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A 60-year-old Japanese woman presented with subacute progressive muscle pain and weakness in her proximal extremities. She was diagnosed with influenza A (H3N2) infection a week before the onset of muscle pain. At the time of admission, she exhibited weakness in the proximal muscles of the upper and lower limbs, elevated serum liver enzymes and creatinine kinase, and myoglobinuria. She did not manifest renal failure and cardiac abnormalities, indicating myocarditis.Electromyography revealed myogenic changes, and magnetic resonance imaging of the upper limb showed abnormal signal intensities in the muscles, suggestive of myopathy. Muscle biopsy of the biceps revealed numerous necrotic regeneration fibers and mild inflammatory cell infiltration, suggesting immune-mediated necrotizing myopathy (IMNM). Necrotized muscle cells were positive for human influenza A (H3N2). Autoantibody analysis showed the presence of antibodies against the signal recognition particle (SRP), and the patient was diagnosed with anti-SRP-associated IMNM. She was resistant to intravenous methylprednisolone pulse therapy but recovered after administration of oral systemic corticosteroids and immunoglobulins. We speculate that the influenza A (H3N2)infection might have triggered her IMNM. Thus, IMNM should be considered as a differential diagnosis in patients with proximal muscle weakness that persists after viral infections., International Journal of Infectious Diseases, 103, pp.33-36: 2020

Biodiversity offset, with a focus on securing biological validity, is primarily practiced in developed countries. However, various social issues, such as the tradeoff between ecosystem conservation...

A 25-year-old woman was admitted to our hospital due to tonic convulsion with severe headache after having experienced symptoms of nausea and vomiting for a month. Brain magnetic resonance imaging showed extensive symmetrical lesions in the cortical and subcortical areas of parieto-occipital lobes and basal ganglia, consistent with typical characteristics of posterior reversible encephalopathy syndrome (PRES). Furthermore, some residual lesions in the left side of dorsal medulla oblongata and central area of the cervical spinal cord along with the presence of serum anti-aquaporin-4 antibody yielded the diagnosis of neuromyelitis optica spectrum disorder (NMOSD). We herein discuss the mechanism by which PRES may occur together with NMOSD., Internal medicine, 59(15), pp.1887-1890; 2020

This study aimed to evaluate the diagnostic usefulness of motor end-plate (MEP) analysis along with clustered acetylcholine receptor (AChR) antibody (Ab) assays in patients with myasthenia-like symptoms but negative routine AChR and muscle-specific kinase (MuSK) Ab tests. MEP analysis of muscle biopsies of the biceps brachii was performed in 20 patients to try to differentiate between those with or without immune-mediated myasthenia gravis (MG). Using a quantitative method, complement C3 deposition and AChR densities in MEPs were examined. Independently, cell-based assays were used to detect serum clustered-AChR Abs. Only five of 20 patients had complement deposition at MEPs; four of these patients had reduced AChR densities similar to those in patients with typical AChR Ab positive MG, and distinct from those in the remaining 15 patients. Two of the four serum samples from these patients had clustered-AChR Abs. All complement-positive patients were considered as having immune-mediated MG and improved with appropriate treatments; although one patient presented with MG 3 years later, the remaining patients had other diagnoses during over 10 years of follow-up. These results suggest the usefulness of MEP analysis of muscle biopsies in diagnosing immune-mediated MG in seronegative patients with myasthenia-like symptoms but, due to the invasiveness of the muscle biopsy procedure, clustered AChR Abs should, if possible, be tested first.

Although acute retinal necrosis (ARN) and optic neuritis following herpes encephalitis are known causes of acute visual impairment associated with herpes simplex virus (HSV) infection, there have been no reports of parainfectious optic neuritis associated with genital HSV type 2 (HSV-2) infection. A young Japanese woman developed unilateral optic neuritis 7 days after the onset of genital HSV-2 infection. Ophthalmologic examination revealed no findings suggestive of ARN and both multiple sclerosis and neuromyelitis optica were ruled out by the brain images and serum antibody testing. An oral steroid therapy improved her symptoms. Here, we describe the first case of parainfectious optic neuritis associated with genital HSV-2 infection.

VCP mutations were first associated with inclusion body myopathy with Paget’s disease of bone and frontotemporal dementia (IBMPFD) but was later associated with amyotrophic lateral sclerosis and Charcot–Marie–Tooth disease. Now, a new name, “multisystem proteinopathy (MSP)”, is proposed for this condition. VCP encodes valosin-containing protein, which is involved in protein degradation in the ubiquitin proteasome system. We report here two MSP patients with two novel heterozygous missense variants in VCP: c.259G>T (p.Val87Phe) and c.376A>G (p.Ile126Val).

Background We report a case of a 64-year-old Japanese man who was diagnosed with definite multifocal motor neuropathy and successfully treated with administration of intravenous immunoglobulin (IVIg) spread over two separate weeks. Case presentation After IVIg administration (30 g/day, five consecutive days), motor function was improved, but it was not possible to maintain the muscle strength just a few months after treatment. Although plasma exchange and cyclosporine were combined, the patient developed muscle weakness just 2 weeks after initial IVIg treatment. His grip strength decreased to 0 kg, proximal upper-limb muscle strength reduced to 2/5 according to manual muscle testing, and muscle weakness developed in the proximal lower limb muscle. We modified IVIg administration protocol from five consecutive days to two separate weeks: 3 days in the first week and 2 days in the third week without changing the total dose per month. After initiation of divided IVIg protocol, muscle weakness dramatically improved, and muscle power could be kept normal. Corrected optical density value of immunoglobulin M antibodies against GM1 elevated in the all clinical course did not correlate with muscle strength improvement. Serum immunoglobulin G levels became stable in ≥2000 mg/dL, and were associated with muscle strength improvement. Conclusion Administration of IVIg over two separate weeks might be a treatment option in intractable patients with multifocal motor neuropathy.

A 72-year-old Japanese man developed progressive disturbance in ambulation with flexion contractures 5years before this admission. At 49 years of age, he was diagnosed with hypopituitarism after an operation for a Rathke's cleft. On admission, he could not fully extend his knees and hips because of painful muscle stiffness of the lower extremities. Initially, we suspected Stiff-person syndrome and initiated diazepam, which had no effect. Serum anti-glutamic acid decarboxylase antibody was negative. Next, we suspected flexion contractures associated with hypopituitarism. Endocrine evaluation revealed that ACTH, cortisol, and other hormone levels were lower than those reported in the previous evaluation. We treated the patient with hydrocortisone and his symptoms dramatically improved. It is rare for patients with hypopituitarism to have flexion contracture. This case suggests that we should consider hypopituitararism in the setting of flexion contractures. (Received October 18, 2018; Accepted March 26, 2019; Published June 1, 2019).

Background: It is unclear whether biomarkers of cardiac dysfunction are associated with embolic stroke of undetermined source (ESUS), while large patent foramen ovale (PFO) could relate to it. Method: We retrospectively review patients with ischemic stroke who underwent transesophageal echocardiography (TEE) from April 2012, to April 2018. The peak transmitral filling velocity/early diastolic mitral annular tissue velocity (E/e’) on transthoracic echocardiography was used to estimate diastolic dysfunction. PFO and left atrial appendage (LAA) flow velocity were evaluated by TEE. We compared risk factors, clinical characteristics and biomarkers of cardiac dysfunction (brain natriuretic peptide [BNP], left atrial diameter, E/e’, the presence of systolic dysfunction [EF Results: Among 294 patients with ESUS, 163 patients underwent TEE (55%). Of these, 24 patients (15%) had large PFO. Compared with ESUS patients with large PFO, those without large PFO had higher BNP (adjusted odds ratio 1.02, 95% confidence interval; 1.00-1.03, p=0.002) and higher E/e’ (1.25, 1.06-1.48; p=0.003). Left atrial diameter, EF 50 pg/ml and E/e’ > 12, which were median values, had worse clinical outcome compared to patients who have less cardiac biomarkers and patients with large PFO. (p=0.005) Conclusion: ESUS Patients without large PFO often have biomarkers of cardiac dysfunction. The clinic outcome of ESUS patients without large PFO who have biomarkers of cardiac dysfunction could be worse than that of ESUS patients with large PFO.

Introduction The aim of this study is to improve the level of the hygiene management at asbestos demolition site. For this aim, we conducted a questionnaire survey to understand the differences in local governments’ efforts towards to the hygiene management. We consider that a good example of a local government must be a reference to others. Now, it is banned to use asbestos and asbestos-containing materials except temporary exemption for some uses. Asbestos survey and removal before the demolition of buildings are requested by the law. Measurement asbestos concentration in the air during the demolition is also requested. However, some cases were found where asbestos surveys were not perfect. Furthermore, asbestos dispersal in the demolition was confirmed in some cases. We would like to prevent the dispersal of asbestos into general environment. Methods We have conducted a questionnaire survey among 159 local governments that make onsite inspection at the time of the demolition. Result Our analysis focuses mainly on how the system of the local government influences onsite inspection at the time of the demolition. The result of this survey shows current situation of onsite inspection (check with eyes, measurement of asbestos concentration in the air, instruction to demolition stuffs). In addition, we have made a study of the suitable asbestos measurement method adjusted to the demolition site. We also have considered cost-effectiveness of dispersal of asbestos. Discussion One of our key findings is difficulty of that all demolition sites are made onsite inspection by the local governments in the current government system. On the other hand, some local government make onsite inspection to all demolition sites with good systems and methods. We hope that these good systems and methods should.be shared to other local governments

Tokyo Metropolitan Government enforced an ordinance of Environmental Impact Assessment (EIA) in 1981. The ordinance prescribes 26 types of development projects including high-rise buildings as they are likely to cause significant adverse effects on the environment. On the other hand, the ordinance amended in 2002 to bring easing of restrictions. Most of the projects of high-rise buildings have been exempt from the objects of the ordinance since then.The study focuses on the effect of EIA of high-rise buildings. Firstly, we figured out the circumstances behind each amendment of the ordinance. Secondly, the current environmental quality of high-rise buildings in Tokyo central area is investigated. And some cases of the high-rise building EIA projects are discussed to identify the influences of EIA to the original plans. Based on these examinations and analyses, we finally identified the points of the improvements of the current EIA ordinance of Tokyo.JEL classification: Q51, Q56, R52, R58

In this paper, a procedure is established for solving simultaneously a set of thirty conditional equations with respect to forces and moments acting on three spherical rollers, the tripod and the housing of tripod constant velocity joints, which are cylindrical-paired and sphere-cylinder-paired respectively, for any values of friction coefficients between spherical rollers and its grooves and axes. Moreover, the rotational velocity of the spherical roller relative to the tripod and the condition for rolling motion of the spherical roller to change into sliding motion on its groove are deduced. The established numerical procedure simulates the normal force of the spherical roller and the groove thrust force with a period of π and the housing thrust force with a period of 2π/3 for given values of the joint angle. These results are inspected by experimental analyses.

Irradiation of 1-methyl-5α-cholest-1-en-3-one oxime or its 4,4-dimethyl derivative in either a protic or an aprotic solvent gave 1-methylene-5α-cholestan-3-one oxime or the corresponding 4,4-dimethyl derivative, arising from an unprecedented photodeconjugation of α,β-enone oximes into the β,γ-isomers. Neither the expected isoxazole derivative (a product in the photoreaction of 5α-cholest-1-en-3-one oxime or its 4,4-dimethyl derivative) nor the unsaturated lactam that arises from a photo-Beckmann rearrangement was formed. Deuterium-labelling studies on the photoreactions of 1-methyl-5α-cholest-1-en-3-one oxime established that either a proton or a deuteron is stereospecifically introduced at the 2α-position of the steroidal oxime in this photodeconjugation. A pathway which involves the sterospecific addition of either a proton or deuteron to the photogenerated, twisted double bond of the oximes from the rear side of the steroidal framework, followed by the loss of a proton or deuteron from the 1-methyl group of the resulting carbocation intermediate, is proposed regarding the formation of β,γ-unsaturated oximes from the excited α,β-unsaturated oximes.

Irradiation of 5β-cholest-1-en-3-one oxime 14 in methanol gave 1α-methoxy-5β-cholestan-3-one oxime 16, arising from the photoaddition of methanol to the double bond of the enone oxime. 1α-Methoxy-5β-cholestan-3-one 17 as well as 10β-methoxy-5(10→1)abeo-1β(H),5β,10α(Me)-cholestan-3-one 15, arising from a skeletal rearrangement of 5β-cholest-1-en-3-one (generated from the oxime), were the accompanying products in this photoreaction. Deuterium-labelling studies confirmed that the formation of 1α-methoxy-5β-cholestan-3-oxime 16 involves a stereospecific syn addition of methanol to the photogenerated, twisted, ground-state double bond of the oximes B from the rear side of the steroidal framework.Irradiation of 1-methyl-5β-cholest-1-en-3-one oxime 23 in methanol, on the other hand, gave almost exclusively 1-methylene-5β-cholestan-3-one oxime 24, arising from photodeconjugation of the α,β-double bond to the β,γ-position. A deuterium-labelling study established that deuterium is stereospecifically introduced at the 2β-position of 1-methyl-5β-cholest-1-en-3-one oxime 23 in the photodeconjugation in methanol[2H]ol while deuterium is stereospecifically introduced at the 2α-position in the photodeconjugation of its 5α-isomer 6. These results are fully consistent with our previously proposed pathway concerning the photodeconjugation of 1-methyl-5α-cholest-1-en-3-one oxime 6; the stereospecific addition of a proton to the photogenerated, twisted double bond of the oxime D from the rear side of the steroidal framework was followed by the loss of a proton from the 1-methyl group of the resulting carbocation intermediate. Neither the isoxazole derivative, a product in the photoreaction of 5α-cholest-1-en-3-one oxime 1, nor the unsaturated lactam from a photo-Beckmann rearrangement was formed in the photoreactions of either 5β-cholest-1-en-3-one oxime 14 or its 1-methyl derivative 23.

Irradiation of 1-methyl-5α-cholest-1-en-3-one oxime or its 4,4-dimethyl derivative in either a protic or an aprotic solvent gave 1-methylene-5α-cholestan-3-one oxime or the corresponding 4,4-dimethyl derivative, arising from an unprecedented photodeconjugation of α,β-enone oximes into the β,γ-isomers. Neither the expected isoxazole derivative (a product in the photoreaction of 5α-cholest-1-en-3-one oxime or its 4,4-dimethyl derivative) nor the unsaturated lactam that arises from a photo-Beckmann rearrangement was formed. Deuterium-labelling studies on the photoreactions of 1-methyl-5α-cholest-1-en-3-one oxime established that either a proton or a deuteron is stereospecifically introduced at the 2α-position of the steroidal oxime in this photodeconjugation. A pathway which involves the sterospecific addition of either a proton or deuteron to the photogenerated, twisted double bond of the oximes from the rear side of the steroidal framework, followed by the loss of a proton or deuteron from the 1-methyl group of the resulting carbocation intermediate, is proposed regarding the formation of β,γ-unsaturated oximes from the excited α,β-unsaturated oximes.

Irradiation of 5β-cholest-1-en-3-one oxime 14 in methanol gave 1α-methoxy-5β-cholestan-3-one oxime 16, arising from the photoaddition of methanol to the double bond of the enone oxime. 1α-Methoxy-5β-cholestan-3-one 17 as well as 10β-methoxy-5(10→1)abeo-1β(H),5β,10α(Me)-cholestan-3-one 15, arising from a skeletal rearrangement of 5β-cholest-1-en-3-one (generated from the oxime), were the accompanying products in this photoreaction. Deuterium-labelling studies confirmed that the formation of 1α-methoxy-5β-cholestan-3-oxime 16 involves a stereospecific syn addition of methanol to the photogenerated, twisted, ground-state double bond of the oximes B from the rear side of the steroidal framework.Irradiation of 1-methyl-5β-cholest-1-en-3-one oxime 23 in methanol, on the other hand, gave almost exclusively 1-methylene-5β-cholestan-3-one oxime 24, arising from photodeconjugation of the α,β-double bond to the β,γ-position. A deuterium-labelling study established that deuterium is stereospecifically introduced at the 2β-position of 1-methyl-5β-cholest-1-en-3-one oxime 23 in the photodeconjugation in methanol[2H]ol while deuterium is stereospecifically introduced at the 2α-position in the photodeconjugation of its 5α-isomer 6. These results are fully consistent with our previously proposed pathway concerning the photodeconjugation of 1-methyl-5α-cholest-1-en-3-one oxime 6; the stereospecific addition of a proton to the photogenerated, twisted double bond of the oxime D from the rear side of the steroidal framework was followed by the loss of a proton from the 1-methyl group of the resulting carbocation intermediate. Neither the isoxazole derivative, a product in the photoreaction of 5α-cholest-1-en-3-one oxime 1, nor the unsaturated lactam from a photo-Beckmann rearrangement was formed in the photoreactions of either 5β-cholest-1-en-3-one oxime 14 or its 1-methyl derivative 23.

Hiding image data with a material such as a light-scattering medium is useful as an initial stage of data protection, because the hidden image can be detected only by observation with a specific technique. A light-scattering medium is used to hide the image data, and a low-temporal-coherence interferometer performs the readout processing. A new readout method for detecting pixel values of the image is proposed to overcome spatial variation of the light intensity and distortion of the interference fringes. The introduction of spatial coding further improves the performance by overcoming spatial variations of the light-scattering medium and variations in the reflectance of given pixels.