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A 60-year-old Japanese woman with polymyositis (PM) developed hemolytic anemia (hemoglobin of 7.3 g/dL), thrombocytopenia (platelet of 9.1×104/µL), and acute kidney injury (Cre of 4.7 mg/dL) at 14 days after starting steroid therapy. Renal biopsy revealed glomerular endothelial swelling with fibrin thrombi and fragmented erythrocytes in the capillary lumens. Hemolytic uremic syndrome (HUS) with thrombotic microangiopathy (TMA) was diagnosed. Hemodialysis and plasma exchange/plasma transfusion were initiated, but HUS did not subside. After 45 days, the patient died of hemorrhagic respiratory failure. Autopsy showed fibrin thrombi filling the glomerular vascular pole and the small arteries in most glomeruli, resulting in glomerular collapse and glomerular basement membrane (GBM) duplication. Although renal involvement by PM is rare, HUS/TMA should be remembered as one of the serious renal complications of PM.

Case 1: A 59-year-old Japanese woman with rheumatoid arthritis (RA) for 36 years was admitted for evaluation of deteriorating renal function. Her serum creatine was 4.2 mg/dL, and proteinuria was 6.5 g daily. Renal and duodenal biopsy revealed AA amyloidosis. After treatment with tocilizumab (a humanized anti-interleukin-6 receptor antibody), proteinuria decreased to 1.1 g daily. The patient's renal function subsequently remained stable for 8 years. Case 2: A 71-year-old Japanese man with RA for 30 years was admitted due to deterioration of renal function. Serum creatine was 2.9 mg/dL, and urinary protein excretion was 0.06 g daily. Renal and duodenal biopsy identified AA amyloidosis. Tocilizumab was initiated, and his renal function remained stable for 6 years. The 2nd duodenal biopsy showed a marked decrease of AA amyloid deposits. Conclusion: These two cases suggest that tocilizumab may preserve renal function in the setting of end-stage kidney disease and shift the point of no return for RA patients with AA amyloidosis and renal dysfunction.

Treatment of a Monteggia fracture-dislocation primarily includes anatomical reduction and fixation of the ulna. However, in rare cases, reduction of the radial head remains impossible even after performing this standard procedure. We have encountered patients with Monteggia fracture-dislocation whose radial head could be reduced by 'overcorrecting' the ulna. In this retrospective study, we aimed to propose an unreported subtype of Monteggia fracture-dislocation. Data of three patients (age 6, 14, and 16 years) with Monteggia fracture-dislocations whose radial head could not be reduced by anatomical fixation of the ulna were retrospectively reviewed. In all three patients, the radial head could not be reduced by anatomical reduction and internal fixation of the ulna even after confirmation of the absence of interposed tissue such as annular ligament in the radiocapitellar joint. However, the radial head could be reduced by fixation of the ulna in a posterior convex shape at the fracture site. At the final follow-up, stable reduction of the radial head was maintained in all patients. We hypothesized that these patients had simultaneous existence of a fracture and acute plastic deformity of the ulna. To the best of our knowledge, this pathological state has not been reported previously but it may not be extremely rare and may only be unrecognized. We believe that a new subtype, that is, type A + C, should be established based on Letts' classification.

Highlights • We describe a new operative technique for creating a radial artery-second dorsal metacarpal vein AVF in the first interdigital space for hemodialysis patients. • This technique involves the creation of the AVF using the most peripheral site and autologous vein in the upper limb. • This technique has several advantages including preserving many future VA options and providing a long segment of arterialized vein for cannulation. • This technique is a worthwhile option in patients with the proper vessels for the creation of the AVF., Introduction The creation of the first arteriovenous fistula (AVF) as far distally in the upper limb as possible is ideal. We developed a new operative technique for creating a radial artery-second dorsal metacarpal vein AVF in the first interdigital space. This technique involves the creation of the AVF using the most peripheral site and autologous vein in the upper limb. Case presentation We herein describe the steps of this technique and its successful performance in a 71-year-old man with end-stage renal disease. Discussion This technique has several advantages including preserving many future vascular access options and providing a long segment of arterialized vein for cannulation. Conclusion We consider this technique to be a worthwhile option and recommend the use in patients with the proper vessels for the creation of the AVF.

A radiocephalic arteriovenous fistula in the anatomical snuffbox (tabatière region) was first described in 1969 as the most peripheral site for arteriovenous fistula in the upper limb. In cases in which the internal diameter of the first dorsal metacarpal vein under avascularization is ⩾2.0 mm, we have adopted a new operative technique for creating a radial artery-first dorsal metacarpal vein arteriovenous fistula in the first interdigital space of the dorsal hand, which lies between the thumb and the index finger. This technique is the creation of the arteriovenous fistula using the first dorsal metacarpal vein and the most peripheral site in the upper limb. To our knowledge, no previous report has described the creation of a radial artery-first dorsal metacarpal vein arteriovenous fistula. We herein describe the steps of the technique and report its successful performance in a patient with chronic renal failure.

We herein report the case of myeloperoxidase (MPO) anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with anti-glomerular basement membrane (anti-GBM) antibody positivity that successfully treated with mizoribine (MZR) as an immunosuppressive drug for remission maintenance therapy after the initiation of dialysis in addition to plasma exchange (PE) and glucocorticoid treatment to control the disease condition. A 79-year-old woman developed serious renal dysfunction and pulmonary alveolar hemorrhaging due to MPO–ANCA and anti-GBM antibody double-positive vasculitis. She was started on hemodialysis and was treated with methylprednisolone (m-PSL) pulse therapy with PE, followed by oral prednisolone (PSL). The pulmonary alveolar hemorrhaging disappeared, and both antibody titers immediately decreased but then rose again. Thus, m-PSL pulse therapy performed again in combination with combined with MZR treatment. Her poor renal function was irreversible; however, this therapy decreased both antibody titers, and they did not increase again. The patient developed pancytopenia and hyperuricemia. It was considered likely that these conditions developed in association with MZR treatment. We, therefore, measured the patient’s blood concentration of MZR, and the maintenance dose was finally set at 50 mg after each dialysis session. The patient’s pancytopenia and hyperuricemia improved and PSL could be smoothly tapered. This is the first case report of the use of MZR for remission maintenance therapy in a patient on hemodialysis who was positive for both ANCA and anti-GBM antibodies. The findings suggest that MZR can be used safely and effectively in such cases.

The hypothalamus is a critical regulator of glucose metabolism and is capable of correcting diabetes conditions independently of an effect on energy balance. The small GTPase Rap1 in the forebrain is implicated in high-fat diet-induced (HFD-induced) obesity and glucose imbalance. Here, we report that increasing Rap1 activity selectively in the medial hypothalamus elevated blood glucose without increasing the body weight of HFD-fed mice. In contrast, decreasing hypothalamic Rap1 activity protected mice from diet-induced hyperglycemia but did not prevent weight gain. The remarkable glycemic effect of Rap1 was reproduced when Rap1 was specifically deleted in steroidogenic factor-1-positive (SF-1-positive) neurons in the ventromedial hypothalamic nucleus (VMH) known to regulate glucose metabolism. While having no effect on body weight regardless of sex, diet, and age, Rap1 deficiency in the VMH SF1 neurons markedly lowered blood glucose and insulin levels, improved glucose and insulin tolerance, and protected mice against HFD-induced neural leptin resistance and peripheral insulin resistance at the cellular and whole-body levels. Last, acute pharmacological inhibition of brain exchange protein directly activated by cAMP 2, a direct activator of Rap1, corrected glucose imbalance in obese mouse models. Our findings uncover the primary role of VMH Rap1 in glycemic control and implicate Rap1 signaling as a potential target for therapeutic intervention in diabetes.

We experienced a case in which improving the renal damage caused by warfarin‐related nephropathy took a long time. It is important to follow up for a long time after the initiation of dialysis due to warfarin‐related nephropathy.

This study investigated the effects of cooling between exercise bouts and post-exercise with a commercially available fan cooling jacket on thermal and perceptual responses during and following exercise in hot-humid environments. Ten male athletes completed two 30 min cycling bouts at a constant workload (1.4 watts⋅kg–1 of body mass) with a 5 min recovery period in between. Exercise was followed by a 10 min recovery period. In an environmental chamber (33°C, 65% relative humidity), participants performed two trials with (FCJ) or without (CON) the fan cooling jacket on a T-shirt during the 5 min inter-exercise and 10 min post-exercise recovery periods. Mean, chest and upper arm skin temperatures, and thermal sensation and comfort were lower in FCJ than CON trial during and following exercise (P < 0.05). Thigh and calf skin temperatures, infrared tympanic temperature and heart rate were lower in FCJ than CON trial during the experimental trials (P < 0.05). The rates of fall in mean, chest and upper arm skin temperatures, infrared tympanic temperature and thermal sensation and comfort were faster in FCJ than CON trial during both recovery periods (P < 0.05). There were faster rates of fall in thigh and calf skin temperatures and heart rate in FCJ than CON trial during the post-exercise recovery period (P < 0.05). No difference was observed between trials in the rating of perceived exertion (P > 0.05). This study indicates that cooling between exercise bouts and post-exercise with the fan cooling jacket would effectively mitigate thermal strain and perception/discomfort during and following exercise in hot-humid environments. This garment would reduce whole-body skin temperature quickly while promoting falls in lower-body as well as upper-body skin temperatures.

We previously described the success and usefulness of two operative techniques for creating a radial artery-first or second dorsal metacarpal vein arteriovenous fistula (AVF) in the first interdigital space of the dorsal hand using the most distal site and autologous veins in the upper limb. These techniques utilize the dorsal metacarpal veins on the radial side of the dorsal hand. Developing these ideas, we devised a novel operative technique for creating a transposed radial artery-third metacarpal vein AVF in the first interdigital space of the dorsal hand using the most distal vein on the ulnar side of the upper limb and most distal site in the upper limb. The distinctive advantage of this technique is that it can be applied to patients whose cephalic vein in the forearm and the dorsal metacarpal veins on the radial side of the dorsal hand are of a poor quality. We herein report the steps of this technique and describe its successful performance in a patient who has been on hemodialysis for 14 months without any additional vascular access interventions or postoperative complications. We consider this technique to be a valuable option in select patients who meet the applicable conditions. The creation of the first AVF as distally as possible is ideal, and it offers a further viable option of distal native vascular access that may be overlooked.

Obesity is a serious global health problem because of its increasing prevalence and comorbidities, but its treatments are limited. The serotonin 2C receptor (5-HT(2C)R), a G-protein-coupled receptor, activates proopiomelanocortin (POMC) neurons in the arcuate nucleus of hypothalamus (ARH) to reduce appetite and weight gain. However, several 5-HT analogs targeting this receptor, e.g., lorcaserin (Lor), suffer from diminished efficacy to reduce weight after prolonged administration. Here, we show that barbadin (Bar), a novel β-arrestin/β2-adaptin inhibitor, can prevent 5-HT(2C)R internalization in cells and potentiate long-term effects of Lor to reduce appetite and body weight in male mice. Mechanistically, we demonstrate that Bar co-treatment can effectively maintain the sensitivity of the 5-HT(2C)R in POMC(ARH) neurons, despite prolonged Lor exposure, thereby allowing these neurons to be activated through opening the transient receptor potential cation (TRPC) channels. Thus, our results prove the concept that inhibition of 5-HT(2C)R desensitization can be a valid strategy to improve the long-term weight loss effects of Lor or other 5-HT(2C)R agonists, and also provide an intellectual framework to develop effective long-term management of weight by targeting 5-HT(2C)R desensitization. SIGNIFICANCE STATEMENT By demonstrating that the combination of barbadin (Bar) with a G-protein-coupled receptor (GPCR) agonist can provide prolonged weight-lowering benefits in a preclinical setting, our work should call for additional efforts to validate Bar as a safe and effective medicine or to use Bar as a lead compound to develop more suitable compounds for obesity treatment. These results prove the concept that inhibition of serotonin 2C receptor (5-HT(2C)R) desensitization can be a valid strategy to improve the long-term weight loss effects of lorcaserin (Lor) or other 5-HT(2C)R agonists. Since GPCRs represent a major category as therapeutic targets for various human diseases and desensitization of GPCRs is a common issue, our work may provide a conceptual framework to enhance effects of a broad range of GPCR medicines.

A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2–3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.

We report the case of a 69-year-old male patient with extensor pollicis longus (EPL) tendon rupture associated with a scaphoid nonunion advanced collapse (SNAC) wrist. He could not actively extend the left thumb interphalangeal joint and visited our institution for an examination. Plain X-rays revealed advanced stage SNAC and an enlarged soft tissue shadow owing to dorsal ridge growth. The patient was diagnosed with EPL tendon subcutaneous rupture due to SNAC. During surgery, the EPL tendon was found to be absent, a proximal-type scaphoid nonunion was detected, and bone growth to the dorsal part of the dorsal ridge was observed. Considering that the EPL tendon rupture was associated with the bone growth, we performed scaphoid lunate advanced collapse (SLAC) reconstruction and extensor indicis proprius tendon transfer which needed a revision tendon surgery afterward. To the best of our knowledge, EPL tendon ruptures caused by SLAC or SNAC are considered rare and have not yet been reported.

Highlights • We describe a one-sheath inverse method in vascular access intervention therapy (VAIVT) for hemodialysis patients. • It allows VAIVT to be performed using one sheath with one approach site in cases in which lesions are present on the upstream and downstream sides. • Because vascular access location is usually superficial, the technique can be utilized with relative ease., Introduction Vascular access intervention therapy (VAIVT) is an essential interventional therapy in the field of hemodialysis therapy that allows for the long-term vascular access functionality to be maintained. The venous approach is often performed in VAIVT for arteriovenous fistula. When lesions are present on the upstream and downstream sides from the approach site, it is likely that two sheaths will be inserted from two facing punctures. However, we have adopted a one-sheath inverse method using a guidewire in such cases. Case presentation We herein describe the steps of the technique that we have performed and report the successful treatment of a 77-year-old woman who developed arteriovenous fistula failure. Discussion To the best of our knowledge, the concrete and detailed technique has not been reported in the English literature to date. The merit of the technique is that it allows VAIVT to be performed using one sheath with one approach site in cases in which lesions are present on the upstream and downstream sides from the approach site. The other benefits include pain reduction, a shortened operation time, and reduced costs. Because vascular access location is usually superficial, the technique can be utilized with relative ease. Conclusion A one-sheath inverse method is useful. We hope that the technique will be more widely recognized, allowing the technique to be applied to more cases.

Aim The effect of tonsillectomy on IgA nephropathy remains controversial. The aim of this study was to compare the effect of tonsillectomy on the outcome, end stage kidney disease (ESKD) and all-cause death in IgA nephropathy patients who did and did not undergo tonsillectomy. Methods All basic data were retrospectively gathered from patients who had undergone renal biopsies at two Japanese clinical centers. Two hundred and twenty-seven patients were eligible for the study, with a median age of 34 (Interquartile range (IQR): 25 to 43) years and median follow-up of 92 (IQR: 40 to 178) months. The primary endpoint was the composite outcome of the onset of ESKD and all-cause death before ESKD. We performed a Cox proportional hazard regression analysis after adjusting for patient characteristics using the inverse probability therapy weighting (IPTW) method and a Cox analysis using the Matching method. Similarly, we analyzed these outcomes in a mild cohort. Results We were unable to find any significant advantages of tonsillectomy in either analysis (IPTW and matching, HR: 0.40 (0.12-1.36) P = 0.072 and 0.78 (0.13-4.64) P = 0.786). However, in the mild cohort analysis, our data showed that the Tonsillectomy group tended to be less likely to reach the composite outcomes than the Not Tonsillectomy group with statistical significance (hazard ratio (HR)

Background Concerns about sodium overload when using sodium polystyrene sulfonate (Na-resin) as an ion-exchange resin for the treatment of hyperkalemia led our institution to gradually shift to the use of calcium polystyrene sulfonate (Ca-resin). However, as serum potassium levels were insufficiently controlled and patients experienced constipation, we returned to using Na-resin and observed better results than previously. Objective As few papers have examined the potassium adsorption ability of Ca-resin compared with Na-resin, we investigated this issue within our institution. Methods We studied potassium adsorption in patients who switched from Ca-resin to an equivalent amount of Na-resin (change group). We also investigated the incidence of sodium loading with Na-resin, including in patients newly commencing Na-resin treatment (new start group). Results Mean (± standard deviation) serum potassium levels decreased significantly, from 5.5 ± 0.6 to 4.9 ± 0.6 mEq/l in the change group and from 5.9 ± 0.4 to 4.7 ± 0.6 mEq/l in the new start group. No changes were observed in blood pressure, weight gain or serum sodium levels in the change group, but serum sodium levels in the new start group increased significantly, from 137.4 ± 2.3 to 139.0 ± 2.5 mEq/l, although they remained within the normal range. Conclusions Our results indicate that Na-resin exhibited an advantage in treating hyperkalemia when used in small amounts. However, when prescribing an ion-exchange resin at a higher dose, physicians should select the type and amount of resin according to the sodium and/or calcium load in each case.

Retropharyngeal abscess is an infection involving the retropharyngeal space which is posterior to the pharynx and oesophagus, and it results as a complication of a primary infection elsewhere in the head and neck including the nasopharynx, paranasal sinuses, or middle ear, which drain lymph to the retropharyngeal lymph nodes. Their lymph nodes are prominent in children and atrophy with age. Therefore, retropharyngeal abscess is most frequently encountered in children, with 75% of cases occurring before the age of 5 years, and often in the first year of life. We experienced a rare adult case of poststreptococcal acute glomerulonephritis with a retropharyngeal abscess, and conservative therapy ameliorated them. According to past reports, only one child with a retropharyngeal abscess and poststreptococcal acute glomerulonephritis has been presented at a conference to date; this is the first adult case of poststreptococcal acute glomerulonephritis with a retropharyngeal abscess. Retropharyngeal abscess can be fatal including airway compression, so it is important to remember retropharyngeal abscess in a case of poststreptococcal acute glomerulonephritis with severe symptoms of neck.

Volar locking plate (VLP) fixation for distal radius fractures (DRF) is a technically demanding procedure, where accurate placement of the distal screws for subchondral articular support is essential. The purpose of this retrospective, case-control study was to compare a computed tomography (CT) navigation system for VLP fixation of intra-articular DRF with conventional freehand fluoroscopy guided surgery. Twelve consecutive patients with DRF, AO type C3.1, underwent VLP fixation using intraoperative CT navigation (navigated group) and 16 consecutive patients had conventional freehand fluoroscopy guided surgery (non-navigated group). Follow-up was done mean 12 (range, 4-18) months after surgery. Radiological outcomes included evaluation of placement for the distal fixation screws and radiological parameters such as; radial inclination, palmar tilt, ulnar variance, fracture-gap, and step-off. Clinical outcomes included grip strength, wrist range of motion, Mayo wrist score, and the Disabilities of the arm, shoulder and hand (DASH) questionnaire. Dorsal cortical and articular screw penetrations were significantly more common in the non-navigated group compared with the navigated group. At the final follow-up, a significantly larger intra-articular fracture gap was observed in the non-navigated group compared to the navigated group. There were no significant differences in clinical outcomes between the two treatment groups. Our results suggest that CT navigation guided surgery for VLP fixation of type C3 DRF, compared with conventional freehand fluoroscopy guided surgery, provides a more accurate placement of the distal screws which minimize the risk for intra-articular and dorsal cortical screw penetration.

This article developes a pediatric membrane oxygenator that is compact, high performance, and highly safe. This novel experimental approach, which imaging the inside of a membrane oxygenator during fluid perfusion using high-power X-ray CT, identifies air and blood retention in the local part of a membrane oxygenator. The cause of excessive pressure drop in a membrane oxygenator, which has been the most serious dysfunction in cardiovascular surgery and extracorporeal membrane oxygenation (ECMO), is the local retention of blood and air inside the oxygenator. Our designed blood flow channel for a membrane oxygenator has a circular channel and minimizes the boundary between laminated parts. The pressure drop in the blood flow channel is reduced, and the maximum gas transfer rates are increased by using this pediatric membrane oxygenator, as compared with the conventional oxygenator. Furthermore, it would be possible to reduce the incidents, which have occurred clinically, due to excessive pressure drop in the blood flow channel of the membrane oxygenator. The membrane oxygenator is said to be the &ldquo, last stronghold&rdquo, for patients with COVID-19 receiving ECMO treatment. Accordingly, the specification of our prototype is promising for low weight and pediatric patients.

Background: Leukocyte removal therapy (LRT) is an effective treatment for active ulcerative colitis (UC). The present study was performed to evaluate the relapse-free period after LRT and identify risk factors for relapse. Methods: In total, 94 patients who underwent first-time LRT for remission of moderate to severe UC from April 2004 to March 2016 were enrolled in the present study. The patients were randomly assigned to one of 2 treatments: leukocytapheresis (LCAP; n = 43) or granulocyte and monocyte/macrophage adsorptive apheresis (GMA; n = 51). The 5-year cumulative relapse-free rate and risk factors for relapse were evaluated. Results: The therapeutic response rate was 82% for GMA and 70% for LCAP without a statistically significant difference. The 5-year relapse-free rate was 34.7% in the LRT group. The 5-year relapse-free rate in patients aged > 40 years was 49.9%, which was significantly higher than that in patients aged ≤40 years (22.9%, p < 0.01). The relapse-free period was longer in the older than younger patients. Conclusions: The relapse-free period after LRT was examined in patients with UC, and 34.7% of patients achieved clinical remission within a 5-year period. The risk factor for early relapse after LRT was younger age.

Calcaneal osteomyelitis (CO) is considered to be difficult to cure when it turned into a chronic phase. We report one case of calcaneal osteomyelitis which arises after the operation of calcaneal fracture. Remission was obtained by performing curettage of the infected cancellous bone of the calcaneal body and filling antibiotic-containing calcium phosphate cements (CPC) within its bone defect. This one-stage surgery is useful to treat calcaneal osteomyelitis.

Background and Purpose Most forms of human obesity are characterized by impaired leptin sensitivity and, therefore, the effectiveness of anti-obesity leptin therapy in these leptin-resistant obese patients is marginal. Hence, the development of strategies to increase leptin sensitivity is of high priority in the field of obesity research. Experimental Approach We first examined the effects of co-administration of leptin and meta-chlorophenylpiperazine (mCPP), an agonist of 5-HT2C and 5-HT1B receptors, on energy balance in leptin-resistant diet-induced obese (DIO) mice. We further assessed leptin-induced phosphorylation of the STAT-3 (pSTAT3) in various brain regions of DIO mice pretreated with mCPP or in mice genetically lacking 5-HT2C receptors. Results Co-administration of mCPP with leptin had an additive effect on reducing body weight in DIO mice. Furthermore, mCPP pretreatment in DIO mice enhanced leptin-induced pSTAT3 in the arcuate nucleus, the ventromedial hypothalamic nucleus, and the ventral premammillary nucleus. Finally, deletion of 5-HT2C receptors significantly blunted leptin-induced pSTAT3 in these same hypothalamic regions. Conclusions and Implications Our study provides evidence that drugs, which activate 5-HT2C receptors, could function as leptin sensitizers and be used in combination with leptin to provide additional weight loss in DIO.

An evaluation method of the bolt conclusion using the reflection coefficient, S 11 , from the scattering parameter of ultrasonic waves was proposed. First, the optimal resonance frequency of the transducer was determined. As the result, the transducer of the 2 MHz resonance frequency would be used in the next experiment because the variation of the reflection coefficient was the greatest compared with transducers of other resonance frequencies. Second, the reflection coefficient, S 11 , of the axial force was measured. The reflection coefficient decreased as the axial force was increased. The reflection coefficient greatly decreased at the almost standard axial force of the bolt. The usefulness of this evaluation method of the bolt conclusion was demonstrated.

Background The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab is a low-density lipoprotein (LDL)-lowering drug with a new mechanism, which is currently available in Japan. Here, for the first time, we report the successful use of the PCSK9 inhibitor in a patient with refractory nephrotic syndrome. Case presentation A 61-year-old woman was diagnosed with minimal change-type nephrotic syndrome in October 2012. She received prednisolone (PSL) and cyclosporin A (CyA), but she experienced several cycles of relapse and remission and was hospitalized in May 2016 due to relapse. However, in spite of steroid pulse therapy and adrenocorticotropic hormone (ACTH) administration, her urinary protein level did not improve. We started her on evolocumab with the expectation of equivalent LDL-lowering effects as seen with LDL apheresis. After that, the LDL cholesterol level and UP/UC were concomitantly decreased, and the serum albumin was increased. This was maintained even when we reduced the PSL dose. This suggests that evolocumab clinically improves the nephrotic condition. Conclusion No other report has described the use of evolocumab for nephrotic syndrome (NS) or its effect on similar nephrotic conditions. We believe that the findings presented here are unique and may be beneficial when treating similar cases.

We examined the thyroid function of non-dialysis-dependent chronic kidney disease (CKD) patients in Japan.Serum-free thyroxine, free triiodothyronine, thyroid-stimulating hormone (TSH), and thyroglobulin (Tg) levels were evaluated in 37 CKD patients. CKD was defined as sustained kidney damage for more than 3 months and was classified as CKD 1+2 (n = 11), 3+4 (n = 10), or 5 (n = 16), which were defined by glomerular filtration rates of ≥ 60, 15 - 59, or 15 mL/min/1.73mThe prevalence of primary hypothyroidism (TSH ≥ 4.83 mU/L) in CKD 1+2, CKD 3+4, and CKD 5 was 9%, 20%, and 56%, respectively (p 0.05). Unexpectedly, elevated serum Tg levels ( 30 ng/mL), a marker of the reversible recovery of the thyroid function, were found in 67% of the CKD 5 patients (p0.05). The serum TSH and Tg levels became lower, without replacement therapy, after the initiation of hemodialysis and iodine restriction, and there was a significant correlation between the serum TSH and Tg levels in the CKD 5 patients (p0.05).The high prevalence of reversible hypothyroidism and the TSH-dependent elevation of the serum Tg levels was suggested in Japanese patients with advanced CKD. The excess ingestion and the impaired urinary excretion of iodine may be responsible for this reversible thyroid dysfunction. .

Obesity is characterized by diminished neural sensitivity to leptin, the most powerful anorectic hormone that critically maintains normal body weight, yet exact mechanisms underlying leptin resista...

Background Goodpasture’s syndrome is a rare disease that is characterized by rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage. Case presentation A 71-year-old Japanese man who had chronic interstitial pneumonia was diagnosed as having Goodpasture’s syndrome. Both anti-glomerular basement membrane antibody and myeloperoxidase anti-neutrophil cytoplasmic antibody were increased. Despite intensive treatments, including mechanical ventilation, he died from respiratory failure. Pathological findings at autopsy showed rapidly progressive glomerulonephritis in his kidneys, diffuse alveolar hemorrhage, hyaline membranes, and fibroblastic foci in his lungs. The cause of death was diagnosed as respiratory failure as a result of diffuse alveolar damage induced by a combination of diffuse alveolar hemorrhage and exacerbation of interstitial pneumonia. Conclusions We report a case of Goodpasture’s syndrome complicated with pre-existing chronic interstitial pneumonia and positive myeloperoxidase anti-neutrophil cytoplasmic antibody. We reviewed six similar cases reported in the literature and concluded that Goodpasture’s syndrome with pre-existing interstitial pneumonia and myeloperoxidase anti-neutrophil cytoplasmic antibody is related to a poor prognosis.

A chronic traumatic hyperextension of the proximal interphalangeal (PIP) joint can result from traumatic volar plate (VP) disruption. For the treatment of this disorder, reconstruction procedures have been traditionally recommended, because the condition of the VP was not considered susceptible to repair due to retraction or attenuation. The purpose of this paper is to present the operative technique and report the clinical results of late VP repair. Late VP repair was performed for chronic, post-traumatic hyperextension deformity of the PIP joint of the little finger resulting from VP disruption in seven consecutive patients. The range of motion and the lateral stability of the PIP joint were evaluated. The radiographic images were also used to evaluate the alignment and degenerative changes of the PIP joint. Clinical results were classified according to Catalano's criteria. Intraoperative findings showed that the VP could be mobilised and repaired in all cases. The hyperextension was well corrected, and none showed recurrence of the initial deformity. Average flexion of the PIP joint was 92° (range = 75-98°), and flexion contracture was 9° (range = 0-20°). On clinical evaluation, there were two excellent, three good, and two fair results. The postoperative radiographs revealed no degenerative change in the PIP joint in six patients. Late VP repair is a successful and reliable alternative and more physiologic than other reconstruction methods. One should first consider late VP repair, despite a long interval between injury and repair.

A radio-cephalic arteriovenous fistula (AVF) in the anatomical snuffbox is the most distal site of AVF in the upper limb. When the cephalic vein distal to the wrist is in poor condition or thrombosed, creating the typical radio-cephalic AVF in the distal forearm just proximal to the wrist will likely be considered. However, we have adopted an operative technique for creating a transposed radial artery-dorsal metacarpal vein AVF (RDAVF) in the anatomical snuffbox when possible in such cases. RDAVF is AVF using the most peripheral autologous vein in the upper limb. To our knowledge, the creation of an RDAVF has not been previously reported. We herein describe the steps of the technique and report the successful treatment of a hemodialysis patient who developed occlusion of a radio-cephalic AVF in the anatomical snuffbox.

Recent demand on the measurement resolution of precise positioning comes up to tens of picometers. Some distinguished researches have been performed to measure the displacement in picometer order, however, few of them can verify the measurement performance as available tools in industry. This is not only because the picometer displacement is not yet required for industrial use, but also due to the lack of standard tools to verify such precise displacement. We proposed a displacement reduction mechanism for generating precise displacement using torsional leaf spring hinges (TLSHs) that consist of four leaf springs arranged radially. It has been demonstrated that a prototype of the reduction mechanism was able to provide one-nanometer displacement with 1/1000 reduction rate by a piezoelectric actuator. In order to clarify the potential of the reduction mechanism, a displacement reduction table that can be mounted on AFM stage was newly developed using TLSHs. This paper describes the design of the reduction mechanism and the sub-nanometer displacement performance of the table obtained from its dynamic and static characteristics measured by displacement sensors and from the AFM images

Background: The medial epicondyle nonunion becomes symptomatic valgus instability with medial elbow pain and joint instability due to dysfunction of the medial collateral ligament (MCL), thus requiring surgical treatment. The purpose of the present study is to report the clinical result of the fragment excision and ligament reconstruction by free tendon graft in the treatment of symptomatic medial epicondyle nonunion. Methods: A retrospective study of five consecutive patients was performed. All five patients had signs and symptoms of valgus instability of the elbow. The mean period of nonunion was 25 years, and their injuries progressed asymptomatically until symptoms developed in adulthood after a second injury. Results: All patients were treated by fragment excision and MCL reconstruction. At the final follow-up, no patients exhibited pain or instability. The mean joint range of motion was 0o of extension and 138o of flexion, with an MEPS of 100 points in all patients. Conclusions: By ligament reconstruction for MCL insufficiency and removing the bone fragments avoided irritation by the bone fragments, pain and instability disappeared, good range of motion was restored, and excellent outcomes were achieved in all patients. We believe that fragment excision and MCL reconstruction should be considered as the treatment option for symptomatic medial epicondyle nonunion of the humerus.

An air bearing lead screw, whose nuts are levitated from the screw threads, has a great advantage of accurately transforming rotational motion to linear motion due to no friction, no backlash and no hysteresis. Therefor precise linear motion can be provided by precise rotational motion which can be obtained by a precise rotary encoder and a motor controller. We developed a positioning controller with servo sampling rate of 10 kHz that employed FPGA (Field Programmable Gate Array) and applied it to positioning of an air bearing stage. The stage consists of an air bearing lead screw and an air bearing linear guide. A rotary encoder, whose resolution has 225000 pulses per rotation, was directly mounted on an axis of the lead screw. This paper describes the positioning performance of the stage by the use of this semi-closed loop control, such as the resolution of less than 10 nm, the linearity over the long stroke.

Displacement reduction mechanisms based on the leverage provided by elastic leaf springs and flexure hinges are widely used due to the high positioning repeatability and the capability of linear motion. One application is to provide the precise motion needed for use as a standard for nanometer displacement. However, a large reduction ratio exceeding 1/1000 has not yet been achieved because the fulcrum cannot withstand the large stress induced by the accumulated force produced by the mechanism. We have developed a displacement reduction mechanism based on torsional leaf spring hinges that can provide a reduction ratio of over 1/1000. The hinge is of solid construction and consists of four leaf springs arranged radially around an axis with a circular platecapping each end. The hinge provides accurate twisting around the centralaxis and accurate reduction without deformation of the fulcrum. This paper describes the characteristics of the displacement reduction system, which can demonstrably producea 1-nm step displacement. The dynamic characteristics were examined by analyzing the transfer function of the system for a nanometer displacement. Furthermore, the motionalcapability of the mechanism was demonstrated by producing sinusoidal, triangular, and rectangular wave nanometer-scale displacements.

症例は66歳，男性．耕運機の操作を誤り，後進してきたハンドル部で左下顎を強く圧迫され，一時的に頸部過伸展状態となった．その後，左後頸部痛が持続し，受傷10週後に激しい後頸部痛・左不全麻痺・意識障害を生じ当院へ搬送された．拡散強調画像では上位頸髄と左後下小脳動脈領域に急性梗塞を認めた．左椎骨動脈のMRAとbasi-parallel anatomical scanning画像の所見にミスマッチがあったこと，頭部単純CTで左椎骨動脈から脳底動脈にかけて壁内血栓を示唆する高吸収域を認めたことから10週前の鈍的頸部外傷に関連した椎骨動脈損傷に伴う解離・閉塞が生じたと考えた．本例を通じ椎骨動脈損傷の受傷機転には多様性があること，詳細な問診の重要性を改めて認識した．また頸部外傷後に慢性的な後頸部痛を訴える患者と遭遇した場合には，受傷からの期間があったとしても椎骨動脈損傷の可能性を考慮すべきと思われた．

The electromagnetic bandgap (EBG) structure is a kind of photonic crystal that can be used in microwave and millimeter-wave frequency regions. In this paper, we present the analysis and design of two types of periodic structure circuit with one-dimensional (1-D) EBG structures using alternately arranged, linear, tapered microstrip line (MSL) elements. In order to design the circuits, we calculated their frequency characteristics on the basis of transmission line models. First, we found an ABCD matrix using a model consisting of very short, series-connected MSL elements. Thereafter, we converted these ABCD matrices into S matrices. Based on the theoretical analyses, we fabricated two types of circuits on printed circuit boards (PCBs) and evaluated their frequency characteristics. The results of evaluation showed that one of the circuits had a stopband of 2 GHz bandwidth and the other had a passband in the center of the stopband. The measured and calculated results were found to be in good agreement. Copyright © 2010 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.

The present study examined how muscle cross-sectional area (CSA) indices determined at rest and during maximal voluntary contraction (MVC) are related to muscle strength in middle-aged and elderly individuals (22 men and 36 women, 51-77 years). The muscle thickness (MT) of elbow flexors and circumference (C) at the level 60% distal to the upper arm was measured by ultrasonography and a measuring tape, respectively, both at rest and during isometric MVC of elbow flexion. The muscle strength (F) of elbow flexors was calculated by dividing the torque developed during MVC by the forearm length of each subject. The product of MT and C (MTxC) and the square of MT (MT) were defined as the muscle CSA indices. The F was significantly correlated with MTxC during MVC (r = 0.905, p < or = 0.001) and at rest (r = 0.778, p < or = 0.001), with the former relationship significantly stronger than the latter (p < or = 0.001). Similarly, F was significantly correlated with MT both during MVC (r = 0.896, p < or = 0.001) and at rest (r = 0.780, p < or = 0.001), and there was also a significant difference between the correlation coefficients (p < or = 0.01). These findings show that, in middle-aged and elderly individuals, muscle strength is more closely related to muscle CSA indices during MVC than at rest. It is concluded that the present muscle CSA indices taken during MVC enable easy and practical evaluation of the muscle strength per size of elbow flexors in middle-aged and elderly individuals.

We fabricated distributed-feedback (DFB) solid-state dye lasers with moire gratings. We formed a moire grating pattern by superimposing two grating patterns with a rotation angle. The moire gratings were fabricated by an “etchless” process utilizing a two-beam interference method. The gratings were coated with solidified rhodamine-B. The five laser devices were pumped with the second harmonic generation of a Nd:YAG laser and we obtained narrow-banded laser oscillations at 590, 600, 610, 620, and 630 nm wavelength. Full widths at half maximum of laser spectra were less than 0.5 nm. The results indicated that a moire fringe can function as a resonator of DFB solid-state dye lasers.

A novel detection system for sub-harmonic components of ultrasonic pulse waves is constructed. A new double-layered piezoelectric transducer (DLPT), having the same polarization direction for each layer, is introduced to enhance the sensitivity for sub-harmonic components. In the case of DLPT stacked and bonded to one another in the same polarization direction, the resonance frequencies of the DLPT, fr, are f0 in a parallel connection and f0/2 in a series connection. As a result, the receiving sensitivity of the sub-harmonic components is increased by approximately 30 dB and the receiving sensitivity of fundamental components is decreased by approximately 20 dB, compared with those in the parallel connection. As an application of this system, the detection of sub-harmonic components generated from plastic-deformed metal rods is demonstrated. The DLPT system can be used to detect some deformed samples, while sub-harmonic components cannot be detected using a single transducer system.

Multilayered waveguide holography (MWH) is one of a number of page-oriented data multiplexing holographies that will be applied to optical data storage and three-dimensional (3D) moving images. While conventional volumetric holography using photopolymer or photorefractive materials requires page-by-page light exposure for recording, MWH media can be made by employing stamping and laminating technologies that are suitable for mass production. This makes devising an economical mastering technique for replicating holograms a key issue. In this paper, we discuss an approach to pit distribution design that enables us to replace expensive electron beam mastering with economical laser beam mastering. We propose an algorithm that avoids the overlapping of even comparatively large adjacent pits when we employ laser beam mastering. We also compensate for the angular dependence of the diffraction power, which strongly depends on pit shape, by introducing an enhancement profile so that a diffracted image has uniform intensity.

Polycrystalline silicon (poly-Si) films thicker than 1.5 μm, consisting of dense small grains called nano-grain poly-Si (ngp-Si), are formed by flash lamp annealing (FLA) of amorphous silicon (a-Si) films prepared by catalytic chemical vapor deposition (Cat-CVD) method. Crystallinity of the ngp-Si films can be controlled by changing lamp irradiance. Secondary ion mass spectroscopy (SIMS) profiles of dopants in the ngp-Si films after FLA shows no serious diffusion. A minority carrier lifetime of over 5 μs is observed from these ngp-Si films after defect termination process using high pressure water vapor annealing (HPWVA), showing possibility of application for high-efficient thin film solar cells.

We describe two types of gratings that have been developed for application in distributed feedback (DFB) solid-state dye lasers. One type of grating is referred to as a "photoresist grating", because it is composed of photoresists. This type of grating can be fabricated in approximately 3 h. In order to improve its durability, the periodic structure of the photoresist grating was transferred to the surface of acrylic plastic maintained at room temperature. We refer to this grating as an "acrylic grating", and it is a replica of the photoresist grating. In this study, a unique method was introduced for fabricating the acrylic grating. By this technique, high-quality acrylic gratings can be prepared inexpensively and within a very short time, similarly to photoresist gratings. It was confirmed that these two types of gratings are of good quality for applications in wavelength-selective devices for DFB solid-state dye lasers.

Meckel's diverticulum has been known to occur in 2% of the general population and is usually asymptomatic; it causes complications in 4% of cases. We have recently experienced a rare case of perforation of Meckel's diverticulum in a neonate delivered to a mother who had been treated with methimazole for hyperthyroidism during pregnancy. A 2-day-old neonate who was delivered by Cesarean section at 39 weeks' gestation underwent an emergency operation; he was diagnosed with gastrointestinal perforation, showing a large amount of air within the gastrointestinal tract, and pneumoperitoneum radio graphically. Laparotomy showed a perforated Meckel's diverticulum in the jejunum with a moderate amount of serous ascitic fluid. Segmental resection of the small bowel and intraperitoneal drainage were performed. A pathological examination for Meckel's diverticulum revealed a partially thinned muscular layer suggesting the existence of an increase in pressure within the diverticulum. The neonate needed to be administrated thyroid hormone for a hypothyroid state, which was possibly due to the maternal treatment with methimazole during pregnancy. We hypothesize that maternal treatment with methimazole during pregnancy may be associated with the formation of Meckel's diverticulum in a neonate; and it may be associated with an abdominal distention and subsequent perforation of Meckel's diverticulum with secondary hypothyroidism.