Abdominal pain as an initial symptom of isolated ACTH deficiency induced by nivolumab in a patient with malignant mesothelioma.

Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

Assessing the Relationship between Helicobacter pylori and Chronic Kidney Disease.

The relationship between Helicobacter pylori infection and/or gastric disorders and chronic kidney disease (CKD) has not been elucidated. We investigated the relationship between Helicobacter pylori and/or atrophic gastritis (AG) and chronic kidney disease. In total, 3560 participants (1127 men and 2433 women) were eligible for this cross-sectional study. We divided participants into four study groups: with/without Helicobacter pylori infection and with/without AG. The HP (+) AG (-) group demonstrated a significant association with CKD compared with the HP (-) AG (-) group (adjusted odds ratio, 1.443; 95% confidence interval, 1.047-1.989). In contrast, the HP (+) AG (+) group showed significantly lower adjusted odds of CKD than the HP (-) AG (-) group (adjusted odds ratio, 0.608; 95% confidence interval, 0.402-0.920). H. pylori infection without AG might be associated with CKD in these participants. Conversely, the HP (+) AG (+) group had lower odds of CKD. Uncovering an association between gastric and renal conditions could lead to development of new treatment strategies.

Dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid, likely triggered by scabies, in a hemodialysis patient with human leukocyte antigen-DQB1*03:01.

Bullous pemphigoid (BP) is the most common autoimmune subepidermal bullous diseases. Autoantibodies against hemidesmosomal adhesion proteins might be involved in the developing process. BP usually affects the elderly with high mortality whereas the drug-induced BP is often improved and rarely relapses after the withdrawal of the suspected drug. An accumulated evidence suggests that dipeptidyl peptidase-4 inhibitor (DPP-4I), which has been widely used as the antidiabetic drug improves glycemic control with little risk for hypoglycemia, could be an inducer of DPP-4I-associated BP (DPP-4I-BP). While the precise mechanism remains unclear, a unique immunological profile with human leukocyte antigen (HLA)-DQB1*03:01 could be a biomarker of genetic susceptibility to DPP-4I-BP. Here, we encountered an interesting case of DPP-4I-BP with HLA-DQB1*03:01, which was likely triggered by scabies. A 56-year-old Japanese male with type 2 diabetes on hemodialysis was referred to our hospital due to worsened blisters. Prior to his admission, he had been on linagliptin, a DPP-4I, for 5 months. He then suffered from scabies 2 weeks before his admission while the treatment with ivermectin failed to improve his symptom. Based on his clinical symptom, positive for anti-BP180 autoantibody in serum, and the pathological alterations of skin biopsy specimens, he was diagnosed with DPP-4I-BP. Importantly, he also carried an HLA-DQB1*03:01 allele. Oral prednisolone was subsequently administered after the discontinuation of linagliptin, and his symptom gradually disappeared. Given the fact that the DPP-4I-BP could be a life-threating disease, we should be cautious of prescribing DPP-4I in hemodialysis patients, whose immune system could be impaired.

A cohort study of the acute and chronic respiratory effects of toner exposure among handlers: a longitudinal analyses from 2004 to 2013.

This study examines the acute and chronic respiratory effects of toner exposure based on markers for interstitial pneumonia, oxidative stress and pulmonary function tests. A total of 112 subjects working in a Japanese toner and photocopier manufacturing company participated in this study in 2004. We annually conducted personal exposure measurements, pulmonary function tests, chest X-ray examinations, biomarkers, and questionnaires on respiratory symptoms to the subjects. We report in this paper the results of the analysis of combined annual survey point data from 2004 to 2008 and data from three annual survey points, 2004, 2008, and 2013. During these survey periods, we observed that none of subjects had a new onset of respiratory disease or died of such a disease. In both the analyses, there were no significant differences in each biomarker and pulmonary function tests within the subjects, nor between a toner-handling group and a non-toner-handling group, except for a few results on pulmonary function tests. The findings of this study suggest that there were no acute and chronic respiratory effects of toner exposure in this cohort group, although the number of subjects was small and the level of toner exposure in this worksite was low.

A 4-Year Follow-up Cohort Study of the Respiratory Functions in Toner-handling Workers.

BACKGROUND: Focusing on the respiratory function for health effect indices, we conducted a cross-sectional study on workers who did and did not handle toner to compare the longitudinal changes. METHODS: Among 116 individuals who worked for a Japanese business equipment manufacturer and participated in the study, the analysis included 69 male workers who we were able to follow up for 4 years. We categorized the 40 workers engaged in toner-handling work as the exposed group and the 29 workers not engaged in these tasks as the referent group, and compared their respiratory function test results: peak expiratory flow rate (PEFR), vital capacity (VC), predicted vital capacity (%VC), forced expiratory volume in 1 second (FEV1), and forced expiratory volume in 1 second as a percent of forced vital capacity (FEV1%). RESULTS: The cross-sectional study of the respiratory function test results at the baseline and at the 5(th) year showed no statistically significant differences in PEFR, VC, %VC, FEV1, and FEV1% between the exposed and referent workers. Also, respiratory function time-course for 4 years was calculated and compared between the groups. No statistically significant differences were shown. CONCLUSION: Our study does not suggest any toner exposure effects on respiratory function. However, the number of subjects was small in our study; studies of larger populations will be desired in the future.

Relationship between overtime work hours and cardio-ankle vascular index (CAVI): a cross-sectional study in Japan.

OBJECTIVES: The purpose of this research was to evaluate the relationship between overtime work hours and CAVI, a new index of arterial stiffness. METHODS: We measured CAVI of Japanese workers (3,862 men) aged 26 to 59 years. Simultaneously, we obtained information on their monthly overtime work hours for the past few months using a self-administered questionnaire, with responses divided into five groups: <45, ≥45 and <60, ≥60 and <80, ≥80 and <100 and ≥100 hours/month. We calculated the odds ratios of CAVI≥9.0 for each group of overtime work hours. RESULTS: In the full sample, there was no significant association between the average CAVI and overtime work hours. Taking<45 overtime hours/month as the reference category, the odds ratios of CAVI≥9.0 were as follows: OR=1.11, 95% CI=0.73-1.69 (≥45 and <60 hours/month); OR=0.92, 95% CI=0.48-1.76 (≥60 and <80 hours/month); OR=1.50, 95% CI=0.50-4.49 (≥80 and <100 hours/month); and OR=2.65, 95% CI=0.82-8.54 (≥100 hours/month). However, for workers in their 50 s, the odds ratio of CAVI≥9.0 was significantly higher among subjects with≥100 hours/month than among those with<45 hours/month (OR=4.26, 95% CI=1.2-15.1) CONCLUSIONS: The present study suggests that CAVI is more likely to be 9.0 or higher in workers in their 50 s when they work≥100 hours of overtime per month.

A cohort study on self-reported respiratory symptoms of toner-handling workers: cross-sectional and longitudinal analysis from 2003 to 2008.

This study examines the relationship between toner-handling work and its health effects on self-reported respiratory symptoms. The subjects were 1,504 male workers in a Japanese toner and photocopier manufacturing company. Personal exposure measurement, pulmonary function tests, chest X-ray examination, measurement of biomarkers, and a questionnaire about self-reported respiratory symptoms were performed annually. This study discusses the questionnaire results. We found that the toner-handling group showed significantly higher prevalence of breathlessness than the never-toner-handling group. The significant reduction of pulmonary function and fibrosis change in the chest X-ray examination associated with breathlessness were not observed. However the morbidity of asthma was higher compared to the Japanese population in both of the toner-handling group and the never-toner handling group, the effect of toner exposure was not clarified. Nevertheless, while the toner exposure levels in the current well-controlled working environment may be sufficiently low to prevent adverse health effects, further studies are needed to assess the more long-term latent health effects of toner exposure.

Relationship between smoking and a new index of arterial stiffness, the cardio-ankle vascular index, in male workers: a cross-sectional study.

BACKGROUND: Cigarette smoking is one of the major factors that increases arterial stiffness. The purpose of this study was to examine further the relationship between smoking status and arterial stiffness using a new index, the cardio-ankle vascular index (CAVI), in male Japanese workers. METHODS: This cross-sectional study included 4,729 male Japanese workers undergoing annual health checkups. CAVI was measured at the time of the annual health checkup between April 2007 and March 2008. The subjects were divided into three groups, smokers (n = 1,913), former smokers (n = 1,481) and non-smokers (n = 1,348) according to their responses to a questionnaire. We compared the CAVI in the three groups after adjusting for age. Multiple regression analysis was used to examine the association between CAVI and the number of cigarettes smoked per day in order to examine whether there was a dose-response relationship between smoking and CAVI. RESULTS: The mean CAVI for each group was 7.81 ± 0.02 for smokers, 7.70 ± 0.02 for former smokers and 7.64 ± 0.02 for non-smokers. A significant difference was observed between each group. According to the results of multiple regression analysis, the standardized ß of the number of cigarettes smoked per day was 0.09 (p < 0.01). This confirmed a positive association with CAVI. CONCLUSIONS: Our study demonstrated that there is a significant association between the number of cigarettes smoked per day and arterial stiffness, as measured by CAVI.

Cross-sectional study on respiratory effect of toner exposure.

In this baseline study, part of a cohort study to clarify the effect of toner exposure on the respiratory system, we surveyed 803 male toner workers and 802 referents with regard to their subjective respiratory symptoms and chest X-ray results. We also examined individual exposure history, current working conditions, and personal exposure levels to toner. There was a significantly higher prevalence of "coughing and sputum" related complaints among toner-exposed workers in the 30 and 40-year age groups. The group with toner-exposure history showed a higher odds ratio, by logistic regression, in relation to all questions regarding coughing. Mild fibrotic changes were observed in the chest X-rays of four workers who had engaged in toner-exposure work for at least a decade or more, and all four had reported allergic disease. Although we observed a tendency of higher prevalence of "coughing and sputum" in toner-exposed workers, the possibility of information bias cannot be eliminated. It should also be noted that this tendency did not exceed that of the general public. Further analysis is required in this ongoing 10-year cohort study to clarify the effect of toner exposure on the respiratory system.

Spin polarization of field-emitted electrons from half-metallic Co2MnSi thin films grown on a W(001) facet.

We measured spin polarization of electrons field-emitted from half-metallic Co(2)MnSi thin film grown on a W(001) facet via chromium buffer layer using Mott scattering. For spontaneously magnetized samples, values of polarization at room temperature were observed in a range from 10% to 46% and the polarization direction was 110 orientation of substrate tungsten, which agreed with an easy axis of magnetization of bulky Co(2)MnSi. An enhancement of polarization was observed as a consequence of applying a magnetic field of 350G perpendicular to the emitter axis after the annealing at 800K. This result is considered to be caused by improvement in crystallinity of the evaporated film due to annealing.

Ru(II)-catalyzed [2 + 2 + 2] cycloaddition of 1,2-bis(propiolyl)benzenes with monoalkynes leading to substituted anthraquinones.

[2 + 2 + 2] cycloadditions of 1,2-bis(propiolyl)benzenes with monoalkynes were effectively catalysed by Cp*RuCl(cod) under mild conditions to give substituted anthraquinones in moderate to high yields.

Field emission from multiwall carbon nanotubes in controlled ambient gases, H2, CO, N2 and O2.

Adsorption and desorption on clean pentagons at a tip of multiwall carbon nanotube (MWNT) have been investigated by field emission microscopy (FEM) in an atmosphere of various gases, i.e., hydrogen, carbon monoxide, nitrogen and oxygen. A MWNT with clean surface which is obtained by heat treatment gives FEM patterns consisting of six bright pentagonal rings. Adsorbates are recognized as bright spots in the FEM pattern. They reside preferentially on the pentagonal sites where the strong electric field is concentrated, and bring about stepwise increase in the emission current. Heat treatment of the MWNT emitter at about 1300K allows adsorbates to desorb. After the desorption of hydrogen and nitrogen, the original clean surface with pentagons is recovered, while the tip structure is destroyed after the desorption of oxygen.

Energy distributions of field emitted electrons from a multi-wall carbon nanotube.

Field emission energy distributions of electrons from one of the six pentagons located at the end of a multi-wall carbon nanotube have been measured by means of a high-resolution cylindrical energy analyzer. In a clean pentagon, the sub-peak was obtained at about 500 meV below the main peak, exhibiting a shift with increasing applied voltage. For electrons emitted from an adsorbate onto the pentagon, no fine structure was observed in the spectra. The broadening of the leading edge was also observed for both clean and adsorbed pentagon, indicating the field penetration into the nanotube due to its semimetallic nature. The full-width at half-maximum was 280 meV at the applied voltage of 660 V and increased linearly with applied voltage.