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Background: Chronic subjective dizziness (CSD), which was superseded by persistent postural-perceptual dizziness as of 2017, has a great impact on patients’ quality of life. Cognitive-behavioural t...

Bladder outlet obstruction (BOO) often results in lower urinary tract symptoms (LUTSs) and negatively affects quality of life. Here, we evaluated gene expression patterns in the urinary bladder during tissue remodeling due to BOO. We divided BOO model rats into two groups according to the degree of hypertrophy of smooth muscle in the bladder. The strong muscular hypertrophy group, which exhibited markedly increased bladder smooth muscle proportion and HIF1α mRNA levels compared with the control group, was considered a model for the termination of hypertrophy, whereas the mild muscular hypertrophy group was considered a model of the initiation of hypertrophy. Some genes related to urinary function showed different expression patterns between the two groups. Furthermore, we found that several genes, including D-box binding PAR bZIP transcription factor (DBP), were upregulated only in the mild muscular hypertrophy group. DBP expression levels were increased in bladder smooth muscle cells in response to hypoxic stress. DBP associated with enhancer and promoter regions of NOS3 gene locus and upregulated NOS3 gene expression under hypoxic conditions. These findings suggested that the regulatory systems of gene expression were altered during tissue remodeling following BOO. Furthermore, circadian clock components might be involved in control of urinary function via transcriptional gene regulation in response to hypoxic stimuli.

Background In Japan, regional differences in asthma mortality have been reported; however, regional differences in asthma exacerbations have not been studied extensively. Therefore, using a health insurance claims database, we investigated the regional differences in the incidence of asthma exacerbations in Japan. Methods This study used data from Medi-Scope (Japan Medical Information Research Institute Inc., Japan)—a nationwide health insurance claims database. Patients with asthma at the index date (the latest date of an asthma-related prescription with an asthma diagnosis before October 1, 2018) were included in the analysis. The pre-index period was defined as 1 year before the index date, and the follow-up period as 1 year after the index date. The incidence of asthma exacerbation events was analyzed for each region. Results The primary analysis population comprised 24,883 patients who were continuously prescribed ICS or ICS/LABA at least four times during the pre-index period. The incidence rate of asthma exacerbations with hospitalization was the highest in Chugoku (2.95/100 person-years [95% CI, 1.97–4.43]) and the lowest in Kanto (1.52/100 person-years [95% CI, 1.26–1.83]). The incidence rate of asthma exacerbations for the composite outcome of hospitalization, injectable corticosteroid prescription, and oral corticosteroid burst was the highest in Fukui (105.00/100 person-years [95% CI, 64.53–170.85]) and the lowest in Nagasaki (15.69/100 person-years [95% CI, 10.84–22.72]). Conclusions Regional differences in the incidence of asthma exacerbations as well as their treatments were observed in Japan.

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.

平成29年度

Objective Dizziness is one of the most common symptoms in the general population. Patients with dizziness experience balance problems and anxiety, which can lead to decreased physical activity levels and participation in their daily activities. Moreover, recovery of vestibular function from vestibular injury requires physical activity. Although there are reports that decreased physical activity is associated with handicap, anxiety, postural instability and reduced recovery of vestibular function in patients with chronic dizziness, these data were collected by self-report questionnaires. Therefore, the objective data of physical activity and the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness are not clear. The purpose of this research was to objectively measure the physical activity of patients with chronic dizziness in daily living as well as handicap, anxiety and postural stability compared to healthy adults. Additionally, we aimed to investigate the relationships between physical activity, handicap, anxiety and postural stability in patients with chronic dizziness. Methods Twenty-eight patients with chronic dizziness of more than 3 months caused by unilateral vestibular hypofunction (patient group) and twenty-eight age-matched community dwelling healthy adults (healthy group) participated in this study. The amount of physical activity including time of sedentary behavior, light physical activity, moderate to vigorous physical activity and total physical activity using tri-axial accelerometer, self-perceived handicap and anxiety using questionnaires, and postural stability were measured using computerized dynamic posturography. Results The results showed worse handicap, anxiety and postural stability in the patient group compared to the healthy group. Objective measures of physical activity revealed that the patient group had significantly longer time of sedentary behavior, shorter time of light physical activity, and shorter time of total physical activity compared to the healthy group; however, time of moderate to vigorous physical activity was not significantly different between groups. Moreover, there were correlations between physical activity and postural stability in the patient group, while there were no correlations between physical activity, handicap or anxiety in the patient group. Conclusion These results suggest that objectively measured physical activity of the patients with chronic unilateral vestibular hypofunction is lower compared to the healthy adults, and less active patients showed decreased postural stability. However, the details of physical activity and causal effect between physical activity and postural stability were not clear and further investigation is needed.

A 55-year-old man was transported to our hospital after a sudden onset of left lower abdominal pain while driving. Computed tomography (CT) of the abdominal region revealed an extensive iso-intense signal region that had a maximum area of 14×15 cm, which we treated conservatively. A series of follow-up CT images showed the gradual decrease of the left peritoneal mass, while continuity with the left adrenal gland became apparent. He was diagnosed with idiopathic adrenal hemorrhage. Adrenal hemorrhage presenting with huge retroperitoneal tumors is rare, and most cases are treated surgically. Therefore, CT images with conservative treatment are rare, holding both clinical interest and significance.

Background: Nivolumab is a humanized IgG4 anti-programmed cell death protein-1 (PD-1) antibody. In recent years, type 1 diabetes associated with anti-PD-1 immunotherapy has been reported. Case report: We report a 62-year-old woman with primary choroidal melanoma who developed fulminant type 1 diabetes after anti-PD-1 immunotherapy (nivolumab). She had elevated levels of blood glucose and total blood ketone body. Her hemoglobin A1c level was at the upper limit of normal, and she had decreased endogenous insulin secretion. Anti-glutamic acid decarboxylase and anti-islet antigen 2 antibody tests were negative. Endogenous insulin was still being secreted at the time of diagnosis; therefore, we administered steroids and glucagon-like peptide-1 (GLP-1). However, insulin secretion did not recover. Approximately 10 months after onset, her diabetes was under control with intensive insulin therapy and voglibose treatment. Discussion: The mechanism of diabetes caused by nivolumab is unclear, but it may involve the excessive autoimmune response associated with PD-1 inhibition. GLP-1 has a protective effect on the pancreas by promoting differentiation and proliferation of pancreatic β cells and suppressing pancreatic β cell apoptosis. We attempted to treat with steroids and GLP-1 before depletion of endogenous insulin to suppress the hyperimmunization and protect the pancreatic β cells. Insulin secretion did not recover. However, no reports have described using these therapies to treat diabetes associated with immune checkpoint inhibitors during early onset to date. We consider this case is the meaningful report as a negative data.

ODS associated with hyperglycemia is rare, with few reports.Immune responses have been recently reported as a mechanism of ODS onset. In the present case, an autoimmune predisposition may have contributed to ODS pathogenesis.

The purpose of this study is to propose a novel differential protection scheme for DC-AC converters. The current differential relay is widely used to protect transformers, generators, busbars and transmission lines. However, it cannot be applied to a DC-AC inverter, which is used in an AC-DC transmission line system. This paper presents a novel differential protection scheme for DC-AC converters, using Tellegen's Theorem. Tellegen's Theorem is a simple theorem of electric power proved from Kirchhoff's current law and Kirchhoff's voltage law. Under the theorem, we define three kinds of electric power as power flow. The proposed technique is evaluated using simulation studies based on an ideal inverter circuit which transforms DC to AC. The test results show the validity of the proposed protection.

Although there are reports of hyperintense lesions in hyperglycemic hemichorea-hemiballism by brain magnetic resonance imaging (MRI) (1, 2), such findings by magnetic resonance angiography (MRA) are rare. An 82-year-old man presented with a 1-month history of left-sided involuntary movements of his face and limbs. Laboratory data revealed a blood glucose level of 20.8 mmol/L, glycosylated hemoglobin of 11.5%, and serum C-peptide of 2.20 ng/mL. There were no urinary ketones or metabolic acidosis. T1-weighed brain MRI showed a hyperintense lesion in the putamen and caudate nucleus, whereas cranial MRA showed an irregular perivascular hyperintense lesion and an arteriostenosis in the middle cerebral artery (MCA) (Figure 1A, arrows). After a diagnosis of hyperglycemic hemichorea-hemiballism, he was treated with insulin. Upon correction of blood glucose levels, the ballistic movements improved. At the 1-month follow-up visit, the abnormal hyperintense areas had improved slightly (Figure 1B), and they had disappeared completely at the 6-month follow-up visit (Figure 1C). His glycosylated hemoglobin improved to 7.6%. Hyperglycemic hemichorea-hemiballism is more common among patients with type 2 diabetes, Asians, and the elderly. Possible underlying mechanisms include microhemorrhages due to blood-brain-barrier failure (3), reactive astrocytes associated with ischemia (4), and decreased -aminobutyric acid production after dehydration (5), and they present as a high-intensity signal on T1-weighed MRI. We observed high perivascular signal intensity on MRA, along with stenosis of the MCA at the bifurcation of the lenticulostriate arteries, which supply the putamen and caudate nucleus. This suggests that these lesions have vascular fragility and they are vulnerable to ischemia and metabolic disorders associated with hyperglycemia.

High strength steel sheets are becoming increasingly important for the weight reduction of automotive bodies to meet the requirements for reduced environmental impact. However, dimensional defects resulting from springback are serious issues, and effective methods of predicting and reducing such defects are necessary. In this study, we numerically and experimentally analyzed the mechanisms of dimensional inaccuracies caused by springback occurring in curved hat channel deep drawing products. The analysis was based on the static explicit FEM software “TP‐STRUCT” (the solver part is known as “STAMP3D”). The results of the experiments and simulations similarly show that the twist angle is positive (right‐hand system) when the drawing height is relatively large. We calculated the twist torque around the longitudinal axis using the stress distributions obtained by FE analysis. Through the investigation of twist torque and its transition during the drawing and die removal processes, we found that the negative torque generated by side wall opening occurring in the die removal process is the dominant factor of the positive twist. Knowing such mechanisms of twist in cases with a relatively large drawing height, we attempted to explore methods of reducing side wall opening by giving the side wall a stepped shape with the eventual aim of reducing twist. Consequently, we concluded that the stepped shape on the side wall has marked effects of reducing side wall opening, mainly through the elimination of bending‐unbending effects on die shoulders, which was verified by observing the stress distribution obtained by FE analysis.

The mutant CP, derived from Aspergillus usamii mut. shiro-usamii IFO 6082, exhibits high transglucosidase activity. The mutant AP, derived from Aspergillus oryzae IFO 4079, shows high acid carboxypeptidase activity. Cell fusion was carried out between CP and AP, and one fusant strain was obtained. The use of koji prepared with the fusant strain produced mirin with about twice as much oligosaccharides compared to that of the mirin of mutant AP.

Fibroin of the silkworm, Bombyx mori , was subjected to sequential digestion with trypsin and pronase. The small quantity of glucosamine and mannose present in the fibroin could be detected in the digest largely as two glycopeptides, the structure of which was studied with sequential periodate oxidation, Edman degradation, and alkaline treatment. One of the glycopeptides contained two residues of glucosamine and five residues of mannose, whereas the other which occured in a lower concentration contained two residues of glucosamine and three residues of mannose. Both glycopeptides had the same amino acid sequence, SerAsnThr, to which oligosaccharide unit was attached by a glucosaminylasparagine linkage.