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Objective The efficacy of maintenance intravenous immunoglobulin (IVIg) therapy has been established to prevent relapse in chronic inflammatory demyelinating polyneuropathy (CIDP). This prospective post-marketing surveillance study evaluated the treatment duration, efficacy, and safety of maintenance IVIg therapy in Japanese patients with CIDP. Methods Patients were registered between June 2017 and December 2018. After induction of IVIg therapy (0.4 g/kg/day for 5 consecutive days), patients received maintenance IVIg (1.0 g/kg every 3 weeks). The observation period was 18 months. Efficacy in preventing relapse was assessed using the Inflammatory Neuropathy Cause and Treatment (INCAT) disability score. Relapse was defined as a worsening of the INCAT score by ≥1 from baseline. Patients The efficacy population comprised 103 patients (80 with typical CIDP and 23 with CIDP variants). Results During the observation period, 86 (83%) patients were scheduled to continue maintenance IVIg therapy during the observation period, and the relapse rate was 24% (21/86). In the remaining 17 patients who showed continuous remission, maintenance IVIg therapy was stopped (mean, 136 days after the start), and the relapse rate was 24% (4/17). One serious adverse drug reaction of cardiac failure was reported. Conclusion In this post-marketing surveillance, most (83%) patients with CIDP were scheduled to continue maintenance IVIg for 18 months, with a relapse rate of 24%, indicating long-term efficacy. Maintenance IVIg therapy was rarely withdrawn, and the relapse rate after withdrawal was 24%. Further studies are required to determine the optimal maintenance IVIg dose and duration.

The present study investigated how life stress and sleep disturbance impact depressive symptoms among Chinese (N = 185) and Japanese (N = 464) workers. Based on a hypothesis that sleep disturbance can cause depression, a statistical model is established, expecting that work-related life stress indirectly increases depressive symptoms by worsening sleep disturbance rather than initiating depression directly. The study also examined the buffering effects of social support on depression. The extent of depressive symptoms, sleep disturbance symptoms (insomnia, hypersomnia, and nightmare), work-related stressors, and available social support were measured. The result revealed that the extent of depression was equivalent for both groups, but the Chinese reported more stress, less social support, and more severe sleep disturbance symptoms than the Japanese. Despite those differences, the statistical model fitted both groups well, suggesting that addressing sleep disturbance at the earliest opportunity can effectively prevent depression onset for workers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Matsuda, Kikutani. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Script memory is stored information about a sequential structure of an activity (e.g., going shopping), including what actors do, the purpose of the activity, and the likely consequences of the actor's actions. It has been reported that script memory is impaired among schizophrenia patients. The present research investigated the relationship between schizotypal personality tendencies (schizotypy) and script memory by testing Japanese individuals., Method: First, a new test to measure the intactness of the script memory was created by asking the public to report activities they often perform and what behaviors each activity contains. The test contains 15 everyday activities, each accompanied by 15 behavior choices, either strongly associated, completely unrelated, or weakly associated with the activity. Next, undergraduate participants were presented with the test and chose appropriate behaviors for each activity (Study 1 and 2). Their extent of schizotypy was measured using Schizotypal Personality Questionnaire Brief (SPQ-B). Study 3 targeted the public of various ages. In addition to Study 2 procedure, participants reported the extent of psychological burden for performing each activity, their life satisfaction, and subjective evaluation of their memory ability., Results: All studies consistently found that the script memory performance was worse for individuals with higher schizotypy. Signal detection indices for accurate discrimination between correct and incorrect choices, which were A' in Study 1 and C in Study 2 and 3, negatively correlated with the SPQ-B scores ( r = -0.16, -0.11, -0.17, respectively). Study 3 found that the relationship between schizotypy and memory task performance was mediated by the extent of psychological burden. When a signal detection index ( d' ) for the memory task was regressed on the SPQ-B, while the psychological burden scores being a mediator, the mediation effect was significant ( B = 0.003, SE = 0.001, 95% CI [0.001, 0.005])., Conclusion: Individuals with higher schizotypy seem to associate unrelated behaviors to an event, forming script memory with irrelevant information, maybe due to the schizotypy symptom of having peculiar thoughts. The newly created test must be validated using a clinical population to expand its potential to be used in clinical research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kikutani, Takiguchi, Ebina and Matsui.)

Objectives: To investigate potential knowledge gaps between neurologists and non-specialists and identify challenges in the current management of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), with a focus on 'early diagnosis' and 'appropriate treatment' for CIDP., Design: A non-interventional, cross-sectional, web-based quantitative survey of physicians working in healthcare clinics or hospitals in Japan., Setting: Participants were recruited from the Nikkei Business Publications panel from 18 August to 14 September 2022., Participants: Responses from 360 physicians (120 each of internists, orthopaedists and neurologists) were collected., Outcome Measures: Responses relating to a CIDP hypothetical case and current understanding were assessed to determine awareness, collaboration preferences and diagnosis and treatment decisions., Results: Understanding of CIDP was 90.8% among neurologists, 10.8% among orthopaedists and 13.3% among internists; >80% of orthopaedists and internists answered that neurologists are preferable for treatment. Diagnostic assessment using a hypothetical case showed 95.0% of neurologists, 74.2% of orthopaedists and 72.5% of internists suspected CIDP. Among orthopaedists and internists suspecting CIDP, >70% considered referring to neurology, while ~10% considered continuing treatment without a referral. Among neurologists, 69.4% chose intravenous immunoglobulin (IVIg) as first-line treatment and determined effectiveness to be ≤3 months., Conclusions: Orthopaedists and internists had lower CIDP awareness compared with neurologists, which may lead to inadequate referrals to neurology. Evaluation of IVIg effectiveness for maintenance therapy occurred earlier than the guideline recommendations (6-12 months), risking premature discontinuation. Improving CIDP knowledge among orthopaedists and internists is critical for better diagnosis and collaboration with neurologists. Neurologists should consider slow and careful evaluation of IVIg maintenance therapy., Trial Registration Number: UMIN000048516., Competing Interests: Competing interests: YT and YI have received support and consulting fees from Takeda Pharmaceutical Company Limited. AO, MK and NO are employees of Takeda Pharmaceutical Company Limited., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Engaging in leisure activities promotes mental health. The effect is likely associated with resilience as the broaden-and-build theory suggests positive emotions elicited from leisure increase mental resources for stress coping. The present research examined whether participating in different leisure activities at a given time increases the level of resilience, which in turn reduces psychological problems. It also investigated the changes in people's leisure activities due to the COVID-19 outbreak and the impact of these changes on their mental health. Japanese participants (N = 300) responded to two online surveys conducted before (January 2020) and after the outbreak (February 2021). They selected the leisure activities they had engaged in from 100 choices and reported their levels of resilience and depressive symptoms. An analysis of covariates revealed that the total number of selected activities significantly reduced in the second survey, but the levels of resilience and depressive symptoms remained constant. Regression analysis showed that the reduction in leisure activities did not predict depressive symptoms. However, structural equation modeling established that the relationship between leisure and depression was mediated by resilience, supporting the initial hypothesis. Importantly, this relationship slightly differed by age group, likely because popular activities and their psychological impacts vary depending on age., (© 2022 International Association of Applied Psychology.)

This study investigated how daily behaviors of Japanese people changed during the early stages of the COVID-19 pandemic and whether the change was mediated by demographics. It also examined whether the magnitude of behavior change in a demographic group is related to their attitudes towards the COVID-19 vaccine. 301 Japanese responded to an online survey in February 2021, in which they first wrote some activities they frequently performed before the virus outbreak and then wrote about activities in their current life. The number of gathered answers were 1858 for 'before' and 1668 for 'after', and they were grouped into 19 behavior categories. Overall, behaviors such as traveling, eating out, and shopping were much less frequently described in the 'after' condition; while housework, food delivery, and pandemic prevention were mentioned more. However, the change pattern was significantly influenced by demographics of age, gender, having children or not, and household income. Especially women, younger generations, and people without children showed the greatest extent of behavior change compared with the other demographic cohorts. These groups were reported to be vaccine-hesitant in the literature. This study suggests that individuals with hesitant attitudes towards vaccines are more willing to change their behaviors to control viral transmission.

This research investigated how we detect emotion in speech when the emotional cues in the sound of voice do not match the semantic content. It examined the dominance of the voice or semantics in the perception of emotion from incongruent speech and the influence of language on the interaction between the two modalities. Japanese participants heard a voice emoting anger, happiness or sadness while saying "I'm angry", "I'm pleased" or "I'm sad", which were in their native language, in their second language (English) and in unfamiliar languages (Khmer and Swedish). They reported how much they agree that the speaker is expressing each of the three emotions. Two experiments were conducted with different number of voice stimuli, and both found consistent results. Strong reliance on the voice was found for the speech in participants' second and unfamiliar languages but the dominance was weakened for the speech in their native language. Among the three emotions, voice was most important for perception of sadness. This research concludes that the impact of the emotional cues expressed by the voice and semantics varies depending on the expressed emotions and the language.

The concept of emotion can be organized within a hypothetical space comprising a limited number of dimensions representing essential properties of emotion. The present study examined cultural influences on such conceptual structure by comparing the performance of emotion word classification between Japanese and Korean individuals. Two types of emotional words were used; central concepts, highly typical examples of emotion, and less typical peripheral concepts. Participants classified 30 words into groups based on conceptual similarity. MDS analyses revealed a three-dimensional structure with valence, social engagement, and arousal dimensions for both cultures, with the valence dimension being the most salient one. The Japanese prioritized the social engagement over the arousal while the Koreans showed sensitivities to the arousal dimension. Although the conceptual structure was similar for the two countries, the weight of importance among the three dimensions seems to be different, reflecting each culture's values and communication styles., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Park, Kikutani, Suzuki, Ikemoto and Lee.)

According to one important set of theories, different domains of immorality are linked to different discrete emotions-panculturally. Violations against the community elicit contempt, whereas violations against an individual elicit anger. To test this theory, American, Indian and Japanese participants (N = 480) indicated contempt and anger reactions (with verbal rating and face selection) to both the types of immorality. To remedy method problems in previous research, community and autonomy violations were created for the same story-frame, by varying the target to be either the community or an individual. Community and autonomy violations did not differ significantly in the emotion elicited: overall, both types of violations elicited more anger than contempt (and more negative emotion of any kind than positive emotion). By verbal rating, Americans and Indians reported more anger than contempt for both types of violation, whereas Japanese reported more contempt than anger for both types. By face selection, the three cultural groups selected anger more than contempt for both types of violation. The results speak against defining distinct domains of morality by their association with distinct emotions., (© 2018 International Union of Psychological Science.)

The reported experiment investigated memory of unfamiliar faces and how it is influenced by race, facial expression, direction of gaze and observers' level of social anxiety. In total, 87 Japanese participants initially memorized images of Oriental and Caucasian faces displaying either happy or angry expressions with direct or averted gaze. They then saw the previously seen faces and additional distractor faces displaying neutral expressions and judged whether they had seen them before. Their level of social anxiety was measured with a questionnaire. Regardless of gaze or race of the faces, recognition for faces studied with happy expressions was more accurate than for those studied with angry expressions (happiness advantage), but this tendency weakened for people with higher levels of social anxiety, possibly due to their increased anxiety for positive feedback regarding social interactions. Interestingly, the reduction in the happiness advantage observed for the highly anxious participants was more prominent for the own-race faces than for the other-race faces. The results suggest that angry expression disrupts processing of identity-relevant features of the faces, but the memory for happy faces is affected by the social anxiety traits, and the magnitude of the impact may depend on the importance of the face.

Research on Japanese reading has generally indicated that processing of the logographic script Kanji primarily involves whole-word lexical processing and follows a semantics-to-phonology route, while the two phonological scripts Hiragana and Katakana (collectively called Kana) are processed via a sub-lexical route, and more in a phonology-to-semantics manner. Therefore, switching between the two scripts often involves switching between two reading processes, which results in a delayed response for the second script (a script switch cost). In the present study, participants responded to pairs of words that were written either in the same orthography (within-script), or in two different Japanese orthographies (cross-script), switching either between Kanji and Hiragana, or between Katakana and Hiragana. They were asked to read the words aloud (Experiments 1 and 3) and to make a semantic decision about them (Experiments 2 and 4). In contrast to initial predictions, a clear switch cost was observed when participants switched between the two Kana scripts, while script switch costs were less consistent when participants switched between Kanji and Hiragana. This indicates that there are distinct processes involved in reading of the two types of Kana, where Hiragana reading appears to bear some similarities to Kanji processing. This suggests that the role of semantic processing in Hiragana (but not Katakana) reading is more prominent than previously thought and thus, Hiragana is not likely to be processed strictly phonologically.

Metastasis from breast carcinoma is an uncommon occurrence in skeletal muscle, compared to local invasion into muscle from direct tumor spread. A 49-year-old woman was referred to our hospital with an 8.5-cm mass in the right breast. Core needle biopsy revealed metaplastic carcinoma with squamous metaplasia. The mass was rapidly growing and metaplastic, so mastectomy with dissection of axillary lymph nodes was performed. Pathological examination showed metaplastic carcinoma, histological grade 3, triple negative, and a MIB-1 labeling index of 80%. Six months postoperatively, during adjuvant chemotherapy treatment, she reported numbness and pain in the right lateral thigh and a mass in the right lower abdomen. Computed tomography revealed multiple lined masses in the abdominal wall and iliac muscle. Core needle biopsy showed metastatic breast carcinoma. Radio- and chemotherapy were administered, but the mass in the muscle became enlarged. To control her pain, a combined treatment with morphine, fentanyl, ketamine, antiepilepsy drug, and NSAIDs was administered. Liver metastasis appeared 9 months (15 months postoperatively) after recognition of muscle metastasis, and the patient died 16 months postoperatively. Skeletal muscle metastasis is uncommon, and therapeutic intervention is mainly palliative. The most common symptom of skeletal muscle metastasis is pain; thus, pain control is a pivotal goal of treatment.

IgG4-related sclerosing disease was first identified and defined in the twenty-first century. In this pathology, the serum IgG4 level increases and IgG4-positive plasma cells and lymphocytes infiltrate organs such as the pancreas, salivary glands, lacrimal glands, kidneys, and the retroperitoneum. Presented in this report is a case of IgG4-related sclerosing disease that occurred in the breast and was treated successfully with steroid therapy. A 51-year-old woman presented with bilaterally swollen eyelids and an elevated serum IgG4 concentration. Screening CT revealed a lesion in her right breast but no other lesions. Mammography, ultrasonography, and MRI could not rule out malignancy, so a core needle biopsy was performed. Histologically, the lesion was composed of papilloma with fibrosis, adenosis, and severe lymphoplasmacytic infiltration. No malignant features were observed. Many plasma cells within the lesion were immunohistochemically positive for IgG4. IgG4-related sclerosing disease of the breast was diagnosed, and steroid therapy was initiated. During 4 weeks of steroid treatment the lesion became smaller in size, and at 7-months follow-up the lesion showed no new growth. Since steroid therapy is effective for this disease, IgG4-related sclerosing disease should be considered in the differential diagnosis of breast lesions in order to avoid unnecessary surgery.

Three studies investigated developmental changes in facial expression processing, between 3 years-of-age and adulthood. For adults and older children, the addition of sunglasses to upright faces caused an equivalent decrement in performance to face inversion. However, younger children showed better classification of expressions of faces wearing sunglasses than children who saw the same faces un-occluded. When the mouth area was occluded with a mask, children under nine years showed no impairment in expression classification, relative to un-occluded faces. An early selective focus of attention on the eyes may be optimal for socialization, but mediate against accurate expression classification. The data support a model in which a threshold level of attentional control must be reached before children can develop adult-like configural processing skills and be flexible in their use of face- processing strategies., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: The effects of intravenous oxytocics on blood loss and uterine contraction during cesarean section were studied in 136 parturients., Methods: The subjects were randomized to receive either methylergometrine 0.2 mg bolus (MEM group; n = 34), oxytocin 10 IU over 30 seconds (OX 30 s group; n = 34), oxytocin 10 IU over 5 minutes (OX 5 m group; n = 34) or oxytocin 10 IU over 15 minutes (OX 15 m group; n = 34). The subjects received spinal anesthesia with 11-12 mg of intrathecal isobaric bupivacaine (0.5%). Additional intramyometrial prostaglandin F2alpha (PGF2alpha) was administered when obstetrician diagnosed uterine atony. We analyzed total amount of blood loss including amniotic fluid and number of parturients that received additional intramyometrial PGF2alpha to evaluate uterine contraction., Results: The amounts of blood loss in the OX 30 s and OX 5 m groups were significantly lower than in the MEM group, and the numbers of parturients received additional PGF2alpha in all the oxytocin treat ment groups were significantly lower than in the MEM group (P < 0.05). There were no significant differences in blood loss and uterine contractior among the oxytocin treatment groups., Conclusions: Intravenous oxytocin 10 IU over 30 seconds to 15 minutes was effective to decrease blood loss and uterine contraction than intravenous methylergometrine 0.2 mg bolus.

Placental abruption is a serious cause of fetal mortality. We retrospectively reviewed 24 patients with placental abruption who underwent cesarean section to evaluate ultrasonographic images with reference to the clinical findings and fetal and maternal prognosis. Fourteen of these patients presenting with placental edge separation and persistent hematoma showed a significantly smaller area of abruption, a smaller amount of intraoperative bleeding, a smaller incidence of disseminated intravascular coagulation, and a higher Apgar score as compared to the 10 patients with a thickened placenta. The patients with thickened placenta tended to have a typical clinical presentation, whereas those with placental edge separation and hematoma appeared to have an atypical and mild clinical manifestation. It was concluded that ultrasonography is useful in the diagnosis of mild and atypical placental abruption.

Extracts of human term placenta were fractionated by Sephadex G-75 gel filtration and assayed for immunoreactive ACTH. Both high and low molecular weight protein fractions were detected to be immunologically reactive toward anti-human ACTH (1--39 alpha) antibody. For the extraction of low molecular weight ACTH from human term placenta (pl. -ACTH), a glacial acetic acid-acetone mixture was employed, while a pH 3.0-HCl solution was used for high molecular weight immunoreactive ACTH. The high molecular weight immunoreactive ACTH fraction (F-I), co-eluted with horse hemoglobin from a Sephadex G-75.column in 0.1M acetic acid, was essentially devoid of low molecular weight materials as revealed by polyacrylamide gel disc electrophoresis at pHs 9.5 and 4.3. Tryptic digestion of F-1 at pH 8.1 and 37 degrees C for 4 hr with E/S of 1/100, followed by fractionation with a Sephadex G-75, resulted in the formation of lower molecular weight fragments. One fragment was eluted at the same position as that of porcine ACTH with a recovery of 86% of immunoreactivity of F-I. Another fragment which was eluted last exhibited positive beta-endorphin receptor binding activity. These results suggest the presence of a common precursor protein to ACTH and beta-endorphin in human term placenta.

A histological study on small intestine of Wistar rats after oral administration of ricin, a proteinous toxin from castor bean seeds, was carried out. In Experiment I, the jejunum was examined at 1, 2, 5, 10, 15, 20, 24, and 40 hours after oral administration of ricin 30 mg/kg. In Experiment II, ricin was administered at dose of 1, 3, 5, 10, 15, 30, and 60 mg/kg, and after 5 hours the jejunum, mid-portion, and ileum were examined. For comparison, ricin 0.5 mg/kg was administered intraperitoneally and castor bean hemagglutinin (CBH) 30 mg/kg orally. In both experiments, the changes of mucosa were essentially similar dependent on time-lapse and dose respectively, which were atrophy of villus, elongation of crypt, degeneration of epithelium, decrease of goblet cell, fusion of intervillous epithelia, infiltration of neutrophils and eosinophils, and dissociation between epithelium and lamina propria. These changes were most manifest in the jejunum that was contacted with ricin first in a high concentration. In contrast, intraperitoneal administration of ricin caused only dissociation between epithelium and lamina propria and oral administration of CBH caused only milder atrophic changes. The evidences suggest that the mucosal changes by oral administration were caused by direct contact with ricin.

An enzyme-linked immunoassay was applied to the determination of hCG, a glycoprotein hormone usually assayed by RIA. For this purpose, an enzyme hormone conjugate was prepared by reacting hCG with beta-D-galactosidase (beta-Gal.) of E. coli in the presence of N-(m-maleimidobenzoyloxy) succinimide (MBS) as coupling reagent. The conjugate, after purification by affinity and gel chromatographies, was shown to exhibit sufficient enzyme activity and immunoactivity. The immunoassay of hCG was performed by the double antibody method and, using this assay, 0.4-250 mIU/ml hCG were detectable. This was about 10 times as sensitive as the RIA. Difficulty was experienced when this method was utilized for the determination of hCG in plasma samples from patients. Since the presence of the plasma may have affected this assay method, the following improvements were made: 1) the same volume of hormone-free plasma was added to the standard solutions of hCG, and 2) the volume of plasma sample was 10 microliter. The performance and validity of this assay were comparable to the RIA using [125I]hCG as tracer. The dose-response curves of both assay have the same slope and there was no significant difference between the values (correlation coefficient, Y = 0.96X + 1.53).