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TAMによる卵巣過剰刺激作用はかねてより問題となっているが，性腺系への作用，経時的変化の実態は明らかになっていない．初発の乳がん患者において術前から術後TAM内服22か月までのホルモン値を測定し，高エストロゲン血症の発症頻度を含む経時的変化を明らかにした．乳腺外科クリニックにて，同意の得られた閉経前ホルモン感受性陽性乳がん患者に対し，術前から術後（4,10,16,22か月）の定期フォロー時エストラジオール（E2），性腺刺激ホルモン（LH，FSH）を測定した．20例の平均年齢は44.9±2.81(40-50)歳であった．術前の月経は19例で順調であり，LH高値のPCOを疑わせる月経不順の1例のみ術前高E2（>400pg/ml）を示した．術後の総測定回数は78回で，そのうち18回（12例）で高E2がみられた．３か月間無月経でも異常高値をみるものが２例あった．今回の検討症例は40代の症例がほとんどであったにもかかわらず，高エストロゲン血症の発生頻度が今まで報告されてきたより多く，患者の年齢により高エストロゲン血症の発症頻度がかわることはなかった．年齢は少なくとも独立した因子ではなく，卵巣の予備能や環境因子の影響が大きいと考える．予想以上に多くの症例でE2は高値を示すことがわかったが，持続して高値を示すことは多くないこともわかった．内膜への影響の報告もあり，TAM治療の際には乳腺外科と婦人科の連携が必須である． Adjuvant hormone therapy for hormone-sensitive breast cancer has established the efficacy of tamoxifen (TAM). TAM is widely used in premenopausal patients. In the present study, hormone levels were measured beginning preoperatively to 22 months after oral administration of TAM in patients with first-episode breast cancer. Changes over time, including the frequency of hyperestrogenism, were evaluated. With patient consent, estradiol (E2) and gonadotropin (luteinizing hormone [LH], follicle-stimulating hormone [FSH]) levels were measured at regular follow-up at 4, 10, 16, and 22 months in premenopausal, hormone-sensitive, positive breast cancer patients treated at a Breast Surgery Clinic. The mean age of 20 patients was 44.9 ± 2.81 (40-50) years. Preoperative menstruation was regular in 19 patients. Only one patient with high LH and suspected polycystic ovary syndrome had high preoperative E2 (>400 pg/mL). The total number of postoperative measurements was 72. Of these, 18 (12 cases) showed high E2. There were two cases in which abnormally high values were observed even after amenorrhea for 3 months. Most of the patients in this study were in their 40s. However, the frequency of hyperestrogenism was higher than previously reported, and the frequency of hyperestrogenism did not change with patient age. Age was at least not an independent factor. However, ovarian reserve and environmental factors are believed to have significant impacts. E2 was high in more cases than expected, but was not often persistently high. Effects on the endometrium have been reported, and breast surgery and gynecological cooperation are essential for TAM treatment.

In this paper, we discuss the 3 types of concussion that occur in sports; brain concussion, spinal concussion (spinal cord neurapraxia), and labyrinthine (inner ear) concussion. Brain concussion data was collected from professional ice hockey players (Tohoku Free Blades, Japan) during 9 consecutive seasons. Spinal cord concussion and Labyrinthine concussion data was collected from athletes who sustained the injury in various sports including ice hockey. Material and methods The average incidence of brain concussion in professional ice hockey players was 2.0 per season. All 13 cases of spinal cord concussion were cervical cord concussion. Seven cases showed evidence of spinal cord compression; six cases had no radiological abnormality observed. All cases of labyrinthine concussion were sustained through a traumatic blow to the lateral aspect of the head. Results In any sports injury, all three of these concussions can co-exist and requires the team doctor to be at the site in order to fully assess the injury.

Intimal sarcoma arising from the tunica intima of both systemic and pulmonary circulations is a rare disorder, whereas intimal sarcoma with chondroblastic osteosarcomatous differentiation (ISCOS) is even rarer. We present the case of a 25-year-old woman with ISCOS of the pulmonary artery (PA) where the patient went through surgical treatment after careful imaging assessment under a rather emergent situation. A 25-year-old Japanese female presented to our hospital with the chief complaints of dyspnea and palpitations on exertion. Upon arrival, she had systolic murmur, moderate tricuspid regurgitation, and possible pulmonary hypertension. A contrast-enhanced chest computed tomography (CT) showed dilatation of the main PA, filled with a hypodense area with calcification adjacent to the right and left PA. The calcified lesions within the tumor were the key findings suggesting osteoid-forming sarcoma, differentiating it from pulmonary embolism. Due to presence of critical symptomatic obliteration of the pulmonary circulation, an emergency surgery was performed. A whitish shiny mass filled the lumens from the main PA to the bilateral main PAs. The tumor was not attached to the surrounding intima, except for a slight attachment to the left interlobar PA, and could be completely removed from the vessel lumen. Based on the pathological findings, it was diagnosed as a primary ISCOS of the PA, which correlated with the findings of the CT, namely intratumoral calcification. Although the diagnosis-making is quite challenging, multidisciplinary collaboration between clinicians, radiologists, and pathologists is crucial for reaching the correct diagnosis.

Cerebellar neuromodulation could influence the pathological abnormalities of movement disorders through several connections between the cerebellum and the basal ganglia or other cortices. In the present report, the authors demonstrate the effects of cerebellar deep brain stimulation (DBS) on a patient with severe generalized fixed dystonia (FD) that was refractory to bilateral pallidotomy and intrathecal baclofen therapy. A previously healthy 16-year-old girl presented with generalized FD. Bilateral pallidotomy and intrathecal baclofen therapy had failed to resolve her condition, following which she received DBS through the bilateral superior cerebellar peduncle (SCP) and dentate nucleus (DN). Ipsilateral stimulation of the SCP or DN improved the FD, and the ability of DBS administered via the SCP to relax muscles was better than that of DN DBS. A considerable improvement of generalized FD, from a bedridden state to a wheelchair-bound state, was observed in the patient following 6 months of chronic bilateral DBS via the SCP; moreover, the patient was able to move her arms and legs. The findings in the present case suggest that neuromodulation of deep cerebellar structures is a promising treatment for FD that is refractory to conventional treatments.

The potential of erythritol as a platform chemical in biomass refinery is discussed in terms of erythritol production and utilization. Regarding erythritol production, fermentation of sugar or starch has been already commercialized. The shift of the carbon source from glucose to inexpensive inedible waste glycerol is being investigated, which will decrease the price of erythritol. The carbon-based yield of erythritol from glycerol is comparable to or even higher than that from glucose. The metabolic pathway of erythritol biosynthesis has become clarified: erythrose-4-phosphate, which is one of the intermediates in the pentose phosphate pathway, is dephosphorylated and reduced to erythritol. The information about the metabolic pathway may give insights to improve the productivity by bleeding. Regarding erythritol utilization, chemical conversions of erythritol, especially deoxygenation, have been investigated in these days. Erythritol is easily dehydrated to 1,4-anhydroerythritol, which can be also used as the substrate for production of useful C4 chemicals. C-O hydrogenolysis and deoxydehydration using heterogeneous catalysts are effective reactions for erythritol/1,4-anhydroerythritol conversion.

We report our experience with needlescopic splenectomy (NS) for the surgical treatment of idiopathic thrombocytopenic purpura using a 3-mm needlescope with three ports. One patient was male and two were females, and their mean age was 58 years. The patient was placed in the right lateral decubitus position. The first 12-mm port was introduced through the lateral margin of the left rectus abdominis muscle, and the other two 3-mm ports were inserted in the left upper quadrant. NS was performed by a standard technique under the observation of 3.3-mm needlescope. The surgical procedure was successfully completed in all the patients. The mean duration of surgery, intra-operative bleeding volume and post-operative hospital stay were 176 min, 70 ml and 4.7 days, respectively. There were no particular peri-operative complications in spite of dense adhesions or simultaneous laparoscopic procedures. Our method is safe and feasible with low morbidity and without impairing cosmetic benefits.

The control of coating shell becoming important to improve the applicability of magnetic nanoparticles. Herein, we present the scalable technique for preparing MgFe2O4/SiO2 core-shell nanospheres with finely tuned shell thickness and their efficiency in magnetic hyperthermia heating agent. At first, MgFe2O4 dense nanosphere derived from one-step ultrasonic spray pyrolysis (USP) technique. Silica shells were then coated on the as prepared nanospheres with tunable thickness from 10 to 30 nm. We show that the thickness of this coating is finely controlled at allowing our proposed level by using the required amount of SiO2 precursor (SiC8H20O4)/acidic catalyst (HCl) ratio where the surface area of core nano- spheres are significantly considered. X-ray diffraction reveals the cubic spinel ferrite structure of core particles with crystallite size 9.6 ± 1.8 nm and Fourier transform infrared spectrum analysis confirmed the formation of SiO2. The morphological observation clarified the uniform and smooth SiO2 shell where core-shell nanostructure is highly monodispersed in a liquid medium. M-H loops confirmed the super- paramagnetic nature of all samples at room temperature. Significantly reduced ion release concentration in an aqueous solvent of the coated nanospheres compared with uncoated sample demonstrates the her- metically coating feature of dense SiO2. This MgFe2O4/SiO2 core-shell nanospheres with thine SiO2 shell (10 nm) shows effective heating rate in the operative region (

A 42-year-old man was hospitalized due to a fever, orchiodynia, and extremely severe myalgia predominantly in the extremities, which made it difficult for him to stand or walk. He had a history of contact with his son who had acute upper respiratory infection. Based on the characteristic clinical symptoms and detection of the partial sequence of human parechovirus type 3 (HPeV3) in throat swabs as well as stool and serum samples, he was diagnosed with epidemic myalgia associated with HPeV3 infection. Because HPeV3 infection is widespread among children in Japan, HPeV3-associated myalgia should be considered when adult patients manifest such distinguishing clinical characteristics.

Background: Whether antithrombotic agents should be stopped before prostate biopsy is unsettled. We investigated the impact of antithrombotic agents on bleeding complications after prostate biopsy. Materials and methods: Among the patients who underwent transrectal ultrasound-guided prostate biopsy from June 2006 to December 2013 at Ebina General Hospital, Kanagawa, Japan, 1817 cases were retrospectively assessed. Patients were divided into two groups: those not taking antithrombotic agents (control group) and those taking them (experimental group). The frequency and severity of bleeding complications after the procedure were compared. The severity of bleeding events was graded using the Common Terminology Criteria for Advanced Events vol. 4.0. Results: Hemorrhagic complications were classified into grades 1 to 3. Patients with complications of Grade 2 and above needed treatment. As for the Grade 1 event, there were no differences between two groups. The frequency of more than Grade 2 bleeding events was 1.7% and 3.5% in the control and experimental group, respectively; the odds ratio was 2.18 (P = 0.039). Grade 3 events occurred in seven patients of the control group (0.5%) and four patients of the experimental group (1.2%). Conclusions: The present study showed that continuation of antithrombotic agents increased the frequency of hemorrhagic complications requiring intervention. It suggests that attention should be paid to the patients taking antithrombotic agents before prostate biopsy. Keywords: Anticoagulants, Biopsy, Hemorrhage, Platelet aggregation inhibitors, Prostate

Following the logic of studies showing that collective efficacy within neighborhoods deters intimate partner violence (IPV), the promotion of social distancing during the COVID-19 pandemic may have weakened that effect. To examine that possibility, we analyzed panel data from 318 adults in Japan regarding IPV victimization and perceived collective efficacy at four time points. A latent growth model (LGM) analysis for each measure revealed that informal social control, a subscale of collective efficacy, has declined since the pandemic began, whereas no significant changes have occurred in social cohesion and trust, another subscale of collective efficacy, and IPV victimization. Furthermore, two parallel LGM analyses revealed that although collective efficacy before the pandemic suppressed subsequent IPV victimization, changes in collective efficacy during the pandemic have been positively associated with changes in IPV. Those results suggest that collective efficacy’s protective effect on IPV is moderated by whether interactions between intimate partners and their neighbors are socially normative.

Background Suicide remains one of the leading causes of death among adolescents. Although recent studies have suggested a strong association between auditory hallucinations and suicidal behaviors, little is known regarding the association between suicidal behaviors and visual hallucinations, which are also common among adolescent psychiatric patients. Method A cross-sectional study of all first-time patients aged 10-15 years was conducted at three child and adolescent psychiatric outpatient facilities in Kanagawa Prefecture, Japan, from April 2015 to March 2018. Self-reported questionnaires were administered to evaluate auditory and visual hallucinations, suicide planning, and suicide attempts within the two weeks prior to the first visit. Our logistic regression model included three covariates (sex, age, and presence of major depressive episode) for adjustments. Among the 1285 respondents, 37 who had moderate or severe intellectual disability were excluded, leaving 1248 for analysis. Results Among the 1069 patients who completed questionnaire items on hallucinations, 230 (21.5%) experienced auditory or visual hallucinations. After controlling for all confounders, visual hallucinations, but not auditory hallucinations, were significantly associated with increased odds of suicide planning (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.1). In contrast, auditory hallucinations, but not visual hallucinations, were significantly associated with increased odds of suicide attempts (OR 2.8, 95% CI 1.3-6.1). No interaction effects were observed between suicidal behaviors and auditory or visual hallucinations. Conclusions Clinicians should consider the prevalence of both auditory and visual hallucinations among young adolescent patients, with emphasis on auditory hallucinations, given their association with suicide attempts.

We propose a probability distribution for multivariate binary random variables. For this purpose, we use the Grassmann number, an anti-commuting number. In our model, the partition function, the central moment, and the marginal and conditional distributions are expressed analytically by the matrix of the parameters analogous to the covariance matrix in the multivariate Gaussian distribution. That is, summation over all possible states is not necessary for obtaining the partition function and various expected values, which is a problem with the conventional multivariate Bernoulli distribution. The proposed model has many similarities to the multivariate Gaussian distribution. For example, the marginal and conditional distributions are expressed by the parameter matrix and its inverse matrix, respectively. That is, the inverse matrix expresses a sort of partial correlation. Analytical expressions for the marginal and conditional distributions are also useful in generating random numbers for multivariate binary variables. Hence, we validated the proposed method using synthetic datasets. We observed that the sampling distributions of various statistics are consistent with the theoretical predictions and estimates are consistent and asymptotically normal., Comment: 24 pages, 3 figures

Retropharyngeal hematomas are uncommon, but they may rarely cause occlusion of the upper airway and threaten life. Retropharyngeal hematomas often occur due to head or neck injury;they rarely occur due to iatrogenic causes such as insertion of a gastric tube or anticoagulant therapy. It has been found that patients receiving anticoagulant therapy are more likely to experience potentially severe retropharyngeal hematomas. We report the case of a patient with retropharyngeal hematoma with cervical cord damage. A 75-year-old man was transferred to our hospital after he sustained a fall and damaged his face. CT showed a massive retropharyngeal hematoma, but he did not complain of any breathing issues. Therefore, we selected conservative therapy. However, after approximately 4 hours, he suddenly complained of breathing problems and suffered from loss of consciousness. We performed intubation and provided sedation. After one week, his condition clearly improved and he was extubated.

Objectives Valganciclovir (VGCV) has been shown to improve sensorineural hearing loss (SNHL) and neurological outcomes in patients with neonatal symptomatic congenital cytomegalovirus (cCMV) infection. However, reports on the pharmacokinetics, efficacy and safety of oral VGCV are limited. The aim of this study is to evaluate the pharmacokinetics of VGCV for use in the treatment of cCMV. Methods This was a single-center, retrospective observational study conducted at Saitama Children's Medical Center in Japan between 2012 and 2017. CMV DNA copy number, maximum plasma VGCV concentration (Cmax), and adverse events (ADEs) during treatment were evaluated. Results A total of 26 patients with cCMV who received VGCV were included in this study. The median age at VGCV initiation was 9.5 months (range 0–46). Twenty-one patients (81%) had SNHL at baseline. Of these, five patients (19%) presented with improved SNHL, and none experienced worsened SNHL during treatment. The mean VGCV Cmax was 3.5 μg/mL (range 2–5.3), with no significant variation among individual values, and the values were maintained during treatment. Furthermore, there were no correlations between the Cmax values and age, sex, SNHL improvement or ADEs. Neutropenia ( Conclusions VGCV prevented the progression of SNHL without serious ADEs due to its stable pharmacokinetics. This study provides safety and tolerability of VGCV for the treatment of cCMV patients.

Nanomaterial morphology is important for the targeted delivery of drugs to tissues as well as subsequent cellular uptake. Hollow nanotubes composed of peptides, with a diameter of 80 nm and various lengths (100, 200, 300, 600 nm), were successfully capped and sealed with a peptide hemisphere to encapsulate the anticancer drug, cisplatin. The torpedo-shaped nanocapsules with an aspect ratio (length/diameter) of 2.4 showed more rapid cellular uptake and accumulation at the tumor site compared with spherical analogues. Successful delivery of cisplatin to tumors was achieved in a mouse model and tumor growth was efficiently suppressed.