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A 43-year-old woman with a history of tick bite in the mountains in Hokkaido presented with a fever of 39°C, headache, and nausea. Cerebrospinal fluid findings indicated meningitis. On day 3 after admission, she presented with restlessness, disturbance of consciousness, and ataxic breathing, indicative of encephalitis. We administered steroid pulse therapy, tracheal intubation, and a respirator. Her symptoms improved gradually and she was able to breathe without the respirator on day 10 after admission. She was discharged on day 24 after admission with no sequelae. This is the fifth reported case of tick-borne encephalitis in Japan. In the previous four cases, the patients died or suffered severe sequelae. This is the first case without any sequelae in Japan.

Mutation burden in a tumor, presumably involving neo-antigens in the tumor tissue, is also thought to be one of the better predictors for the efficacy of immune checkpoint inhibitors. However, it is difficult to analyze the mutation burden routinely in the clinic. Here, we describe more convenient factors that can be used as surrogate markers of mutation burden. Ninety-four patients with NSCLC who underwent resection in our institution were recruited for this study. Mutation burden and major gene alterations were analyzed by using next generation sequencing. Several immunological parameters were also assessed using immunohistochemistry. Statistical analysis was performed on mutation burden, major gene alternations, immunohistochemistry, and clinical parameters. The median mutation load was 54 mutations(range, 10-363 mutations). Squamous cell carcinoma, EGFRmutation -negativity, and TP53 alteration-positivity were closely connected with higher mutation burden. Multiple regression analysis showed that mutation burden in the tumor could be associated with EGFRmutation and TP53 alteration status.

Pediatric anaplastic large cell lymphoma (ALCL) is a chemosensitive malignancy, but about 30% of patients experience relapse. In most of these patients, a second complete remission is obtainable with salvage chemotherapy, though relapse free survival rates are as low as 30-60%. Herein, we report a 6-year-old boy with relapsed anaplastic lymphoma kinase (ALK) positive ALCL successfully treated with vinblastine monotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT), with a reduced intensity conditioning (RIC) regimen, from his father. One HLA locus from the father was mismatched. The boy had neither severe graft-versus-host disease nor transplantation related complications. He is currently well and has remained disease free for 10 months, to date, since transplantation. Allo-HSCT with a RIC regimen may be a promising treatment strategy for relapsed ALK positive ALCL based on obtaining graft-versus lymphoma effects as well as reducing transplantation-related mortality.

Objective: The present study examined the effectiveness of response to intervention (RTI) for the early detection and intervention for specific reading disorder., Method: RTIs were applied to seventy-seven first graders (36 boys and 41 girls) for the early detection and intervention of specific reading disorders. The outcomes were examined when the children reached the third grade., Results: Reading difficulties were detected in four children at the beginning of the first grade. Decoding training and vocabulary learning were conducted with these children as interventions for reading difficulties. Three children exhibited improvements in reading difficulties at the end of the first grade. The fourth child responded poorly and was diagnosed with specific reading disorder. The assessment of outcomes at the third grade showed that this child still had reading difficulties, whereas no other child displayed symptoms for being diagnosed with specific reading disorder., Conclusion: RTI is effective for the early detection and intervention of specific reading disorder.

Objective: The present study aimed to clarify the efficacy of decoding training focusing on the correspondence between written symbols and their readings for children with difficulty reading hiragana (Japanese syllabary)., Methods: Thirty-five children with difficulty reading hiragana were selected from among 367 first-grade elementary school students using a reading aloud test and were then divided into intervention (n=15) and control (n=20) groups. The intervention comprised 5 minutes of decoding training each day for a period of 3 weeks using an original program on a personal computer. Reading time and number of reading errors in the reading aloud test were compared between the groups., Results: The intervention group showed a significant shortening of reading time (F(1,33)=5.40, p<0.05, two-way ANOVA) compared to the control group. However, no significant difference in the number of errors was observed between the two groups. Ten children in the control group who wished to participate in the decoding training were included in an additional study;as a result, improvement of the number of reading errors was observed (t= 2.863, p< 0.05, paired t test), but there was no improvement in reading time., Conclusions: Decoding training was found to be effective for improving both reading time and reading errors in children with difficulty reading hiragana.

Substantial evidence indicates that brain neurons containing and secreting norepinephrine (NE) and corticotrophin-releasing hormone (CRH) are activated during stress. The acoustic startle reflex (ASR) can be enhanced by CRH neuronal activity in the central nucleus of the amygdala. Our previous study demonstrates an augmentation of the footshock-induced ASR (f-ASR) 1 day after chronic variable stress (CVS) for 13 days. In this study, to evaluate a long-term neural plasticity in NE-CRH systems after CVS, we examined f-ASR 1, 8 or 15 days after CVS. The augmented magnitude of the f-ASR 15 day after CVS was potentiated and delayed compared with that 1 day after CVS. The delayed augmentation of f-ASR was inhibited by repeated treatment with desipramine, maprotiline or paroxetine for 14 days after CVS. A single treatment with any antidepressant agent had no influence the f-ASR while a marked inhibition by a single dose of alprazolam, CRH1-receptor antagonist, prazosin and propranolol was observed. The decreased tyrosine hydroxylase activity in the locus coeruleus and the beta-adrenoceptor down-regulation in the amygdaloid complex might be involved in the inhibiton of the delayed augmentation of f-ASR by repeated antidepressant treatment, leading to the possibility that the delayed sensitization of CRH response to stress after CVS might contribute to the biological mechanism underlying the formation of pathological states such as anxiety and depressive disorders.

Fragment-Based Drug Discovery (FBDD) has been recognized as a newly emerging lead discovery methodology that involves biophysical fragment screening and chemistry-driven fragment-to-lead stages. Although fragments, defined as structurally simple and small compounds (typically <300 Da), have not been employed in conventional high-throughput screening (HTS), the recent significant progress in the biophysical screening methods enables fragment screening at a practical level. The intention of FBDD primarily turns our attention to weakly but specifically binding fragments (hit fragments) as the starting point of medicinal chemistry. Hit fragments are then promoted to more potent lead compounds through linking or merging with another hit fragment and/or attaching functional groups. Another positive aspect of FBDD is ligand efficiency. Ligand efficiency is a useful guide in screening hit selection and hit-to-lead phases to achieve lead-likeness. Owing to these features, a number of successful applications of FBDD to "undruggable targets" (where HTS and other lead identification methods failed to identify useful lead compounds) have been reported. As a result, FBDD is now expected to complement more conventional methodologies. This review, as an introduction of the following articles, will summarize the fundamental concepts of FBDD and will discuss its advantages over other conventional drug discovery approaches.

Recent technological advances have enabled the miniaturization of catheters for coronary angiography and intervention. As a result of this advancement, the transradial approach is becoming more popular. The advantages of this approach include a lower incidence of access site complications, earlier patient ambulation, improved patient satisfaction, and lower cost. The cardiologists of our institute have introduced this technique without delay and have taken the initiative in Japan. However, there are concerns regarding the effect of transradial cardiac catheterization on the condition of radial artery grafts for coronary artery bypass grafting (CABG). In this study, we evaluated the influence of transradial catheterization on CABG. We retrospectively evaluated 157 patients who had undergone CABG using the radial artery. The condition of the grafts was assessed intraoperatively. Postoperative coronary angiography was carried out 3 months after the surgical intervention. The patency of the grafts was assessed by 2 cardiologists. One-quarter of the radial artery grafts were affected by transradial catheterization. Since most of them were located only at the puncture site, the graft itself was capable of being used for grafting after the resection of its affected distal end. The patency rate was not affected by transradial catheterization.

Corticotropin releasing hormone (CRH)--and norepinephrine (NE) -containing neurons in the brain are activated during stress. We previously reported a decrease in the basal level of CRH immunoreactivity in the central nucleus of the amygdala and the tyrosine hydroxylase immunoreactivity in the locus coeruleus after chronic variable stress (CVS), whereas both responses were augmented by a novel stress (footshock). Since the acoustic startle reflex (ASR) can be enhanced by the CRH neuronal activity in the central nucleus of the amygdala, we examined the influence of footshock on ASR in rats exposed to CVS. The footshock after CVS caused a significant augmentation of ASR compared with the acute footshock. Moreover, the enhanced startle to acute footshock was maximally increased at 6 min and was absent after 40 min, whereas the maximal change of the enhanced startle to footshock after CVS was delayed to 14 min and the significant enhanced startle was found until 180 min. The footshock-enhanced startle after CVS may be related to the augmentation of CRH-NE activity, leading to the possibility that a prolonged CRH hyperactivity to stress might generate a pathophysiology of major depression with a vulnerability to stress.

We studied 107 isolates of Escherichia coli O153 from sporadic diarrhea cases in Fukui, Toyama, Aichi, and Saga prefectures from 1991 to 2005 for antimicrobial susceptibility and mechanisms of fluoroquinolone resistance, based on standard disk diffusion. Of 12 drugs tested, ampicillin displayed resistance to 72.9% of isolates, streptomycin to 48.6%, tetracycline to 46.7%, sulfisoxazole to 46.7%, trimethoprim/sulfamethoxazole to 29.9%, nalidixic acid (NA) to 29.9%, and ciprofloxacin (CPFX) to 24.3%. Ten of 32 isolates resistant to 3-6 drugs and 16 of 18 isolates resistant to 7-10 drugs were resistant both to NA and CPFX. Mutations of amino acid in quinolone resistance-determining regions of gyrA and parC genes were detected in 24 isolates resistant both to NA and CPFX, and in 1 isolate resistant to NA. The former possessed a combination of double substitution (S83L and D87L) in GyrA and a single substitution (S80I) in ParC. Some 12 of 24 isolates possessed another single substitution (E84V or E84G or A108T) in ParC. The 25 isolates were classified into 4 types as follows. 1 isolate as type 1: GyrA (S83L) and ParC (S80I); 12 isolates as type 2: GyrA (S83L and D87N) and ParC (S80I); 8 isolates as type 3: GyrA (S83L and D87N) and ParC (S80I and E84G/S80R and E84V); and 4 isolate as type 4: GyrA (S83L and D87N) and ParC (S80I and A108T). In the relationship between amino acid mutations and minimal inhibitory concentrations (MIC) of fluoroquinolone, MICs of CPFX, ofloxacin, and norfloxacin showed 1microg/mL, 2microg/mL and 8microg/mL in type 1; 8 approximately 32microg/mL, 8 approximately 32microg/mL and 16 approximately 256microg/mL in type 2; and 32 approximately 256microg/mL' 32 approximately 128microg/mL and 128-->512microg/ mL in types 3 and 4. These results suggest that most of multiple-antimicrobial-resitant E. coli O153 isolates from sporadic diarrhea cases were resistant to fluoroquinolones and possessed mutations at gyrA and parC genes associated with fluoroquinolone resistance.

Group A Streptococci (GAS) from patients with pharyngitis and skin infections were examined for T serotypes, emm types, and streptococcal pyrogenic exotoxin gene types. The results were summarized as follows: 1) T and emm types were determined in 130 GAS isolates obtained between 2000 and 2004. Among 85 throat isolates, predominant T/emm types were T12/emm12 (25%), T4/emm4 (19%), and T1/emm1 (14%). Among 45 skin isolates, predominant T/emm types were T28/emm28 (13%), TB 3264/emm89 (13%), Tnontypeable/emm58 (13%), T1/emm1 (11%), and T12/emm12 (11%). Predominant T/emm types of skin isolates in 2000-2004 slightly differed from those during 1990s in our previous report. 2) The presence of streptococcal pyrogenic exotoxin genes in 292 GAS isolates obtained between 1990 and 2004 was examined. Significantly lower proportion of skin isolates, compared with throat isolates, was found to harbor the speA gene (12 versus 26%, respectively; p<0.01), or the speC gene (40 versus 65%, respectively; P<0.01). All but one of tested isolates carried the speB gene. The speB-negative isolate was identified as S. dysgalactiae subsp. equisimilis with the group A antigen. 3) Types of the speA alleles were determined in 59 speA-positive GAS isolates. Among 44 throat isolates, 37 (84%) were speA lineage I (speA1-speA2-speA3-speA6), and 7 (16%) were lineage II (speA4-speA5). Among 15 skin isolates, 11 (73%) were lineage I and 4 (27%) were lineage II. The pairwise associations were observed between emm type and speA allele: emm1 and speA2, emm3 and speA3, emm6 and speA4, emm11 and speA2, emm18 and speA1.

Locus coeruleus (LC) is the major component of noradrenergic neurons in the brain. The corticotropin-releasing hormone (CRH) and norepinephrine (NE) are suggested to play a role in modulating the central stress response. In a previous study we observed a decrease of the basal level of tyrosine hydroxylase (TH) immunoreactivity (-ir) in the LC of rats treated with chronic variable stress (CVS) for 14 days. Furthermore a novel stressor produced an enhanced response of the TH-ir after CVS. In the present study we examined the effect of CVS on the glutamic acid decarboxylase (GAD)-ir activity of periaqueductal gray (PAG), prepositus hypoglossi (PrH) and peri-LC. The GAD-ir was significantly increased in PrH and peri-LC after CVS. The footshock-induced reactivity in the GAD-ir was decreased in both regions after CVS. Moreover, we investigated the influence of the CRH receptor antagonist, alphah-CRH (i.c.v.) on the CVS-induced activation of the TH-ir in the LC. The alphah-CRH i.c.v. diminished the enhanced-TH reactivity by novel stressor after CVS. Our results suggest that the GABA activity in peri-LC and PrH might regulate the LC-TH response, and also the CRH input from central nucleus of amygdala (CeA) and/or the bed nucleus of stria terminalis (BNST) might regulate the TH reactivity.

The Corticotropin-releasing hormone (CRH) is a key mediator in the stress response. Two CRH-receptor subtypes have been identified in the brain, CRH-receptor 1 (CRH-R1) and CRH-receptor 2, and stress responses are mediated by the CRH-R1. In this study we have examined the effect of chronic variable stress (CVS) on the CRH-R1 immunoreactivity in the hypothalamic and limbic brain regions of the rat. For CVS we selected the six stressors described in previous reports. Male Wistar rats were randomly exposed to one stressor per a day during 13 days and finally exposed to a novel stressor (footshock). There was a significant increase of the CRH-R1 immunoreactivity 24 hours after CVS in the bed nucleus of the stria terminalis (BNST) and basolateral amygdala (BLA), whereas a single footshock had no influence on the immunoreactivity in any of the regions. A novel stressor after CVS suppressed within 24 hours the CVS-induced increase in the CRH-R1 immuoreactivity in the BNST and BLA. Our results suggest that an up-regulation of the limbic CRH-R1 may contribute to stress sensitization (vulnerability) such as an anxiety, arousal and hypersympathetic autonomic symptoms under stressful situations.

Shiga-like-toxin-producing Esherichia coli O128:HNM were isolated from feces of a one-year-old boy with diarrhea and abdominal pain on July, 2002, and a 11-month-old girl with diarrhea and fever on June, 1997. None of other enteropathogenic bacteria including Salmonella were isolated. E. coli O128:HNM isolates from both patients carry stx2f and eaeA gene, but not stx1, stx2, aggR, bfpA, esth, estp, invE, astA, ureC and hlyA gene. As far as we know, this may be the first report indicating that E. coli O128:HNM carrying stx2f gene were isolated from patients in Japan.

Locus coeruleus (LC) is the major component of noradrenergic neurons in the brain. corticotropine-releasing hormone (CRH) and norepinephrine (NE) are suggested to play significant roles in the pathophysiology of depression, although the involvement of the serotonergic system in the CRH-NE systems is not elucidated. Chronic inescapable and unpredictable stress can result in a sustained dysregulation of both of CRH and NE systems. In the present study we have investigated the TH immunoreactivity in the LC by immunohistochemical staining in rats treated with chronic variable stress (CVS) and concurrent administration with clomipramine or fluvoxamine. There was a significant decrease in TH levels 24 h after the last stressor of CVS, followed by a further decrease in that of 72 h later, whereas a marked increase was observed in TH levels immediately after the last stress of CVS 13 d. Concurrent clomipramine and fluvoxamine treatment prevented the sensitization of TH reactivity and the delayed decrease until 72 h later. These data suggest that an increase in serotonin availability would contribute to the normalization of both hypoactivity and sensitization of LC-NE neurons modified under "chronically stressful" situations.

The hyperactivity of corticotropin-releasing hormone (CRH) neurons of the hypothalamic and/or extrahypothalamic regions is believed to contribute to the pathophysiology of major depression in an experimental animal chronically exposed to stress. In the present study, we examined the effects of chronic variable stress (CVS) and novel stress (footshock) on the CRH immunoreactivity in the hypothalamic paraventricular nucleus (PVN) and subdivision of PVN, and the extrahypothalamic bed nucleus of the stria terminalis (BNST) and the central nucleus of the amygdala (CeA). We observed a significant reduction in CRH levels in the whole PVN, lateral parvocellular part of PVN, BNST and CeA 24 hours after the last stressor of CVS for 13 days. A novel stressor after CVS caused a marked increase in CRH levels in these four regions, followed a further reduction observed 24 hours later. Since the CVS-induced modulation of CRH levels are consistent with an alteration of tyrosine hydroxylase levels in the locus coeruleus, CRH-norepinephrine (NE) interaction in the terminal projection of forebrain NE systems, PVN, BNST and CeA where NE stimulates CRII release, might contribute to the bi-directional change in CRH. The CVS-induced bi-directional changes in CRH of PVN, BNST and CeA might play a role in the formation of the pathophysiology of major depressive disorders.

Restriction endonuclease (Sma I) digestion patterns of chromosomal DNAs of T types 1 and 3 (T1 and T3) group A streptococci (GAS), isolated at two hospitals in Toyama Prefecture from 1983 to 1994, were analysed by pulsed-filed gel electrophoresis (PFGE). One hundred twenty seven isolated of T1 GAS were further divided into 5 PFGE types, which were provisionally designated as T1-1 approximately T1-5. Two epidemics of T1 GAS were observed during the 1983 approximately 1994 period, the first of which (1887 approximately 1988) seemed to be caused by T1-2, and the second (1991 approximately 1993) by T1-5. Some differences in biological characteristics between the two PFGE type strains were also observed. On the other hand, eighty one T3 GAS strains were divided into only two PFGE types, provisionally designated as T3-1 and T3-2, most of which belonged to T3-2. Naturally, both epidemics by T3 GAS, first from 1985 to 1986 and second from 1993 to 1994, seemed to be caused by the same PFGE type, T3-2. No differences in biological characteristics were observed between T3-1 and T3-2 strains.

Restriction endonuclease (Sma I) digestion patterns of chromosomal DNAs from 459 group B streptococci (GBS) isolated in two hospitals (C and S) in Toyama Prefecture were analysed by pulsed-field gel electrophoresis (PFGE). Results were summarized as follows. 1) One hundred thirty eight isolates of GBS serotype Ia, 174 of serotype III, 102 of serotype JM-9 and 45 of serotype NT-6 were further divided into 56, 41, 36 and 19 PFGE types, respectively. 2) Appreciable differences in the distribution of PFGE types were not observed between C and S hospital isolates, nor among specimens from which GBS strains were isolated. 3) Long-term inspection of 5 patients, from whom the same serotype strains were repeatedly isolated, revealed that some changes in PFGE types were observed in 2 patients, but not in the other 3.

Twenty patients with unresectable hepatocellular carcinoma were treated by intra-arterial subsegmental injection of Cisplatin/4-0-Tetrahydro-Pyranyl-adriamycin Lipiodol suspension (CTLS). The mean single doses of Lipiodol, cisplatin and THP were 2.3 ml, 85 mg and 8.9 mg, respectively. The therapy was given once in 10 patients, twice in 8 and 3 times in two. Over 25% reduction in tumor size was recognized in 12 patients (60%). Fifty or more % decrease of alfa-feto-protein (AFP) was observed in all of 7 patients (100%) with the initial serum AFP level of more than 200 ng/ml. Although transitional and mild symptoms, such as fever, abdominal pain and vomiting were recognized in some cases, no severe complications were encountered. This method is promising as an excellent procedure for unresectable hepatocellular carcinoma.

One hundred thirty-five patients with hepatocellular carcinoma (HCC) were treated by intraarterial injection of adriamycin/mitomycin C oil suspension (ADMOS) alone (59 cases) and ADMOS plus cis-diaminodichloroplatinum (CDDP) (76 cases). Tumor size was reduced by over 25% in 13 of 38 patients (35%) in the ADMOS alone group and in 39 of 76 patients (50%) in the ADMOS plus CDDP group. Serum alpha-fetoprotein (AFP) levels decreased by more than 50% in 7/17 (59%) in the ADMOS alone group and in 23/32 (70%) in the ADMOS plus CDDP group. The overall 1- and 2-year survival rates were 68% and 41% by the Kaplan-Meier method. However, no significant difference in the survival rates was observed between the two groups.