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Background: Surgical lung biopsy (SLB) is performed in patients with acute respiratory distress syndrome (ARDS); however, its clinical utility remains unclear. Objectives: We categorized the pathological diagnoses and investigated the predictive value for short-term mortality. Method: Three electronic databases (MEDLINE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) were searched for the included studies. The QUADAS-2 was used to evaluate the risk of bias and its applicability. The types and populations of pathological diagnoses were investigated. The pooled sensitivity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) were estimated at a fixed specificity. Hierarchical summary receiver operating characteristic curves were drawn. Results: A total of 16 studies that enrolled 758 patients were included. The pathological diagnoses were as follows: diffuse alveolar damage (DAD) 29.9%; infection 24.7%; interstitial lung disease 17.2%; malignancy 3.6%; cardiovascular disease 3.6%; drug toxicity 2.3%; connective tissue disease 2.2%; allergic disease 1.1%; and nonspecific diagnosis 15.4%. To predict short-term mortality, 13 studies that enrolled 613 patients used DAD as an index test and recorded a mortality rate of 56.9% (349 of 613 patients). A total of 3 studies that used index tests other than DAD were excluded. The pooled sensitivity, fixed specificity, LR+, LR−, and DOR were 0.46 (95% confidence interval [CI]: 0.29–0.56), 0.69, 1.48 (95% CI: 0.92–1.81), 0.78 (95% CI: 0.63–1.03), and 1.90 (95% CI: 0.89–2.86), respectively. Conclusions: SLB is unlikely to provide a specific diagnosis and should not be recommended for confirming DAD or predicting ARDS prognosis.

Background Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) is often positive in patients with interstitial lung disease (ILD), which is also often present in patients with microscopic polyangiitis (MPA). A possible association between MPO-ANCA, MPA, and idiopathic ILD remains unclear. The objective of this study was to determine whether high-resolution computed tomography (HRCT) classification based on recent idiopathic pulmonary fibrosis guideline and specific CT findings can obtain new knowledge of prognostic factors in all MPO-ANCA-positive patients with ILD including both idiopathic ILD and MPA-ILD. Methods We analyzed 101 consecutive MPO-ANCA-positive patients with respiratory disease. We assessed the diagnostic accuracy of CT findings, HRCT pattern, and specific radiological signs. Prognostic predictors were determined using Cox regression models. Results Subjects with chronic ILD included 22 patients with MPA-ILD and 39 patients with ILD but without MPA. A quarter of the patients were radiological indeterminate for usual interstitial pneumonia (UIP) pattern, which resulted in a better prognosis than that for UIP pattern. “Increased attenuation around honeycomb and traction bronchiectasis” and “anterior upper lobe honeycomb-like lesion” were found to be highly frequent radiological findings (39% and 30%, respectively). In addition, the latter finding was a significant negative prognostic factor. Conclusions Radiological indeterminate for UIP was a useful HRCT classification in MPO-ANCA-positive patients with ILD. In addition, anterior upper lobe honeycomb-like lesion was found to be specific radiological finding that was a significant prognostic factor. The present results might aid in the assessment of appropriate strategies of diagnosis in these patients.

Amidst ongoing debate about the viability of physical activity (PA) legacies associated with hosting international sports mega events, this systematic review explores quantitative evidence from pop...

A 60-year-old Japanese woman was admitted to our hospital with a fever and shortness of breath occurring immediately after using hairspray. Chest high-resolution computed tomography (HRCT) showed ground-glass opacities (GGOs) predominantly distributed around the bronchovascular bundles, and a pathological evaluation by a transbronchial lung cryobiopsy (TBLC) revealed fibrotic non-specific interstitial pneumonia (f-NSIP). Her symptoms disappeared without the use of corticosteroids, and GGOs on HRCT improved markedly over time. This case suggests that a pathological evaluation by a TBLC for lung injury due to inhalation pathogen exposure may provide a more accurate diagnosis and a better understanding of the pathology from bronchial to interstitial lesions than transbronchial lung biopsy.

Exploding head syndrome is a rare sleep disorder, characterized by an explosive feeling in the head, that occurs during the sleep-wake transition. Usually the attacks are painless, but the fear caused by the attack can result in awakening and insomnia when it is generated frequently. It has been suspected that exploding head syndrome is related to emotional stress, because most patients report stressful life situations in periods when attacks are intense and frequent. The benign character and good prognosis of exploding head syndrome are the most likely reasons why it has not become a subject of more extensive neurologic research. Moreover, most of the articles reported symptomatic episodes but a lack of objective physiologic examinations, such as polysomnography, and effective treatment. Here, we report two cases of exploding head syndrome with the attacks documented by polysomnography and our trial treatment. CITATION: Nakayama M, Nakano N, Mihara T, et al. Two cases of exploding head syndrome documented by polysomnography that improved after treatment. J Clin Sleep Med. 2021;17(1):103–106.

Objetivo do estudo: Apesar da existência de oportunidades de desenvolvimento de marcas dos atletas, em esportes menos populares os atletas encontram dificuldades neste tema. Portanto, o presente estudo teve como objetivo contribuir com a literatura existente sobre a marca do atleta, fornecendo uma compreensão melhor e holística da marca do atleta em esportes menos populares.Metodologia: Empregamos a abordagem triádica que envolveu três partes interessadas: Atleta, fãs e mídia, para explorar fatores importantes nas estratégias de marca do atleta em esportes menos populares..Originalidade/Relevância: Há menos foco no esporte menos popular e na marca de seus stakeholders. Com o crescente interesse dos fãs por esportes menos populares e seus atletas estão ganhando mais atenção do que nunca. Assim, o estudo optou por discutir um fenômeno ignorado no contexto da marca do atleta.Principais resultados: Os resultados identificaram quatro temas principais e oito subtemas associados com base nas entrevistas e na análise de conteúdo da mídia. Esses principais e subtemas incluem (1) desempenho (sucesso esportivo, nível de competição), (2) pessoal / privado (características fora do esporte, gerenciamento de imagem), (3) negócios / marketing (promoção de atleta, produtos mercadológicos) e (4) fator contextual (natureza esportiva, proximidade).Contribuições teóricas/metodológicas: o estudo atual contribuiu na literatura existente sobre a marca do atleta por meio do foco em um atleta importante de um esporte menos popular.

We herein report four cases of diffuse bronchiolitis proven by a transbronchial lung cryobiopsy (TBLC). Based on various aspects, including the pathological findings, we definitively diagnosed two patients with diffuse panbronchiolitis (DPB) and the other two with primary ciliary dyskinesia (PCD). One of the DPB patients had more severe peribronchiolar fibrosis than the other, and the disease course was refractory to macrolide therapy. One of the PCD patients was additionally diagnosed with combined constrictive bronchiolitis. This report highlights the importance of a TBLC in the differentiation of bronchiolitis, suggesting its utility for helping pulmonologists formulate a treatment strategy.

BackgroundRadial endobronchial ultrasonography (R-EBUS) has been used in conjunction with transbronchial lung cryobiopsy (TBLC) to diagnose diffuse parenchymal lung disease (DPLD) and to decrease the risk of bleeding complications. The diagnostic utility of different R-EBUS signs, however, remains unknown.ObjectivesThis study aimed to determine whether different R-EBUS signs could be used to more accurately diagnose DPLD and whether bronchial bleeding could be prevented with use of R-EBUS during TBLC.MethodEighty-seven patients with DPLD were included in this multicentre prospective study, with 49 patients undergoing R-EBUS. R-EBUS signals were characterised as displaying either dense or blizzard signs. Pathological confidence of specimens obtained from TBLC was compared between patients with dense versus blizzard signs, and severity of bronchial bleeding was determined based on whether R-EBUS was performed or not.ResultsAll patients with dense signs on R-EBUS showed consolidation on high-resolution CT (HRCT) imaging. Pathological confidence of lung specimens was significantly higher in patients with dense signs versus those with blizzard signs (pConclusionsThe dense R-EBUS sign corresponded with consolidation on HRCT. High-quality lung specimens may be obtainable when the dense sign is observed on R-EBUS, and R-EBUS combined with TBLC may reduce risk of bronchial bleeding and shorten procedure times.

Previous studies of animal behavioural sleep is mainly divided into two study types, observation by video recording or counts by sensor, both of which require a complex environment and procedure. An actigraph unit is a commercially available product which can provide non-invasive monitoring human rest/activity cycles. The goal of this study was to evaluate whether actigraphy can be applied for analysing behavioural sleep in rats, since no reports have described utilization of the actigraphy unit for monitoring sleep of small animals. The actigraph unit was held on the chest of eight male rats by a loose elastic belt. The rats spent two days in a normal condition, followed by two days of sleep deprivation. Total counts measured by the actigraph could be clearly divided into two phases, sleep phase and awake phase, when the rats were kept in the normal cage. Next, the rats were moved into the sleep-deviation cage, and the total counts were significantly higher during daytime, indicating the successful induction of sleep deprivation. These results showed that the actigraphy unit monitored rest/activity cycles of rats, which will contribute to making sleep behaviour experiments easier.

Lung or head and neck cancer have been indicated as solid cancers associated with invasive pulmonary aspergillosis (IPA), but the relationship with hepatocellular carcinoma (HCC) is unknown. We report a case of HCC in which the presence of cirrhosis and corticosteroid administration may have caused the development of IPA., The presence of hepatocellular carcinoma, cirrhosis of the liver, and corticosteroid administration predisposed the patient to the development of invasive pulmonary aspergillosis.

Recently, gamified wearable fitness trackers have received greater attention and usage among sport consumers. Although a moderate amount of aerobic physical activity can significantly reduce the risk of many serious illnesses, physical inactivity issues are still prominent. Although wearable fitness trackers have the potential to contribute to physical activity engagement and sustainable health outcomes, there are dwindling engagement and discontinuance issues. Thus, examining its gamification elements and role in physical activity becomes critical. This study examined the gamification elements in wearable fitness trackers and their role in physical activity and sports engagement. A comprehensive literature review yielded 26 articles that empirically measured a variety of gamification features and the effect of the device on physical activity and sports engagement. The study suggests three key gamification themes: goal-based, social-based, and rewards-based gamification that can be a point of interest for future scholars and practitioners. Based on the review, we propose a conceptual framework that embraces motivational affordances and engagement in physical activity and sports.

Our current study focused on elucidating the role of specific chemokine-receptor interactions in antigen (Ag)-specific immune cell migration from nasal to genital mucosal tissues. This cellular migration is critical to induce effective Ag-specific immune responses against sexually transmitted genital infections. In this study, nasal immunization with live attenuated HSV-2 TK- induced the upregulation of CCR5 expression in effector immune cells, including CD4+ T cells, in Ag-priming sites and vaginal tissue. The CCR5 ligands CCL3, CCL4, and CCL5 all showed upregulated expression in vaginal tissue; in particular, CCL5 expression was highly enhanced in the stromal cells of vaginal tissue after nasal immunization. Intravaginal blockade of CCL5 by using neutralizing antibody diminished the number of HSV-2-specific effector cells in the vagina. Furthermore, loss of CCR5, a receptor for CCL5, impaired the migration of nasally primed Ag-specific effector cells from the airway to vagina. Effector cells adoptively transferred from CCR5-deficient mice failed to migrate into vaginal tissue, consequently increasing recipient mice's susceptibility to HSV-2 vaginal infection. These results indicate that the CCR5-CCL5 chemokine pathway is required for the migration and retention of nasally primed Ag-specific effector cells in vagina for providing protective immunity against HSV-2 infection.

Purpose By testing a moderated mediation model, the purpose of this paper is to examine the mediating role of credit card self-efficacy in the relationship between credit card literacy and financial well-being. The authors further examine if credit card number moderates this effect. Design/methodology/approach Data for the study were collected from 427 college students. The PROCESS macros in IBM SPSS Statistics 23 was used to assess the hypothesized relationships. Findings Credit card literacy positively influences financial well-being through self-efficacy. However, this effect is stronger when college students own fewer credit cards. Practical implications Banks and credit card issuers, policymakers and colleges and universities should place a greater emphasis on credit card literacy programs that enhance students’ general understanding of credit card terms and conditions and confidence in their ability to effectively use and manage their credit cards. Originality/value To our knowledge, this is the first study to examine the relationship between credit card literacy, self-efficacy and financial well-being.

It is important for brands to appropriately respond when their athlete endorsers are involved in a scandal. The present study examines how consumer evaluations of endorsed brands are influenced by a brand’s response to an endorser scandal. A 2 (brand response strategy type: maintenance vs. termination) × 2 (endorser scandal type: competence-relevant vs. competence-irrelevant) between-subjects experiment is conducted. Specifically, the authors focus on the perceived appropriateness of the response strategy and consumer attitudes toward an endorsed brand. Subjects were recruited from Amazon Mechanical Turk ( N = 111). Consumers perceive that terminating an endorsement contract with a scandalized endorser is more appropriate than maintaining the relationship. This is particularly true when celebrity endorsers are involved in competence-relevant scandals. A further analysis provided support for the idea that perceived “appropriateness” mediates the relationship between competence-relevant scandal and consumer attitude toward an endorsed brand. A termination strategy was considered appropriate when scandalized endorsers engaged in competence-relevant scandals, which eventually lead to more favorable consumer evaluations toward an endorsed brand.

Tracheobronchial lesions are rare extramuscular complications for idiopathic inflammatory myopathies including dermatomyositis. We herein report a 65-year-old woman with tracheal ulcer during the progression of dermatomyositis-associated interstitial lung disease. Treatment with corticosteroids combined with immunosuppressive agents resulted in improvement of the tracheal ulcer and pulmonary involvement. We believe that the tracheal ulceration might reflect the disease behaviour of dermatomyositis and dermatomyositis-associated interstitial pneumonia.

Bottom-up synthesis of graphene nanoribbons (GNRs) may open new possibilities in future electronic devices owing to their tunable electronic structure, which depends strongly on their well-defined width and edge geometry. For instance, armchair-edged GNRs (AGNRs) exhibit width-dependent bandgaps. However, the bandgaps of AGNRs synthesized experimentally so far are relatively large, well above 1 eV. Such a large bandgap may deteriorate device performance due to large Schottky barriers and carrier effective masses. Here, we describe the bottom-up synthesis of AGNRs with smaller bandgaps, using dibromobenzene-based precursors. Two types of AGNRs with different widths, namely 17 and 13 carbon atoms, were synthesized on Au(111), and their atomic and electronic structures were investigated by scanning probe microscopy and spectroscopy. We reveal that 17-AGNRs have the smallest bandgap, as well as the smallest electron/hole effective mass, among bottom-up AGNRs reported so far. The successful synthesis of 17-AGNRs is a significant step toward the development of GNR-based electronic devices. Armchair-edged graphene nanoribbons, characterized by width-dependent bandgaps, may become prominent in future semiconductor devices. Here, a small bandgap of 0.19 eV is achieved in 17-atom-wide nanoribbons, promising better transport characteristics in field-effect transistors.

Transbronchial lung cryobiopsy (TBLC) has been increasingly utilised to diagnose diffuse parenchymal lung diseases (DPLDs) and lung cancers; however, TBLC protocols have not yet been standardised and the rate of complications associated with this procedure vary widely. Therefore, this prospective multicentre observational study investigated the safety and utility of the TBLC technique in patients with diffuse and localised respiratory diseases. This study was conducted at multiple medical centres in Japan between July 2018 and April 2019. The study's primary end-point was the rate of severe or serious adverse events associated with TBLC. Adverse events included bronchial bleeding, pneumothorax, pneumonia, respiratory failure, and an acute exacerbation of interstitial pneumonia. Adverse events were graded according to severity. During the TBLC procedure, an endobronchial balloon catheter for bronchial blockade was used in all patients. Pathological confidence and quality of specimens were categorised into three groups. A total of 112 patients were included. Neither severe nor serious adverse events were identified; therefore, the primary end-point was met. Nineteen patients (17%) experienced no bronchial bleeding. Mild or moderate bronchial bleeding was identified in 67% and 16% of patients, respectively. Mild pneumothoraces were identified in four patients (3.6%). The safety profile in patients aged ≥75 years was not significantly different from younger patients. Definite or probable pathological diagnoses were made in 84.9% of patients. This TBLC protocol with routine use of an endobronchial balloon had an acceptable safety profile and diagnostic yield in patients, including elderly ones, with diffuse and localised respiratory diseases., This multicentre prospective study showed an acceptable safety profile and diagnostic yield for transbronchial cryobiopsy with routine use of an endobronchial balloon for patients with diffuse and localised respiratory diseases, including elderly patients https://bit.ly/2Vv8Gky

Background Interstitial lung disease (ILD) is associated with high morbidity and mortality in patients with connective tissue disease (CTD). Because some patients with CTD overlap present with ILD first, with CTD diagnosed later, specific radiologic signs are needed to help differentiate each CTD or CTD-ILD from idiopathic ILD. Objectives To determine whether specific CT findings can help differentiate CTD as rheumatoid arthritis (RA), systemic sclerosis (SSc), or polymyositis/dermatomyositis (PM/DM). Methods We analyzed 143 consecutive ILD patients with RA, SSc, or PM/DM. We assessed diagnostic accuracy of CT findings of CTD-ILD, CT pattern, and signs including “anterior upper lobe honeycomb-like lesion” and “low attenuation area (LAA) within an interstitial abnormality” for each CTD-ILD. Prognostic predictors were determined using Cox regression models. Results Subjects were 78 patients with RA-ILD, 38 with SSc-ILD, 24 with PM/DM-ILD, and 3 with overlapping CTD-ILD. High frequency of anterior upper lobe honeycomb-like lesion suggests that CTD-ILD is due to RA-ILD (22%) rather than SSc-ILD (8%) or PM/DM-ILD (8%), whereas LAA within an interstitial abnormality suggests that CTD-ILD is due to SSc-ILD (26%) rather than RA-ILD (4%) or PM/DM-ILD (0%). Multivariate analysis showed that while not associated with survival, current or ex-smoker, honeycombing, and acute exacerbation were negative prognostic factors of mortality. Conclusions The tendency is high for RA-ILD, in which anterior upper lobe honeycomb-like lesion is a specific feature, to show UIP or NSIP/UIP pattern, combined emphysema, and honeycombing; SSc-ILD to show NSIP pattern and LAA within an interstitial abnormality; and PM/DM-ILD to show NSIP pattern and non-honeycombing.

Background Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of surfactant proteins within the alveolar spaces. Autoimmune PAP (APAP) caused by elevated levels of GM-CSF autoantibodies (GM-Ab) is very rarely associated with systemic autoimmune disease. Here we report a case of APAP manifested during immunosuppressive treatment for polymyositis with interstitial lung disease. Case presentation A 52-year-old woman treated at our hospital because of polymyositis with interstitial pneumonia had maintained remission by immunosuppressive treatment for 15 years. She had progressive dyspnea subsequently over several months with her chest CT showing ground-glass opacities (GGO) in bilateral geographic distribution. Her bronchoalveolar lavage fluid with cloudy appearance revealed medium-sized foamy macrophages and PAS-positive amorphous eosinophilic materials by cytological examination. We diagnosed her as APAP due to an increased serum GM-CSF autoantibody level. Attenuating immunosuppression failed to lead GGO improvement, but whole lung lavage (WLL) was effective in her condition. Conclusions PAP should be considered as one of the differential diseases when the newly interstitial shadow was observed during immunosuppressive treatment. WLL should be regarded as the treatment option for APAP concurred in connective tissue disease (CTD).

Most vaccines for humans are administered parenterally, often with alum adjuvant. These injectable vaccines elicit primarily systemic immunity, mostly humoral immunity, evident by elevated vaccine-specific serum immunoglobulin G antibodies. Few approved vaccines are administered mucosally, and generally, these are live vaccines. Being less immunogenic in humans, oral subunit vaccines require a coadministered mucosal adjuvant or a targeting moiety to facilitate vaccine uptake by the mucosal antigen-sampling and presenting system consisted of microfold (M) cells and antigen-presenting cells (APC). Upon antigen presentation, immunity or tolerance occurs, directed by the activation mechanism induced, and it ultimately influences regional and distal immune responses. In the context of mucosal subunit vaccine delivery, the challenge is how to induce immunity or tolerance without requiring large amounts of antigen to protect the vast mucosal surfaces and systemic immune compartment. To achieve immunity or tolerance, experimental oral vaccination methods show the importance of stimulating mucosal inductive tissues (e.g., mucosal-associated lymphoid tissue). This chapter focuses on the features of specialized epithelial cells, called M cells, which are responsible for luminal antigen sampling and transfer to mucosal APCs. Hence this chapter describes the benefits and practical applications of M-cell-targeted vaccines for immunity and tolerance.

Objective This was a first cross-sectional single-center study to research the relation between globus pharyngeus, OSA and GERD. Since previous clinical studies have demonstrated a relationship between globus phayrngeus and GERD, however, no reported study on the relation between globus pharyngeus, sleep disorders including OSA, and GERD. Methods Seventeen patients underwent general and otorhinolaryngological examinations and responded to several questionnaires (ESS, PSQI, HADS, and Globus pharyngeus VAS score) at their first visit, and underwent a gastroesophageal test for 24-h pH monitoring and in-laboratory PSG one to two months later. Results No significant differences were seen in ESS, PSQI, or HADS scores between the groups. The acid exposure time was not significantly different among the groups. The percentage of esophageal reflux time was higher than the percentage of laryngopharyngeal reflux time through the total time as well as the supine period. This indicated that GERD occurred more frequently than laryngopharyngeal reflux. The entire results showed concurrent OSA in 10 cases (59%) and concurrent GERD in 7 cases (41%). The cases with OSA were treated by CPAP or oral appliance, and those treatments were effective for globus pharyngeus. Conclusion Although the relation between OSA and globus phayngeus is still controversial, these findings suggest that OSA may be a previously undetected cause of globus pharyngeus. By improving OSA, it may offer an additional option of treatment for those globus pharyngeus cases combined with OSA.

Background: Interstitial lung disease (ILD) is associated with high morbidity and mortality in rheumatoid arthritis (RA). Although usual interstitial pneumonia (UIP) pattern was reported as a poor prognostic factor, in clinical practice, we often cannot classify high-resolution computed tomography (HRCT) patterns specifically as UIP or nonspecific interstitial pneumonia (NSIP). This study of RA-ILD aimed to elucidate prognosis by using our modified HRCT pattern classification according to the latest guideline on idiopathic pulmonary fibrosis (IPF). Methods: We analysed the medical records of 96 consecutive patients diagnosed as having RA-ILD. The modified HRCT classifications were defined as definite UIP, probable UIP, indeterminate for UIP (i.e., early UIP or NSIP/UIP), NSIP, organizing pneumonia (OP), NSIP+OP, and unclassifiable. Predictors of prognosis were determined using Cox regression models. Results: Our RA-ILD cohort included definite UIP (21%), probable UIP (20%), indeterminate for UIP (30%) including NSIP/UIP (27%), alternative diagnosis (29%) including NSIP (14%), and other patterns. Interrater agreement for HRCT pattern was good (κ =0.75). Multivariate analysis showed that older age, history of acute exacerbation, and radiological honeycombing were negative prognostic factors of mortality. Conclusions: NSIP/UIP pattern of indeterminate for UIP was the major pattern in RA-ILD. Although classifications of HRCT patterns were not related to survival, the presence of radiological honeycombing could be a useful predictor of poor prognosis, and acute exacerbation of ILD can seriously impact patient survival regardless of the presence of a UIP or indeterminate for UIP pattern. Our modified HRCT classification based on the latest IPF guideline might be useful to assess appropriate strategies of diagnosis in future RA-ILD studies, and radiological honeycombing could better predict poor prognosis rather than HRCT pattern.

Despite some of the recent examinations of an athlete’s reputational crisis (ARC), their negative spillover effects on endorsed and competing brands have been overlooked. The purpose of this study is to investigate the relationships between perceived severity, athlete endorser credibility (i.e., incompetence, untrustworthiness), and attitudes towards endorsed and competing brands. To enhance theoretical understanding of the phenomenon, the moderating role of consumer knowledge was also tested. Participants were recruited from Amazon Mechanical Turk ( N = 339). A multigroup structural equation model was employed to test the hypothesized model. Results indicated that the severity of an ARC is associated with the perceived incompetence and untrustworthiness of focal athletes. Perceived incompetence is associated with negative evaluation of an endorsed brand. Furthermore, this impact is significantly stronger for consumers with greater knowledge of the athletes than those who are less knowledgeable. Interestingly, competitor brands received negative impact indirectly from the athlete endorsers’ incompetence. This spillover effect is also manifested differently depending on the level of consumer knowledge.

Through a survey method, this study compares the process of how travel decision makers (DMs) and non-decision makers (Non-DMs) are motivated to travel and how they develop destination loyalty in an adventure tourism setting. The term 'DMs' refers to those individuals who make travel choices for a trip while 'Non-DMs' are those who take the trip but do not make the travel choices (e.g. family members). Data were collected from Japanese rafting tourists (N=597) in Niseko, a famous adventure sport destination. The results demonstrate that the tourism motivations of DMs and Non-DMs differ, with DMs being more likely to pursue excitement compared to Non-DMs, who tend to be more motivated by family-related needs. The findings also show that DMs' destination loyalty is predicted by rafting services and cultural aspects of the destination. However, tourist satisfaction failed to mediate the relationship between pull motivations and destination loyalty for the DM group. Furthermore, these destination attributes also predicted Non-DMs' destination loyalty indirectly through tourist satisfaction. Destination marketers in adventure tourism settings should understand that the key to successful destination marketing isto develop destination loyalty among Non-DMs by satisfying their expected destination attributes while at the same time providing extraordinary experiences that exceed the expectations of the DM.

We demonstrate that a flexible dielectric-barrier-discharge (DBD) plasma actuator fabricated by an inkjet printing process using metallic inks generates stable surface discharge and ionic wind for active airflow control. The establishment of a practical fabrication method for DBD plasma actuators is a critical issue to be tackled for industrial applications. The inkjet process requires just the printing of the metallic inks and sintering processes while the conventional photolithography technology requires a lot of processes for the fabrication of the DBD plasma actuators. The electrical and mechanical characteristics of a multi-stage DBD plasma actuator fabricated by this printed electronics technology are investigated and are compared with the DBD plasma actuator made by the conventional method using copper tape. The DBD plasma actuator developed in this study induces a similar or even stronger ionic wind than that of the conventional one. Also, a thin exposed electrode (≃1 μm), which is preferable in terms of airflow control applications, is achieved by the inkjet printing process. The development of the fabrication method using printed electronics expands the application field of the DBD plasma actuator, including complex curved surfaces and full-scale size applications.

The sport labor market’s needs are susceptive to environmental factors. The situation regarding COVID-19 has particularly been influential in altering employment and education policies. The purpose of this research was twofold (1) to understand the graduate employability (i.e., hard and soft skills): and contributions that higher education institutions can make to produce human resources and (2) to identify the differences regarding the above factors before and after COVID-19. The results of Delphi study with executive-level experts in sport business identified various hard/soft skills and higher education’s potential contributions. Moreover, experts' expectations are found to be intensified after the COVID-19 outbreak.

In this paper, we report about platform and architecture that real-time analysis of big data are possible, and structured IT infrastructure that they are optimally combined. We developed a distributed architecture which the data conversion and the abnormality determination are multi-blocked. Furthermore, by selecting a distributed storage database (DB), we succeeded in constructing IT infrastructure capable of high-speed processing at a large number of manufacturing sites. In the new IT infrastructure, we achieved resource leveling of the application server and improvement of data processing time. It is expected that data file stagnation and delay of DB registration can be resolved.

Purpose This study examines the use of high-expertise sources such as doctors to sell dietary supplements and the use of skeptical statements toward approved drugs in the act of selling dietary supplements. Design/methodology/approach The research questions are addressed by means of a scenario experiment that manipulated two independent variables: expertise (high- vs low-expertise) and skepticism toward prescription drugs (present vs absent). Findings Surprisingly, skeptical statements from a low-expertise source toward a prescription drug made while selling dietary supplements was found to have an insignificant effect on selling effectiveness (willingness to recommend and perceived product effectiveness). However, when a high-expertise source (doctor) did the same, selling effectiveness was reduced. Research limitations/implications The paper identifies a boundary condition for competitive selling claims of dietary supplements. Doctors are likely to get away with claims regarding the efficacy of dietary supplements until they criticize a more credible prescription drug in favor of supplements. Practical implications Claims made by a low-expertise sources and high-expertise sources in the act of selling dietary supplements must be carefully considered. Conventional wisdom tactics may be ineffective. Originality/value This paper uniquely demonstrates the role of competitive skepticism at different levels of expertise. The findings of this study suggest that managers, in especially the multi-level marketing industry, should reconsider some of their selling tactics.

Understanding active sport tourists’ profiles and nurturing their destination loyalty are important considerations in the tourism market. Loyal tourists are valuable because they tend to revisit a ...

We herein report the first case, to our knowledge, of tracheobronchial ulcer with anti-melanoma differentiation-associated gene 5 (anti-MDA 5) antibody-positive interstitial lung disease (ILD). A 53-year-old man complained of shoulder and wrist pain and was suspected of having polymyalgia rheumatica at another hospital. Thereafter, treatment with prednisolone was started. Although his arthralgia improved, he suffered from progressive dyspnea on exertion and an abnormal shadow was noted on chest X-ray, so he was transferred to our hospital. Chest computed tomography scan revealed ground-glass opacities and intralobular septal thickening. We diagnosed him as having clinically amyopathic dermatomyositis associated with ILD based on the specific skin findings and elevated anti-MDA 5 antibody titer. Fiberoptic bronchoscopy showed ulcerations of the trachea and bronchus. Treatment with dose increments of prednisolone combined with other immunosuppressive drugs resulted in improvement of his respiratory condition and tracheobronchial lesions. Clinicians should be aware that tracheobronchial ulcers can be associated with anti-MDA 5 antibody-positive interstitial lung disease. Keywords: Tracheo-bronchial ulcer, Anti-melanoma differentiation-associated gene 5, Interstitial lung disease

Pulmonary tumor thrombotic microangiopathy (PTTM) is rare but should be considered as a possible diagnosis in patients with cancer. In this case, PTTM induced by lung cancer was more accurately diagnosed using cell block immunohistochemistry of pulmonary microvascular cytology (PMC) because we could confirm that lung adenocarcinoma was the origin of PTTM by the positive result of TTF-1 for atypical cells in PMC. The PMC procedure was minimally invasive and safer than lung biopsy. We believe that the cell block technique of PMC should be considered as one diagnostic option in PTTM. Keywords: Pulmonary tumor thrombotic microangiopathy, Pulmonary microvascular cytology, Cell block technique

Background: Multicentric Castleman’s disease (MCD) is a rare polyclonal lymphoproliferative disorder and often involves pulmonary lesions. An infection by a virus called human herpesvirus 8 (HHV-8) is associated with multicentric Castleman disease in about half of people with MCD. Whilst in Japan, most of the cases are associated with negative HHV-8. There is no standard therapy for MCD, and the literature consists mostly of single case reports and small case series. Aim: To analyze the clinical features and treatment options of MCD. Methods: The medical records of patients with MCD from 2008 to 2018 were retrospectively reviewed. Results: Seven patients (male: 2, female: 5) were diagnosed in those 11 years. All were non - HIV. The average age at diagnosis was 45 years. These 7 patients visited hospital because of: cough in 2, arthralgia in 1, chest pain in 1, fever in 1, anemia in 1, and finally chest X-ray abnormality in 1. Radiological findings revealed centrilobular nodules in 6 (86%), septal thickening in 6 (86%), multiple nodules in all (100%), ground glass attenuation in 5 (71%), and cysts in 4 (57%). Laboratory findings for almost all of the patients revealed anemia and elevated serum levels of CRP, IgG. Five patients were treated with steroid and tocilizumab and the remaining 2 had no treatment. Conclusion: The clinical course of MCD varies from stable to progressive. Long term treatment was needed and the combination of tocilizumab with steroid allowed the steroid to be tapered off safely and to successfully prevent the progression of MCD.

Background: Aspiration pneumonia is serious problem of elderly patients. It is important to objectively assess and control the risk factors of aspiration pneumonia. Aim: The purpose of this study was to clarify procedure objectively evaluating the risk of aspiration pneumonia in clinical situation and control them. Methods: We examined 62 elderly adults, aged older than 50 years, who were admitted to our hospital and agreed to participate in this study. We evaluated the number of bacteria in the oral cavity, the oral hygiene situation (OHAT), performance status (PS) and serum biomarker among 3 groups (aspiration pneumonia (AP), community acquired pneumonia(CP), and control). For serum markers, albumin was measured as a factor related to nutrition. CRP, CRP / Alb and WBC were also measured as serological evaluation of inflammatory response. During hospitalization, we conducted oral care by nurses. Result: OHAT score at the time of admission was 5.13±0.178 in the AP group, 4.40±0.255 in the CP group and 3.90±0.216 in the control. PS of the AP group (2.7±1.0) was significantly worse than that of the CP (1.6±0.6) . We also observed significant differences among three groups in BMI, albumin, CRP and WBC. Oral bacterial count (logarithm) in the AP group (7.20±0.110) was significantly greater than that in the CP group (6.89±0.115), which is comparable to OHAT score. In addition, oral bacterial count was significantly reduced by oral care. Conclusion: OHAT and bacterial count are useful for assessing the risk of aspiration pneumonia and the effect of oral care by nurses.

Background Nintedanib is a tyrosine kinase inhibitor that efficiently slows the progression of idiopathic pulmonary fibrosis (IPF) and has an acceptable tolerability profile. In contrast, immune checkpoint inhibitors (ICIs) such as programmed death 1 and programmed death ligand 1 inhibitors have shown clinical activity and marked efficacy in the treatment of non-small cell lung cancer. However, it is unclear whether nintedanib reduces the risk of ICI-induced pneumonitis in IPF. Case presentation A 78-year-old man with squamous cell lung carcinoma in IPF underwent second-line treatment with pembrolizumab. He was diagnosed as having pembrolizumab-induced pneumonitis after two cycles. He was administered prednisolone (PSL) and then improved immediately. Thereafter, his lung cancer lesion enlarged despite treatment with TS-1. Atezolizumab was then administered as 4th-line chemotherapy, but he immediately developed atezolizumab-induced pneumonitis after 1 cycle. The re-escalated dosage of PSL improved the pneumonitis, and then nintedanib was started as additional therapy. Under careful observation with nintedanib, atezolizumab was re-administered on day 1 of an every-21-day cycle. After three cycles, it remained stable without exacerbation of drug-induced pneumonitis. Conclusion This case indicates the possibility that the addition of nintedanib to ICI therapy might prevent drug-induced pneumonitis or acute exacerbation of IPF. However, whether anti-fibrotic agents such as nintedanib are actually effective in preventing ICI-induced pneumonitis in ILD remains unknown and additional research is greatly needed to identify effective therapies for ILD combined with lung cancer.

A sensor using the photothermoelectric effect of graphene is anticipated as a candidate for infrared sensors that can operate at room temperature with fast response and high sensitivity. We investigate photothermoelectric detection and the signal-to-noise characteristics of a sensor with a simple metal–graphene–metal structure numerically and analytically and obtain an analytical expression giving the ideal value of specific detectivity D ∗ for a sensor having an ideal potential distribution. It is found that the optimal sensor length is approximately three times longer than the cooling length and that the value of D ∗ for such a sensor with typical cooling length is estimated to be as large as 106 cm Hz / W. The sensor performance can be greatly enhanced by employing light-confining structures such as cavities and plasmon antennas, achieving D ∗ above 108 cm Hz / W.

A new concept of electrode shape and arrangement is proposed to develop a multi-stage plasma synthetic jet actuator for the low-voltage operation. Exposed and covered electrodes, which have complicated shapes due to electrical wiring to the inner side of annular electrodes, are fabricated by an inkjet printing process using a silver nanoparticle-based ink. The plasma synthetic jet actuator developed in this study can be operated at 1000 V or lower. The discharge spreads uniformly from only the inner side of each annular electrode, inducing a unidirectional ionic wind toward the center of the coaxial electrode circle. Particle image velocimetry measurements reveal that the wall-normal jet induced by the multi-stage plasma synthetic jet actuator can be characterized as an axisymmetric free shear flow. The electrical and mechanical characteristics are similar to the linear-type dielectric-barrier-discharge plasma actuators. We also demonstrate that the printed electronics technique is suitable for the generation of arbitrary electrode shapes and arrangements and hence is a powerful tool for the realization of industrial applications of active airflow control devices using atmospheric pressure discharge.

Successful operation of a multi-stage dielectric-barrier-discharge (DBD) plasma actuator is demonstrated by operating it on voltage one order of magnitude lower than that of a conventional single-stage DBD plasma actuator. An applied voltage waveform of direct current (DC) voltage combined with high-frequency repetitive pulses is generated by a simple power system consisting of a DC power supply and silicon carbide metal-oxide-semiconductor field-effect transistors. The time-averaged flow field obtained by particle image velocimetry indicates that a successively accelerated ionic wind is obtained by the eight-stage DBD plasma actuator. The velocity of the induced ionic wind increases with increasing DC voltage and repetitive pulse frequency. The maximum velocity of approximately 4.5 m s−1 is achieved when the DC voltage of is applied with the switching frequency of , suggesting that the proposed multi-stage DBD plasma actuator induces the same level of ionic wind as a conventional high-voltage-operated single-stage DBD plasma actuator, even with a low voltage.

An 85-year-old man was being treated for advanced squamous cell lung carcinoma with nivolumab as a second-line treatment. From the beginning of the third course, erythema appeared on his trunk and gradually progressed. Around the start of the fifth course, erythema spread to the proximal part of all limbs in addition to the trunk and was accompanied by a strong itching sensation. He was diagnosed as having contact dermatitis by a dermatologist because his rash was observed only where the moisture-absorbing fiber material of his underwear made contact with the skin surface. After suspending treatment of nivolumab, changing his underwear to a cotton material, and using moisturizers and steroid ointments, his rash disappeared in about a month and the size of his lung tumors remained reduced. The patient developed contact dermatitis despite the use of similar underwear without any skin problems for several years. We speculated that nivolumab-induced T-cell activation may have occurred in his skin, making him more likely to develop contact dermatitis, whose onset is thought to involve T-cell activation. No cases of contact dermatitis have been reported previously although the frequency of eruption as an immune-related adverse event is relatively high. When using immune checkpoint inhibitors including nivolumab, clinicians need to pay attention to the occurrence of skin disorders related to T-cell activation.

An 85-year-old woman with antibiotics-resistant pneumonia after surgery for metastatic brain tumor from lung cancer was consulted to our department. Chest CT showed diffuse GGO bilaterally. BALF showed elevated ratios of lymphocytes and CD4/CD8. Tests for bacteria, mycobacteria, and fungi were negative. She improved following levetiracetam discontinuance and systemic corticosteroid administration, and we diagnosed levetiracetam-induced lung injury. Although levetiracetam is widely used, few reports of levetiracetam-induced pneumonia exist. Changes in chest images may occur after levetiracetam administration if patients have multiple risk factors for development of drug-induced interstitial lung disease. Bronchoscopy is useful for differential diagnosis if new lung lesions appear after starting levetiracetam.