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Psoriasis is a chronic systemic inflammatory disease with various co-morbidities, having been recently considered as a comprehensive disease named psoriatic disease or psoriatic syndrome. Autoimmune diseases are one form of its co-morbidities. In addition to the genetic background, shared pathogenesis including innate immunity, neutrophil extracellular trap (NETs), and type I interferon, as well as acquitted immunity such as T helper-17 (Th17) related cytokines are speculated to play a significant role in both psoriasis and connective tissue diseases. On the other hand, there are definite differences between psoriasis and connective tissue diseases, such as their pathomechanisms and response to drugs. Therefore, we cannot expect that one stone kills two birds, and thus caution is necessary when considering whether the administered drug for one disease is effective or not for another disease. In this review, several connective tissue diseases and related diseases are discussed from the viewpoint of their coexistence with psoriasis.

Genomic studies are increasingly revealing that neurodevelopmental disorders are caused by underlying genomic alterations. Chromosomal microarray testing has been used to reliably detect minute changes in genomic copy numbers. The genes located in the aberrated regions identified in patients with neurodevelopmental disorders may be associated with the phenotypic features. In such cases, haploinsufficiency is considered to be the mechanism, when the deletion of a gene is related to neurodevelopmental delay. The loss-of-function mutation in such genes may be evaluated using next-generation sequencing. On the other hand, the patients with increased copy numbers of the genes may exhibit different clinical symptoms compared to those with loss-of-function mutation in the genes. In such cases, the additional copies of the genes are considered to have a dominant negative effect, inducing cell stress. In other cases, not the copy number changes, but mutations of the genes are responsible for causing the clinical symptoms. This can be explained by the dominant negative effects of the gene mutations. Currently, the diagnostic yield of genomic alterations using comprehensive analysis is less than 50%, indicating the existence of more subtle alterations or genomic changes in the untranslated regions. Copy-neutral inversions and insertions may be related. Hence, better analytical algorithms specialized for the detection of such alterations are required for higher diagnostic yields.

Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by sterile pustules predominantly involving the palms and soles. PPP is refractory to various therapies such as topical ointment, oral medicine, and phototherapies. Pustulotic arthroosteitis (PAO) is a major comorbidity of PPP that severely impairs patients' quality of life. Recently, guselkumab, a monoclonal antibody against IL-23, has been available for the treatment of PPP in Japan. The purpose of the present review is to describe the characteristics of Japanese PPP patients and biologic therapy of PPP/PAO using guselkumab. Most Japanese dermatologists consider PPP as a distinct entity and co-existence of PPP and psoriasis is rare. However, outside Japan, PPP is often considered to be palmoplantar psoriasis, and extrapalmoplantar lesions associated with PPP are regarded as psoriasis. PPP develops or exacerbates either with or without arthralgia, following focal infections, such as tonsillitis, odontogenic infection, and sinusitis. Treatment of focal infection results in dramatic effects on cutaneous lesions as well as joint pain. By contrast, we sometimes see patients whose skin/joint symptoms do not improve after treatment of focal infection, whose focus of infection cannot be identifed even in a detailed examination, and/or who refuse tonsillectomy even if strongly recommended. Such cases are considered to be indications of biologics. In this review, clinical features, pathophysiology and guselkumab therapy are discussed. Keywords: palmoplantar pustulosis, pustulotic arthro-osteitis, therapy, biologics

In accordance with recent therapeutic progress of immune checkpoint inhibitors for certain cancers, various disorders are induced as immune-related adverse events (irAEs) affecting the skin, gut, thyroid gland, lung, and liver. Among such irAEs, mucocutaneous manifestation is the most common. Cutaneous manifestations are categorized into several groups, ie, inflammatory reactions, immunobullous reactions, alterations of epidermal keratinocytes, and alterations of epidermal melanocytes; however, there are additionally various cutaneous toxicities, unclassified into those groups. Blocking of programmed cell death 1 (PD-1)/programmed cell death ligand 1(PDL1) can lead to the induction of autoimmune reaction, via activation of cytotoxic T cells, inhibition of regulatory T cell function, and alteration of cytokine balance. Similarly, blockade of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) reduces the suppressive function of regulatory T cells. Due to those mechanisms, various autoimmune conditions can be induced, in addition to nonspecific drug eruptions. Dermatologists should be aware of various types of those mucocutaneous manifestations, either common or rare, as well as the management of such conditions. Herein, various mucocutaneous manifestations of irAEs and cases involving Japanese patients have been described, based on a single institute's experience.

This paper presents a review on relevant studies and reports related to older drivers’ behavior and stress. Questionnaires, simulators, and on-road/in-vehicle systems are used to collect driving data in most studies. In addition, research either directly compares older drivers and the other drivers or considers participants according to various age groups. Nevertheless, the definition of ‘older driver’ varies not only across studies but also across different government reports. Although questionnaire surveys are widely used to affordably obtain massive data in a short time, they lack objectivity. In contrast, biomedical information can increase the reliability of a driving stress assessment when collected in environments such as driving simulators and on-road experiments. Various studies determined that driving behavior and stress remain stable regardless of age, whereas others reported degradation of driving abilities and increased driving stress among older drivers. Instead of age, many researchers recommended considering other influencing factors, such as gender, living area, and driving experience. To mitigate bias in findings, this literature review suggests a hybrid method by applying surveys and collecting on-road/in-vehicle data.

Psoriasiform plaques were scattered on the dorsum of hands [Figure 1]a, whereas small, scaly erythemas were observed on the soles [Figure 1]b. He denied either sore throat or upper respiratory tract infection. Laboratory examinations showed normal eosinophil ratio (0.8%) in the peripheral blood, mild increased level of C-reactive protein (1.7 mg/dl), and normal liver and renal functions. A skin biopsy from the dorsum of the hand revealed mild parakeratotic hyperkeratosis, regular acanthosis, mild telangiectasia in the papillary dermis, and mild infiltration of lymphocytes admixed with a small number of neutrophils [Figure 1]c. Another specimen from the sole also showed epidermal proliferation with parakeratosis in the thickened cornified layers and moderate perivascular infiltration of mononuclear cells [Figure 1]d. The infiltrating cells were mainly composed of intraepidermal and dermal CD8-positive T-cells and CD3- and CD4-positive T-cells in the dermis [Figure 1]e and [Figure 1]f. The patient was being treated with topical corticosteroids without discontinuation of nivolumab.

The interactions among different types of vehicle ownership including car, motorcycle and bicycle are examined by developing simultaneous vehicle ownership models in this study. Large scale person trip survey data for Osaka metropolitan area, Japan and Kuala Lumpur, Malaysia are used for empirical analysis. The results suggest that population density at residential area significantly and negatively affects car ownership for both areas, and that the effects are larger for Osaka metropolitan area than for Kuala Lumpur. Also, bicycle ownership becomes higher at higher population density area for Osaka area, while higher at lower population density area for Kuala Lumpur, which represents the different usage patterns of bicycle between the two areas.

Balanced chromosomal translocation is one of chromosomal variations. Carriers of balanced chromosomal translocations have an increased risk of spontaneous miscarriage. To avoid the risk, preimplantation genetic testing (PGT) using comprehensive genomic copy number analysis has been developed. This study aimed to verify whether and how embryos from couples in which one partner is a balanced translocation carrier have a higher ratio of chromosomal abnormalities. A total of 894 biopsied trophectoderms (TEs) were obtained from 130 couples in which one partner was a balanced translocation carrier (Robertsonian translocation, reciprocal translocation, or intrachromosomal inversion) and grouped as PGT-SR. Conversely, 3269 TEs from 697 couples who experienced recurrent implantation failure or recurrent pregnancy loss were included in the PGT-A group. The transferable blastocyst ratio was significantly lower in the PGT-SR group, even when bias related to the sample number and patient age was corrected. Subgroup analysis of the PGT-SR group revealed that the transferable blastocyst ratio was higher in the Robertsonian translocation group. Because the PGT-SR group had a higher proportion of untransferable embryos than the PGT-A group, PGT using comprehensive genomic copy number analysis was more beneficial for balanced translocation carriers than for infertility patients without chromosomal translocations. The frequencies of de novo aneuploidies were further analyzed, and the frequency in the PGT-SR group was lower than that in the PGT-A group. Therefore, we could not confirm the existence of interchromosomal effects in this study.

The limited number of charging stations for electric vehicles (EVs) necessitates periodic charging, resulting in extended queues at charging stations as drivers await their availability. This study contributes to the existing body of literature by providing estimates of consumer preferences for allowable waiting times at charging stations, as well as furthering the understanding of the roles of the explanatory variables influencing these preferences. The study also compares the average and maximum waiting times experienced by EV drivers, with the acceptable waiting time. Responses from the stated preference survey in Japan in 2021 were analyzed using a generalized ordered logit model. The results show that (a) the sex, age, household income, employment status, and vehicle usage frequency significantly influenced the preferences for allowable waiting times, and (b) the allowable waiting time preferences were significantly associated with the charging locations. Our estimation model indicated a positive association of convenience stores, large commercial facilities, and highway locations with short and medium allowable waiting times. The results provide useful insights into the policy implications of the charging infrastructure.

This study focuses on charging-related decisions for fast charging at highway service and parking areas, slow charging at home, fast charging at commercial facilities, and fast and slow charging at workplaces. This research contributes to the existing literature by estimating the charging behavior variables, as well as understanding the role of explanatory variables in influencing charging-related decisions. Responses from the stated preference (SP) survey in Japan in 2021 were analyzed with a mixed logit model (MXL). The results showed that, (1) when the battery level is 75% or higher, users of battery electric vehicles (BEVs) are not keen to charge their vehicles, but when the next trip is anticipated to be 50 or more kilometers, they choose to charge their vehicles; (2) individuals are not willing to tolerate any waiting time for their vehicles to be charged at each location; and (3) the recurrence of charging at the target location affects the charging decision of BEV users. We found significant relationships between socioeconomic characteristics and charging decisions. Furthermore, we examined the practical applications of the empirical findings in this study for policymaking and charging infrastructure planning.