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Background:Mikulicz’s disease (MD) has been considered as one manifestation of Sjögren’s syndrome (SS). Recently, it has also been considered as an IgG4-related disorder.Objective:To determine the differences between IgG4-related disorders including MD and SS.Methods:A study was undertaken to investigate patients with MD and IgG4-related disorders registered in Japan and to set up provisional criteria for the new clinical entity IgG4-positive multiorgan lymphoproliferative syndrome (IgG4+MOLPS). The preliminary diagnostic criteria include raised serum levels of IgG4 (>135 mg/dl) and infiltration of IgG4+ plasma cells in the tissue (IgG4+/IgG+ plasma cells >50%) with fibrosis or sclerosis. The clinical features, laboratory data and pathologies of 64 patients with IgG4+MOLPS and 31 patients with typical SS were compared.Results:The incidence of xerostomia, xerophthalmia and arthralgia, rheumatoid factor and antinuclear, antiSS-A/Ro and antiSS-B/La antibodies was significantly lower in patients with IgG4+MOLPS than in those with typical SS. Allergic rhinitis and autoimmune pancreatitis were significantly more frequent and total IgG, IgG2, IgG4 and IgE levels were significantly increased in IgG4+MOLPS. Histological specimens from patients with IgG4+MOLPS revealed marked IgG4+ plasma cell infiltration. Many patients with IgG4+MOLPS had lymphocytic follicle formation, but lymphoepithelial lesions were rare. Few IgG4+ cells were seen in the tissue of patients with typical SS. Thirty-eight patients with IgG4+MOLPS treated with glucocorticoids showed marked clinical improvement.Conclusion:Despite similarities in the involved organs, there are considerable clinical and pathological differences between IgG4+MOLPS and SS. Based on the clinical features and good response to glucocorticoids, we propose a new clinical entity: IgG4+MOLPS.

Sitagliptin has been suggested as a treatment option for older adults with type 2 diabetes (T2D). However, no randomized controlled trial has been performed to evaluate the efficacy and safety of sitagliptin treatment in older Japanese patients with T2D. The STREAM study was a multicenter, open-label, randomized controlled trial. T2D outpatients aged 65–80 years with moderately controlled glycemic levels (HbA1c 7.4–10.4%) under lifestyle interventions without or with oral anti-diabetic drugs excluding DPP4 inhibitors or GLP-1 receptor agonists were recruited (n = 176). The participants were randomized into sitagliptin group (n = 88) who received sitagliptin as an initial or an additive anti-diabetic drug and control group (n = 88) who did not. The treatment goal was HbA1c level < 7.4%. Efficacy and safety during 12-month treatment period were investigated. The mean (± SD) ages were 70.6 ± 3.9 and 71.9 ± 4.4 years old in sitagliptin and control groups, respectively. According to a mixed-effects model analysis, average changes from baseline over the treatment period in fasting plasma glucose (FPG), HbA1c, and glycated albumin (GA) were − 27.2 mg/dL, − 0.61%, and − 2.39%, respectively, in sitagliptin group, and 0.50 mg/dL, − 0.29%, and − 0.93%, respectively, in control group. The reductions in FPG, HbA1c, and GA were significantly greater in sitagliptin group (P < 0.0001, P < 0.01, and P < 0.0001, respectively). There were no differences in the incidence of adverse effects, except for cystatin C elevation and platelet count reduction in sitagliptin group. Sitagliptin treatment effectively improved the glycemic profile without any serious adverse effects in older T2D patients. Trial registration number: UMIN000010376.

This is an attempt to perform an environmental evaluation of wastewater reclamation systems as part of TC282 activity. Four treatment levels were set to evaluate the performance of the water for reuse: secondary, advanced, membrane bioreactor, and reclaimed. In this study, reclaimed treatment was determined to be the most effective in the evaluation of the efficiency of wastewater reclamation systems. The selection of an appropriate wastewater reclamation system to obtain water quality for the purpose of reuse is also important as part of the effort to minimize greenhouse gas emissions.

This study examines the possibilities of sensor-instrumented training (SIT) in mid-distance running training sessions. Within this framework, variations of ground contact time (GCT) between straight and curved running, as well as GCT as a fatigue indicator, are explored. Seven experienced runners, with two elite female athletes, participated in two training protocols: 15 sets of 400 m with 1-minute rest and five sets of 300 m with 3-minute rest. GCT was calculated using two inertial measurement units (IMU) attached to the athletes’ feet. The running speed of all athletes was measured with wearable GPS devices. GCT showed variations between inner and outer feet, notably during curve running (300m: 2.56%; 400m: 2.35%). However, for the 300m runs, statistically insignificant GCT differences were more pronounced in straight runs (3.54%) than in curve runs (2.56%), contrasting with the typical assumption of higher differences in curve running. A fatigue-indicating pattern is visible in GCT, as well as speed curves. Other data of this study are consistent with prior research that has observed differences between the inner and outer foot during curve running, while our understanding of the development throughout the training session is enhanced. Using SIT can be a valuable tool for refining curve running technique. By incorporating novel sensing technology, the possibilities enhance our understanding of running kinematics and offer an excellent application of SIT in sports.

Every three years the IAU Working Group on Cartographic Coordinates and Rotational Elements revises tables giving the directions of the poles of rotation and the prime meridians of the planets, satellites, minor planets, and comets. This report takes into account the IAU Working Group for Planetary System Nomenclature (WGPSN) and the IAU Committee on Small Body Nomenclature (CSBN) definition of dwarf planets, introduces improved values for the pole and rotation rate of Mercury, returns the rotation rate of Jupiter to a previous value, introduces improved values for the rotation of five satellites of Saturn, and adds the equatorial radius of the Sun for comparison. It also adds or updates size and shape information for the Earth, Mars’ satellites Deimos and Phobos, the four Galilean satellites of Jupiter, and 22 satellites of Saturn. Pole, rotation, and size information has been added for the asteroids (21) Lutetia, (511) Davida, and (2867) Šteins. Pole and rotation information has been added for (2) Pallas and (21) Lutetia. Pole and rotation and mean radius information has been added for (1) Ceres. Pole information has been updated for (4) Vesta. The high precision realization for the pole and rotation rate of the Moon is updated. Alternative orientation models for Mars, Jupiter, and Saturn are noted. The Working Group also reaffirms that once an observable feature at a defined longitude is chosen, a longitude definition origin should not change except under unusual circumstances. It is also noted that alternative coordinate systems may exist for various (e.g. dynamical) purposes, but specific cartographic coordinate system information continues to be recommended for each body. The Working Group elaborates on its purpose, and also announces its plans to occasionally provide limited updates to its recommendations via its website, in order to address community needs for some updates more often than every 3 years. Brief recommendations are also made to the general planetary community regarding the need for controlled products, and improved or consensus rotation models for Mars, Jupiter, and Saturn.

Multidrug resistance protein 4 (MRP4) is involved in the efflux of nucleoside derivatives and has a role in the determination of drug sensitivity. We investigated the relationship between MRP4 genetic polymorphisms and doses of the 6-mercaptopurine (6-MP) and methotrexate. Further, we evaluated the frequency of therapeutic interruption during maintenance therapy in Japanese children with acute lymphoblastic leukemia (ALL). Ninety-four patients received an initial 6-MP dose in the range of 30−50 mg m −2 in this analysis. Patients with homozygous variant allele in any of MRP4 G2269A, C912A and G559T required high frequency of 6-MP dose reduction compared with non-homozygous individuals. Average 6-MP dose for patients with homozygous variant allele on either MRP4 or inosine triphosphate pyrophosphatase was significantly lower than that for patients with non-homozygous variant allele during maintenance therapy (30.5 versus 40.0 mg m −2 , P =0.024). Therefore, MRP4 genotyping may be useful for personalizing the therapeutic dose of 6-MP during the ALL maintenance therapy in Japanese.

Background The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. Methods A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. Results The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient’s counselling. Conclusion This article represents the consensually derived opinion of the task force with respect to the management of PCMs.

Both proto-oncogenic and tumor-suppressive functions have been reported for enhancer of zeste homolog 2 (EZH2). To investigate the effects of its inactivation, a mutant EZH2 lacking its catalytic domain was prepared (EZH2-dSET). In a mouse bone marrow transplant model, EZH2-dSET expression in bone marrow cells induced a myelodysplastic syndrome (MDS)-like disease in transplanted mice. Analysis of these mice identified Abcg2 as a direct target of EZH2. Intriguingly, Abcg2 expression alone induced the same disease in the transplanted mice, where stemness genes were enriched. Interestingly, ABCG2 expression is specifically high in MDS patients. The present results indicate that ABCG2 de-repression induced by EZH2 mutations have crucial roles in MDS pathogenesis.

Background Patients undergoing abdominal surgery for solid tumours frequently develop major postoperative complications, which negatively affect quality of life, costs of care and survival. Few studies have identified the determinants of perioperative complications in this group. Methods We performed a prospective observational study including all patients (age > 18) undergoing abdominal surgery for cancer at a single institution between June 2011 and August 2013. Patients undergoing emergency surgery, palliative procedures, or participating in other studies were excluded. Primary outcome was a composite of 30-day all-cause mortality and infectious, cardiovascular, respiratory, neurologic, renal and surgical complications. Univariate and multiple logistic regression analyses were performed to identify predictive factors for major perioperative adverse events. Results Of a total 308 included patients, 106 (34.4%) developed a major complication during the 30-day follow-up period. Independent predictors of postoperative major complications were: age (odds ratio [OR] 1.03 [95% CI 1.01–1.06], p  = 0.012 per year), ASA (American Society of Anesthesiologists) physical status greater than or equal to 3 (OR 2.61 [95% CI 1.33–5.17], p  = 0.003), a preoperative haemoglobin level lower than 12 g/dL (OR 2.13 [95% CI 1.21–4.07], p  = 0.014), intraoperative use of colloids (OR 1.89, [95% CI 1.03–4.07], p  = 0.047), total amount of intravenous fluids (OR 1.22 [95% CI 0.98–1.59], p  = 0.106 per litre), intraoperative blood losses greater than 500 mL (2.07 [95% CI 1.00–4.31], p  = 0.043), and hypotension needing vasopressor support (OR 4.68 [95% CI 1.55–27.72], p  = 0.004). The model had good discrimination with the area under the ROC curve being 0.80 (95% CI 0.75–0.84, p  < 0.001). Conclusions Our findings suggest that a perioperative strategy aimed at reducing perioperative complications in cancer surgery should include treatment of preoperative anaemia and an optimal fluid strategy, avoiding fluid overload and intraoperative use of colloids.