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The birefringence of optical polymers is a great issue in optical devices, inhibiting major applications of polymers to optical lenses and films. In this study, we have synthesized effective bottlebrush polymers with which we could attain almost zero birefringence when mixed with optical poly(methyl methacrylate) (PMMA). In detail, the PMMA bottlebrush polymers (PMMA-BBP) were synthesized by the ring-opening metathesis polymerization (ROMP) of norbornene-terminated PMMA macromonomers prepared via atom transfer radical polymerization (ATRP). Linear PMMA and PMMA-BBP were mixed to fabricate blend-film samples (PMMA/PMMA-BBP), which were uniaxially drawn to introduce molecular orientations. Linear PMMA possessed a negative value for its orientation birefringence, while the value of PMMA/PMMA-BBP increased as the PMMA-BBP content increased, whose orientation birefringence could reach almost zero when the ratio of the linear PMMA to PMMA-BBP became 73:27, regardless of the magnitude of the strain. The results reveal that the orientation birefringence of PMMA can be effectively controlled and removed by blending the appropriate content of PMMA-BBP.

Background: Camouflaging refers to behaviors in which autistic individuals hide their autistic characteristics and “pass” as non-autistic people. It is postulated that camouflaging is a response to stigma, and preliminary evidence supports this hypothesis. However, there has been limited research on this topic outside of Western countries. This study sought to replicate and extend previous work examining the relationships between camouflaging, stigma, and mental health in Japanese autistic people. Methods: Two hundred eighty seven autistic people living in Japan completed an online survey on camouflaging, perceived stigma, individualistic and collective strategies, mental wellbeing, anxiety, social anxiety, and depression. We used multiple regression analysis, mediation analyses, and two-sample t-tests to analyze the collected data. Results: We found that higher camouflaging was predicted by higher perceived stigma and more individualistic and collective strategy use. Camouflaging mediates the association of stigma with depression, anxiety, and social anxiety (but not wellbeing). Furthermore, autistic people in Japan reported lower perceived stigma, camouflaging, wellbeing, and collective strategy use but more individualistic strategies than those in a Western sample. Conclusion: Our findings support the hypothesis that camouflaging is a response to stigma and can influence the impact of stigma on mental health. There are also cross-cultural differences worth attending to, and more work around supporting positive autistic identity in Japan would be beneficial.

A 45-year-old man with allergic bronchopulmonary aspergillosis (ABPA) was treated with oral prednisolone (PSL) (30 mg/day), inhaled corticosteroids, and long-acting beta2-agonists. After confirmation of a PSL-dependent status (8 mg/day), subcutaneous injection with anti-interleukin (IL)-5 antibody (mepolizumab, 100 mg/month) was performed, and the PSL dose was tapered to 5 mg/day. However, ABPA recurred and proved refractory to oral itraconazole (200 mg/day). Alternative subcutaneous injection therapy with dupilumab (induction dose of 600 mg followed by a maintenance dose of 300 mg/2 weeks) enabled the successful withdrawal of oral PSL without clinical deterioration. This case demonstrates the potential utility of dupilumab for steroid-dependent ABPA via the synergistic suppression of IL-4 and IL-13 compared to monotherapy with anti-IL-5 antibody.

Purpose: To examine the reliability and validity of the Camouflaging Autistic Traits Questionnaire–Japanese version (CAT-Q-J). Methods: Self-report questionnaires were administered to 204 adults with and 410 adults without autism. Test–retest reliability was confirmed via another survey administered after two weeks.Results: The overall CAT-Q-J showed good reliability, correlating approximately with other scales, supporting its convergent validity. However, a few subscales had insufficient reliability and validity. Exploratory factor analyses showed three factors similar to the original in non-autistic sample (plus a factor comprising reversed items). For the autistic sample, three factors partially differed from the original. Conclusion: Despite acceptable consistency, reliability, and validity at an overall level, the CAT-Q-J should be used with caution.

Background: Despite the availability of evidence-based treatments and support measures for mental disorders, very few people with mental disorders seek treatment and use mental health services. Previous studies have shown that barriers to access to care, such as the treatment stigma experienced by patients, practical issues such as financial deprivation, and problems related to patients’ attitudes toward receiving care, cause delay in using medical services. However, there is insufficient knowledge regarding patient attributes which increases the likelihood of people with mental disorders to experience substantial barriers to access to care.This study aimed to investigate how patients’ attributes such as gender, age, history of hospitalisation for treatment of mental disorder, and psychiatric diagnosis affect barriers to access to care for people with mental disorders. Methods: This study is a secondary analysis of a web-based survey conducted by Hongo et al. on standardising the Barriers to Access to Care Evaluation scale version3-Japanese version (BACEv3-J). Hongo et al. selected 268 adults diagnosed with mental disorders who had received mental health services within the past 12 months. Participants responded online using the BACEv3-J. Then, we quantitatively examined the effects of their attributes on the total BACEv3-J score and subscale (treatment stigma and non-stigma) scores. Results: Compared with men, women experienced more substantial barriers to access to care, particularly non-stigma-related barriers. Age and treatment stigma had a significant negative correlation, whereas age and non-stigma-related barriers had no significant correlation. History of hospitalisation for treatment of mental disorders and the difference in psychiatric diagnosis did not affect barriers to access to care. Conclusion: This study showed that patients’ attributes such as gender and age affect barriers to access to care. Further, to encourage people with mental disorders to receive care, their characteristics need to be considered during these interventions.

This report presents an unusual case of multiple paraovarian cysts that required emergency surgery due to a paraovarian cyst being entrapped by another paraovarian cyst. Laparoscopic surgery is considered useful for diagnostic and therapeutic purposes and is therefore recommended owing to difficulty in differentiating paraovarian cysts from ovarian cysts.

This clinical image presents an unusual report of simultaneous laparoscopic resection of a hydrocele of the canal of Nuck and an ovarian tumor. Laparoscopic treatment with a proper approach is a useful technique in some cases.

Background Neutrophilic inflammation is associated with poorly controlled asthma. Serum levels of sST2, a soluble IL-33 receptor, increase in neutrophilic lung diseases. We hypothesized that high serum sST2 levels in stable asthmatics are a predictor for exacerbation within a short duration. Methods This prospective observational study evaluated the serum sST2 levels of 104 asthmatic patients who were treated by a lung disease specialist with follow-ups for 3 months. Results High serum sST2 levels (> 18 ng/ml) predicted severe asthma exacerbation within 3 months. Serum sST2 levels correlated positively with asthma severity (treatment step), airway H2O2 levels, and serum IL-8 levels. High serum sST2 levels and blood neutrophilia (> 6000 /μl) were independent predictors of exacerbation. We defined a post-hoc exacerbation-risk score combining high serum sST2 level and blood neutrophilia, which stratified patients into four groups. The score predicted exacerbation-risk with an area under curve of 0.91 in the receiver operating characteristic curve analysis. Patients with the highest scores had the most severe phenotype, with 85.7% showing exacerbation, airflow limitation, and corticosteroid-insensitivity. Conclusions High serum sST2 levels predicted exacerbation within the general asthmatic population and, when combined with blood neutrophil levels, provided an exacerbation-risk score that was an accurate predictor of exacerbation occurring within 3 months. Electronic supplementary material The online version of this article (10.1186/s12931-018-0872-2) contains supplementary material, which is available to authorized users.

Objective We investigated a novel diagnostic scoring system to differentiate Legionella pneumophila pneumonia from Streptococcus pneumoniae pneumonia. Methods We retrospectively reviewed the clinical data of 62 patients with L. pneumophila pneumonia (L-group) and 70 patients with S. pneumoniae pneumonia (S-group). Results The serum sodium (Na) levels tended to be lower according to the severity [age, dehydration, respiratory failure, orientation disturbance, low blood pressure (A-DROP)] score in the L-group. On a multivariate analysis, we found that four factors were independent predictive markers for inclusion in the L-group: relative bradycardia [hazard ratio (HR) 5.177, 95% confidence interval (CI): 1.072-24.993, p=0.041], lactate dehydrogenase (LDH) levels ≥292 IU/L (HR 6.804, 95% CI: 1.629-28.416, p=0.009), C-reactive protein (CRP) levels ≥21 mg/dL (HR 28.073, 95% CI: 5.654-139.462, p

We herein report our study into the hydrogenolysis of benzofuran, a model compound for the poorly decomposable compounds derived from lignin, over Pt supported catalysts in methanol in the absence of gaseous hydrogen. In this in situ hydrogenolysis reaction system, it was elucidated that both hydrogen production from methanol and selective hydrogenolysis of the furan moiety proceeded simultaneously to yield monophenolic compounds and gaseous hydrogen. This in situ hydrogenolysis reaction was investigated at temperatures between 180 and 220 °C and with reaction times ranging from 1 to 48 h. We found that the hydrogenolysis reaction was accelerated with increased hydrogen concentrations in the solvent. The molar ratio of consumed hydrogen to net hydrogen production increased gradually upon increasing the reaction temperature and time. In addition, the in situ hydrogenolysis of benzofuran under a hydrogen gas atmosphere revealed that the hydrogen produced in situ was more effective in the reaction than gaseous hydrogen, likely due to the dissolution and diffusion resistances of the solvent. Furthermore, dibenzyl ether was hydrogenolyzed to give monocyclic aromatic compounds under the same reaction conditions, suggesting that this in situ hydrogenolysis process could be effective in converting the by-products obtained during lignin depolymerization into valuable aromatic compounds.

Background The impact of viral infections on acute exacerbations in idiopathic pulmonary fibrosis (IPF) and/or non-IPF interstitial lung disease (ILDs) has been scarcely described. Objectives To elucidate the frequency of virus infections in patients with IPF or non-IPF ILDs including idiopathic interstitial pneumonia (IIP) or connective tissue disease (CTD)-associated pneumonia, and its influence on their short-term mortality. Methods We prospectively enrolled adult patients with acute exacerbation of IPF and non-IPF ILDs who were admitted to the hospital during the last 3 years, and examined the respiratory samples obtained from nasopharyngeal, sputum, and bronchoalveolar lavage fluid. Results A total of 78 patients were identified, consisting of 27 patients with acute exacerbation of IPF and 51 patients with non-IPF ILDs (IIP: n = 27, CTD-associated IP: n = 24). Of all patients, 15 (19.2%) had viruses detected in their respiratory samples including the human herpesvirus 7 (HHV7; n = 4) and cytomegalovirus (CMV) plus HHV7 (n = 3). The proportion of virus infections in the IPF and non-IPF ILDs groups was comparable. The Kaplan-Meier survival curves over 60 days revealed a lower survival probability in the virus positive group (n = 15, 60%) than in the virus negative group (n = 60, 83.3%, p

Background: Increasing number of evidences suggest that IL-33/sST2 axis associates with occurring neutrophilic inflammation but its mechanism remains unknown. Objectives: We hypothesized that IL-33/sST2 balance regulates neutrophil-related cytokine production in bronchial epithelial cells. Methods: We cultured normal human bronchial epithelial (NHBE) cells to assess functions and production mechanisms of IL-33 and sST2. We measured IL-33 and sST2 levels in exhaled breath condensate (EBC) from bronchial asthma (BA), COPD, and asthma-COPD overlap (ACO) patients (n=143) and healthy control (HC) subjects (n=11) and in sputum from BA, COPD, and ACO patients (n=31). Results: In NHBE cells, IL-33 enhanced neutrophil-related (CXCL8, CXCL1, CXCL5, and GM-CSF) and Th17-related (CCL20 and IL-6) cytokine production, which was inhibited by excess sST2. Neutrophil elastase (NE) upregulated intracellular IL-33 expression and further NE-induced cell damage caused IL-33 release into extracellular space. IL-4 and -13 enhanced sST2 production. EBC IL-33 levels were higher in ACO patients than in others (ACO vs BA plus COPD plus HC: n=15 vs 143, P=0.0008). EBC sST2 levels were higher in asthmatics than in others (BA plus ACO vs COPD plus HC: n=111 vs 47, P=0.0036). Sputum IL-33 levels correlated positively with sputum CXCL8 (r=0.56, P=0.003, n=38) and CCL20 (r=0.44, P=0.0121, n=32) levels. Sputum sST2 levels correlated positively with %FEV1 (r=0.48, P=0.0197, n=28), indicating that sST2 was protective against tissue damage. Conclusion: IL-33/sST2 axis regulates neutrophil-related cytokine production in the human airways, where high IL-33 and sST2 levels suggest presence of neutrophilic and type-2 inflammation, respectively.

Immune checkpoint inhibitors (ICIs) have emerged as evolutionary treatments for malignant diseases. Although ICIs can cause immune-related adverse events (irAEs) in various organs, precise timing after ICI initiation has been scarcely reported. Elucidating the effects of irAEs, such as time to onset, involvement of major organs, influence on progression-free survival (PFS), and overall survival (OS), are critical issues for physicians. Furthermore, lung-irAE as a whole is not well known. We conducted a retrospective study of 156 patients who were treated with ICIs and compared 82 irAE patients with 74 non-irAE patients. This study clearly demonstrated that the preferred period after induction of ICIs was significantly longer in lung-irAE than in other major organs (skin, digestive tract, and endocrine). The effect of irAEs on PFS and OS was evident PFS in the irAE group (n = 82) (median 128 days, interquartile range [IQR] 62–269 days, P = .002) was significantly longer than that in the non-irAE group (n = 74) (median 53 days, IQR 33–151 days). Similarly, OS was significantly longer in the irAE group (median 578 days, IQR 274–1027 days, P = .007) than in the non-irAE group (median 464 days, IQR: 209–842 days). However, this positive effect of irAEs in the lungs was not proportional to the extent of severity. Lung-irAEs can occur at a later phase than non-lung-irAEs and seemed not to prolong OS and PFS. However, further studies are needed to support these findings.

Carcinomatous meningitis (CM) is a critical issue for physicians. However, no study has reported a simple and useful diagnostic or predictive marker for CM. This study aimed to elucidate the potential markers for diagnosing CM derived from cerebrospinal fluid (CSF). We retrospectively enrolled 78 lung cancer patients with suspected CM during the clinical course, including 42 CM and 36 non-CM patients. We compared the clinical and CSF findings, including carcinoembryonic antigen (CEA), between CM and non-CM patients, and explored the diagnostic markers for early identification of CM as well as the contributing factors for mortality. On CSF analysis, with cutoff values of CEA ≥5 ng/ml, total protein (TP) in CSF ≥45 g/dl, and total cell count (TCC) ≥7 cells/μL, the sensitivity, specificity, and area under the curve (AUC) for CM were 85.7%, 84.6%, and 0.887 (95% CI: 0.758–1.0, P patients’ age)” (n = 19, P = .008) showed significantly shorter 90-day survival probability than the residual patients (n = 20). None of the CSF parameters could predict the risk of mortality on Cox regression analysis. The cutoff value of CEA ≥5 ng/ml in CSF is a simple and useful method with a high diagnostic value for CM diagnosis, but not a suitable predicting factor for mortality. ‘TP in CSF >patients’ age” might be a novel factor for assessing short-term mortality.

During bronchoscopy, discomfort is mainly caused by an unavoidable cough; however, there are no reports of any predictive factors for strong cough during bronchoscopy identified before the procedure. To clarify the factors underlying the discomfort status and predictive factors for strong cough during bronchoscopy, we prospectively evaluated patients who underwent bronchoscopy at Kyorin University Hospital between March 2018 and July 2019. Before and after bronchoscopy, the enrolled patients answered a questionnaire regarding the procedure. At the same time, bronchoscopists evaluated cough severity using a four-grade cough scale. We evaluated patient characteristics and predictive factors associated with bronchoscopy from the perspective of discomfort and strong cough. A total of 172 patients were ultimately enrolled in this study. On multivariate logistic regression analysis, comparison of the subjective data between the discomfort and comfort groups revealed that factors that were more common in the former group were younger age (OR = 0.96, p = 0.002), less experienced bronchoscopist (OR = 2.08, p = 0.047), and elevation of cough score per 1 point (OR = 1.69, p < 0.001). Furthermore, the predictive factors for strong cough prior to performing bronchoscopy were female sex (OR = 2.57, p = 0.009), EBUS-TBNA (OR = 2.95, p = 0.004), and prolonged examination time of more than 36 min (OR = 2.32, p = 0.022). Regarding patients’ discomfort, younger age, less experienced bronchoscopist, and the elevation of cough score per 1 point were important factors for discomfort in bronchoscopy. On the other hand, female sex, EBUS-TBNA, and prolonged examination time were crucial factors for strong cough.

We studied the diagnostic value of cytokines, including vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and interleukin-8 (IL-8), and the ratio of lactate dehydrogenase (LDH) to adenosine deaminase (ADA) in pleural fluid. Prospective analysis of 44 inpatients or outpatients with pleural fluid, from December 2016 to March 2017 was conducted. We enrolled patients with malignant pleural effusion (MPE, N = 15), empyema (N = 11), parapneumonic effusion (PPE, N = 7), chronic renal failure (CRF)/chronic heart failure (CHF) (N = 7), and tuberculous pleural effusion (TBPE, N = 4). The pleural fluid values of IL-8 and VEGF were significantly higher in empyema patients than in CRF/CHF or PPE patients. In all patients, the pleural fluid VEGF and IL-8 values were significantly positively correlated (r = 0.405, p = 0.006; r = 0.474, p = 0.047, respectively). TGF-β was elevated in patients with empyema, PPE, TBPE, and MPE. The pleural LDH-to-ADA ratio in patients with MPE or empyema/PPE was significantly higher than in patients with CRF/CHF or TBPE. LDH and ADA levels correlated significantly only in patients with MPE (r = 0.648, p = 0.009) and empyema/PPE (r = 0.978, p