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Background: Cerebral small vessel disease (SVD) has received attention as a risk stratification tool for antithrombotic-related intracranial hemorrhage but may also be a predictor for bleeding in other organs. Purpose: To determine the excess risk of antithrombotic-related bleeding due to cerebral SVD burden. Methods: Patients with cerebrovascular or cardiovascular diseases taking oral antithrombotic agents were prospectively enrolled from 52 hospitals across Japan between 2016 and 2019. Multimodal brain MRI was acquired at baseline for all patients under prespecified conditions. All MRI examinations were interpreted by a central diagnostic radiology committee for cerebral microbleeds, lacunes, white matter hyperintensities, and enlarged basal ganglia perivascular spaces, for calculation of a total SVD score (range 0-4). The primary outcome was major bleeding during 2-year follow-up. Secondary outcomes included bleeding in each site and ischemic events. Event risks according to SVD score were estimated with multivariable Cox proportional hazards models. Results: Of the analyzed 5250 patients (1736 women; median age, 73 years; 9933 patient-years follow-up), antiplatelets and anticoagulants were administered at baseline in 3948 and 1565, respectively. Median of the total SVD score was 2 (IQR 1-3). As SVD score increased, advanced age, hypertension, anemia, and chronic kidney disease were more prevalent (P Conclusions: The total SVD score was predictive for intracranial hemorrhage and probably for extracranial bleeding, suggesting a broader clinical relevance of cerebral SVD as a marker for safe implementation of antithrombotic therapy.

Dermatomyositis is a rare immune-related adverse event caused by immune checkpoint inhibitors. We herein report a 75-year-old Japanese man with small-cell lung carcinoma who developed dermatomyositis after the administration of atezolizumab. He developed rashes on day 13 and myalgia and motor weakness on day 30 of the first administration of atezolizumab. Anti-transcriptional intermediary factor 1-gamma antibody was positive, and serum interleukin-6 levels were prominently elevated in the acute phase. Symptoms were improved by corticosteroid therapy. This is the first report of dermatomyositis associated with atezolizumab. Clinicians should be aware of the possibility of dermatomyositis after the administration of immune checkpoint inhibitors.

Perivascular spaces, also known as Virchow-Robin spaces, are usually considered as a normal, asymptomatic finding. However, this finding can occasionally demonstrate an atypical appearance and can be symptomatic. We report herein a rare case of cognitive impairment associated with extremely enlarged perivascular spaces. A 68-year-old Japanese woman visited our hospital with a 1-year history of progressive memory impairment. In addition to temporal disorientation and short-term memory impairment, neuropsychological testing showed frontal lobe-related symptoms such as slowed thinking processes, reduced verbal fluency, attention deficit, and reduced working memory. Magnetic resonance imaging of the brain showed widespread enlarged perivascular spaces almost symmetrically in the subcortical white matter of bilateral hemispheres, prominently in bilateral insulas, and frontal opercula. On 99mTc-ethyl cysteinate dimer single photon emission computed tomography, hypoperfusion was apparent in bilateral insulas and frontal opercula where enlarged periventricular spaces were prominent, whereas cerebral perfusion was preserved in areas where enlargement of perivascular spaces was mild or absent. Because symptoms were consistent with the distribution of the enlarged perivascular spaces and hypoperfusion in the brain, cognitive impairment due to enlarged perivascular spaces was diagnosed. Clinicians should note enlarged perivascular spaces as a potential cause of neurological deficits including cognitive impairment.

Accumulation of amyloid β peptides (Aβ) is thought to be one of the causal factors of Alzheimer's disease (AD). The aspartyl protease β-site amyloid precursor protein cleaving enzyme 1 (BACE1) is the rate-limiting protease for Aβ production, and therefore, BACE1 inhibition is a promising therapeutic approach for the treatment of AD. Starting with a dihydro-1,3-thiazine-based lead, Compound J, we discovered atabecestat 1 (JNJ-54861911) as a centrally efficacious BACE1 inhibitor that was advanced into the EARLY Phase 2b/3 clinical trial for the treatment of preclinical AD patients. Compound 1 demonstrated robust and dose-dependent Aβ reduction and showed sufficient safety margins in preclinical models. The potential of reactive metabolite formation was evaluated in a covalent binding study to assess its irreversible binding to human hepatocytes. Unfortunately, the EARLY trial was discontinued due to significant elevation of liver enzymes, and subsequent analysis of the clinical outcomes showed dose-related cognitive worsening.

A 76-year-old man was admitted because of visual loss in his right eye, and was diagnosed with central retinal artery occlusion. Brain MRI revealed asymptomatic acute infarctions in the right middle cerebral artery territory. The proximal right internal carotid artery had migrated into a retropharyngeal location, presenting a 50% stenosis with calcified plaques, and was compressed by the hyoid bone and thyroid cartilage during swallowing on dynamic 3D-CT angiography. Partial resection of the hyoid bone and thyroid cartilage was performed and the postoperative course was uneventful. This case supports the utility of dynamic 3D-CT angiography during swallowing for diagnosing hyoid bone or thyroid cartilage compression-induced thromboembolism.

The first study reporting the morphological characterization of Sarcocystis sybillensis was performed in 1983; however, without any molecular analysis. Sarcocystis nipponi has been recently described as a species synonymic to S. sybillensis. We reconfirmed the presence of S. sybillensis in Japanese sika deer (Cervus nippon) captured in its native territory; and performed its molecular and phylogenetic characterization. The morphological characteristics of the sarcocysts were consistent with those of S. nipponi and S. sybillensis described in the first report. However, the nucleotide sequence of 18S rRNA gene of S. sybillensis showed only 91.9% identity to that of S. nipponi, suggesting low homology among the concerned Sarcocystis spp. Accordingly, S. sybillensis was found to occupy a clade distinct from that of S. nipponi in a phylogenetic tree of Sarcocystis. Therefore, the present study provides essential information on 18S rRNA-based molecular characterization of S. sybillensis and disproves the existing notion of morphology-based species synonymity of S. sibillensis and S. nipponi. These results also suggest that S. sybillensis belongs to type 2 Sarcocystis.

A nickel pincer complex bearing a β-aminoketonato-based O,N,P-tridentate ligand (1a) has been employed for the highly Markovnikov-selective hydroboration of vinylarenes using bis(pinacolato)diboron. This reaction proceeds smoothly under mild reaction conditions and affords the corresponding Markovnikov products in good to high yield.

Although transition-metal-catalysed hydroboration reactions of alkenes have been extensively studied, only three examples using Ni complexes have been reported so far. In this study, we have examined hydroboration reactions of alkenes using Ni/phosphine complexes. The commercially available and bottleable complex NiCl2(dppe) (dppe = 1,2-bis(diphenylphosphino)ethane) serves as a catalyst for the highly Markovnikov-selective hydroboration of styrene derivatives that affords the desired Markovnikov products in high yield.

A beam monitor is developed at the Rare-RI Ring storage ring facility at the RI beam factory at RIKEN. Because the Rare-RI Ring stores only a single exotic ion according to the operation principle, conventional beam instruments cannot be employed. In the present study, we design a simple monitoring system to confirm particle storage. The system comprises a thin foil and scintillators with photon sensors. When an ion passes through the foil, secondary electrons, including δ -rays, are emitted and are detected by a set of scintillation detectors without any guiding field. A beam test using 78 Ge with 175 MeV/nucleon successfully demonstrates the periodic revolution of the stored ions.

Two patients who showed transient lesions in the splenium of the corpus callosum (SCC) secondary to acute ischemic stroke are reported. Both patients had embolic strokes and showed an isolated lesion in the SCC on magnetic resonance imaging (MRI) 1-2 weeks after the onset of stroke, with a hyperintense lesion on diffusion-weighted imaging and decreased apparent diffusion coefficient values, with no symptoms related to the lesion. In both cases, the lesion disappeared on MRI approximately 1 week later. Clinicians should note that transient SCC lesions can occur following acute ischemic stroke and avoid misdiagnosing them and performing unnecessary examinations or treatment.

A β‐diketiminato‐based tridentate pincer‐type nickel(II) complex Ni‐NNP was prepared by the reaction of the nickel(II) precursor [NiCl2(2,4‐lutidine)2] with the lithiated NNP ligand, which was generated in situ by the reaction of the NNP pro‐ligand H‐NNP with nBuLi. H‐NNP was prepared by the condensation of 4‐[(2,4,6‐trimethylphenyl)amino]pent‐3‐en‐2‐one with 2‐(diphenylphosphanyl)ethylamine. Ni‐NNP was characterized spectroscopically and by X‐ray diffraction, revealing a slightly distorted square‐planar geometry around the nickel center. Density functional theory calculations indicated that the highest occupied molecular orbital in Ni‐NNP is located at higher energy than those of three other homologous nickel(II) complexes, i.e., Ni‐ONN, Ni‐ONP, and Ni‐NNN, which contain β‐aminoketonato‐ or β‐diketiminato‐based pincer‐type ligands. The electronic and steric properties of Ni‐NNP effectively facilitated the cross‐coupling of aryl fluorides with aryl Grignard reagents., This is the peer reviewed version of the following article: [Nobutaka Kurisu et al, 2019, The European Journal of Inorganic Chemistry, 2019 1 126-133], which has been published in final form at [https://doi.org/10.1002/ejic.201801179]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

Introduction: Liquid-based cytology (LBC) is increasingly used for nongynecologic applications. However, the cytological preparation of LBC specimens is influenced by the processing technique and the preservative used. In this study, the influence of the processing techniques and preservatives on cell morphology was examined mathematically and statistically. Methods: Cytological specimens were prepared using the ThinPrep (TP), SurePath (SP), and AutoSmear methods, with 5 different preservative solutions. The cytoplasmic and nuclear areas of Papanicolaou-stained specimens were measured for all samples. Results: The cytoplasmic and nuclear areas were smaller in cells prepared using the 2 LBC methods, compared to that prepared using the AutoSmear method, irrespective of the preservative used. The cytoplasmic and nuclear areas of cells prepared using the SP method were smaller than those of cells prepared using the TP method, irrespective of the preservative used. There were fewer differences among the cytoplasmic areas of cells prepared with different preservative solutions using the TP method; however, the cytoplasmic areas of cells prepared using the SP method changed with the preservative solution used. Conclusions: The most significant difference affecting the cytoplasmic and nuclear areas was the processing technique. The TP method increased the cytoplasmic and nuclear areas, while the methanol-based PreservCyt solution enabled the highest enlargement of the cell. LBC is a superior preparation technique for standardization of the specimens. Our results offer a better understanding of methods suitable for specimen preparation for developing precision AI-based diagnosis in cytology.

Spinal cord infarction (SCI) is rare, difficult to diagnose, and often fails to be detected by diffusion-weighted imaging (DWI) of spinal cord magnetic resonance imaging (MRI). Because the clinical features of SCI can vary widely, diagnosis during the acute phase of SCI is often challenging for clinicians. Although SCI shares similar etiologies with cerebral infarction, the characteristics of SCI without vessel dissection remain largely unknown. We present two older patients with mild neurological symptoms who each presented with a small, unilateral, upper cervical cord lesion, which was detected by thin-section, coronal DWI of brain MRI. Both unilateral small lesions were localized in the right lateral funiculus, and each patient showed good prognosis. The anatomical findings suggested that the pial collateral network surrounding the cervical cord contributed to lesion formation. Small and localized lesions have been associated with mild neurological symptoms and better short-term prognosis. The present report indicated that the use of thin-section coronal DWI when performing brain MRI may be helpful for the diagnosis of small, unilateral, upper cervical cord infarctions.

Conformational conversion of the cellular prion protein, PrPC, into the abnormally folded isoform, PrPSc, is a key pathogenic event in prion diseases. However, the exact conversion mechanism remains largely unknown. Transgenic mice expressing PrP with a deletion of the central residues 91&ndash, 106 were generated in the absence of endogenous PrPC, designated Tg(PrP∆91&ndash, 106)/Prnp0/0 mice and intracerebrally inoculated with various prions. Tg(PrP∆91&ndash, 106)/Prnp0/0 mice were resistant to RML, 22L and FK-1 prions, neither producing PrPSc∆91&ndash, 106 or prions in the brain nor developing disease after inoculation. However, they remained marginally susceptible to bovine spongiform encephalopathy (BSE) prions, developing disease after elongated incubation times and accumulating PrPSc∆91&ndash, 106 and prions in the brain after inoculation with BSE prions. Recombinant PrP∆91-104 converted into PrPSc∆91&ndash, 104 after incubation with BSE-PrPSc-prions but not with RML- and 22L&ndash, PrPSc-prions, in a protein misfolding cyclic amplification assay. However, digitonin and heparin stimulated the conversion of PrP∆91&ndash, 104 into PrPSc∆91&ndash, 104 even after incubation with RML- and 22L-PrPSc-prions. These results suggest that residues 91&ndash, 106 or 91&ndash, 104 of PrPC are crucially involved in prion pathogenesis in a strain-dependent manner and may play a similar role to digitonin and heparin in the conversion of PrPC into PrPSc.

Although transition-metal-catalysed hydroboration reactions of alkenes have been extensively studied, only three examples using Ni complexes have been reported so far. In this study, we have examined hydroboration reactions of alkenes using Ni/phosphine complexes. The commercially available and bottleable complex NiCl2(dppe) (dppe = 1,2-bis(diphenylphosphino)ethane) serves as a catalyst for the highly Markovnikov-selective hydroboration of styrene derivatives that affords the desired Markovnikov products in high yield.

Background and aims Polymerase chain reaction-based techniques require expensive equipment for fluorescence detection of the products. However, the measurement of inorganic pyrophosphate (PPi) released during DNA synthesis can be used to quantify target genes without such equipment. Here, we devised a high-sensitivity enzymatic assay for detection of PPi. Materials and methods In our assay method, PPi was converted to hypoxanthine by hypoxanthine phosphoribosyl transferase. Xanthine dehydrogenase converted the hypoxanthine to uric acid and yielded two molecules of NADH, which in turn reduced Fe3+ to Fe2+ (mediated by 1-methoxy-5-ethylphenazinium ethylsulfate). 2-Nitroso-5-(N-propyl-N-sulfopropylamino) phenol chelated the Fe2+, which resulted in an intensely colored product that could be measured using a biochemical automated analyzer. Results The assay was able to detect PPi within 10 min. It was linear between 0 and 10 µmol/L PPi, and intra-run and inter-run coefficients of variation were 1%–2%. Other validation tests with a biochemical automated analyzer were satisfactory. The assay could potentially be used to directly quantify samples after isothermal nucleic acid sequence-based amplification of a target gene. Conclusion The method developed here for detection of PPi can be used to measure nucleic acid biomarkers in biological samples in clinical practice using a high-throughput biochemical automated analyzer.

Background In recent years, immune checkpoint inhibitors have been widely used as a crucial therapy in malignant tumors. Immune checkpoint inhibitors can cause various autoimmune side effects called immune-related adverse events because they generate an exaggerated inflammatory response. Encephalitis associated with atezolizumab has rarely been reported as an immune-related adverse event. A case of encephalitis caused by treatment with atezolizumab is presented. Case presentation A 56-year-old Japanese man with lung cancer previously treated with surgery and chemotherapy was admitted with high fever, consciousness disorder, and motor aphasia. His first atezolizumab treatment was 17 days earlier. Admission brain magnetic resonance imaging with gadolinium enhancement showed no abnormalities. Cerebrospinal fluid showed cell count 20/l, protein 166 mg/dl, glucose 73 mg/dl, and interleukin 6 82.9 pg/ml (normal

Primary sclerosing cholangitis (PSC) is associated with significant risk for hepatobiliary cancers. Primary hepatic adenosquamous carcinoma (ASC), a rare subtype of cholangiocarcinoma, is composed of both adenocarcinoma and squamous cell carcinoma components. We herein report the case of a patient with PSC who was diagnosed with ASC of the liver during cancer surveillance. A 74-year-old male patient was diagnosed with PSC based on blood chemistry and magnetic resonance cholangiopancreatography findings, and regular surveillance for hepatobiliary cancers was initiated. Four years later, the level of carbohydrate antigen 19–9 rapidly increased, and abdominal imaging studies revealed a cystic mass, 40 mm in diameter, containing a solid component in the right liver lobe. Right lobectomy was performed with a pre-operative diagnosis of cholangiocarcinoma; however, the definitive diagnosis was ASC based on the presence of adenocarcinoma and squamous cell carcinoma components in the resected tumor. The patient did not receive post-operative chemotherapy, but was alive for more than 4 years without recurrence at last follow-up. The present case illustrates that regular surveillance and curative resection might achieve long-term survival in hepatic ASC, which has a poor prognosis.

Aims The bleeding risk of current antithrombotic strategies in clinical settings, including recently developed agents, needs to be clarified. Methods and Design In an investigator-initiated, prospective, multicentre, observational study, patients with cerebrovascular or cardiovascular diseases who were taking oral antiplatelet or anticoagulant agents were enrolled. Compulsory multimodal magnetic resonance images were acquired at baseline to assess cerebral small vessel disease. Six-month follow-up will be performed for two years. The primary outcome is major bleeding as defined by the International Society on Thrombosis and Hemostasis. Results Between October 2016 and March 2019, 5306 patients (71.7 ± 11.2 years old, 1762 women) were enrolled. Previous intracranial haemorrhage was documented in 181 patients (3.4%), cerebrovascular disease (including asymptomatic) requiring antithrombotic therapy in 5006 patients (94.3%), and atrial fibrillation in 1061 patients (20.0%). At entry, 3726 patients (70.2%) were taking antiplatelet agents alone, including 551 (10.4%) using dual antiplatelet agents, 1317 (24.8%) taking anticoagulants alone, and the remaining 263 (5.0%) taking both. The leading antiplatelet agent was clopidogrel (2014 patients), and the leading combination of dual antiplatelet medication was clopidogrel plus aspirin (362). Use of direct oral anticoagulants (1029 patients, 19.4%) exceeded warfarin use (554, 10.4%). The number of pivotal bleeding events exceeded 200 in April 2020. Conclusions This study is expected to provide the incidence of bleeding complications of recent oral antithrombotics in clinical practice and identify their associations with underlying small vessel disease and other biomarkers. Novel risk stratification models for bleeding risk will be able to be created based on the study results.

A previous study showed early statin administration in patients with acute ischemic stroke (AIS) was associated with a lower risk of early-onset seizure (ES), which is a high risk of epilepsy, but this retrospective study design may not have eliminated confounding factor effects. We aimed to verify the determinants and prognostic significance of ES and clarify the effects of statin administration. Consecutive AIS patients without a history of epilepsy were enrolled. The relationship between ES (within 7 days of index-stroke) and statin treatment was assessed using multivariate and propensity scores (PS). Of 2,969 patients with AIS, 1,623 (54.6%) were treated with statin, and 66 (2.2%) developed ES. In logistic regression models, cortical stroke lesion [odds ratio (OR), 2.82; 95% confidence interval (CI), 1.29–7.28) and pre-morbid modified Rankin Scale (per 1 point) (OR, 1.39; 95% CI, 1.18–1.65) were higher risks for ES, while statin significantly reduced the risk of ES (OR, 0.44; 95% CI, 0.24–0.79). In accordance with PS-matching, statin treatment produced consistent results for ES after adjusting by inverse probability of treatment-weighting PS (OR, 0.41; 95% CI, 0.22–0.75). In conclusion, as previously, statin treatment was independently associated with a lower risk of ES in AIS.

RATIONALE Sulfur is widely distributed in nature, and sulfur isotopic measurements have been applied to elucidate the origin and transport of sulfuric compounds in the lithosphere, biosphere, and atmosphere. Analyses of samples containing small amounts of sulfur, such as the Antarctic ice core samples analyzed herein, require a high-sensitivity analytical method. METHODS We developed a high-sensitivity sulfur isotopic ratio (δ34 S value) analytical system equipped with an elemental analyzer, a cryo-flow device, and an isotope ratio mass spectrometer, and established a measurement and calibration procedure. RESULTS Using this system, we precisely measured the δ34 S values of samples containing 5-40 nmol sulfate. Test runs were performed on samples from the Antarctic shallow ice core DF01, and the data obtained were consistent with those obtained by previous studies that reported δ34 S values for Antarctic snow and ice samples of more than 200 g (containing more than 150 nmol sulfate). Among the analyzed samples, one showed a peak sulfate concentration in its depth profile that is considered to have resulted from a large volcanic eruption. The δ34 S value obtained at that depth in the sample was distinct from values at other depths and consistent with reported values for volcanic sulfates. CONCLUSIONS The analytical system developed herein is a powerful tool for trace sulfur isotopic analyses. The results obtained from the DF01 ice core samples are the first step towards elucidating high-time-resolution (less than 1 year) paleo-environmental changes by sulfur isotopic analyses.

BACKGROUND We determined the 2-year long-term risk-benefit profile in patients with stroke or transient ischemic attack (TIA) receiving warfarin or direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry in Japan.Methods and Results:NVAF patients within 7 days after onset of ischemic stroke/TIA were enrolled in 18 stroke centers. Outcome measures included ischemic and bleeding events and death in the 2-year follow-up period. We enrolled 1,116 patients taking either warfarin (650 patients) or DOACs (466 patients) at acute hospital discharge. DOAC users were younger and had lower National Institutes of Health Stroke Scale, CHADS2and discharge modified Rankin Scale scores than warfarin users (P

In this work, three different types of acetylacetonato-based pincer-type nickel(ii) complexes (2) were prepared. Complex 2a possessed the tridentate ONN ligand, which was constructed by the condensation reaction of acetylacetone with N,N-diethylethylenediamine. Complex 2b contained the PPh2 donor group in contrast to the NEt2 group in 2a, i.e., an ONP ligand framework. Complex 2c was composed of the NNN ligand, which was prepared by the reaction of 4-((2,4,6-trimethylphenyl)amino)pent-3-en-2-one with N,N-diethylethylenediamine. In addition to X-ray diffraction analysis, these complexes were characterized spectroscopically. Their catalytic activity for a cross-coupling reaction of aryl halides with aryl Grignard reagents was also evaluated. Among these complexes, 2b acted as an effective catalyst for the cross-coupling reaction using aryl chlorides as electrophiles. The electronic properties of these Ni(ii) complexes were investigated by cyclic voltammetry and density functional theory calculations.

Phosphonium ylide complexes of Mo and W formulated as [M(η3-allyl){η2-(NPh)2CH}(CO)2(CH2PR3)] (M = Mo, R = Me: 2a-Mo; M = Mo, R = Ph: 2b-Mo, and M = W, R = Me: 2a-W) were prepared by the reaction of amidinato(pyridine) complex, [M(η3-allyl){η2-(NPh)2CH}(CO)2(NC5H5)] (M = Mo: 1-Mo and M = W: 1-W), with a phosphonium ylide, CH2PR3 (R = Me, Ph), which was generated in situ by the reaction of the corresponding phosphonium salt with nBuLi. These complexes were characterized spectroscopically, as well as by the X-ray diffraction. The phosphonium ylide ligand shows stronger electron donating ability toward the metal than N-heterocyclic carbene or phosphine ligands. This trend is supported by the comparison of the spectroscopic data and the DFT calculations. We also investigated the reactivity of the phosphonium ylide complexes 2-Mo with two-electron donors such as PEt3 and NHC. In the case of the PPh3 ylide complex (2b-Mo), the substitution reaction of the ylide ligand for the two-electron donors took place cleanly to yield the corresponding complexes. On the other hand, in the PMe3 ylide complex (2a-Mo), the substituted complexes formed but the unreacted ylide complex 2a-Mo was also present in the reaction mixture. These results show that the bond strength of the M-C(phosphonium ylide) bond is affected by the substituents on the phosphorus atom.