Cytokine release syndrome induced by immune checkpoint inhibitor treatment for uterine cervical cancer recurrence: A case report.

Cytokine release syndrome (CRS) is a systemic inflammatory condition caused by an excessive immune response and cytokine overproduction. CRS is a life-threatening condition that is often associated with chimeric antigen receptor T-cell therapy. Despite the increased use of immune checkpoint inhibitors (ICIs), ICI-induced CRS remains rare. The present study describes a case of CRS that occurred after the administration of ICIs for recurrent adenocarcinoma of the uterine cervix. A 49-year-old woman received paclitaxel, carboplatin and pembrolizumab for recurrent cervical adenocarcinoma. On day 27 of the third cycle, the patient was admitted with a fever and suspected pyelonephritis. The following day, hypotension, upper respiratory symptoms and myalgia of the extremities were noted, and the left ventricular ejection fraction (LVEF) was decreased to 20%. Multiorgan failure (MOF) occurred, and the patient received ventilator support and continuous hemodiafiltration. Rhabdomyolysis, pancreatitis, erythema multiforme and enteritis were observed. CRS was diagnosed based on elevated ferritin and IL-6 levels. Steroid pulse therapy was administered; however, the MOF did not improve and the anti-IL-6-receptor monoclonal antibody tocilizumab (TOC) was administered. Subsequently, the LVEF improved to 50%, and the patient was removed from the ventilator on day 4 and from the continuous hemodiafiltration unit on day 6 after TOC administration. The patient was discharged on day 21. In conclusion, considering that ICI-induced CRS is a rare but severe complication, fever and other systemic conditions following ICI administration should be monitored.

Secondary syphilis in the third trimester of pregnancy.

Syphilis infections discovered late in pregnancy, as in this case, may not be treated long enough for delivery. The Japanese guidelines should be revised because they do not describe the mode of delivery for pregnant women infected with syphilis.

Home exercises after volar locking plate fixation for distal radius fracture in the elderly are as effective as supervised physiotherapy -multicenter retrospective study.

BACKGROUND: Although home exercises are used for postoperative rehabilitation of distal radius fractures (DRF), the superiority of home exercise over supervised physiotherapy rehabilitation is controversial. This study aimed to compare the function of home exercise and supervised physiotherapy rehabilitation during postoperative rehabilitation for DRF. METHODS: We conducted a multicenter, retrospective study in which we included 1949 patients over 65 years old who underwent volar locking plate fixation for DRF. After propensity score matching, 308 patients were assigned to each of an independent home exercise group (IHG) and supervised physiotherapy group (SPG). Wrist function was assessed after 3, 6, and 12 months postoperatively. RESULTS: The results showed that the Mayo Wrist Score did not differ significantly within the observation period. Range of motion of the wrist was better in the SPG up to 3 months postoperatively but was almost the same as that in the IHG at 6 months. However, the Numerical Rating Scale score was lower in the IHG during all observation periods. CONCLUSIONS: Home exercise may be as effective as supervised physiotherapy in the medium term, but supervised physiotherapy rehabilitation should be considered if early recovery and good wrist function are desired.

The association between circadian rest-activity patterns and the behavioral and psychological symptoms depending on the cognitive status in Japanese nursing-home residents.

BACKGROUND: Limited information is available on the relationship between sleep disturbances during nighttime and the behavioral and psychological symptoms of dementia in older nursing-home residents. However, a few reports on the association between the circadian rest-activity rhythm and the behavioral and psychological symptoms of dementia in older residents have been published. The main objective of the present study was to examine the association among the circadian rest-activity rhythm, behavioral and psychological symptoms, and the cognitive function status among older individuals living in facilities. METHOD: The investigation was conducted from September 2017 to February 2018, and participants were recruited from five nursing homes in Akita prefecture, Japan, after obtaining patient agreement to participate in the study. To measure nonparametric circadian rest-activity parameters such as interdaily stability, intradaily variability, relative amplitude, mean of the least active 5-h period, and mean of the most active 10-h period, Actigraph devices were worn on the participants' nondominant wrists continuously for seven days. The score or classification of the cognitive status and the severity of the behavioral and psychological symptoms of dementia (BPSD) were assessed using the clinical dementia rating (CDR) and the dementia behavior disturbance scale (DBD), respectively. The binomial logistic regression model was applied to clarify which kinds of circadian rest-activity parameters predicted the cognitive status in nursing home residents as well as the BPSD outcome. A multi-level model was also used to examine the association between the nonparametric rest-activity parameters and the BPSD outcome explained by the cognitive status among older individuals in facilities. RESULTS: Seventy-seven participants (49 residents with dementia, and 28 residents without dementia) were included in this study. According to the binomial logistic regression analysis after adjusting for covariates, the classification of the cognitive status for older residents was associated with the DBD score (odds ratio, 1.22; 95% confidence interval [CI], 1.08, 1.38; p < 0.001), the IS (odds ratio, 0.01; 95% CI, 0.00, 1.00; p = 0.05) and the L5 (odds ratio, 0.99; 95% CI, 0.99, 1.00; p = 0.05). The results of a multi-level model also indicated that the IV at individual-level was significantly associated with the DBD score for nursing home residents, with the CDR score at cluster-level as an explanatory variable. As well, a significant association between the RA at individual level and the DBD score was observed in a multi-level model explained by the CDR score at cluster-level. CONCLUSION: Of these models, the multi-level model provided grounds for our proposal that the fragmentation or the amplitude of rest-activity parameters might be associated with the outcome of BPSD, considering the cognitive status of older individuals in different facilities. The findings offer practical insight into the prevention of BPSD and the improvement of rest-activity rhythms in rehabilitative care in nursing homes.

Role of Hydrogen-Bond Interactions in CO2 Capture by Wet Phosphonium Formate Ionic Liquid: A Raman Spectroscopic Study.

The mechanism of CO2 absorption by a formate ionic liquid, [P4444 ]HCOO, was studied by Raman spectroscopy. The band area for the symmetric CO2 stretching of the formate anion linearly decreases with the CO2 loading. From the slope of the decrease, 1 : 1 stoichiometry is proven between CO2 and the formate anion. The result favors the mechanism we proposed in a preceding work [J. Chem. Eng. Data 61, 837 (2016)]: HCOO- +CO2 +H2 O→HCOOH+HCO3- →[HCOOH…HCO3- ]. Further support for the mechanism is obtained by the observation of antisymmetric vibration of CO for the proposed hydrogen-bonded complex between HCOOH and HCO3- . The bands appeared as a doublet (1677 and 1730 cm-1 ) as this complex has two carbonyl groups. Based on DFT calculations, the [HCOOH…HCO3- ] complex is supposed to be the most abundant form of chemisorbed CO2 .

A new species of the hermit crab genus Pagurus Fabricius, 1775 (Crustacea: Decapoda: Anomura: Paguridae) from shallow coastal waters in Japan, with a checklist of the East Asian species of the genus.

A new species of hermit crab of the family Paguridae, Pagurus rectidactylus, is described and illustrated on the basis of material from inshore waters in the Seto Inland Sea and the Sea of Japan. It appears closest to P. quinquelineatus Komai, 2003, also known from Japan, but is easily distinguished from the latter by the dactylus of the right cheliped almost unarmed or armed only with a few tiny spines or tubercles, instead of dorsal and dorsomesial rows of conspicuous spines, and the more elongate and slender ambulatory legs with more numerous ventral corneous spines on dactyli and propodi. Housing is also different between the two species: the new species exclusively inhabits carcinoecia formed by a hydrozoan Stylactaria misakiensis (Iwasa, 1934), whereas P. quinquelineatus uses gastropod shells without association with coelenterates. A checklist of East Asian (Japanese Archipelago to Taiwan Island, Far Eastern Russia to northern China) species of Pagurus along with general geographical distributions is presented.