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A 78-year-old woman progressively developed right-sided blindness, total ophthalmoplegia, painful facial palsy, and deafness with erythema 8 months before death. MRI showed enlarged right trigeminal nerve with contrast enhancement. FDG-PET showed abnormal uptake from the right trigeminal nerve to optic canal (Figure 1). CSF cytology showed no malignant findings. Skin biopsy showed perineural proliferation of CD20-positive lymphocytic cells (Figure 2). We diagnosed diffuse large B-cell lymphoma. Garcin syndrome is characterized by global ipsilateral cranial nerve palsies without long tract disturbance or intracranial hypertension.1 Few reports have documented Garcin syndrome in neurolymphomatosis.2 Accurate diagnosis is important due to extremely poor prognosis.

In this paper, we describe Wataloricus japonicus gen. et sp. nov. (phylum Loricifera), based on specimens collected during surveys of Japanese waters in the Northwest Pacific conducted onboard the TR/Vs TOYOSHIO MARU and SEISUI MARU. This new loriciferan is placed in the family Pliciloricidae based on the morphology of the adult lorica and Higgins larval internal armature, setae, and toes. It is readily distinguished from other pliciloricid genera by the following combination of characters: adult with a long rigid mouth tube bearing an umbrella-like membrane that extrudes from the mouth opening; a double organ consisting of two untransformed separate spinoscalids; 15 single trichoscalids; and approximately 46 longitudinal folds in the lorica and anal field; and Higgins larva with clavoscalids characterized by ventral swelling and spine-like tip; short unsegmented spinoscalids of the second scalid row; indistinct collar, heavily wrinkled thorax; two pairs of anterior setae; two pairs of posterior setae; and slender toes with sub-terminal swelling. The new genus described herein appears to be synonymous with a previously reported undescribed genus sensu Heiner and Neuhaus (2007) from the Galapagos Spreading Centre, thereby indicating that the geographical distribution of the new genus may at least span the entire Pacific region.

Toxocariasis is a zoonotic helminthiasis caused by the migrating larvae of Toxocara canis and T. cati, common roundworms of dogs and cats. Our previous study in Savannakhet Province of Lao PDR showed an infection rate of 44.1% of Toxocara spp. in dogs. Thus, we investigate if this previous high prevalence in the definitive hosts influenced the occurrence of human toxocariasis. For that we used a 38 kDa recombinant protein derived from T. canis larvae excretion secretion products in ELISA. Human serum samples were collected in the Lahanam area of Savannakhet province. The population attending the study in Lahanam village were aged from 7 to 59 years old (y/o) 65.9% (54/82) were male and 34.1% (28/82) were female. The total percentage of seropositivity to Toxocara sp. was 30.4% (25/82). Males were more likely to test positive for toxocariasis with a risk ratio of 2.70 (CI95 0.87–4.93). No significant differences between ages were seen. However, it was possible to observe an increase of optical density (OD) values in ELISA according to age. The awareness of the health system on the high prevalence of seropositivity to Toxocara sp. in Savannakhet can prevent irreversible consequences as permanent vision loss and seizures caused by this silent chronic disease revealed in the Lahanam area., Highlights • The first survey for human toxocariasis was carried out in Savannakhet, Lao-PDR. • Seropositivity was higher in males than females. • Despite no reported clinical cases of toxocariasis 30.4% of seropositivity was found. • People are at risk of exposure to Toxocara sp. larvae in Savannakhet, Lao-PDR.

Studies on serum leucine-rich alpha-2 glycoprotein (LRG) in inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are scarce; the methods for estimating disease activity are less established, particularly for CD. This study is aimed at evaluating the utility of serum LRG as a potential inflammatory marker for IBD and to investigate the LRG gene expression in peripheral blood mononuclear cells (PBMCs) as a possible source of serum LRG. Overall, 98 patients with UC and 96 patients with CD were prospectively enrolled and clinically evaluated; 92 age-matched individuals served as the healthy controls. The blood samples were analyzed for serum LRG levels and routine laboratory parameters. Disease activity was assessed clinically and endoscopically. Finally, LRG gene expression in the PBMCs from a different cohort (41 patients with UC, 34 patients with CD, and 30 healthy controls) was examined. The serum LRG levels were higher during active disease than during inactive disease; additionally, serum LRG levels were positively correlated with clinical disease activity, C-reactive protein (CRP) levels, and other laboratory parameters in patients with UC and CD and with endoscopic disease activity in UC. UC and CD showed comparable areas under the curve (AUC) values for determining clinical remission and differentiating between endoscopic remission associated with LRG and CRP. The levels of LRG mRNA were also increased in PBMCs from patients with UC and CD and reflected disease activity. These data suggest that serum LRG, originated partially from PBMCs, is an inflammatory marker in UC and CD. A large-scale well-designed study should be conducted in the future to more accurately reveal the clinical significance of LRG in patients with IBD.

We examined the expression profile of transient receptor potential (TRP) channels in peripheral blood mononuclear cells (PBMCs) from patients with inflammatory bowel disease (IBD). PBMCs were obtained from 41 ulcerative colitis (UC) patients, 34 Crohn&rsquo, s disease (CD) patients, and 30 normal subjects. mRNA levels of TRP channels were measured using the quantitative real-time polymerase chain reaction, and correlation tests with disease ranking, as well as laboratory parameters, were performed. Compared with controls, TRPV2 and TRPC1 mRNA expression was lower, while that of TRPM2, was higher in PBMCs of UC and CD patients. Moreover, TRPV3 mRNA expression was lower, while that of TRPV4 was higher in CD patients. TRPC6 mRNA expression was higher in patients with CD than in patients with UC. There was also a tendency for the expression of TRPV2 mRNA to be negatively correlated with disease activity in patients with UC and CD, while that of TRPM4 mRNA was negatively correlated with disease activity only in patients with UC. PBMCs from patients with IBD exhibited varying mRNA expression levels of TRP channel members, which may play an important role in the progression of IBD.

Leukocyte apheresis (LCAP) is a safe and effective treatment for active ulcerative colitis (UC) in Japan. Nevertheless, a limitation of LCAP is its requirement for two puncture sites (double-needle [DN] apheresis), sometimes leading to problems with needle puncture. Single-needle (SN) apheresis is useful in hemodialysis and reduces needle puncture pain. If SN apheresis were found to be useful in LCAP for UC, it may reduce patient burden. The aim of this study was to compare the safety and efficacy of SN apheresis with that of DN apheresis. Twenty-four patients with active UC were retrospectively enrolled. They underwent either SN apheresis (n = 12) or conventional double-needle (DN) apheresis (n = 12) at the Kurume University Hospital from February 2014 to March 2018. At each session, we recorded access problems defined by the time required to initiate apheresis and the frequency of puncture-related problems, as well as blood circuit clotting, defined as clotting necessitating interruption of apheresis and changing of the circuit. Efficacy was assessed using partial Mayo scores. The number of apheresis sessions was comparable between SN and DN apheresis (9.0 ± 2.0 times vs 9.6 ± 1.4 times, mean ± SEM). SN significantly reduced the time required to start apheresis (10.0 ± 5.4 minutes vs 19.4 ± 11.9 minutes, P < .05) as well as needle puncture troubles (0.9% vs 11.5%, P < .05). SN had comparable frequency of blood clotting episodes (5.6% vs 8.7%). SN apheresis had similar clinical efficacy (P < .001 in SN and P < .01 in DN). The improvement and remission rates were comparable between groups. SN apheresis may be safe and effective and may reduce patient burden during UC treatment. Nevertheless, further comparative studies are needed.

Introduction Granulocyte and monocyte apheresis (GMA) is an effective treatment strategy for active ulcerative colitis (UC) in Japan. Single needle (SN) apheresis reduces needle puncture pain in patients because it requires only one puncture site. We evaluated whether single-needle apheresis could be a safe and effective means of reducing patient burden. Method We performed a retrospective study of active UC patients who were treated with either SN apheresis or conventional double-needle (DN) apheresis at the Kurume university hospital from April 2014 to March 2018. All the patients treated with GMA after September 2016 underwent SN apheresis. Thus, the two groups predominantly belonged to different time periods. We assessed the safety of SN apheresis. Result Six patients underwent SN apheresis, and 6 underwent DN apheresis. The average time to the start of apheresis was significantly reduced from 23.1 minutes in the case of DN apheresis to 12.6 minutes for SN apheresis. In addition, the number of difficult punctures was significantly reduced with SN apheresis. There were no differences in adverse events between SN and DN apheresis. Treatment benefits, remission rate and disease activity were similar between SN and DN apheresis. Conclusion SN apheresis reduced both the time to treatment initiation and pain during puncture, and there was no difference in the number of blood clotting episodes as compared with DN. Although further comparative studies are needed, SN apheresis may be a safe alternative for patients to reduce the strain of treatment.

Gastrointestinal parasite infections in livestock and companion animals in Mongolia have not been investigated sufficiently. This study aimed to determine the prevalence of cyclophyllid cestodes (Taeniidae and Mesocestoididae) in Mongolian sheepdogs using copro-DNA analysis. Sheepdog fecal samples (n = 1242) were collected from five ecological zones (mountain taiga, forest-steppe, steppe, desert-steppe, and desert) and four geographical regions (Western, Khangai, Central, and Eastern) within 20 of the country's 21 provinces. Among the 1242 samples, 201 (16.2%) tested positive for mitochondrial cytochrome c oxidase subunit 1 (cox1) and ribosomal 12S rRNA encoding genes of cyclophyllid cestodes. Prevalence in the mountain taiga, forest-steppe, steppe, desert-steppe, and desert zones was 29.2%, 15.4%, 15.1%, 20.1%, and 9.1%, respectively. Prevalence in the Western, Khangai, Central, and Eastern regions was 19.9%, 18.6%, 12.1%, and 12.8%, respectively. Taenia hydatigena, Taenia multiceps, and two Mesocestoides species (Mesocestoides sp.1 and Mesocestoides sp.2) were identified. T. hydatigena was found in the samples from all 20 provinces (all five zones and four regions), while T. multiceps was detected in the samples from 19 provinces (all five zones and four regions). Mesocestoides sp.1 infection was detected in the samples from all zones (except desert) and regions; it was detected in 14 provinces. Mesocestoides sp.2 infection was detected in the samples from all zones (except mountain taiga) and regions and found in seven provinces. Cyclophyllidea infection in sheepdogs is highly prevalent across Mongolia, representing a zoonotic risk. Implementation of a surveillance program for sheepdogs and their owners, and the wild animals in all ecological zones should be considered. In addition, control measures, including public awareness campaigns, especially for sheepdog owners, and periodic deworming of sheepdogs are warranted.

Introduction Camptocormia (severe bending of the spine) is a debilitating complication of Parkinson’s disease (PD) without established treatment. Botulinum toxin (BT) may be beneficial, but data is scarce regarding the efficacy of administration of BT into the bilateral external oblique (EO) muscle for treatment of camptocormia in PD. Methods Six patients with PD and camptocormia, with flexion of the thoracic spine, were enrolled in the study. BT (75 or 90 units, onabotulinum toxin A) were injected into each EO bilaterally under sonographic guidance. Camptocormia angle (CA) was defined as the angle between the acromion-greater trochanter line and a vertical line. CA and disabling symptoms were evaluated during the treatment course. Results Two weeks after the injection of BT, the mean CA showed significant attenuation [median (interquartile range); 38° (23.5°) vs. 18° (21°), p = 0.028]. Subjective relief was present in cases 1–3 and 6, and absent in cases 4 and 5. Cases 1–3 received repeated injections to maintain the amelioration; in cases 1 and 2, this was for 1 year or longer, while falls of case 3 limited the amelioration. Conclusion Botulinum therapy into bilateral EO attenuated the angle of thoracic-level camptocormia in six patients with PD over the observation period of 2 weeks. The reproducibility of the results, long-term efficacy, and subjective relief of symptoms require further examination.

The threat from this disease, the most common cestodiasis in Japan, is increasing because of globalization and lack of awareness., We report 958 cases of cestodiasis occurring in Japan during 2001–2016. The predominant pathogen was Diphyllobothrium nihonkaiense tapeworm (n = 825), which caused 86.1% of all cases. The other cestode species involved were Taenia spp. (10.3%), Diplogonoporus balaenopterae (3.3%), and Spirometra spp. (0.2%). We estimated D. nihonkaiense diphyllobothriasis incidence as 52 cases/year. We observed a predominance of cases during March–July, coinciding with the cherry salmon and immature chum salmon fishing season, but cases were present year-round, suggesting that other fish could be involved in transmission to humans. Because of increased salmon trade, increased tourism in Japan, and lack of awareness of the risks associated with eating raw fish, cases of D. nihonkaiense diphyllobothriasis are expected to rise. Therefore, information regarding these concerning parasitic infections and warnings of the potential risks associated with these infections must be disseminated to consumers, food producers, restaurant owners, physicians, and travelers.

Kinorhynchs rarely show a wide distribution pattern, due to their putatively low dispersal capabilities and/or limited sampling efforts. In this study, a new kinorhynch species is described,Echinoderespterussp. n., which shows a geographically and bathymetrically wide distribution, occurring on the Karasik Seamount and off the Svalbard Islands (Arctic Ocean), on the Sedlo Seamount (northeast Atlantic Ocean), and on the deep-sea floor off Crete and on the Anaximenes Seamount (Mediterranean Sea), at a depth range of 675–4,403 m. The new species is characterized by a combination of middorsal acicular spines on segments 4–8, laterodorsal tubes on segment 10, lateroventral tubes on segment 5, lateroventral acicular spines on segments 6–9, tufts of long hairs rising from slits in a laterodorsal position on segment 9, truncated tergal extensions on segment 11, and the absence of any type-2 gland cell outlet. The specimens belonging to the populations from the Arctic Ocean, the Sedlo Seamount, and the Mediterranean Sea show morphological variation in the thickness and length of the spines as well as in the presence/absence of ventromedial sensory spots on segment 7. The different populations are regarded as belonging to a single species because of their overlapping variable characters.

Stroke patients suffer from declined physical ability, and it is important to analyze rehabilitation intervention and clarify its effect on the motion of patients. In this study, the effect of intervention on the standing-up motion of stroke patients is investigated. First, the intervention timing of a physical therapist (PT) is analyzed quantitatively from the muscle activity of upper limbs during therapy. Next, the intervention effect is evaluated based on body kinematics and muscle synergy. In this study, twenty trials are conducted, in which the standing-up motion of hemiplegic patients (n=12) is measured with and without the intervention by a PT. The results show that PTs teach hemiplegic patients the timing of lifting their buttocks during standing-up motion. Furthermore, it has been found that this intervention could improve the standing-up motion, although stroke patients had inadequate muscle synergy structure. In particular, some patients had delayed activation of the synergy and they could only stood up after they moved their center of mass toward their feet. However, the intervention by PTs could induce earlier activation of the synergy. Moreover, the intervention could properly shorten the activation duration of muscle synergy for those who had unusually inappropriate longer activation of synergy. These results imply that disordered and inadequate muscle synergy structure can be improved by proper intervention, and this study contributes to the further development of new rehabilitation methodologies.

The muscle-synergy hypothesis is a widely used method for describing simple motion patterns and how the central nervous system deals with the complexity of controlling a large set of muscles in parallel. However, the physiological interpretation of synergies and the mathematical techniques behind their computation are still far from being properly standardized. This letter proposes a novel approach to obtaining detailed and accurate information about how muscular synergies are triggered during different stages of a given motion. In that regard, a way to find the number of muscle synergies working in parallel is introduced based on the appearance of unexpected high-frequencies in the time series of electromyographic (EMG) signals during synergy extraction. This phenomenon allows the definition of a robust threshold for the number of synergies. The proposed methods are tested on muscle synergies computed from superficial EMG signals recorded during wheel steering. The results show the advantage of the proposed approach in relation to the currently used methods that require segmenting the signal according to the stages of the movement, and suggest future increases in the understanding of motor control from a neurological point of view.

BACKGROUND AND AIM Proteinase 3 antineutrophil cytoplasmic antibodies (PR3-ANCAs) are well-known serological markers for granulomatosis with polyangiitis, but their role as serological markers for inflammatory bowel disease remains uncertain. The present study aimed to evaluate the diagnostic and clinical role of PR3-ANCAs as markers for inflammatory bowel disease. METHODS Using a new methodology with chemiluminescence enzyme immunoassay, serum PR3-ANCA titers were assessed in 102 patients with ulcerative colitis (UC), 67 patients with Crohn's disease (CD), 44 controls with other intestinal diseases, and 66 healthy controls. Associations with clinical data were investigated. The diagnostic role of PR3-ANCAs was evaluated by receiver operating characteristic analysis. RESULTS Proteinase 3 antineutrophil cytoplasmic antibody titers were significantly higher in patients with UC than in those with CD patients, patients with intestinal diseases (intestinal controls), and healthy controls (all P

Echinoderes komatsui (Kinorhyncha: Cyclorhagida) is a meiobenthic animal inhabiting the interstitial spaces of the sediment on a subtropical tidal flat along the Oura River, Japan. This species mostly occurred within 0–10 mm from the surface of the sediment, and the dispersion pattern was significantly patchy. The population dynamics of E. komatsui were investigated by monthly surveys from January 2014 to May 2016 at four sites along the river, and from April 2015 to May 2016 at one site in the mangrove forest. Echinoderes komatsui occurred all year round; however, the population density showed different patterns among the sampling sites in response to seasonal changes. On the tidal flat, the population density was high in winter, but very low in summer. In the mangrove forest, the density was high (or not low) throughout the year. As was shown in laboratory experiments, E. komatsui survived in 1–44 salinity seawater but died at 0 (salinity experiments), and died within 4.5 days at 40°C (temperature experiments). Therefore, the low population density recorded in summer on the tidal flat was likely caused by high temperature and fresh water. The shade offered by the mangrove forest suppressed the increase in temperature of the sediment in the summer, probably resulting in the higher population density at this site relative to the tidal flat population. Mangrove forests may also mitigate the disturbance of the sediment by summer typhoons and serve as stable environments that are fundamental in the sustainability of estuarine meiobenthic fauna.

Background: Although muscle ultrasound (MUS) is known to facilitate the diagnosis and evaluation of the severity of amyotrophic lateral sclerosis (ALS), the number of fasciculation has been scarcely examined as a predictive marker of the prognosis in ALS. Objective: The objective of this study was to examine the predictive value of fasciculation number for the prognosis of ALS. Materials and Methods: We examined fasciculation count (FasC), defined as the number of fasciculation per unit of time and area in MUS, of 11 patients with clinically probable or definite ALS. Thereafter, they were observed for maximally 2 years, unless they reached the endpoint of decease or receiving tracheostomy. Results: Six patients, who thereafter reached the endpoint within 2 years, had significantly higher FasC (223 [49.3] vs. 34 [13], P = 0.0043) and shorter disease duration (7 [2.3] vs. 33 [17], P = 0.0022) at MUS than the remaining five patients without reaching the endpoint. Discussion and Conclusion: Our study suggested that high FasC in MUS can predict rapid progression in ALS. Due to the limitations such as small sample size, suboptimal length of the observational period, and confounding factor of disease duration, further investigations are required.

A 92-year-old Japanese woman presented with a mass in the left breast, and sparganosis was suspected by biopsy of the mass. The mass disappeared once, but it reappeared at the same site one year later. For a definitive diagnosis, the mass was surgically removed, and a sparganum-like worm was detected. The causative agent was confirmed as Spirometra Type I (most probably Spirometra mansoni) by mitochondrial DNA analysis. The serological examination also proved the case as sparganosis. Considering the presence of two Spirometra species (Type I and II) in Asia, particularly Japan, molecular analysis of the causative agents is highly recommended to understand the epidemiology, infection sources, and pathogenicity in humans in both species, if the parasite specimens are available.

This report describes 33 confirmed cases of "Taenia asiatica" taeniosis in Tokyo, Japan, and six adjacent prefectures between 2010 and 2019. Of the 33 cases, 28 were domestic infections. Thirty patients had histories of eating raw pork and/or beef liver. It was highly suspected that the sources of infection were foreigners from T. asiatica-endemic countries who had worked on pig farms in these prefectures. We postulated that the rate of domestic infection has decreased as a result of legal regulations that have banned the serving of raw and undercooked pig and cattle viscera in restaurants in Japan. Haplotype analyses of genetic markers revealed that "T. asiatica" in Japan are the descendants of hybrids of T. asiatica and Taenia saginata that originated from the Philippines and/or Taiwan. It is critical that close attention continues to be paid to domestic recurrences and imported cases of T. asiatica taeniosis, with the goal of communicating information on risk factors for this infection to consumers, pig farmers, restaurant owners, physicians, and visitors coming to Japan.

The aim of the present study was to quantify calprotectin levels using an enzyme-linked immunosorbent assay (ELISA) and a point-of-care test (POCT) in patients with inflammatory bowel disease. Overall, 113 patients with ulcerative colitis (UC; 51 men and 62 women) and 42 patients with Crohn's disease (CD; 29 men and 13 women), who were scheduled to undergo a colonoscopy, were prospectively enrolled and scored endoscopically and clinically. An additional 96 healthy, age-matched subjects served as the normal controls. Feces and blood samples from the patients with UC and CD, and the normal controls were analyzed. These patients had received adequate medical treatment. The tissue distribution of calprotectin was investigated using immunohistochemistry. The fecal calprotectin levels, as measured using an ELISA, were correlated with the endoscopic and clinical disease activities and laboratory parameters, including serum levels of hemoglobin (Hb), albumin and C-reactive protein, and erythrocyte sedimentation rate, particularly among the patients with UC. The fecal Hb level was close to that of the fecal calprotectin level (r=0.57; P

Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients. We retrospectively assessed racial differences in health status using responses to the Peripheral Arterial Questionnaire (PAQ) at baseline (pre-PVI) and up to 6 months following PVI among 387 patients. We used the PAQ summary score (which includes physical limitation, symptoms, social function and quality of life) as a measure of QOH. We compared QOH scores at baseline and at follow-up after PVI between black ( n=132, 34.1%) and white ( n=255, 65.9%) patients. We then computed the change in score from baseline to follow-up for each patient (the delta) and compared the median delta between the two groups. Multivariable regression was used to model the delta QOH after controlling for factors associated with race or with the delta QOH. There was no significant difference in mean QOH by race either at baseline ( p=0.09) or at follow-up ( p=0.45). There was no significant difference in the unadjusted median delta by race (white 25.3 vs black 21.5, p=0.28) and QOH scores improved significantly at follow-up in both groups, albeit the improvement was marginally lower in black compared with white patients after adjustment for baseline confounders ( b = −6.6, p=0.05, 95% CI −13.2, −0.11).

We first constructed and characterized the complete mitochondrial genome (mitogenome) sequence of Diphyllobothrium stemmacephalum, the type species of genus Diphyllobothrium, using next generation sequencing (NGS). The mitogenome of D. stemmacephalum was 13,716bp, including 12 protein-coding genes, 22 tRNA genes, 2 rRNA genes and 2 longer intergenic non-coding regions, and has features common to mitogenomes of other cestodes. Although it has been accepted that tRNA for serine (trnS2(UCN)) in Platyhelminthes lacks a D arm, the trnS2(UCN) of D. stemmacephalum was predicted to have a paired D arm as in Diplogonoporus balaenopterae. The non-coding region 2 contained eight tandem repeat units (34nucleotides/unit). This study also corroborated that D. stemmacephalum is phylogenetically more closely related to Dip. balaenopterae than to Diphyllobothrium latum and Diphyllobothrium nihonkaiense. As demonstrated here, mitogenome sequence data obtained using NGS is useful for gaining a better understanding of the systematics, phylogeny and taxonomic revisions involving valuable specimens preserved in museums, universities or research institutes for which sequence data are not yet available, and also for making diagnoses based on clinical samples.

A novel method of forecasting bifurcations based on only the observation of the pre-bifurcation regime is proposed. The method is an extension of previous approaches with a focus on oscillatory systems. The method also enables the use of much less measurement data. Numerical results are presented to demonstrate that this new approach predicts the post-bifurcation regime accurately and to explore the robustness of this method to process noise.

Bleeding is the most important clinical outcome in patients with immune thrombocytopenia (ITP), and the goal of therapy in such cases is to treat or prevent bleeding. The frequency of and risk factors for bleeding events in ITP have only recently been identified in several large-scale studies. However, there is little published information about severe life-threatening bleeding in ITP. To clarify the clinical features of life-threatening bleeding in patients with primary ITP, we systematically reviewed the medical records of all ITP patients that were admitted to our hospital between January 1, 1992, and December 31, 2015. Of 169 consecutive inpatients with primary ITP, 8 suffered life-threatening bleeding (10 episodes: gastrointestinal, 4 cases; pulmonary, 1 case; and intracranial, 5 cases). All of these patients were ≥ 60 years of age and had platelet counts of

Patients with longstanding ulcerative colitis have an increased risk of colorectal cancer. Mouse models for colitis-associated tumors are indispensable for the development of novel strategies for prevention and intervention, as well as an improved understanding of the mechanisms underlying tumor formation. The present study examined whether stereomicroscopic observations with dye-application were able to detect and discriminate tumors in a colitis-associated tumor model in mice. Colonic tumors were induced in C57BL/6 mice by 15 cycles of treatment with dextran sulfate sodium (DSS) in drinking water. The mice were then divided into 4 groups: normal mice fed a control diet, normal mice fed an iron-supplemented diet, 0.7% DSS mice fed an iron diet and 1.5% DSS mice fed an iron diet. The entire colons were characterized with respect to both morphology and histology. The pit pattern architecture was analyzed using stereomicroscopy with dye agents (0.2% indigo carmine or 0.06% crystal violet). The tumor histology was graded as negative, indefinite or positive for dysplasia. The positive category was divided into two subcategories: low-grade dysplasia (LGD) and high-grade dysplasia (HGD). The tumor incidences and multiplicity were significantly higher in mice fed an iron diet and 1.5% DSS compared with in mice fed an iron diet and 0.7% DSS. Compared with LGD, HGD was predominantly located in the distal colon, was larger in size and had a higher incidence of elevated lesions (Is and IIa) and a lower incidence of flat lesions (IIb). In regards to the pit pattern, HGD had a high incidence of VI pits and a low incidence of IV, IIIL and II pits. In conclusion, evaluation of the pit pattern using stereomicroscopy with dye-application is useful for detecting and discriminating neoplastic changes in DSS mice and may further our understanding of the mechanisms that induce tumor formation in patients with ulcerative colitis and the characterization of pharmaceutical responses.

We described 4 human infection cases of zoonotic fish-tapeworm, Diphyllobothrium nihonkaiense, identified with morphological and molecular characters and briefly reviewed Chinese cases in consideration of it as an emerging parasitic disease in China. The scolex and mature and gravid proglottids of some cases were seen, a rosette-shaped uterus was observed in the middle of the mature and gravid proglottids, and the diphyllobothriid eggs were yellowish-brown in color and displayed a small knob or abopercular protuberance on the opposite end of a lid-like opening. The average size of the eggs was recorded as 62-67×42-45 μm. The parasitic materials gathered from 4 human cases were morphologically identified as belonging to the genera Diphyllobothrium and Adenocephalus. The phylogenetic analysis based on the nucleotide sequences of cytochrome c oxidase subunit 1 gene of the etiologic agents confirmed that the 4 cases were D. nihonkaiense infection. The finding of 4 additional D. nihonkaiense cases suggests that D. nihonkaiense might be a major causative species of human diphyllobothriasis in China. A combined morphological and molecular analysis is the main method to confirm D. nihonkaiense infection.

Two new species of the genus Tubiluchus (Priapulida) are described from marine sediments in Japan. Both species were found to differ in a number of fine structural characters (the pharyngeal teeth, the buccal tube and the scalids) from previously described species. Tubiluchus soyoae n.sp. differs from other species by the structure of the male genital region, a size-increase of scalids from anterior to posterior and the structure of scalids in the first ring. There are no anterior buccal papillae. Pharyngeal teeth possess the usual two combs and those of the anterior ring possess an additional third comb which is unknown from other species. Intraspecific variability of 18S rDNA and COI sequences was low (0.17% and 0.76%, respectively), but interspecific variability of 18S rDNA was 1.43–3.32% within the genus. Tubiluchus pardosi n.sp. differs from other species by the fine structure of scalids, in particular the division into a basal part with smooth cuticle and a distal part with fine cuticular hairs. Further differences are in the structure of the pharyngeal teeth in the anterior ring, the transition between pectinate teeth and fimbrillae and in the structure of the buccal tube.

A new armoured marine tardigrade, Nodarctus hallucis gen. et sp. nov., is described from specimens collected from sandy beaches of Haterumajima, Ishigakijima and Okinawajima Islands, Ryukyu Archipelago, Japan. It is a member of the rare family Renaudarctidae, which is characterized by a stocky body with dorsal and ventral plates and stumpy legs with digits, claws and accessory filaments. However, the collected animals have prominent characters that differ from the two known species of the family: subdivided dorsal segmental plates I–III lacking lateral processes, an acute caudal spike, indented sensory plates, short spikes and peculiar papillae on legs I–III, basal spikes of legs IV and only two digits on legs IV. These differences justify the erection of a new genus and species for the animal. Morphological affinities with other marine taxa, the function of the leg papillae and the distribution pattern of the new species are discussed.http://zoobank.org/urn:lsid:zoobank.org:pub:041878AA-B437-45BF...

The electrospray is an injection system which is using the high electric potential to cause the liquid atomization without traditional pressure force. This investigation reports the difference of electrode distances between the capillary and wire-netting effect on electrostatic atomization from bio-emulsified fuel. The well-known biofuel, such as biodiesel fuel (BDF), which is expected as carbon neutral fuel and contained water remained in the production phase, thus, making the biodiesel as emulsified fuel can take advantage of water fractions to provide low temperature condition (LTC) and result in the reduction of nitrogen oxide (NOx) emission. In addition, the viscosity of emulsified fuel is depending on the class of surface-active agent, nevertheless the emulsified fuel has the large electric conductivity which can be used in electric potential supplied to control and atomize into several particles. In this paper, the breakup and atomization process of bio-emulsified fuel was investigated with the different electrode distances to estimate the effects of electric field. The atomization mode and injection angle is reported in deal. Furthermore, as the electric field distribustion is estimated with the droplet movement and effect of electric field on the atomization mode is dicussed in this paper.

Birt-Hogg-Dubé syndrome (BHDS) is usually diagnosed at the incidence of pneumothorax. A 65-year-old male fell from the stairs in his house and was injured. Chest computed tomography (CT) revealed fractures of right 1st rib and sternum and hematoma in mediastinum. Irregular shaped pulmonary cyst on the interlobar, mediastinal and diaphragm surface were found by chest CT. White-toned papules were observed from right nosewing to the neck. By biopsies, it was diagnosed fibrofolliculomas. Genetic analysis showed substitution in the folliculin gene confirming the diagnosis of BHDS.

Background Prevalence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists. Although there are several modalities available in treating calcified coronary arteries, lesion preparation of certain heavily calcified vessels remains inadequate prior to stent deployment and/or often associated with worse periprocedural adverse outcomes. Case summary We report feasibility and safety of 3.5 mm peripheral intravascular lithotripsy (IVL) for the treatment of severely calcified coronary stenosis in two patients after orbital atherectomy failed to debulk calcified plaque to enable stent deployment. Discussion Intravascular lithotripsy has recently emerged as a therapeutic option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres in the USA. Studies are ongoing in the safety and efficacy of this technology in treating coronaries.

The aim of this study was to describe the performance and outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in Michigan.CTO PCI has been associated with reduction in angina, but previous registry analyses showed a higher rate of major adverse cardiac events with this procedure.To study uptake and outcomes of CTO PCI in Michigan, patients enrolled in the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry (2010 to 2017) were evaluated. CTO PCI was defined as intervention in a 100% occluded coronary artery ≥3 months old.Among 210,172 patients enrolled in the registry, 7,389 CTO PCIs (3.5%) were attempted, with 4,614 (58.3%) achieving post-procedural TIMI (Thrombolysis In Myocardial Infarction) flow grade 3. The proportion of PCIs performed on CTOs increased over the study period (from 2.67% in 2010 to 4.48% in 2017). Thirty of 47 hospitals performed50 CTO interventions in 2017. Pre-procedural angina class ≤2 was present in one-quarter, and functional assessment for ischemia was performed in 46.6% of patients. Major complications occurred in 245 patients (3.3%) and included death (1.4%), post-procedural stroke (0.4%), cardiac tamponade (0.5%), and urgent coronary artery bypass graft surgery (1.3%). Procedural success improved modestly from 44.5% in 2010 to 54.9% in 2017 (p for trend 0.001). Rates of in-hospital mortality (p for trend = 0.247) and major adverse cardiac event (p for trend = 0.859) for CTO PCI remained unchanged over the study period.The rate of CTO PCI in Michigan increased over the study period. Although the success rate of CTO PCI has increased modestly in contemporary practice, it remained far below the80% reported by select high-volume CTO operators. The rate of periprocedural major adverse cardiac events or death remained unchanged over time. These data suggest room for improvement in the selection and functional assessment of CTO lesions before subjecting patients to the increased procedural risk associated with CTO PCI.

Sit-to-stand (STS) motion is an important daily activity, and many post-stroke patients have difficulty performing STS motion. Previous studies found that there are four muscle synergies (synchronized muscle activations) in the STS motion of healthy adults. However, for post-stroke patients, it is unclear whether muscle synergies change and which features primarily reflect motor impairment. Here, we use a machine learning method to demonstrate that temporal features in two muscle synergies that contribute to hip rising and balance maintenance motion reflect the motor impairment of post-stroke patients. Analyzing the muscle synergies of age-matched healthy elderly people ( $n = 12$ ) and post-stroke patients ( $n = 33$ ), we found that the same four muscle synergies could account for the muscle activity of post-stroke patients. Also, we were able to distinguish post-stroke patients from healthy people on the basis of the temporal features of these muscle synergies. Furthermore, these temporal features were found to correlate with motor impairment of post-stroke patients. We conclude that post-stroke patients can still utilize the same number of muscle synergies as healthy people, but the temporal structure of muscle synergies changes as a result of motor impairment. This could lead to a new rehabilitation strategy for post-stroke patients that focuses on activation timing of muscle synergies.

Chronic infections with the food-borne liver flukes, Opisthorchis viverrini or Clonorchis sinensis, associate with cholangiocarcinoma, bile duct cancer, which generally has a poor prognosis. We have produced a rapid and simple immunochromatographic test (ICT) kit for the diagnosis of opisthorchiasis and clonorchiasis by the detection of IgG antibodies in human infection sera. Sera from volunteers with proven opisthorchiasis and several other parasitic diseases and from healthy controls were evaluated for the presence of liver fluke infection-specific antibodies using a preparation of excretory-secretory antigen from adult stage O. viverrini absorbed onto ICT strips. Diagnostic values were compared with an ELISA. The diagnostic sensitivity, specificity, and positive and negative predictive values of the ELISA were 100%, 98.3%, 97.9%, and 100%, whereas those for the ICT were 94.6%, 91.2%, 89.7%, and 95.4%, respectively. There was 91.7% concordance between the ICT with ELISA, and differences in performance between the tests were not statistically significant (P > 0.05). Twenty-seven of 30 (90%) of the clonorchiasis sera also were positive by ICT. This new ICT provides a facile, rapid test for point-of-care testing tool, which can be used at the bedside without the need for sophisticated equipment. Moreover, the ICT can be anticipated to supplement stool examination as a screening tool in the clinic for the diagnosis of opisthorchiasis and clonorchiasis, and in addition, it may be useful in screens of populations at risk of liver fluke infection-associated cholangiocarcinoma.

Averaging electromyographic activity prior to muscle synergy computation is a common method employed to compensate for the inter-repetition variability usually associated with this kind of physiological recording. Capturing muscle synergies requires the preservation of accurate temporal and spatial information for muscle activity. The natural variation in electromyography data across consecutive repetitions of the same task raises several related challenges that make averaging a non-trivial process. Duration and triggering times of muscle activity generally vary across different repetitions of the same task. Therefore, it is necessary to define a robust methodology to segment and average muscle activity that deals with these issues. Emerging from this need, the present work proposes a standard protocol for segmenting and averaging muscle activations from periodic motions in a way that accurately preserves the temporal and spatial information contained in the original data and enables the isolation of a single averaged motion period. This protocol has been validated with muscle activity data recorded from 15 participants performing elbow flexion/extension motions, a series of actions driven by well-established muscle synergies. Using the averaged data, muscle synergies were computed, permitting their behavior to be compared with previous results related to the evaluated task. The comparison between the method proposed and a widely used methodology based on motion flags, shown the benefits of our system maintaining the consistency of muscle activation timings and synergies

Introduction The number of inflammatory bowel disease (IBD) patients is increasing steadily in Japan, and it is expected that patient groups and patient education will improve the quality of life of patients and IBD care. The 1st Kurume University IBD Center educational lecture was held and a questionnaire survey was administered at this lecture. Methods We asked 78 participants to answer a questionnaire survey on the occasion of the 1st Kurume University IBD Center educational lecture. Results We obtained responses from 56 (71.8%) participants; 31 (55.4%) had IBD [21 (37.4%) had ulcerative colitis (UC) and 10 (17.9%) had Crohn's disease (CD)]. Most participants were female (37, 66%). The age range with the highest number of participants was 40 to 69 (27, 48.2%). Most had heard about this educational lecture through "notification by the patient's doctor" 23 (41.1%). A total of 30 (53.6%) of participants answered "good" about the lecture content, while 50 (89.7%) of participants answered "very good" and "good" about the impression of this lecture. Meanwhile, 10 (32.3%) of patients were interested in patient groups. The percentage of patients who were interested in patient groups was higher in patients with CD 4 (66.7%) than those with UC 2 (33.3%). Conclusion We held the 1st Kurume University IBD center educational lecture. Further studies are needed to assess whether educational lectures and/or patient groups can improve patients' quality of life (QOL) and IBD care in our hospital.

The description of a new representative of the species-poor genus Condyloderes Higgins, 1969 from the Northeast Pacific (Alaska) is reported. The analyzed specimens of Condyloderes shirleyi sp. nov. showed a significant variation of numerous morphological characters, along with female-specific traits known also from other congeneric species. These findings stimulated the re-investigation of the type material of the six species of Condyloderes described so far, i.e., C. kurilensis Adrianov & Maiorova, 2016, C. megastigma Sørensen, Rho & Kim, 2010b, C. multispinosus (McIntyre, 1962) Higgins, 1969, C. paradoxus Higgins, 1969, C. setoensis Adrianov, Murakami & Shirayama, 2002, and C. storchi Higgins, 2004 in Martorelli & Higgins, 2004. Our study allowed to reveal various morphological novelties and to emend the diagnosis of these species and of the genus Condyloderes. Furthermore, our analysis led to synonymize C. megastigma with C. setoensis. The results of our investigation about the significant variation in C. shirleyi sp. nov. raise a wider question on species identity within Kinorhyncha, underscoring the necessity, if possible, to describe new species from a higher number of specimens and to concentrate on the morphological variation of the going-to-be-described species.

Kinorhyncha is a phylum of microscopic, benthic marine invertebrates found throughout the world, from the Arctic to Antarctica and from the intertidal zone to the deep sea. Within the most species-rich genus, Echinoderes, we find a putatively monophyletic species group, the so-called Echinoderes coulli-group. The remarkable morphological similarities of the E. coulli-group species and the fact that the group has a global distribution even though most of the species are restricted to intertidal habitats, has led to the hypothesis that dispersal and speciation within the group has been driven by the process of continental drift. However, this has never been confirmed empirically. With morphology and two molecular loci, COI and 18S, we calculated phylogenetic trees by analysing datasets separately and in combination using Maximum Parsimony, Maximum Likelihood and Bayesian Inference. Using different models of evolution in combination with different statistical approaches, we show that two major clade divergences were consistent with historic drifting of continents, suggesting that vicariance has played an important role for the speciation within the E. coulli-group. Furthermore, we found that reconstructions of past tectonic drifting since the Devonian (416–359 million years ago) were able to explain present species distributions, and suggest that the group originated in a supposedly vast shallow marine environment in north-eastern Gondwana by the mid-late Silurian, 426–416 million years ago.

Background: The new curcumin derivative, Theracurmin® has a 27-fold higher absorption rate than the natural curcumin powder. Its pharmacologic actions include inhibition of the nuclear factor NF-κB, known to mediate the expression of inflammatory cytokines. We were interested to evaluate efficacy of Theracurmin® in patients with Crohn's disease (CD). Methods: Theracurmin® (360mg/day, n=20) or placebo (n=10) was administered to patients with active mild to moderate CD for 12 weeks. Efficacy assessment included clinical and endoscopic remission, healing of anal lesions, and blood levels of inflammatory markers. Findings: In the Theracurmin® group, significant reduction of clinical disease activity was observed at 12 weeks relative to week 0 (P=0.005). The clinical remission rates were 35%, 40%, and 40% at weeks 4, 8, and 12, respectively, significantly higher than in the placebo group (P=0.033, P=0.020, and P=0.020). Further, in the Theracurmin® group, significant healing of anal lesions (P=0.017) and endoscopic CD severity (P=0.032) were observed at weeks 8 and 12, respectively, relative to week 0. However, the mucosal healing rate at week 12 in the Theracurmin® group was 15.0%. No serious adverse event was observed in either group throughout our observation time. Interpretation: In this study, Theracurmin® in patients with active mild to moderate CD produced significant clinical and endoscopic efficacy together with a favourable safety profile. Trial registration: UMIN000015770 Funding Statement: Theracurmin® was a gift from Theravalues Corporation, Tokyo, Japan. The authors received no external funding for this study. Declaration of Interests: All authors acknowledge having no conflict of interest in connection with the publication of this manuscript. Ethics Approval Statement: At each institution, the study protocol was reviewed and approved by the committee on the Ethics of Clinical Trials involving human subjects. Further, the trial was conducted by adherence to the principles of Good Clinical Practice (GCP) and the ethical standards laid down in the 1964 Helsinki Declaration and its subsequent amendments. Similarly, informed consent was obtained from all patients after explaining the purpose of the study and the nature of the procedures involved.

Human gnathostomiasis is a harmful food-borne zoonosis caused by roundworms of the genus Gnathostoma. The parasite can occasionally migrate to the central nervous system, causing life-threatening disease and death. Here, we report a new point-of-care (POC) test kit, the gnathostomiasis blood immunochromatographic test (GB-ICT) kit. The kit is based on recombinant Gnathostoma spinigerum antigen and detects specific IgG4 antibody in whole-blood samples (WBSs). The GB-ICT kit showed potentially high diagnostic values with simulated WBSs (n = 248), which were obtained by spiking patients’ sera with red blood cells. The accuracy, sensitivity, specificity, and positive and negative predictive values were 95.2%, 100%, 93.8%, 81.5%, and 100%, respectively. Ten WBSs from clinically suspected gnathostomiasis patients were all positive according to the GB-ICT kit, while 10 WBSs from healthy volunteers were negative. The GB-ICT kit is a simple and convenient POC testing tool using finger-prick blood samples: venous blood sampling and serum separation processes are not required. The GB-ICT kit can support clinical diagnosis in remote areas and field settings without sophisticated equipment facilities.

Despite considerable controversy concerning the taxonomy of species within the genus Spirometra, human sparganosis and spirometrosis mainly in Asia and Europe has long been confidently ascribed to Spirometra erinaceieuropaei. Recently, the mitochondrial genomes of purported “S. erinaceieuropaei”, “Spirometra decipiens” and “Spirometra ranarum” from Asia have been determined. However, it has been pointed out that the morphological criteria used for identifying these species are unsuitable and thus these identifications are questionable. In the present study, therefore, Spirometra samples from Asia were re-examined based on mitochondrial cytochrome c oxidase subunit 1 gene sequences and the identification of these species was discussed. Haplotype network and phylogenetic analyses revealed that: i) two distinct Spirometra species, Type I and Type II, are present in Asia and neither of which is close to likely European “S. erinaceieuropaei”; ii) Type I is genetically diverse and widely distributed, however Type II is known so far from Japan and Korea; iii) “S. decipiens” and “S. ranarum” reported from Asia are conspecific with Type I; iv) Type I is probably conspecific with Spirometra mansoni, and Type II may represent an undescribed species.

Interleukin-22 (IL-22), plays a vital role in the mucosal repair of inflammatory bowel disease (IBD). Serum levels of IL-22 and IL-22 binding protein (IL-22BP), a soluble inhibitory IL-22 receptor, were measured in patients with IBD to investigate the profile of IL-22 in the systemic circulation.Blood samples from 92 healthy subjects, 98 patients with ulcerative colitis (UC), and 105 patients with Crohn's disease (CD) were analyzed for serum levels of IL-22, IL-22BP, human β-defensin 2 (hBD-2), and serum inflammatory parameters. Disease activity was assessed by the partial Mayo score and Harvey-Bradshaw index for UC and CD, respectively.Serum IL-22 level was lower in UC (P0.001) and CD (P0.001) vs control and its decrease was more pronounced in CD than in UC (P = 0.019). Serum IL-22BP level was lower in UC (P0.001) and CD (P0.001) vs control and correlated with inflammatory parameters (albumin and C-reactive protein (CRP) in UC; hemoglobin, albumin, and CRP in CD). Serum IL-22/IL-22BP ratios were higher in UC (P = 0.009) vs control and correlated with inflammatory parameters (albumin and CRP). Serum hBD-2 level was higher only in CD (P = 0.015) but did not correlate with serum IL-22 levels, IL-22BP levels, IL-22/IL-22BP ratios, or inflammatory parameters.Dysregulation of the IL-22 system in the blood may play a role in the pathogenesis of IBD. Further studies are needed to understand the pathogenic and clinical significance of the blood IL-22 system in IBD.

Ryuguderes iejimaensis gen. et sp. nov. (Xenosomata: Cyclorhagida: Kinorhyncha) is described from the Daidokustu submarine cave off Iejima Island, Ryukyu Islands, Japan. The species is characterized by the presence of outer oral styles with incompletely fused proximal parts and separate distal parts; primary spinoscalids with several internal septa; spinoscalids in ring 02 short; 14 placids, with the midventral one broadest and six broader placids alternating with seven narrower ones; middorsal acicular spines on segments 2–11 in males and on segments 2–9 in females; lateroventral acicular spines on segments 4, 6–7, and 9; short, blunt lateroventral spines on segment 5; midterminal, lateral terminal and lateral terminal accessory spines with a thick proximal cuticle around a central cellular cavity. The placid numbers and morphology of the outer oral styles, spinoscalids, and lateral terminal accessory and midterminal spines suggest Ryuguderes to be closely related with Campyloderes. In addition, morphological similarities between Ryuguderes, Campyloderes, and different genera of Kentrorhagata suggest Xenosomata and Kentrorhagata to be closely related.