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BACKGROUND Inconsistencies between the office and out-of-office blood pressure (BP) values (described as white-coat hypertension or masked hypertension) may be attributable in part to differences in the BP monitoring devices used. METHODS We studied consistency in the classification of BP control (well-controlled BP vs. uncontrolled BP) among office, home, and ambulatory BPs by using a validated “all-in-one” BP monitoring device. In the nationwide, general practitioner-based multicenter HI–JAMP study, 2,322 hypertensive patients treated with antihypertensive drugs underwent office BP measurements and 24-hour ambulatory BP monitoring (ABPM), consecutively followed by 5-day home BP monitoring (HBPM), for a total of seven BP measurement days. RESULTS Using the thresholds of the JSH2019 and ESC2018 guidelines, the patients with consistent classification of well-controlled status in the office ( CONCLUSIONS The combined assessment of the office and home BP is useful in clinical practice. Especially for patients whose office BP classification and home BP classification conflict, the complementary clinical use of both HBPM and ABPM might be recommended.

Sodium‐glucose cotransporter 2 (SGLT2) inhibitors reduce the occurrence of cardiovascular and renal complications in patients with type 2 diabetes mellitus (T2DM) and represent guideline‐recommended therapy in this indication. However, precise mechanisms underlying the beneficial cardiovascular effects of SGLT2 inhibitors are not fully understood. This study investigated the effects of the SGLT2 inhibitor, luseogliflozin, on arterial properties and home blood pressure (BP) in patients with T2DM. This multicenter, single‐arm study enrolled adults with T2DM, glycosylated hemoglobin (HbA1c) 6.5%‐8.9% in the previous 4 weeks, and an indication for new/additional antidiabetic therapy. Luseogliflozin 2.5 mg/d was given for 12 weeks. Primary outcome was change in cardio‐ankle vascular index (CAVI) from baseline to Week 4 and Week 12. Home and office BP, BP variability, and metabolic parameters were secondary endpoints. Forty‐seven patients (mean age 63.5 ± 10.7 years) treated with luseogliflozin were included in the full analysis set. CAVI did not change significantly from baseline (mean [95% confidence interval] 8.67 [8.37‐8.97]) to Week 12 (8.64 [8.38‐8.91]; P = .750), but there were significant reductions from baseline in morning home BP, HbA1c, body weight, body mass index, and serum uric acid levels during luseogliflozin therapy. The reduction in morning home systolic BP was ≥ 5 mm Hg and was independent of baseline BP and BP control status. In conclusion, there was no change in arterial stiffness (based on CAVI) during treatment with luseogliflozin, but changes in BP and metabolic parameters were consistent with the known beneficial effects of SGLT2 inhibitors in T2DM.

Vascular biomarkers, including the cardio‐ankle vascular index (CAVI), are increasingly being recognized as important indicators of cardiovascular risk. CAVI has been shown to have good discriminative ability for detecting new‐onset hypertension, but results of studies investigating cardiovascular risk prediction are inconsistent. Furthermore, there is a lack of data on the prognostic value of changes in CAVI over time. The Cardiovascular Prognostic Coupling study was designed to determine the impact of baseline CAVI and changes in CAVI on cardiovascular events in a Japanese cohort. The design of the ongoing, multicenter, prospective, observational registry and baseline characteristics of the enrolled population are reported. Eligible consecutive patients were aged ≥30 years, had ≥1 cardiovascular risk factor, and were being treated according to relevant Japanese guidelines. The primary outcome is time to onset of a major cardiovascular event (a composite of cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, stroke of unknown etiology, myocardial infarction, cardiovascular intervention for angina pectoris, and sudden death). Screening and enrollment occurred over a period of 3 years, followed by ≥7 years of follow‐up, with CAVI determined annually. A total of 5279 patients were registered, of whom 5109 had baseline data available and will be included in future analyses. Mean CAVI at baseline was 8.8 ± 1.4. The proportion of patients with CAVI of 10 was 25.3%, 57.0%, and 17.7%, respectively. Data from this registry should provide information on the significance of baseline CAVI and change in CAVI as indicators of cardiovascular prognosis in a representative patient population.

Study Design Longitudinal study. Objectives Intravoxel incoherent motion (IVIM), a magnetic resonance imaging (MRI) scanning technique that applies diffusion-weighted imaging (DWI), is effective for the quantitative assessment of malignant tumors of the vertebral bone. We hypothesized that IVIM parameters of vertebral bodies are associated with the prognosis of osteoporotic vertebral fracture (OVF). We aimed to explore the relationships between IVIM parameters for vertebral collapse and non-union after OVF and calculate the cut-off values of these parameters for vertebral collapse and non-union. Methods A total of 150 patients with acute OVF (150 women; mean age: 79.1 ± 7.4 years) were included and treated conservatively with bracing. MRI was performed at the time of injury. IVIM parameters, such as apparent diffusion coefficient (ADC), molecular diffusion coefficient (D), and perfusion-related diffusion (D*) were recorded. The patients were classified into 3 groups: low-collapse (height loss of ≤50%), high-collapse (height loss of >50%), and non-union. We compared ADC, D, and D* among the low-collapse, high-collapse, and non-union groups and performed a receiver operating characteristic (ROC) curve analysis to determine the boundary values of the high-collapse and non-union groups. Results The low-collapse, high-collapse, and non-union groups had no significant differences in ADC and D. However, D* differed significantly among the 3 groups. ROC analysis revealed cut-off values of 19.0 × 10-3 mm2/s and 12.3 × 10-3 mm2/s for the high-collapse and non-union groups, respectively. Conclusions D* is a significant prognostic indicator for high-collapse and non-union groups with OVF. This suggests that D* should be considered when assessing OVF.

Resistant hypertension is an important cardiovascular risk factor. This analysis of the JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) data investigated the effects of uncontrolled resistant hypertension diagnosed using ambulatory blood pressure (BP) monitoring on the risk of heart failure (HF) and overall cardiovascular events. The JAMP study patients with hypertension and no HF history were included. They had true resistant hypertension (24-hour BP ≥130/80 mm Hg), pseudoresistant hypertension (24-hour BP P =0.012 and 2.24 [95% CI, 1.17–4.30]; P =0.015, respectively) and versus uncontrolled nonresistant hypertension (1.51 [1.03–2.20]; P =0.034 and 3.03 [1.58–5.83]; P Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000020377.

A new framework is proposed for the study of collisions between very heavy ions which lead to the synthesis of Super-Heavy Elements (SHE), to address the fusion hindrance phenomenon. The dynamics of the reaction is studied in terms of collective degrees of freedom undergoing relaxation processes with different time scales. The Nakajima–Zwanzig projection operator method is employed to eliminate fast variables and derive a dynamical equation for the reduced system with only slow variables. There, the time evolution operator is renormalised and an inhomogeneous term appears, which represents a propagation of the given initial distribution. The term results in a slip to the initial values of the slow variables. We expect that gives a dynamical origin for the so-called “injection point $s$” introduced by Swiatecki et al. in order to reproduce absolute values of measured cross sections for SHE. A formula for the slip is given in terms of physical parameters of the system, which confirms the results recently obtained with a Langevin equation, and permits us to compare various incident channels.

The value of the cardio-ankle vascular index (CAVI) increases with age. All large-scale studies of the CAVI have investigated patients

Pathological conditions with refractory skeletal pain are often characterized by regional osteoporotic changes such as transient osteoporosis of the hip, regional migratory osteoporosis, or complex regional pain syndrome (CRPS). Our previous study demonstrated that the acidic microenvironment created by osteoclast activation under high bone turnover conditions induced pain-like behaviors in ovariectomized mice through the stimulation of acid-sensing nociceptors. The aim of the present study was to examine whether regional transient osteoporotic changes are related to pain-like behaviors in the hind limb using tail-suspended model mice. The hind limbs of tail-suspended mice were unloaded for 2 weeks, during which time the mice revealed significant regional osteoporotic changes in their hind limbs accompanied by osteoclast activation. In addition, these changes were significantly recovered by the resumption of weight bearing on the hind limbs for 4 weeks. Consistent with the pathological changes in the hind limbs, pain-like behaviors in the mice were induced by tail suspension and recovered by the resumption of weight bearing. Moreover, treatment with bisphosphonate significantly prevented the triggering of the regional osteoporosis and pain-like behaviors, and antagonists of the acid-sensing nociceptors, such as transient receptor potential channel vanilloid subfamily member 1 and acid-sensing ion channels, significantly improved the pain-like behaviors in the tail-suspended mice. We, therefore, believe that regional transient osteoporosis due to osteoclast activation might be a trigger for the pain-like behaviors in tail-suspended model mice. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1226-1236, 2017.

International audience

Objective Emphysematous cystitis (EC) has a high mortality rate compared with urinary tract infection without emphysema. However, its prognostic factors have yet to be determined. The presence of venous gas is suspected to be a rare, adverse prognostic factor of EC. However, all four previously reported cases improved. We hypothesized that venous gas is not an adverse prognostic factor of EC and aimed to assess the effect of venous gas on the EC prognosis. Methods Medical records were reviewed retrospectively. Patients The patients diagnosed with EC at Yodogawa Christian Hospital between April 2004 and September 2014 were included. Results Venous gas was present in 15 of 23 patients with EC. There was no significant difference in the background or clinical presentation between patients with or without venous gas. All patients with venous gas survived without invasive measures, whereas 50% of patients without venous gas died. Conclusion There was no marked difference in the mortality rate due to EC between the patients with and without venous gas. Venous gas may be a more common and less worrying finding in EC than assumed. It does not reflect the severity of infection, and air embolisms have not been reported so far. Venous gas may not affect the prognosis. This may be due to the differences in the mechanism of venous gas production. Gas in EC may develop due to glucose fermentation and intravesical pressurization, in contrast to the necrotizing infection seen in other emphysematous infections. This is the first study to assess the effect of venous gas on EC prognosis.

International audience; Synthesis of superheavy elements beyond oganesson is facing new challenges as new target-projectile combinations are necessary. Guidance from models is thus expected for future experiments. However, hindered fusion models are not well established and predictions in the fission barriers span few MeVs. Consequently, predictions are not reliable. Strategies to constrain both fusion hindrance and fission barriers are necessary to improve the predictive power of the models. But, there is no hope to get an accuracy better than one order of magnitude in fusion-evaporation reactions leading to superheavy elements synthesis.

Background Findings of urban-rural differences in the prevalence of depression have been controversial, and few reports have directly compared the related factors of depression between urban and rural areas. The present study aimed to investigate differences between urban and rural areas in Japan with regards to the prevalence of and related factors of depression in middle-aged adults, in order to further understanding of the features of depression in this demographic. Methods We used a multistage, random sampling procedure and mailing method. In total, 5000 participants were recruited from urban and rural areas in Kumamoto Prefecture (2500 in each area). Participants were aged from 40 to 64 years. Depression was assessed using the Center for Epidemiologic Studies Depression scale (CES-D). Results The prevalence of middle-aged depression was not different between the urban and rural areas. Logistic regression analysis found that being female, living alone, and having a chronic illness were significantly associated with depression in urban-dwelling middle-aged adults. Younger age, sleep disturbance, and financial strain were significantly associated with depression in both urban and rural areas. Limitations The definition of depression was based on CES-D scores, without corroborating clinical evaluation. Conclusions We found no marked differences in the prevalence of middle-aged depression between the urban and rural areas. Some related factors of depression in middle-aged adults differed between urban and rural areas in Japan. Effective intervention programs for middle-aged adults with depression should consider regional differences.

We have recently demonstrated that pathological changes leading to increased bone resorption by osteoclast activation are related to the induction of pain-like behavior in ovariectomized (OVX) mice. In addition, bisphosphonate and the antagonist of transient receptor potential vanilloid type 1 (TRPV1), an acid-sensing nociceptor, improved the threshold value of pain-like behaviors accompanying an improvement in the acidic environment in the bone tissue based on osteoclast inactivation. The aim of this study was to evaluate the effect of (i) an inhibitor of vacuolar H(+) -ATPase, known as an proton pump, (ii) an antagonist of acid-sensing ion channel (ASIC) 3, as another acid-sensing nociceptor, and (iii) the P2X2/3 receptor, as an ATP-ligand nociceptor, on pain-like behavior in OVX mice. This inhibitor and antagonists were found to improve the threshold value of pain-like behavior in OVX mice. These results indicated that the skeletal pain accompanying osteoporosis is possibly associated with the acidic microenvironment and increased ATP level caused by osteoclast activation under a high bone turnover state.

Objective: To evaluate the long-term effects of comprehensive antibiotic stewardship programs (ASPs) on antibiotic use, antimicrobial-resistant bacteria, and clinical outcomes. Design: Before-after study. Setting: National university hospital with 934 beds. Intervention: Implementation in March 2010 of a comprehensive ASPs including, among other strategies, weekly prospective audit and feedback with multidisciplinary collaboration. Methods: The primary outcome was the use of antipseudomonal antibiotics as measured by the monthly mean days of therapy per 1000 patient days each year. Secondary outcomes included overall antibiotic use and that of each antibiotic class, susceptibility of Pseudomonas aeruginosa, the proportion of patients isolated methicillin-resistant Staphylococcus aureus (MRSA) among all patients isolated S. aureus, the incidence of MRSA, and the 30-day mortality attributable to bacteremia. Results: The mean monthly use of antipseudomonal antibiotics significantly decreased in 2011 and after as compared with 2009. Susceptibility to levofloxacin was significantly increased from 2009 to 2016 (P = 0.01 for trend). Its susceptibility to other antibiotics remained over 84% and did not change significantly during the study period. The proportion of patients isolated MRSA and the incidence of MRSA decreased significantly from 2009 to 2016 (P < 0.001 and = 0.02 for trend, respectively). There were no significant changes in the 30-day mortality attributable to bacteremia during the study period (P = 0.57 for trend). Conclusion The comprehensive ASPs had long-term efficacy for reducing the use of the targeted broad-spectrum antibiotics, maintaining the antibiotic susceptibility of P. aeruginosa, and decreasing the prevalence of MRSA, without adversely affecting clinical outcome.

Background Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study. Methods Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated. Results All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p = 0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p = 0.26). Time to recover activity level appeared to be shorter in the GGGS group (p = 0.10), with shorter time to recover health status (p = 0.02). Subgroup analysis on patients with positive PCR showed similar results between the two groups. Conclusion GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.

13 pages, 13 figures, submitted for publication in PRC; International audience; Background: Synthesis of super-heavy elements is performed by heavy-ion fusion-evaporation reactions. However , fusion is known to be hindered with respect to what can be observed with lighter ions. Thus some delicate ambiguities remain on the fusion mechanism that eventually lead to severe discrepancies in the calculated formation probabilities coming from different fusion models. Purpose: In the present work, we propose a general framework based upon uncertainty analysis in the hope of constraining fusion models. Method: To quantify uncertainty associated with the formation probability, we propose to propagate uncertainties in data and parameters using the Monte-Carlo method in combination with a cascade code called KEWPIE2, with the aim of determining the associated uncertainty, namely the 95% confidence interval. We also investigate the impact of different models or options, which cannot be modeled by continuous probability distributions, on the final results. An illustrative example is presented in detail and then a systematic study is carried out for a selected set of cold-fusion reactions. Results: It has been rigorously shown that, at the 95% confidence level, the total uncertainty of the empirical formation probability appears comparable to the discrepancy between calculated values. Conclusions: The results obtained from the present study provide a direct evidence for predictive limitations of the existing fusion-evaporation models. It is thus necessary to find other ways to assess such models for the purpose of establishing a more reliable reaction theory, which is expected to guide future experiments on the production of super-heavy elements.

Meticillin-resistant Staphylococcus aureus (MRSA)-related infections have recently been spreading and are difficult to control, partly because affected patients are frequently in a poor condition. This study retrospectively investigated recent MRSA-related infections focusing on the relationship between clinical risk factors and anti-MRSA drug resistance. The patients with MRSA-related infections in Kobe University Hospital (Kobe, Japan) in 2009 were enrolled in the study. The relationships between various clinical risk factors as well as MRSA bacterial DNA concentration with minimum inhibitory concentrations (MICs) of anti-MRSA drugs were examined. In total, 44 patients were enrolled in the study and MRSA was isolated from blood (23 patients), urine (12 patients) and nasal secretions (9 patients). There was only one resistant strain to linezolid (LZD) among the anti-MRSA drugs tested, and this strain was considered staphylococcal cassette chromosome mec (SCCmec) type IIa from phage open-reading frame typing analyses. Statistical analyses showed that MRSA bacterial DNA concentration, cancer and use of a respirator, respectively, had a significant relationship with the MICs of LZD (P=0.0058) and arbekacin (ABK) (P=0.0003), of quinupristin/dalfopristin (Q/D) (P=0.0500) and ABK (P=0.0133), and of Q/D (P=0.0198) and vancomycin (P=0.0036). In conclusion, bacterial DNA concentration, cancer and use of a respirator were found to be significant risk factors for lower susceptibilities to anti-MRSA drugs; one strain was resistant to LZD. We suggest that further investigation and surveillance for MRSA-related infection are necessary for preventing the spread of MRSA-related infections.

Aim: This study aimed to investigate factors associated with depression in a sample of elderly Japanese individuals in a rural community and to examine differences among factors associated with individuals living alone or living with others. Methods: Using a population-based sample from rural Japan, we assessed a total of 1552 participants aged 65 years or older by mailing a survey and evaluating responses based on the Geriatric Depression Scale. Factors associated with depression were also examined. Results: We received 964 valid responses. Depressed subjects comprised 20.5% of the sample. Living alone was significantly related to depression. In individuals living alone, depression was associated with loss of appetite, suicidal ideation, financial strain, and worries in life. However, multiple linear regression analyses revealed that the influence of living alone was negated by having a good social support system. Conclusion: These findings confirm that living alone is an important factor in depression among the elderly in a rural part of Japan. Results also confirm what others have found in Western cultures: high levels of social support, awareness of receiving social support, and willingness to receive assistance may reduce the risk of depression.

左眼視力低下を初症状として再発を来した直腸癌の脈絡膜転移症例を経験したので，報告する．症例は49歳の男性で，直腸癌の根治手術15か月後に左眼視力低下を初症状として受診．眼底検査で左眼に，漿液性網膜剥離を伴う脈絡膜腫瘍を認め，胸部CTで両肺に空洞形成を伴う小結節影を多数認めた．経気管支肺生検で腺癌を検出したため，直腸癌の左脈絡膜転移，両側多発性肺転移と診断した．全身化学療法を施行した後，漿液性網膜剥離，網膜下の滲出性変化は改善，脈絡膜腫瘍は縮小し扁平化したが，視力の改善は得られなかった．一方，肺転移は次第に増悪，頸椎転移も出現し，再発後11か月で死亡した．結腸直腸癌の脈絡膜転移報告例は自験例を含め9例とまれであり，報告例は多臓器転移症例が多く，肺，肝転移から2次的に脈絡膜転移を起こす可能性が示唆された．

Relationships among East Asian, North American and European Laetiporus sulphureus s. lat., a cosmopolitan brown rot species complex, were assessed with phylogenetic analyses and incompatibility tests. Three East Asian taxa, Laetiporus cremeiporus sp. nov., Laetiporus montanus and Laetiporus versisporus, are described and illustrated as well as compared with related taxa from Southeast Asia, North America and Europe. Phylogenetic analyses showed that L. cremeiporus and L. versisporus are clearly distinct species among Laetiporus taxa. The three conifer inhabiting species, Laetiporus conifericola, Laetiporus huroniensis and L. montanus, are closely related to each other. The European population of L. montanus exhibits two sequence variants of the EF1alpha: one is the same as observed in L. sulphureus in Europe and the other is that observed in East Asian population of L. montanus. A key to the known species of Laetiporus in the northern hemisphere is provided.

The clonal structure of Perenniporia subacida, a wood-rotting basidiomycete, was studied in a 30-year-old stand (site A; 1 ha) and a 43-year-old stand (site B; 0.5 ha) of Chamaecyparis obtusa in northern Kagawa Prefecture, Japan. A total of 110 isolates from decayed trees, stumps, wooden fences, logs, and mycelial mats were analyzed by amplified fragment length polymorphism (AFLP) and somatic incompatibility test (SIT). The results of AFLP, which agreed with those of SIT, revealed that the P. subacida population consisted of at least 17 genets at site A and 6 genets at site B. Individual genets were found in 1 to 9 trees at site A and in 1 to 7 trees at site B. One particular genet had spread over a distance of 70 m. Root contacts were observed among roots of decaying stumps and living trees at both sites. White mycelial mats were often found where roots made contact between stumps and neighboring trees. These results suggest that P. subacida spreads vegetatively over significant distances through root contacts.

膵頭十二指腸切除後膵外瘻の低侵襲な内瘻化の試みはいくつか報告されているが，われわれはPEGを用いて，低侵襲に内瘻化しえた1例を経験したので報告する．症例は54歳，男性．十二指腸乳頭部癌にて亜全胃温存膵頭十二指腸切除施行．再建は胆管空腸，膵胃吻合とした．術後，膵胃吻合縫合不全に伴う胃十二指腸動脈出血があり，止血術施行．胃側の吻合口を閉鎖し，膵管チューブを外瘻にした．術後長期に栄養状態が不良であったため，再度の開腹手術を回避するため，残胃にPEGを造設し，膵外瘻チューブを胃瘻から残胃に挿入，膵液を消化管内に戻したところ，栄養状態が改善．そのまま，チューブを皮下に埋め込んで，内瘻化した．内瘻化後，3年経過したが，現在までチューブ閉鎖などのトラブルはなく，経過良好である．膵外瘻による栄養障害を伴う症例では，膵液を消化管内に戻し，栄養状態を改善してから内瘻化するという方法は安全で，有用であると思われる．

Molecular model developed for resonances observed in medium light heavy-ion collisions is described briefly. At high spins, a stable di-nuclear configuration is found to be equator-equator touching one. Energy spectrum of the normal modes around the equilibrium is shown. These modes are expected to be the origin of the large number of resonances observed. Theoretical analyses for the angular distributions and angular correlations are given and compared with recent experiment performed in Strasbourg.

症例は93歳，女性．胸部不快感，嘔吐を主訴に近医を受診．胆嚢炎，総胆管結石の疑いで当院に紹介された．体温38.2°C，右季肋部に圧痛があり，血液検査では肝逸脱酵素と胆道系酵素の上昇，血小板減少，貧血を認めた．腹部超音波・CTで，腫大した胆嚢と総胆管・肝内胆管の拡張を認め，胆嚢内腔および総胆管内に不整形の高吸収域を認めた．ERCPでは，十二指腸乳頭部から血性胆汁の流出と，総胆管に陰影欠損を認め，PTCDで血性胆汁がドレナージされた．以上より胆道出血を伴った急性胆嚢炎，胆管炎の診断にて，入院当日，胆嚢摘出術を行った．胆嚢は腫大，緊満していた．摘出した胆嚢を切開すると内腔には血液が充満しており，15×13mmの隆起性病変が認められた．病理組織診断は高分化型管状腺癌であった．胆道出血を伴う胆嚢癌の報告は少ないため文献的考察を加え報告する．

For the synthesis of superheavy elements, it is indispensable to divide the fusion process into two steps : Overcoming the Coulomb barrier and passing over the conditional saddle or the ridgeline. To facilitate the understanding of the mechanism which explains the fusion hindrance, we first employ an analytic model with an inverted parabola for the saddle. Then, results by realistic calculations are given for the cold fusion. Ambiguities of the model are also discussed for future investigations. Since the model is general, it is applied to incident channels with neutron-rich projectiles and/or targets. These are necessary for synthesis of nucleides in so-called superheavy island around Z =114 and N =184.

The contact wire breaking accident caused by the arc between the contact wire and the pantograph happens rarely in the DC electric railway system. The contact wire breaking phenomenon is discussed and investigated based on the experimental data performed 30 years ago. The material of the contact strip and the contact wire has changed, however, and the breaking characteristics of the contact wire caused by the arc should be different. In this paper, the contact wire breaking characteristics are carefully investigated using the recent materials. It is cleared that the breaking index of 750As is approximately appropriate in the limited condition and the other breaking condition is summarized based on the experimental data more than 400 times.

Pathological conditions with refractory skeletal pain are often characterized by regional osteoporotic changes such as transient osteoporosis of the hip, regional migratory osteoporosis, or complex regional pain syndrome (CRPS). Our previous study demonstrated that the acidic microenvironment created by osteoclast activation under high bone turnover conditions induced pain-like behaviors in ovariectomized mice through the stimulation of acid-sensing nociceptors. The aim of the present study was to examine whether regional transient osteoporotic changes are related to pain-like behaviors in the hind limb using tail-suspended model mice. The hind limbs of tail-suspended mice were unloaded for 2 weeks, during which time the mice revealed significant regional osteoporotic changes in their hind limbs accompanied by osteoclast activation. In addition, these changes were significantly recovered by the resumption of weight bearing on the hind limbs for 4 weeks. Consistent with the pathological changes in the hind limbs, pain-like behaviors in the mice were induced by tail suspension and recovered by the resumption of weight bearing. Moreover, treatment with bisphosphonate significantly prevented the triggering of the regional osteoporosis and pain-like behaviors, and antagonists of the acid-sensing nociceptors, such as transient receptor potential channel vanilloid subfamily member 1 and acid-sensing ion channels, significantly improved the pain-like behaviors in the tail-suspended mice. We, therefore, believe that regional transient osteoporosis due to osteoclast activation might be a trigger for the pain-like behaviors in tail-suspended model mice. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1226-1236, 2017.

The expression of Kaposi's sarcoma-associated herpesvirus (KSHV/HHV-8)-encoded proteins is herein demonstrated in Kaposi's sarcoma (KS) and multicentric Castleman's disease (MCD) in a single lymph node derived from a patient with acquired immunodeficiency syndrome. Immunohistochemistry revealed that both lytic and latent KSHV proteins were expressed in cells of the MCD lesion. KSHV-encoded viral interleukin-6 was also detected in follicular dendritic cells of the germinal center. Cytoplasmic localization of open reading frame 59 protein and latency-associated nuclear antigen suggested KSHV activation in the MCD lesion. Moreover, a high copy number of KSHV was detected in the blood. Clinically, pegylated-liposomal doxorubicin induced regression of not only KS, but also lymphadenopathy of the MCD lesion with a decrease in KSHV load and human interleukin-6 in the blood. To the best of the authors' knowledge this is the first case demonstrating differential expression of virus proteins in two KSHV-associated diseases, KS and MCD, in the same section. The case confirms lytic KSHV infection in MCD, and suggests that clinical symptoms of MCD might be closely linked with KSHV activation.

Gastrointestinal stromal tumor (GIST)の治療中に発生した,メシル酸イマチニブによると考えられる間質性肺炎を経験した。症例は82歳男性。消化管出血,腹腔内転移を伴うGISTに対し,メシル酸イマチニブの内服を開始し,原発巣,転移巣ともに著明な縮小を認めていた。内服開始35日目頃から労作時呼吸困難,咳嗽が出現し,38日目に入院した。胸部X線上広範囲のスリガラス状陰影を認め,急速に進行する高度の低酸素血症を示したため,同日人工呼吸管理とした。経過よりメシル酸イマチニブによる薬剤性間質性肺炎が疑われたため投与を中止し,メチルプレドニゾロン1g静注を3日間行ったところ,低酸素血症は改善した。その後,ステロイド内服下にメシル酸イマチニブを減量再開し,経過良好である。現時点でメシル酸イマチニブによる間質性肺炎の報告例は稀だが,使用に当たり十分な注意が必要と考えられた。

We report the epidemiological investigation of a nosocomial pneumonia case due to Legionella pneumophila linked to a contaminated hospital cooling tower in an immune-compromised patient. A 73-year-old female patient was diagnosed with nosocomial Legionella pneumonia proven by a culture of L. pneumophila serogroup 1 from bronchoalveolar lavage fluid. Two strains isolated from the patient and two strains isolated from two cooling towers were found to be identical using repetitive-sequence-based-PCR with a 95% probability. This Legionella pneumonia case might be caused by aerosol from cooling towers on the roof of the hospital building which was contaminated by L. pneumophila. We increased up the temperature of hot water supply appropriately for prevention of Legionella breeding in an environment of patients' living. On the other hand, as the maintenance of cooling tower, we increased the frequency of Legionella culture tests from twice a year to three times a year. In addition, we introduced an automated disinfectants insertion machine and added one antiseptic reagent (BALSTER ST-40 N, Tohzai Chemical Industry Co., Ltd., Kawasaki, Japan) after this Legionella disease, and thereafter, we have no additional cases of Legionella disease or detection of Legionella spp. from the cooling tower or hot water supply. This case demonstrates the importance of detecting the infection source and carrying out environmental maintenance in cooperation with the infection control team.

The electoral system of the House of Representatives in Japan was reformed in 1994 from a multimember constituency system to a new system, which combines a single-member constituency system and a proportional representation system. The purpose of this paper is to examine the spatial transformation that is occurring with regard to the organizations of Diet members to garner votes after introducing the new electoral system. Most assemblypersons have maintained their own personal support organizations from the former system after the introduction of the new system. This is because constituencies in the former system, which lasted for about 70 years, have a strong influence even at present on the awareness of assemblypersons and their supporters. It also indicates that even if supporters live outside the present constituency, they give various forms of support (not including voting) to assemblypersons during elections. However, assemblypersons in the Nagasaki third constituency are negative toward maintaining their former personal support organizations. This is due to the geographic condition that traffic access to the entire area is inconvenient. Moreover, for some assemblypersons who became members of the House of Councillors or the governor after being members of or candidates for the House of Representatives, it is difficult to establish personal support organizations that cover the entire prefecture. Accordingly, the spatial range of their organizations is limited to the former constituency. There are also some differences in these organizations between political parties. Assemblypersons of the ruling party can receive support not only from their own support organizations, but also from members of local assemblies and various local organizations supporting the ruling party. However, members of the conservative opposition party tend to depend on their former support organizations, as they cannot expect the support received by ruling party members. As mentioned above, assemblyperson's personal support organizations, which play important roles in the Japanese political system, are being transformed into spatially different forms due to the geographic situations in the constituencies, party affiliations, etc. over the 10 years since the 1994 electoral reform.

An extremely good reproduction of experimental excitation function of the 1n reactions producing Z=110,Z=111 and Z=112 is obtained by the two-step model and the statistical decay code KEWPIE. Thus, an extension of the recipe permits us to predict reliable values of the residue cross-sections of the elements Z=113 and Z=114 which will be a useful guide for planning of experiments., Comment: 4 pages, 2 figures, submitted to Phys. Rev. Let

Two-Step Model is applied to the 1n residue cross sections measured for the heaviest elements Z=110, 111 and 112 in remarkable reproductions with only the scaling parameter for the shell correction energy. With the same model, theoretical predictions are made for Z=113 and 114.

Recent developments on reaction mechanisms in fusion of massive systems are briefly reviewed, especially on a two-step model. The fusion hindrance observed experimentally is simply explained in connection with the fluctuation-dissipation dynamics of shape evolutions and of two-body collisions. Examples are given for fusion excitation functions and compared with the available data on 48Ca+actinide target systems.

Fusion probability of colliding heavy ions is evaluated by exactly solving a Langevin equation with a parabolic potential barrier. The model, which accommodates dissipation in the approaching phase, leads to an inverse Kramers formula and an expression of the extra-push energy. In the very specific case of an overdamped regime, an Arrhenius-type formula is obtained.

Recent particle—particle—γ coincident measurements on a 28Si+28Si resonance have suggested “vanishing spin alignments”. New analyses of the spin alignments with a molecular model are presented. It is clarified that due to a triaxial deformation of the total system a wobbling mode (K-mixing) appears to give rise to spin disalignment.