorrhage (PPH) have been published. Data on Japanese cases with severe PPH in which rFVIIa was administered were collected. Data of obstetric haemorrhage patients treated with rFVIIa between 2005 and 2010 were retrospectively collected throughout Japan. The data included patients' background information, blood product requirements, dose/timing of rFVIIa, and adverse effects. Treating clinicians subjectively assessed the effect of rFVIIa on bleeding at each administration using four categories: 'Stopped', 'Decreased', 'Unchanged', and 'Increased'. A total of 25 women received rFVIIa for the treatment of obstetric haemorrhage in 18 institutions. After the final administration, bleeding was 'stopped' in 16 patients (64%), 'decreased' in eight patients (32%), and 'unchanged' in one patient (4%). A significant reduction in blood product requirement was observed following the first rFVIIa administration. Hysterectomy was required in two patients (15.4%) after rFVIIa administration. Four asymptomatic thrombotic events were reported in three patients. These results suggest that rFVIIa can be a beneficial therapeutic option that can reduce blood loss and prevent hysterectomy in Japanese patients with massive obstetric bleeding. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the efficacy and safety of bolus 5-fluorouracil (5-FU) and leucovorin combined with weekly paclitaxel (FLTAX) in advanced gastric cancer (GC) patients. Methods: Patients with untreated stage IV GC received paclitaxel 80 mg/m2 as a 1-hour infusion, followed by 5-FU 600 mg/m2 as a bolus infusion and L-leucovorin 250 mg/m2 as a 2-hour infusion on days 1, 8 and 15. Treatment cycles were repeated every 28 days. The primary endpoint was response rate. Results: Thirty-five patients were enrolled. The median age was 62 years (range 34-75). Twenty-one patients (60%) had diffuse-type cancer and 11 had peritoneal metastasis. The confirmed response rate was 43% (95% CI 26-61) with 15 partial responses. Stable disease was observed in 16 (46%) patients. Median progression-free survival and overall survival were 6.8 months (95% CI 5.8-7.4) and 16.2 months (95% CI 10.0-22.8), respectively. Grade 3-4 adverse events were: neutropenia (54%), febrile neutropenia (3%), diarrhea (6%) and sensory neuropathy (11%). Conclusion: FLTAX showed a desirable safety profile, and the efficacy against advanced GC was encouraging. FLTAX may be a good option for GC patients with deteriorated general condition, and a randomized clinical trial in such patients is currently underway. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]