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In this paper, we present the first high‐speed video observation of a cloud‐to‐ground lightning flash and its associated downward‐directed Terrestrial Gamma‐ray Flash (TGF). The optical emission of the event was observed by a high‐speed video camera running at 40,000 frames per second in conjunction with the Telescope Array Surface Detector, Lightning Mapping Array, interferometer, electric‐field fast antenna, and the National Lightning Detection Network. The cloud‐to‐ground flash associated with the observed TGF was formed by a fast downward leader followed by a very intense return stroke peak current of −154 kA. The TGF occurred while the downward leader was below cloud base, and even when it was halfway in its propagation to ground. The suite of gamma‐ray and lightning instruments, timing resolution, and source proximity offer us detailed information and therefore a unique look at the TGF phenomena. Plain Language Summary This study provides the very first simultaneous observations of a downward‐directed terrestrial gamma‐ray flash (TGF) together with its associated cloud‐to‐ground lightning flash using a high‐speed camera in addition to gamma‐ray and radio measurements. The camera, running at 40,000 frames per second, allowed us to check the characteristics of the downward leader, the development stage of the lightning flash, and the luminosity variations in coincidence with TGF production. Key Points Simultaneous recordings of a downward‐directed terrestrial gamma‐ray flash (TGF), high‐speed video images, and radio emissions TGF events occurred while the leader was already branching below cloud base and even when it was halfway in its propagation to ground Energetic downward‐directed TGFs were associated with fast downward leaders that produced high return stroke peak currents

Introduction: Dysphagia is a newly acknowledged multifactorial risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). Effective screening methods are awaited. We performed a prospective study to evaluate the impact of musculature and breathing-swallowing discoordination on the exacerbation of COPD with a novel swallowing monitor using a piezoelectric sensor. Patients and Methods: This was the second part of a prospective study of patients with COPD from the Iizuka COPD cohort. Seventy patients with stable COPD underwent dysphagia screening, skeletal muscle mass index (SMI) and tongue pressure measurements, and swallowed 3 mL and 30 mL of water while wearing a swallowing monitor. Patients were followed for one year. Results: During the follow-up period, 28 patients experienced exacerbations (E group), and 42 had none (non-E group). There was no significant difference in tongue pressure measurements between the two groups. The SMI in the E group was significantly lower than that in the non-E group. Among the swallowing monitor measurements, the 3 mL I-SW% (the percentage of swallows in which inspiration preceded the swallow [out of ten 3 mL swallows]) was significantly lower in the E group than in the non-E group. Conclusion: Breathing-swallowing coordination is an independent factor related to the exacerbation of COPD. Not only the presence of discoordination but also the inability to produce an airway protection mechanism may contribute to more frequent aspiration and exacerbations. Keywords: dysphagia, screening, aspiration, piezomonitor, inspiration, COPD

Typhoon Talas (2011) caused extensive damage through landslides on the Kii Peninsula, Japan, in September 2011. The purpose of the present study is to quantitatively describe the potential for the occurrence of heavy rainfall-induced disasters if the typhoon track perturbs slightly or the typhoon intensifies. Regarding to the consideration of the track displacement of the typhoon, a procedure is proposed to generate different typhoon tracks perturbed from the original track of the typhoon. In this procedure, the position of a typhoon is artificially shifted at a certain time before landing in a physically consistent manner by applying potential vorticity inversion (PVI) methodology. After relocating the typhoon, the subsequent progress is simulated by a mesoscale meteorological model. Using the output, which consists of a set of realizations having different typhoon tracks, the worst-case scenario is discussed in terms of the soil water index (SWI) of the Kii Peninsula. The SWI is an indicator of the amount of water in soil that represents the hazard of landslide disasters. The maximum spatially averaged SWI is 1.10 times as large as that from the original typhoon track. Regarding the consideration of severer typhoon, the same method is used, but the intensity of the potential vorticity of a typhoon is artificially modified at the position instead of relocating potential vorticity to a different place. The maximum spatially averaged SWI is 1.28 times as large as that of the original typhoon intensity.

As shown in our previous study, inspiration after swallowing (SW-I) increases during the bi-level positive airway pressure ventilation (BiPAP) in healthy subjects because swallowing-associated non-inspiratory flow (SNIF) triggers inspiratory support, while SW-I during continuous positive pressure ventilation (CPAP) is rare. In the present study, we evaluated the coordination between breathing and swallowing during spontaneous breathing, BiPAP, and CPAP in patients with chronic obstructive pulmonary disease (COPD). This study is a prospective intervention study at the Hoshigaoka Medical Center (November 01, 2015-April 30, 2018). We simultaneously recorded the respiratory flow, laryngeal motion, and swallowing sounds during saliva swallowing in patients with COPD. We estimated the respiratory phase after swallowing, frequency of SNIF, the duration of the respiratory pause during swallowing, and timing of swallowing in the respiratory cycle and compared these parameters among control, CPAP, and BiPAP conditions. The expiration after swallowing (SW-E) frequency was associated with the occurrence of SNIF ( <0.01), pause duration ≤0.8 s ( <0.01), and timing of swallowing at the intermediate respiratory phase (50-80% of the respiratory cycle from the onset of inspiration) ( <0.01). In particular, the occurrence of SNIF most substantially affected the SW-E frequency. The SW-I frequencies under the control, CPAP, and BiPAP conditions were 35.0%, 3.0%, and 37.7%, respectively. The pause durations were shorter during CPAP and BiPAP than under the control condition ( <0.01). During CPAP, the occurrence rates of SW-E. Residual denotes the percentage difference between observed and expected values (residual =10.8: <0.01) and SNIF (residual =9.1: <0.01) were significantly increased, and timing of swallowing shifted toward the intermediate respiratory phase (residual=3.5: <0.01). CPAP decreases the SW-I frequency, increases the SNIF occurrence, and normalizes the timing of swallowing, all of which suggest that CPAP alleviates the risk of aspiration in patients with COPD.

The mesoscale snow distribution over the Namco lake area of the Tibetan Plateau on October 2005 has been investigated in this paper. The base and revised experiments were conducted using the Weather Research Model (WRF) with three nested grids that included a 1 km finest grid centered on the Namco station. Our simulation ran from 6 October through to 10 October 2005, which was concurrent with long term meteorological observations. Evaluation against boundary layer meteorological tower measurements and flux observations showed that the model captured the observed 2 m temperature and 10 m winds reasonably well in the revised experiment. The results suggest that output snow depth maximum amounts from two simulated experiments were centered downwind of the Namco lakeshore. Modified surface state variable, for example, surface skin temperature on the lake help to increase simulated credibility.

Experimental Echinococcus multilocularis infection and deworming was repeated three or five times in nine dogs at various re-infection schedules. The mean number of worms decreased more than 91% in dogs with repeated infection, compared to first infection controls (n= 6). The copro-antigen assay and the egg count in the faeces suggested that the worm burden gradually decreased each time the dogs were re-infected. To examine whether such worm exclusion was a non-specific response, five dogs were sequentially infected with the parasite four times and subsequently fed freely for 6 months. Even after the 6-month interval, the five dogs that were infected five times with the parasite were still able largely to exclude the adult worms. The results suggested that the ability of worm exclusion in dogs that developed a resistance did not become rapidly extinct. Observation of the condition of faeces and the excretion of hooks in the faeces of repeatedly infected dogs revealed that the exclusion of worms started at the first week after the re-infection, and it continued during the patent period. Serum antibodies specific to the parasite antigen increased gradually until the third infection and significantly decreased during the 6-month interval. There was little enhancement of serum antibodies after the fifth infection in most dogs, although no clear correlation was observed between the antibody response and the worm burden. These findings suggested the possibility of developing a vaccine.

An epidemiological survey of 1688 free-ranging raccoons (Procyon lotor) captured on the Japanese main islands of Hokkaido, Honshu and Kyushu was undertaken to determine whether Baylisascaris procyonis, which provokes fatal neurological larva migrans was present; however, the worm was not detected in any of these individuals. A helminthological investigation was carried out on 229 of the captured racoons and the following worms obtained: Toxocara tanuki, Porrocaecum sp., Molineus legerae, Ancylostoma kushimaense, Aonchotheca putorii, Centrorhynchus sp., Centrorhynchus bazaleticus, C. elongatum, Plagiorhynchidae gen sp., Hemiechinosoma sp., Metagonimus takahashii, M. miyatai, Euparyphium sp., Plagiorchis muris, Brachylaima sp., and Taenia hydatigena. These were the first records of Porrocaecum sp., M. miyatai, Brachylaima sp. and T. hydatigena obtained from Japanese feral raccoons. Scanning electron microscopic and/or molecular analyses were performed for both T. tanuki and T. hydatigena as these helminths both have a zoonotic counterpart amongst their families.

BACKGROUND The low attenuation areas on computed tomographic (CT) scans have been reported to represent emphysematous changes of the lung. However, the regional distribution of emphysema between the inner and outer segments of the lung has not been adequately studied. In this study the regional distribution of low attenuation areas has been compared by quantitative CT analysis and the contribution of the regional distribution to pulmonary function tests evaluated in patients with chronic obstructive pulmonary disease (COPD). METHODS Chest CT images and the results of pulmonary function tests were obtained from 73 patients with COPD. The lung images were divided into inner and outer segments in the upper (cranial), middle, and lower (caudal) sections. The percentage ratio of low attenuation area to corresponding lung area (LAA%) was then calculated. The LAA% of each segment was also compared with the results of pulmonary function tests. RESULTS The mean (SD) LAA% of the inner segment was 39.1 (18.5) compared with 28.1 (13.2) for the outer segment (p<0.0001). Linear and multiple regression analyses revealed that airflow limitation is closely correlated with the inner segment LAA% of the lower lung. In contrast, the carbon monoxide transfer factor is closely correlated with the inner segment LAA% of the upper lung. CONCLUSION Low attenuation areas on CT scans are more often found in the inner segment of the lung than in the outer segment, and the contribution of the inner segment to pulmonary function tests may be greater than the outer segment.

The present study aimed to search for and characterize parasite molecules, whose expression levels correlate with the viability and growth activity of Echinococcus multilocularis metacestodes. We focused on the expression profiles of 2 parasite-derived genes, 14-3-3 and II/3-10, as putative molecular markers for viability and growth activity of the larval parasite. In experiments in vivo, gene expression levels of 14-3-3 and II/3-10 were relatively quantified by real-time reverse transcription-PCR using a housekeeping gene, beta-actin, as a reference reaction. All three reactions were compared with growth activity of the parasite developing in permissive nu/nu and in non-permissive wild type BALB/c mice. At 2 months p.i., the transcription level of 14-3-3 was significantly higher in parasites actively proliferating in nu/nu mice compared to parasites moderately growing in wild type mice. Immunoblotting experiments confirmed at the protein level that 14-3-3 was over-expressed in parasites derived from nu/nu mice at 2 months p.i. In vitro treatment of E. multilocularis with an anti-echinococcal drug nitazoxanide resulted in a significant decrease of both 14-3-3 and II/3-10 transcription levels found after 8 days of treatment, which correlated with the kinetics of a housekeeping gene, beta-actin. The conclusion is that 14-3-3, combined with II/3-10, exhibits good potential as a molecular marker to assess viability and growth activity of the parasite.

To assess the clinical effectiveness and safety of traditional herbal medicines (THM: Kampo) used in combination with oral methotrexate (MTX) in order to control the disease activity of rheumatoid arthritis (RA) in patients whose disease remains active despite treatment with MTX. Patients (n=13; male:female = l:12) with RA who achieved only a suboptimal response to MTX therapy (> or =6 mg/week and > or =6 months) were enrolled in this assessment. All patients were treated with Keishinieppiittokaryojutsubu (KER; decoction) according to the traditional diagnostic system. Every 3 months, joint symptoms were examined, and routine blood analysis and general serological tests including anticyclic citrullinated peptide antibody (aCCP) were performed, and then we calculated the disease activity score of 28 joints (DAS28). One patient withdrew from the study after 4 weeks and discontinued consultations with our department for unknown reasons. Five (41.7%) of the twelve patients were defined as responders, and seven patients (58.3%) were classified as nonresponders based on DAS28-CRP findings. On comparison between responders and nonresponders, there was no significant difference with regard to age or disease duration and the dosages of concomitant prednisolone at baseline. KER responders had lower levels of aCCP at baseline than nonresponders (mean +/- standard deviation: 329.2 +/- 113.9 U/mL vs 623.8 +/- 242.8 U/mL, respectively) (P = .046, Mann-Whitney test). Furthermore, responders to KER showed a significant decrease in the serum levels of aCCP. The annual cost for KER treatment is much less than that for other new drugs. In patients whose active RA persists despite treatment with MTX, KER in combination with MTX is safe and well tolerated and provides clinical and economic benefits. Furthermore, pretreatment serum levels of aCCP are a useful predictor of a good response to KER treatment, and a decrease in serum levels of aCCP may be an adjunctive indicator in predicting the efficacy of this kind oftreatment.