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Purpose: Symptomatic narcolepsy is characterized as low orexin (hypocretin) levels (≤ 110 pg/ml) due to neurological diseases. However, we have experienced the cases that show symptoms similar to narcolepsy, complaining of pathological sleepiness even in cases with intermediate orexin levels (110-200 pg/ml). Therefore, we reevaluated the previously reported cases to make the concept of disease to the group in which the orexin concentration is intermediate.Methods: Although orexin-deficient symptomatic narcolepsy has been reported worldwide, facilities that are capable of measuring orexin are still limited. Currently, our laboratory handles with almost all the CSF samples from Asian countries for determining orexin levels. We measured over 2500 cases including 182 cases suspected of symptomatic narcolepsy/hypersomnolence. Therefore, we subdivided these cases into three groups according to CSF orexin levels, low orexin group (≤ 110 pg/ml), intermediate orexin group (110-200 pg/ml), and normal orexin group (> 200 pg/ml). We defined "symptomatic hypersomnia" for hypersomnolence cases with intermediate CSF orexin levels. MSLT was recommended but not necessary. Short sleep latency (< 8 min) without SOREMPs should be observed on MSLT when performed. We compared symptoms (excessive daytime sleepiness and cataplexy) and objective measures (mean sleep latency and number of SOREMPs in MSLT) among the three groups, attempting to characterize the "symptomatic hypersomnia" group.Result: Among the 182 cases with clinical hypersomnolence, there were 32 cases of symptomatic narcolepsy (16%) and 14 cases of symptomatic hypersomnia (8%). Causative diseases of symptomatic narcolepsy cases consist of immune-mediated demyelinating disorders (34%) and neurodegenerations (19%), whereas those of symptomatic hypersomnia are immune-mediated demyelinating disorders (43%) and encephalopathies (14%). Significant differences were not found between orexin levels and the existence of cataplexy, SOREMPs, and short sleep latency among three hypersomnolence groups. From these results, we found that it is difficult to estimate orexin concentration from subjective symptoms and PSG/MSLT findings.Conclusion: We identified that 32 symptomatic narcolepsy and 14 cases of symptomatic hypersomnolence with intermediate CSF orexin levels. We proposed these latter cases as a novel category of "symptomatic hypersomnia". Currently, symptomatic hypersomnia cases with intermediate orexin levels or short sleep latency (< 8 min) without SOREMPs were not classified as a specific entity. However, symptomatic hypersomnia had similar severity of hypersomnolence symptoms to symptomatic narcolepsy. Therefore, these cases including equivalent pathophysiology are enough to make a comparable category as "symptomatic hypersomnia". Since it is difficult to estimate the orexin concentration from subjective symptoms and physiological findings (PSG/MSLT), further studies for the characterization of "symptomatic hypersomnia" and understanding its pathophysiology are necessary. [ABSTRACT FROM AUTHOR]

Summary: We compared the effectiveness of promoting bone healing between two teriparatide preparations for atypical femoral fracture (AFF). A total of 45 AFFs were included in this study, and we compared the duration of bone union. Teriparatide administered by daily injection enhanced bone union more than weekly administration in complete AFFs.Introduction: The efficacy of teriparatide for atypical femoral fracture (AFF) has been recently reported. Although two different teriparatide preparations can be used to treat osteoporosis in Japan, daily or weekly injection, all previous reports on the effectiveness of teriparatide for AFF only examined daily injection formulations. Therefore, we compared the promotion of bone healing between the two teriparatide preparations for AFF.Methods: A total of 45 consecutive AFFs in 43 Japanese patients were included in this study. They received either a daily 20-μg teriparatide injection (daily group; n = 32) or a once-a-week 56.5-μg teriparatide injection (weekly group; n = 13). We compared the clinical background and duration of bone union between these two groups.Results: When all patents were included, the fracture healing time was not significantly different between the two groups. Only patients with complete AFFs had significantly fewer daily bisphosphonate or denosumab injections than the weekly group (P < 0.05). The fracture healing time in the daily group (6.1 ± 4.1 months) was significantly shorter than that in the weekly group (10.1 ± 4.2 months) (P < 0.05). Even if the influence of bisphosphonate or denosumab usage was excluded, a similar significant difference was observed in the fracture healing time (P < 0.05). There was no significant difference between the two groups among patients with incomplete AFFs.Conclusions: Daily teriparatide injections enhance bone union more than weekly injections in complete AFF patients. [ABSTRACT FROM AUTHOR]

Excitonic processes in organic molecular crystals are discussed in terms of two parameters, the crystal size and the constituent molecule size. From the luminescence and absorption spectra of a series of aromatic molecular crystals we fund a systematic change in exciton energy transport as functions of the size of crystal and its constituent molecule size. Characteristic features of bulk crystals and microcrystallites are as follows. (1) In bulk crystals exciton energytransport depends on the constituent molecule size. When molecules are small, the exciton energy transport occurs by free excitons, but when molecules are large free exciton transport disappears because excitons get self-trapped (2) In microcrystallites, exciton energy transport depends on the crystallite size. When the size is larger than a critical one, excitons travel as quantum mechanical waves but when the size is smaller than the critical one the exciton waves get confined within the crystallite. The results are independent of the chemical species of constituent molecules and thus applicable to novel molecular arrays such as biological molecular arrays. [ABSTRACT FROM AUTHOR]