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Japanese spotted fever (JSF) is a tick-borne rickettsiosis caused by Rickettsia japonica. Although the number of JSF cases has been increasing, exceeding 300 per year since 2017, clusters of cases are rare. Here, we report a cluster of seven JSF cases, the first nonfamilial cluster of the disease documented in the Japanese literature, and describe the management of the outbreak through prompt investigation and control-and-prevention measures performed collaboratively by members from the clinical, laboratory, and public health fields. All seven cases in the cluster had visited a cemetery in September or October of 2019. R. japonica was detected in whole-blood and/or skin samples from six patients and in the larvae of Haemaphysalis hystricis collected in a field survey. The evidence suggested that this cluster of cases was caused by the conjunction of two circumstances within a short period of time: an increase in the number of visitors to a cemetery during a Buddhist event and an increase in the number of infectious tick larvae in the cemetery through hatching (vertical transmission from infected females). Delays in the treatment of JSF can lead to severe manifestations. Early interventions through collaborative efforts among members from the clinical, laboratory, and public health fields are important for controlling outbreaks, raising the awareness of the public, and diagnosing and treating patients.

Pricing a multi-asset derivative is an important problem in financial engineering, both theoretically and practically. Although it is suitable to numerically solve partial differential equations to calculate the prices of certain types of derivatives, the computational complexity increases exponentially as the number of underlying assets increases in some classical methods, such as the finite difference method. Therefore, there are efforts to reduce the computational complexity by using quantum computation. However, when solving with naive quantum algorithms, the target derivative price is embedded in the amplitude of one basis of the quantum state, and so an exponential complexity is required to obtain the solution. To avoid the bottleneck, the previous study~[Miyamoto and Kubo, IEEE Transactions on Quantum Engineering, \textbf{3}, 1--25 (2022)] utilizes the fact that the present price of a derivative can be obtained by its discounted expected value at any future point in time and shows that the quantum algorithm can reduce the complexity. In this paper, to make the algorithm feasible to run on a small quantum computer, we use variational quantum simulation to solve the Black-Scholes equation and compute the derivative price from the inner product between the solution and a probability distribution. This avoids the measurement bottleneck of the naive approach and would provide quantum speedup even in noisy quantum computers. We also conduct numerical experiments to validate our method. Our method will be an important breakthrough in derivative pricing using small-scale quantum computers., 18 pages, 4 figures

Streptococcus pneumoniae is a leading cause of bacterial meningitis worldwide. Conventional microbiological assays take several days and require the use of various drugs for empirical treatment. Rapid antigen tests in cerebrospinal fluid (CSF) may be useful to triage pneumococcal meningitis immediately.To elucidate whether rapid antigen tests in CSF are useful in the triage of pneumococcal meningitis.Data sourcesCochrane CENTRAL, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases were searched. Study eligibility criteriaAll types of cohort studies except multiple-group studies, where the sensitivity and specificity of rapid antigen tests in CSF compared with CSF culture can be extracted. ParticipantsPatients with suspected meningitis. TestsRapid antigen tests in CSF. Reference standardsOne or more of the following: blood culture, CSF culture, and polymerase chain reaction in CSF. Assessment of risk of biasThe methodological quality of the included studies was assessed using QUADAS-2. Methods of data synthesisWe used a random-effects bivariate model for the meta-analysis. We conducted a subgroup analysis by dividing studies into types of antigen tests, adults and children, low-income and high-income countries, and with or without exposure to antibiotics before lumbar puncture.Forty-four studies involving 14 791 participants were included. Most studies had a moderate-to-low methodological quality. Summary sensitivity and specificity were 99.5% (95% confidence interval (CI), 92.4-100%) and 98.2% (95% CI, 96.9-98.9%), respectively. Positive predictive values and negative predictive values at the median prevalence (4.2%) in the included studies were 70.8% (95% CI, 56.6-79.9%) and 100% (95% CI, 99.7-100%), respectively. The diagnostic accuracy was consistent across the various subgroups, except for slightly reduced sensitivity in high-income countries.Rapid antigen tests in CSF would be useful in triaging pneumococcal meningitis. Further studies are warranted to investigate the clinical benefit of ruling out pneumococcal meningitis based on the results of rapid antigen tests.

Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves' disease and Hashimoto's thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented the world's first case of PPT developed following COVID-19.

Amyloid β (Aβ) aggregates in the brains of patients with Alzheimer's disease (AD) and accumulates via oligomerization and subsequent fiber elongation processes. These toxicity-induced neuronal damage and shedding processes advance AD progression. Therefore, Aβ aggregation-inhibiting substances may contribute to the prevention and treatment of AD. We screened for Aβ42 aggregation inhibitory activity using various plant extracts and compounds, and found high activity for a Geranium thunbergii extract (EC

This paper presents the view that Lesson Study has the potential to make a significant contribution to future developments in primary physical education. To set the paper in context, we explore the concerns that have long been voiced about primary physical education, particularly the nature of the professional development experiences of generalist primary class teachers. Contemporary approaches to teachers’ professional development, one of which is Lesson Study, are presented as having some potential in addressing these concerns as they are focused on teacher collaboration, autonomy and agency. Building on this background, the paper reports on a longitudinal physical education Lesson Study investigation that took place in one primary school in Japan: a country where Lesson Study has been a key feature of teachers’ professional development for more than a century. Working with 30 teachers over a three-year period, the findings highlight how the long-term, collaborative and situated nature of the Lesson Study experience helped create a positive context for the teachers’ professional development in physical education. Specifically, the findings reveal that the shared planning, observation and reflective experiences over time helped the teachers develop a more positive and detailed view of physical education. The paper concludes by proposing that Lesson Study, as a long-term, collaborative and situated endeavour, has the potential to foster productive developments in generalist teachers’ enactment of the primary physical education curriculum.

The 2016 International Guidelines for the Management of Sepsis and Septic Shock recommend antibiotic therapy for 7-10 days for most patients with sepsis. However, evidence on critically ill patients is limited. Thus, we conducted the first systematic review and meta-analysis comparing the effectiveness and adverse events of shorter- (≤1 week) with longer-course antibiotics in adults with critical infections including sepsis.We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases for randomised controlled trials (RCTs) and observational studies (OSs) from inception to 31 March 2021.We included 6 of 3,766 identified articles, incorporating data from 4 RCTs and 2 OSs (1,721 patients) in meta-analyses. Three RCTs and one OS focussed on ventilator-associated pneumonia, and one RCT and one OS investigated intra-abdominal infections. The severity score levels were similar to that of sepsis, but no study comprehensively focussing on sepsis was found. There were no significant differences in mortality at a maximum follow-up of 30 days (RR 1.08, 95%CI 0.80-1.46); 28-day mortality, clinical cure, the occurrence of new events, and the emergence of resistant organisms between the groups in the RCTs. The OSs findings were consistent. The quality of evidence was assessed as very low to moderate using the GRADE approach, with no uniform description of severity scores, sepsis, or adverse events.Shorter, fixed-duration antibiotic therapy for clinically heterogeneous sepsis or severe infections was not associated with poorer outcomes, but the overall quality of evidence was poor.

Objectives For dry powder inhalers, the airflow properties in the airways could affect the deposition of inhaled particles; the flow patterns vary inherently between patients. This paper provides an evaluation of the effects of six airflow patterns on the behaviour of inhaled particles, as determined by using numerical simulations. Methods Constant-velocity and unsteady inhalation flows were employed. The unsteady inhalation flow was set as an inhalation curve with a peak inspiratory flow rate. Under a constant flow of 28.3 l/min, the total flow rates were calculated to confirm the validity of the numerical simulation. The effects of different inhalation patterns on the particle behaviour in a realistic human airway model were revealed via numerical simulation. Key findings Different flow rates affected the behaviour and deposition of the inhaled particles. Under an inhalation flow pattern, different airflow tendencies were observed between the right and left bronchi. Particle deposition in the airways was promoted by a vortex following terminal-velocity-like breath-holding. The inhalation flow pattern affected the behaviour and deposition of inhaled particles in the airway. Conclusions Our results indicated that particle deposition in a realistic human airway model was promoted by a vortex formation following the terminal-velocity-like breath-holding. Moreover, the inhalation flow pattern significantly influenced the behaviour and deposition of inhaled particles in the airways. Additionally, the effect of flow patterns on the particle deposition in each airway position was quantitatively evaluated by numerical simulations for a realistic human airway model.

Stochastic differential equations (SDEs), which models uncertain phenomena as the time evolution of random variables, are exploited in various fields of natural and social sciences such as finance. Since SDEs rarely admit analytical solutions and must usually be solved numerically with huge classical-computational resources in practical applications, there is strong motivation to use quantum computation to accelerate the calculation. Here, we propose a quantum-classical hybrid algorithm that solves SDEs based on variational quantum simulation (VQS). We first approximate the target SDE by a trinomial tree structure with discretization and then formulate it as the time-evolution of a quantum state embedding the probability distributions of the SDE variables. We embed the probability distribution directly in the amplitudes of the quantum state while the previous studies did the square-root of the probability distribution in the amplitudes. Our embedding enables us to construct simple quantum circuits that simulate the time-evolution of the state for general SDEs. We also develop a scheme to compute the expectation values of the SDE variables and discuss whether our scheme can achieve quantum speed-up for the expectation-value evaluations of the SDE variables. Finally, we numerically validate our algorithm by simulating several types of stochastic processes. Our proposal provides a new direction for simulating SDEs on quantum computers., 14 pages, 6 figures

We describe the clinical features of a 75-year-old man who presented to our hospital with frequent urination for 3 months. Retrograde urethrography showed extended and continuous narrowing of the stricture in the anterior urethra. Cystourethroscopy showed extended narrowing of the urethral lumen without normal membrane. Urine acid-fast bacillus culture and polymerase chain reaction assays indicated a diagnosis of urethral tuberculosis. Anti-tuberculosis therapy was initiated. Urethral tuberculosis is a very rare cause of urethral stricture in developed countries that can be diagnosed by cystourethroscopy. Urethral tuberculosis should be considered in the differential diagnosis of urethral stricture.

We report a case series of 6 patients with confirmed coronavirus disease 2019 (COVID-19) in Wakayama prefecture, Japan. All 6 of the patients tested positive via pharyngeal swab polymerase chain reaction (PCR) tests, and 2 of the 6 were still positive at 3 weeks after onset. All of the patients exhibited bilateral ground glass opacities on computed tomography (CT). This article also reports narrative information on the spectrum of symptoms collected directly from the patients. It would be difficult to triage patients with COVID-19 based on the typical symptoms of fever and/or cough, although PCR and CT are definitive in diagnosis.

To evaluate the diagnostic performance of chest CT to differentiate coronavirus disease 2019 (COVID-19) pneumonia in non-high-epidemic area in Japan. This retrospective study included 21 patients clinically suspected COVID-19 pneumonia and underwent chest CT more than 3 days after the symptom onset: six patients confirmed COVID-19 pneumonia by real-time reverse-transcription polymerase chain reaction (RT-PCR) and 15 patients proved uninfected. Using a Likert scale and its receiver operating characteristic curve analysis, two radiologists (R1/R2) evaluated the diagnostic performance of the five CT criteria: (1) ground glass opacity (GGO)-predominant lesions, (2) GGO- and peripheral-predominant lesions, (3) bilateral GGO-predominant lesions; (4) bilateral GGO- and peripheral-predominant lesions, and (5) bilateral GGO- and peripheral-predominant lesions without nodules, airway abnormalities, pleural effusion, and mediastinal lymphadenopathy. All patients confirmed COVID-19 pneumonia had bilateral GGO- and peripheral-predominant lesions without airway abnormalities, mediastinal lymphadenopathy, and pleural effusion. The five CT criteria showed moderate to excellent diagnostic performance with area under the curves (AUCs) ranging 0.77–0.88 for R1 and 0.78–0.92 for R2. The criterion (e) showed the highest AUC. Chest CT would play a supplemental role to differentiate COVID-19 pneumonia from other respiratory diseases presenting with similar symptoms in a clinical setting.

The therapeutic effect of dry powder inhaler (DPI) formulations can be enhanced by understanding several factors that control the behavior or deposition of inhaled particles in the airways. Computational fluid dynamics (CFD) simulation was performed to predict the behavior and deposition of DPI formulations using a pulmonary model generated on the basis of computed tomography scans of a subject's airway. The effects of inhalation procedures and characteristics, such as flow rate and breath holding, on particle behavior and deposition in the airways were examined. The rate of airflow in the bifurcation area of bronchi was reduced to under 28.3 L/min because, in general, the diameter of the right bronchus is larger than that of the left bronchus in human bronchi. The region of particle deposition differed depending on the rate of airflow. The number of particles deposited in the bronchi decreased upon performing exhalation without breath holding. The results indicated that the turbulence following breath holding promoted particle deposition in the airways. CFD simulation suggested that breath holding is one of the most important factors for enhancing the therapeutic effect of DPI formulations.

Background: The incidences of metastatic brain tumors from malignant melanomas have increased and survival has been prolonged by novel molecular targeted agents and immunotherapy. However, malignant melanomas are uncommon in Asian populations. Objectives: We retrospectively analyzed treatment efficacy and identified prognostic factors impacting tumor control and survival in Japanese melanoma patients with brain metastases treated with gamma knife radiosurgery (GKRS). Methods: We retrospectively reviewed the medical records of 177 patients with 1,500 tumors who underwent GKRS for brain metastases from malignant melanomas. This study was conducted by the Japanese Leksell Gamma Knife Society (JLGK1501). Results: Six and 12 months after GKRS, the cumulative incidences of local tumor recurrence were 9.2 and 13.8%. Intratumoral hemorrhage (p < 0.0001) and larger tumor volume (p = 0.001) in GKRS were associated with significantly poorer local control outcomes. The use of immune checkpoint inhibitors before GKRS was significantly associated with symptomatic adverse events (p = 0.037). The median overall survival time after the initial GKRS was 7.3 months. Lower Karnofsky performance status scores (p = 0.016), uncontrolled primary cancer (p < 0.0001), and multiple brain metastases (p = 0.014) significantly influenced unfavorable overall survival outcomes. The cumulative incidences of neurological death 6 and 12 months after GKRS were 9.7 and 17.4%, those of neurological deterioration were 14.2 and 19.6%, and those of new tumor appearance were 34.5 and 40.5%. Conclusions: The results of the present multicenter study suggest that GKRS is a relatively effective and safe modality for control of tumor progression in Japanese patients with brain metastases from malignant melanomas.

Computational fluid dynamics (CFD) simulation was performed to predict deposition behavior of the dry powder inhaler (DPI) formulation in a pulmonary airway model. A synergistic study on CFD simulation and sample preparation with highly branched cyclic dextrin (HBCD) as an excipient matrix for dry powder inhaler formulations of tranilast (TL) were performed. The crystal form of TL in spray-dried particles was characterized by powder X-ray diffraction and fluorescence spectroscopy. The aerodynamic performance of DPI formulations was assessed using the Andersen cascade impactor. CFD simulations could simulate the movement of fluids by resolving the mathematic equations governing the movement following Navier-Stokes equations. Particle behavior and deposition from CFD analysis compared with experimental data. Spray-dried particles (SDPs) of TL/HBCD showed characteristic diffraction peaks differing from untreated TL crystalline in powder X-ray diffraction. The polymorphic transition of TL was also observed in a fluorescence spectrum. Cascade impactor evaluation on SDPs of TL/HBCD at a 40% ethanol ratio demonstrated high inhalation performance with a fine particle fraction of 33%, while SDPs prepared at a 30% ethanol ratio were lower than that of the others. Regarding the cause of this difference, CFD analysis revealed that high inhalation performance was related to the true density and particle size of SDPs. The change in true density of TL associated with polymorphic transition would affect the inhalation performance. The results on CFD simulations made a prediction about the particle behavior or deposition in pulmonary airways.

Although hypervirulent Klebsiella pneumoniae (hvKp) has been associated with severe community-acquired infections that occur among relatively healthy individuals, information about hvKp infections in health care settings remains limited. Here, we systematically analyzed the clinical and molecular characteristics of K. pneumoniae isolates causing bloodstream infections in a cross-sectional study. Clinical characteristics of K. pneumoniae bloodstream infections from hospitals across Japan were analyzed by a review of the medical records. Whole-genome sequencing of the causative isolates was performed. Bacterial species were confirmed and hvKp were identified using whole-genome sequencing data. Clinical characteristics of hvKp infections were compared with those of non-hvKp infections by bivariate analyses. Of 140 cases of K. pneumoniae bloodstream infections, 26 cases (18.6%) were caused by various clones of hvKp defined by the carriage of cardinal virulence genes. Molecular identification revealed that 24 (17.1%) and 14 (10%) cases were caused by Klebsiella variicola and Klebsiella quasipneumoniae, respectively. Patients with hvKp infections had higher proportions of diabetes mellitus (risk ratio [RR], 1.75; 95% confidence interval [CI], 1.05 to 2.94), and their infections had significantly higher propensity to involve pneumonia (RR, 5.85; 95% CI, 1.39 to 24.6), liver abscess (RR, 5.85; 95% CI, 1.39 to 24.6), and disseminated infections (RR, 6.58; 95% CI, 1.16 to 37.4) than infections by other isolates. More than one-half of hvKp infections were health care associated or hospital acquired, and a probable event of health care-associated transmission of hvKp was documented. hvKp isolates, which are significantly associated with severe and disseminated infections, are frequently involved in health care-associated and hospital-acquired infections in Japan.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines., other authors: Satoru Hashimoto,Daisuke Hasegawa,Junji Hatakeyama,Naoki Hara,Naoki Higashibeppu,Nana Furushima,Hirotaka Furusono,Yujiro Matsuishi,Tasuku Matsuyama,Yusuke Minematsu,Ryoichi Miyashita,Yuji Miyatake,Megumi Moriyasu,Toru Yamada,Hiroyuki Yamada,Ryo Yamamoto,Takeshi Yoshida,Yuhei Yoshida,Jumpei Yoshimura,Ryuichi Yotsumoto,Hiroshi Yonekura,Takeshi Wada,Eizo Watanabe,Makoto Aoki,Hideki Asai,Takakuni Abe,Yutaka Igarashi,Naoya Iguchi,Masami Ishikawa,Go Ishimaru,Shutaro Isokawa,Ryuta Itakura,Hisashi Imahase,Haruki Imura,Takashi Irinoda,Kenji Uehara,Noritaka Ushio,Takeshi Umegaki,Yuko Egawa,Yuki Enomoto,Kohei Ota,Yoshifumi Ohchi,Takanori Ohno,Hiroyuki Ohbe,Kazuyuki Oka,Nobunaga Okada,Yohei Okada,Hiromu Okano,Jun Okamoto,Hiroshi Okuda,Takayuki Ogura,Yu Onodera,Yuhta Oyama,Motoshi Kainuma,Eisuke Kako,Masahiro Kashiura,Hiromi Kato,Akihiro Kanaya,Tadashi Kaneko,Keita Kanehata,Ken-ichi Kano,Hiroyuki Kawano,Kazuya Kikutani,Hitoshi Kikuchi,Takahiro Kido,Sho Kimura,Hiroyuki Koami,Daisuke Kobashi,Iwao Saiki,Masahito Sakai,Ayaka Sakamoto,Tetsuya Sato,Yasuhiro Shiga,Manabu Shimoto,Shinya Shimoyama,Tomohisa Shoko,Yoh Sugawara,Atsunori Sugita,Satoshi Suzuki,Yuji Suzuki,Tomohiro Suhara,Kenji Sonota,Shuhei Takauji,Kohei Takashima,Sho Takahashi,Yoko Takahashi,Jun Takeshita,Yuuki Tanaka,Akihito Tampo,Taichiro Tsunoyama,Kenichi Tetsuhara,Kentaro Tokunaga,Yoshihiro Tomioka,Kentaro Tomita,Naoki Tominaga,Mitsunobu Toyosaki,Yukitoshi Toyoda,Hiromichi Naito,Isao Nagata,Tadashi Nagato,Yoshimi Nakamura,Yuki Nakamori,Isao Nahara,Hiromu Naraba,Chihiro Narita,Norihiro Nishioka,Tomoya Nishimura,Kei Nishiyama,Tomohisa Nomura,Taiki Haga,Yoshihiro Hagiwara,Katsuhiko Hashimoto,Takeshi Hatachi,Toshiaki Hamasaki,Takuya Hayashi,Minoru Hayashi,Atsuki Hayamizu,Go Haraguchi,Yohei Hirano,Ryo Fujii,Motoki Fujita,Naoyuki Fujimura,Hiraku Funakoshi,Masahito Horiguchi,Jun Maki,Naohisa Masunaga,Yosuke Matsumura,Takuya Mayumi,Keisuke Minami,Yuya Miyazaki,Kazuyuki Miyamoto,Teppei Murata,Machi Yanai,Takao Yano,Kohei Yamada,Naoki Yamada,Tomonori Yamamoto,Shodai Yoshihiro,Hiroshi Tanaka,Osamu Nishida, Guidelines

Toxocariasis causes a variety of symptoms. We experienced a case of toxocariasis which was initially treated with steroids for Eosinophilic Granulomatosis with Polyangitis (EGPA). A 53-year-old woman with the past medical history of bronchial asthma presented at the outpatient department in the middle of August. She complained of chest discomfort lasting for one week. Ischemic heart disease was initially suspected due to ST depression on ECG and positive Troponin I. However coronary angiography did not reveal any abnormality. Her symptoms continued and after one month she presented at the hospital again with an elevated eosionophil count. Chest computed tomography showed ground glass opacities on both lungs. She was diagnosed as having EGPA based on her clinical symptoms and the results of the blood test which were consistent with the diagnostic criteria of EGPA. After prednisolone was prescribed, her symptoms and eosinophilia dramatically improved. However, we found that the histology of the lung and kidney was not compatible with EGPA and the result of serum parasite antibodies turned out to be strongly positive for toxocariasis after initiating predonisolone. Based on this result, we concluded that our patient had a case of toxocariasis and prescribed albendazole in addition to prednisolone. The patient completed a 3-week course of albendazole and a 3-month course of prednisolone without any problems. In general, steroids are not commonly used as a treatment of toxocariasis, however it seems to have been effective in this case. Toxocariasis shows a variety of symptoms and can be misdiagnosed as other diseases such as EGPA.

Silicone is widely used in packing materials, medical equipment, and separation membranes. Since microbial cells easily adhere to the surface of silicone materials and form biofilms, techniques for incorporating antimicrobial activity into silicone materials are in high demand. This study describes the preparation of silver (Ag)/silicone composite membranes through a simple two-step immersion process, utilizing an iodine solution followed by a silver nitrate solution at room temperature. Scanning electron microscopy (SEM) observations revealed that particles with sizes of several nanometers to several tens of nanometers were present on the silicone membrane surface; these particles were identified as silver iodide using energy-dispersive X-ray spectroscopy (EDS) . The Ag/silicone membrane possessed excellent antibacterial efficacy against Escherichia coli and Staphylococcus aureus, and the antibacterial efficacy (R) against both types of bacteria was R > 4, even after stomacher treatment or acidic treatment of pH 2-6 for 24 h. The mechanical strength of the silicone membrane was also maintained after antibacterial treatment, with Young's modulus values of 7.9±1.2 MPa and 8.3±1.5 MPa for the untreated membrane and Ag/silicone membrane, respectively (p > 0.05) . In addition, the reduction in permeation performance of the Ag/silicone membrane was only 20%, despite the antibacterial treatment on the membrane surface. This antibacterial treatment method of silicone membranes can be conducted at room temperature (25℃) without special equipment, and may be applied to other types of silicone materials.

Summary Background We aimed to examine whether stereotactic radiosurgery without whole-brain radiotherapy (WBRT) as the initial treatment for patients with five to ten brain metastases is non-inferior to that for patients with two to four brain metastases in terms of overall survival. Methods This prospective observational study enrolled patients with one to ten newly diagnosed brain metastases (largest tumour Findings We enrolled 1194 eligible patients between March 1, 2009, and Feb 15, 2012. Median overall survival after stereotactic radiosurgery was 13·9 months [95% CI 12·0–15·6] in the 455 patients with one tumour, 10·8 months [9·4–12·4] in the 531 patients with two to four tumours, and 10·8 months [9·1–12·7] in the 208 patients with five to ten tumours. Overall survival did not differ between the patients with two to four tumours and those with five to ten (HR 0·97, 95% CI 0·81–1·18 [less than non-inferiority margin], p=0·78; p non-inferiority vs 18 [9%] with five to ten; p=0·89). Four patients died, mainly of complications relating to stereotactic radiosurgery (two with one tumour and one each in the other two groups). Interpretation Our results suggest that stereotactic radiosurgery without WBRT in patients with five to ten brain metastases is non-inferior to that in patients with two to four brain metastases. Considering the minimal invasiveness of stereotactic radiosurgery and the fewer side-effects than with WBRT, stereotactic radiosurgery might be a suitable alternative for patients with up to ten brain metastases. Funding Japan Brain Foundation.

Erysipelothrix rhusiopathiae is a major causative organism of swine erysipelas, but the infection has rarely occurred in humans. A soft-tissue infection with this organism is described as “erysipeloid.” Most reported cases in human are related to occupational exposure. Endocarditis is a common complication of E. rhusiopathiae bacteremia in human.We report the case of a previously healthy 52-year-old Japanese female who presented with fever and an inflamed hand after being bitten by a stray cat. Blood culture was positive for E. rhusiopathiae, but no sign of infective endocarditis was observed. It may be prudent to consider E. rhusiopathiae infection in patients with animal bites. Keywords: Erysipelothrix rhusiopathiae, Animal bites, Bacteremia

A series of symmetrical trimeric liquid crystalline compounds of which the molecular structure with a central core of 1,3,5-benzene attached by three rod-like mesogenic Schiff base moieties via the propylene spacers and ether linkages has successfully been synthesised and characterised by infra red and nuclear magnetic resonance spectroscopic techniques. All the star-shaped compounds in this series exhibit predominantly SmC phase except the analogue possessing terminal C8H17 group. It is apparent that the members with even parity from C10H21 to C16H33 show enantiotropic SmC phase while the member with longest terminal chain of C18H37 is inclined to monotropic smectogen. The X-ray diffraction measurements reveal that the tilted smectic layer structures of the SmC phase are confirmed to have an obvious sharp peak at small angles of 2θ ∼ 1.03°–1.48° with d-spacing values of 4.01–4.58 nm, which are corresponding to tilt angles of ∼48° in the SmC phase.

Objective Central neurocytoma (CN) is a rare benign neuronal tumor, and a limited number of reports have described the usefulness of radiosurgery for a relatively large group of patients. We evaluated the effectiveness and outcomes of Gamma Knife radiosurgery (GKS) for CN in a Japanese multi-institutional study. Methods We performed retrospective analysis of 36 patients with CN who were treated with GKS in 12 institutes in Japan. All patients underwent surgery before GKS. The median tumor volume at GKS was 4.9 mL (range, 0.07–23.4 mL), and the median radiation dose prescribed to the tumor margin was 15 Gy (range, 10–20 Gy). The median follow-up period was 54.5 months (range, 3–180 months). Results The local tumor progression-free survival rates at 5 and 10 years were 94% and 86%, respectively. Three patients developed distant dissemination 16–90 months later. Overall progression-free survival was unrelated to the prescribed dose ( P = 0.62), tumor size ( P = 0.46), gender ( P = 0.36), age ( P = 0.37), target of GKS (residual vs. recurrence, P = 0.90), and type of enhancement (homogeneous vs. inhomogeneous, P = 0.19). Two permanent complications occurred with 1 intratumoral hemorrhage and 1 radiation injury. Conclusions GKS is effective for CN because of its high rate of long-term local tumor control. GKS may have a potential role as a primary treatment for asymptomatic, relatively small tumors in the absence of hydrocephalus without surgical resection.

This article describes the preparation and liquid crystalline properties of a new homologous series of 4-(4-bromopropyloxy)-4′-(4-alkyloxybenzylidene)anilines in which the phenyl ring is armed by a bromopropyloxy chain. The thermal behavior and mesomorphic properties of the synthesized compounds were studied with particular attention given to the correlation between their phase transition temperatures and anisotropic change influenced by molecular structure. All the members displayed enantiotropic smectic phase except for the homologue with the longest alkyloxy chain (R = C 18 H 37 ), exhibiting only monotropic characteristic. The presence of bromine atom from the propyloxy side chain is found to be capable of altering and influencing the mesomorphic properties.

We propose a simple method for separating rare earth elements as oxides from a neodymium magnetic sludge by focusing on the affinity of oxygen for the rare earth elements (Nd, Dy, and Pr) and Fe. We have conducted separation experiments with a carbon crucible as contact material to confirm that carbon maintains the oxygen potential in the coexistence region of rare earth oxides and metallic Fe. In this work, the oxide phase of the rare earth elements and the alloy phase that primarily consists of Fe were separated clearly when the magnetic sludge in the carbon crucible was kept at 1823 K (1550 °C) under an Ar atmosphere. The purity of the rare earth oxide phase was high and only a small amount of rare earth elements were contained in the alloy phase. We found that the melting temperature of the rare earth oxides is a crucial factor for separation efficiency in our proposed method.