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We herein report a patient with rheumatoid arthritis (RA) who successfully delivered a healthy child with continuous administration of sarilumab throughout pregnancy. She delivered her first child, a healthy boy, following in vitro fertilization-embryo transfer (IVF-ET) while using etanercept and low-dose prednisolone. Disease activity persisted after delivery, so etanercept was switched to sarilumab. She became pregnant by IVF-ET again. Because RA was still active, sarilumab was continued during pregnancy. She delivered a healthy girl at the 38th week of gestation by Caesarean section. No abnormalities were detected at or within 6 months after birth. Sarilumab was safe and effective in this pregnant woman with RA.

This article revisits the optimization problems of age-based replacement models for exponential failure distributions. First, we show the steps how an age replacement time goes to an infinite value when the lifetime of a unit has an exponential distribution, and then, we give two discussions of possible replacement times, by introducing a new concept of cost named as deviation cost per unit of time between replacement and failure. Second, similar discussion is given for a random replacement model when the age replacement time is a random variable with a uniform distribution. Third, the models of age-based replacement first and last with deviation costs are discussed when a random replacement is taken into account for an age replacement model. Numerical examples are illustrated to show the results of the analytical discussions. Finally, necessary proofs are provided in the Appendixes.

本稿は，板垣竜太氏による著書に関する公開シンポジウム(「植民地主義・解放・冷戦の歴史経験を再考する－板垣竜太『北に渡った言語学者:金壽卿 1918-2000』(2021年)を手がかりに」)で発表されたふたつの書評コメントから構成されている。, 討論(Discussion)

Background: Organizing pneumonia (OP) is a rare manifestation of systemic lupus erythematosus (SLE). It has been described in very few case reports. Purpose and Methods: We encountered OP in three patients with SLE in 1 year; two manifested OP as an initial presentation of SLE, while the third manifested OP when SLE relapsed. To elucidate the clinical features and outcomes of OP in patients with SLE, we screened the PubMed database for cases diagnosed with OP either at or after the diagnosis of SLE; the search was restricted to articles that were published after 1990, when OP became widely recognized. Results: We identified 15 cases of OP in patients with SLE. Thus, we analyzed a total of 18 cases (including our three). OP developed at the initial diagnosis of SLE in 15 cases and at relapse of SLE in three cases. In most cases, the disease activity of SLE was moderate or high. In all cases, OP was accompanied by other extrapulmonary symptoms of SLE, namely, fever (77.8%), cutaneous manifestations (61.1%), arthralgia/arthritis (50%), and lupus nephritis (33.3%). Steroid monotherapy or increasing the dose of the steroids was effective in seven cases (38.8%); however, steroid monotherapy was ineffective and led to death due to respiratory failure in two cases (11.1%). Combination therapies of steroids with hydroxychloroquine, azathioprine, tacrolimus, mycophenolate mofetil, intravenous pulse cyclophosphamide therapy, and belimumab were effective in seven cases (38.8%). Conclusions: Based on the review of previously reported and our cases, we concluded that OP is an important pulmonary manifestation of SLE. Clinicians should be aware of it as it may require intensive immunosuppressive therapy either at or after the diagnosis of SLE.

Per- and polyfluoroalkyl substances (PFASs) are used in products, such as aqueous film-forming foam and fluorochemical surfactants, because of their high chemical stability. Although the use of perfluoroalkyl carboxylic acids (PFCAs) and perfluoroalkyl sulfonic acids (PFSAs) in PFASs has decreased because of replacement, many products containing them are landfilled. Determining accurate PFCA and PFSA concentrations of leachate from waste disposal sites is necessary, although reports on landfills are scarce, especially industrial waste landfills (IWLs). Little information about the fate of PFCAs and PFSAs during leachate treatment processes is available. Herein, the congener contributions of PFCAs and PFSAs in leachates of IWLs and municipal solid waste landfills (MSWLs) and changes in their concentrations before and after leachate treatment are reported. PFCA and PFSA concentrations in landfill leachates ranged from C9) ones were rarely detected. Moreover, > 95% of these substances were removed in the activated carbon and reverse osmosis (RO) membrane treatments. These results suggest that activated carbon and RO membrane treatments effectively remove PFCAs and PFSAs from leachates.

Pseudoaneurysm is a potentially life-threatening complication after hepatobiliary pancreatic surgery. Although various measures have been taken to prevent the formation of postoperative pseudoaneurysms, completely avoiding complications can be difficult. An 83-year-old man underwent bile duct resection and systematic regional lymphadenectomies for distal cholangiocarcinoma. Polyethylene glycolic acid mesh with fibrin glue was applied to the pancreas around the distal stump and detached artery to prevent leakage of pancreatic juice and reinforce the arterial wall. Screening contrast-enhanced computed tomography on the 7th postoperative day indicated no pseudoaneurysm. The patient was discharged on the 20th postoperative day after an uneventful course. However, 4 days later, the patient visited the emergency outpatient department with a complaint of fever. Contrast-enhanced computed tomography revealed an abscess formation and a pseudoaneurysm around it. Emergency celiac arteriography revealed two pseudoaneurysms at the left hepatic artery and posterior superior pancreaticoduodenal artery; they were successfully treated with transcatheter arterial embolization using microcoils and covered stent placement. The patient was discharged 9 days after interventional radiology treatment. At the 14 months postoperative follow-up, the patient had no recurrence or stent obstruction. Multiple synchronous pseudoaneurysms are rare; accurately identifying the site by angiography and selecting appropriate treatment for each site is important.

In this paper, we propose a computing algorithm to obtain optimal checking times which minimize the expected cost rate of sequential inspection models. This algorithm is applied to two modified inspection models with finite intervals such that the unit is checked at times [Formula: see text] ([Formula: see text]) for given [Formula: see text] and given [Formula: see text]. The modified algorithms are proposed and optimal checking times to minimize the expected cost rates are obtained. Numerical examples of each model are given to show how to use the algorithm. This method would be applied to other sequential inspection models by its suitable modifications.

In order to balance the deviation time between replacement and failure, a new notion of cost named as deviation cost is taken into account for planning replacement policies. We firstly take up a standard parallel system with n identical units and model replacement policies that are done at planned time and at periodic times. Next, we model again the above replacement policies when the number of units is a random variable that has a Poisson distribution. Thirdly, replacement policies are planned preventively at the completion of random working times. Optimum number of units is scheduled for a total working interval that is constantly and randomly given. Finally, we give reliability functions of k-out-of-n systems for extensions of parallel systems. We give analytical discussions for the above replacement policies and illustrate numerical examples when the failure time of each unit has an exponential distribution.

Objectives Postoperative pancreatic fistula (POPF) subsequent to pancreatectomy often causes activation of pancreatic juice, resulting in serious complications. In POPF, the types of pancreatic juices found are active and inactive, and the identification of these two types of pancreatic juice greatly contributes to the development of postoperative management after pancreatectomy. This study reports favorable results of the clinical application of the Forster resonance energy transfer (FRET) nanoprobe that was independently developed to distinguish between the active and inactive types of pancreatic juice. Methods The FRET nanoprobe developed was a nanoprotein capsule. It exuded a red color when the capsule structure was maintained. When activated protease in the pancreatic juice acts on it, the capsules are reduced quantitatively and FRET is abolished, resulting in a change in color from red to green. Pancreatic juice activation can be measured by the FRET signal. A total of 117 drainage fluid samples from 16 postpancreatoduodenectomy cases were obtained and evaluated. Results The diagnosis of pancreatic juice activation was possible using the FRET signal with a cut-off value of 1.6. Pancreatic juice activation was not associated with drainage fluid amylase (AMY) levels. The results demonstrated that pancreatic juice was activated when drainage fluid was infected. Conclusion The use of a FRET nanoprobe enabled real-time detection of the presence or absence of pancreatic juice activation in pancreatic fistula after pancreatic surgery. There was an adequate correlation between infection and pancreatic juice activation regardless of drain AMY levels.

Acanthamoeba can cause visually destructive Acanthamoeba keratitis (AK) in contact lens (CL) users. The purpose of this study was to determine whether Acanthamoeba was present in the CL cases of CL wearers and to develop techniques to prevent the contaminations. To accomplish this, 512 CL case samples were collected from 305 healthy CL wearers. Using real-time PCR, Acanthamoeba DNA was detected in 19.1% of CL cases, however their presence was not directly associated with poor CL case care. Instead, the presence of Acanthamoeba DNA was associated with significant levels of many different bacterial species. When the CL cases underwent metagenomic analysis, the most abundant bacterial orders were Enterobacteriales followed by Burkholderiales, Pseudomonadales, and Flavobacteriales. The presence of Acanthamoeba was characterized by Propionibacterium acnes and Rothia aeria and was also associated with an increase in the α diversity. Collectively, Acanthamoeba contamination occurs when a diversified bacterial flora is present in CL cases. This can effectively be prevented by careful and thorough CL case care.

Iguratimod (IGU) is a conventional synthetic disease-modifying drug that has been approved based on its additive effects with methotrexate (MTX) for the treatment of rheumatoid arthritis (RA). The objective of the study is to establish the effectiveness of IGU with versus IGU without MTX irrespective of whether MTX is well tolerated or not by the patients. Disease activity scores in 177 RA patients treated using IGU were retrospectively evaluated at baseline and after 4, 12, and 24 weeks, and adverse events (AEs) were noted. IGU reduced the disease activity parameters, disease activity score (DAS)-ESR, DAS-CRP, the simplified disease activity index (SDAI), and clinical disease activity index (CDAI) in the concomitant MTX and non-MTX, female and male, and young and elderly patient groups after 24 weeks. Multivariate analysis demonstrated that IGU was more effective with concomitant MTX and in elderly and male patients. Severe AEs were observed only in the elderly group: two cases of pneumonia, 1 of pneumocystis pneumonia, 1 of heart failure, and 1 of salivary gland adenoma. IGU is effective for RA, especially with concomitant MTX, and in elderly and male patients.

Objectives Preterm children with severe dyskinetic cerebral palsy due to bilirubin encephalopathy often suffer from marked generalised hypertonus as they age. We performed a questionnaire survey to investigate patient-reported outcomes of treatments for improving their activities of daily life. Methods A mail questionnaire was administered to the caregivers of 67 children with preterm bilirubin encephalopathy aged >4 years. We asked about the type of treatments they received and their efficacy using a five-point subjective scale for the following five domains: motor function, postural stability, sleep, pain, and care burden. The names of oral drugs and their efficacies were also explored. Results The response rate of the questionnaires was 62.7% (42/67), and we analysed the results from 41 validated cases. All children underwent rehabilitation. A total of 30 children received oral drugs, 22 botulinum toxin, 12 orthopaedic surgery, and 3 intrathecal baclofen. Each of these treatments was subjectively reported to be effective in more than half of the recipients for each of the five domains, whereas 23 (56%) required more than two types of treatments other than rehabilitation. Chlordiazepoxide was the most commonly used oral drug, by 28 children (68%), and was discontinued in 7 patients (25%) only. In the sleep domain, the rate of a positive effect was significantly higher for oral drugs (92.7%) than the other treatments (p Conclusion All treatments were partially effective, but their appropriate combination based on a multidisciplinary approach is essential for muscle tone management in children with preterm bilirubin encephalopathy.

When we consider the improvement of the functional performances that are released by the new updates of the products, it is an interesting problem to revisit the existing replacement polici...

The magnetization switching field is efficiently reduced by exciting precession with a microwave field of GHz frequency. Analytical calculations based on the Landau–Lifshitz–Gilbert equation have revealed that the effect of the thermal activation process plays an important role in magnetization switching behavior under a microwave field. In this study, we experimentally investigated the microwave-assisted magnetization switching (MAS) behavior of Co/Pt nanodot arrays under various microwave field conditions. Experimental results were compared with the calculated effective energy barrier height of MAS. Consequently, all the experimental MAS behaviors can be explained by the effect of thermal activation, but quantitative discussion will require accurate experimental studies.

In the late colonial period, starting in 1858, the ‘European-ness’ of the European community in British India was not as self-evident as we all too easily tend to assume. To maintain the fiction of the community as ‘a race apart’, it was deemed important that the problematic forms of whiteness be vigilantly watched and intervened upon whenever necessary. The imperial politics of whiteness was neither thorough nor effective enough, however, leaving the European community in India visibly divided and hierarchised, with its equivocal boundaries exposed to view.

Ship breaking and recycling industry (SBRI) loops back scarce ferrous and non-ferrous materials from dismantled ships and also renews the global shipping fleet by treating the end-of-life (EoL) ships. Currently, SBRIs in Bangladesh, India, and Pakistan are dismantling the majority of the EoL ships by open beaching method. Accordingly, ship dismantling carries the blame of releasing potentially toxic elements (PTEs) to the coastal and marine environment risking the food chain through potential bioaccumulation and biomagnification. Health risk assessment associated with PTEs from open beach ship dismantling is scarce. This study aimed at assessing concentrations and seasonal variations of PTEs in soils exposed to the activities of SBRIs for their source apportionment by using contamination factor (CF) and multivariate statistical analysis, while carcinogenic and non-carcinogenic health risks due to the PTEs have also been determined. Soil samples were collected twice—during pre-monsoon and post-monsoon seasons—from three working zones of each of the 15 different ship breaking yards spanning the entire SBRI zone in Bangladesh. Soil contamination was assessed by using the CF, and inverse distance weighting interpolation mapping showed the spatial distribution of metals at SBRI zone in Bangladesh. Multivariate statistical analysis, principal component analysis, and correlation matrix yielded the source apportionment of PTEs. Subsequently, carcinogenic and non-carcinogenic health risks were assessed following the approach recommended by the United States Environmental Protection Agency (USEPA) with uncertainty estimation through Monte Carlo simulation. Contamination levels of PTEs followed Cd > Zn > Cr > Cu > Pb > Ni > Mn > As. Concentrations of Cd, Cr, Mn, and Zn were higher than the maximum allowable regulatory limits at storage zone and also higher as compared with the beaching and cutting zones in general. The contamination index indicated extreme Cd contamination in the area with elevated levels in pre-monsoon. Two principal components (PC) were identified—PC1 (Cd, Cu, Mn, Pb, Zn) and PC2 (As, Cr, Ni) inferring their source segmentation. Indirect soil ingestion is the major possible exposure path to PTEs. The health index indicated the absence of any obvious health effects on the people active at SBRI yards in Bangladesh. The carcinogenic risk was for 6 to 7 persons per 100,000 people which was within the USEPA acceptable range.