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Chika Maekura,1 Ayako Muramatsu,1 Hiroaki Nagata,1 Haruya Okamoto,1 Akio Onishi,1 Daishi Kato,1 Reiko Isa,1 Takahiro Fujino,1 Taku Tsukamoto,1 Shinsuke Mizutani,1 Yuji Shimura,1,2 Tsutomu Kobayashi,1 Keita Okumura,3 Tohru Inaba,4 Yoko Nukui,4 Junya Kuroda1 1Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan; 2Department of Blood Transfusion, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; 3Faculty of Clinical Laboratory, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; 4Department of Infection Control & Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, JapanCorrespondence: Junya Kuroda, Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan, Tel +81 75 251 5740, Fax +81 75 251 5743, Email junkuro@koto.kpu-m.ac.jpAbstract: Previous studies have demonstrated that the appropriate production of serum anti-severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) neutralizing antibody (nAb) plays a critical role in the recovery from coronavirus disease 2019 (COVID-19); however, the role of nAb production in the recovery from a flare-up of chronic immune thrombocytopenia (ITP) has been unknown. We here report the first retrospectively investigated case of serum anti-SARS-Cov-2 nAb production during chronic ITP flare-up triggered by COVID-19. A 79-year-old woman with a history of corticosteroid-refractory ITP visited our hospital complaining of fever, cough, and sore throat for 4 days. Although chronic ITP was controlled by 12.5 mg of eltrombopag (EPAG) every other day, laboratory tests showed a decreased peripheral blood platelet count of 15.0 × 109/L, which indicated worsening thrombocytopenia. Meanwhile, PCR testing of a nasopharyngeal swab revealed that the patient was positive for SARS-Cov-2, and a computed tomography scan revealed bilateral pneumonia. On the basis of the flare-up of chronic ITP associated with COVID-19 pneumonia which was determined as a moderately severe status according to the WHO clinical progression scale, intravenous immunoglobulin therapy for 5 days (days 0– 4) and antiviral therapy were added on top of EPAG, which only resulted in a transient increase in the platelet count for several days. After decreasing to 8.0 × 109/L on day 13, the platelet count increased from day 16, coinciding with a positive detection for serum nAb against SARS-Cov-2. Although the increased dose up to 50 mg/day of EPAG was challenged during the clinical course, rapid dose reduction did not cause another relapse. In addition, no thrombotic or bleeding event was seen. These collectively suggest the vital role of the production of anti-SARS-Cov-2 nAb and improvement of clinical symptoms for recovery from a flare-up of chronic ITP in our case.Keywords: chronic immune thrombocytopenia, COVID-19, flare, neutralizing antibody

Yuto Uchida,1 Daisuke Kato,1 Yoriko Yamashita,2 Yasuhiko Ozaki,3 Noriyuki Matsukawa1 1Department of Neurology, 2Department of Experimental Pathology, 3Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Abstract: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a type of autoimmune encephalitis that can be paraneoplastic and usually responds to tumor resection and immunotherapy. More than 75% of patients with anti-NMDAR encephalitis fully recover or have only mild sequelae, whereas the remainder experience severe disability. It remains unknown why certain cases have refractory clinical disease courses. We report a case of anti-NMDAR encephalitis with bilateral ovarian teratomas who was refractory to tumor resection and early initiation of immunotherapy. During intensive care, immunohistochemical analyses of her cerebrospinal fluid showed persistently high reactivity of NMDAR antibody over time. Six months after the operation, pelvic computed tomography detected a recurrent ovarian teratoma. After total enucleation of the bilateral ovaries, with significant pathological findings of bilateral mature cystic teratomas, her clinical condition improved rapidly, paralleled by a decrease in anti-NMDAR reactivity. This case illustrates the need to keep considering why extensive treatment fails to influence the disease when we encounter patients with refractory anti-NMDAR encephalitis. Failure to improve after ovarian resection could be a marker of recurrent ovarian teratoma in anti-NMDAR encephalitis. Keywords: N-methyl-D-aspartate receptor, antibody, autoimmune encephalitis, refractory, recurrence

We aim to present first large scale and systematic investigation on atomic properties of Ge-like ions: As1+, Se2+, Br3+, and Kr4+. The multiconfiguration Dirac–Hartree–Fock and relativistic configuration interaction methods, which are implemented in the general-purpose relativistic atomic structure package Grasp2018, are used in the present work. We computed the energy levels of the 4s2 4p2, 4s4p3, 4p4, 4s2 4p {5s, 6s, 5p, 6p, 4d, 5d, 4f}, and 4s4p2 {4d, 5s} configurations and the electric dipole, magnetic dipole, and electric quadrupole transitions between states of these configurations. The accuracy of energy levels is evaluated by comparing our results with the recommended values of the National Institute of Standards and Technology Atomic Spectra Database and with energy levels estimated with various methods. The accuracy of transition data is investigated using the quantitative and qualitative evaluation method. We applied our results to astrophysics by constructing the list of M1-type transitions for kilonova. For Ge-like ions presented in this paper, we confirmed that the transition list assuming the LS-coupling selection rules, as adopted in the previous studies, includes all the important transitions and that an analytical formula for transition probabilities gives a good accuracy. [ABSTRACT FROM AUTHOR]

Doubly ionized cerium (Ce2+) is one of the most important ions to understand the kilonova spectra. In particular, near-infrared (NIR) transitions of Ce  iii between the ground (5p6 4f2) and first excited (5p6 4f 5d) configurations are responsible for the absorption features around 14 500 Å. However, there is no dedicated theoretical studies to provide accurate transition probabilities for these transitions. We present energy levels of the ground and first excited configurations and transition data between them for Ce  iii. Calculations are performed using the grasp 2018 package, which is based on the multiconfiguration Dirac–Hartree–Fock and relativistic configuration interaction methods. Compared with the energy levels in the NIST data base (Kramida et al. 2024), our calculations reach the accuracy with the root-mean-square (rms) of 2732 or 1404 cm−1 (excluding one highest level) for ground configuration, and rms of 618 cm−1 for the first excited configuration. We extensively study the line strengths and find that the Babushkin gauge provides the more accurate values. By using the calculated gf values, we show that the NIR spectral features of kilonova can be explained by the Ce  iii lines. [ABSTRACT FROM AUTHOR]

We report electron impact triple-differential cross sections (TDCSs) for the ionization of W+ (6s) and W+ (5d) in the intermediate energy range. The TDCSs are obtained at projectile energies of 100, 200, and 500 eV for ejected electron energies of 2 and 10 eV in the distorted-wave Born approximation approach. Tungsten and related materials are prime candidates for building plasma-facing components in fusion devices, and tungsten and its ions enter the plasma as an impurity. The electron-induced processes from tungsten ions are very important for the diagnostics and modelling of plasma. In the present study, we report the kinematically complete cross section data for the ionization of tungsten ions, which will be helpful for the particular application in fusion plasma. The TDCS trends observed for W+ (6s) and W+ (5d) are analysed in terms of binary and recoil peak positions and magnitude, and a sensitive dependence on values of momentum transfer is observed. It is further observed that the TDCS trends are very different for W+ (5d), which may be due to the open d shell, and thus further investigation is required for a complete understanding of the collision dynamics. [ABSTRACT FROM AUTHOR]

Belongingness has been proposed as a potential proxy for legitimate peripheral participation in medical education. Previous studies have shown good internal and external validity for tools designed to measure this variable, with potential use measuring the effectiveness of clinical teaching environments and as a marker of student wellbeing. This study examined changes in belongingness in medical students at the University of Exeter measured in spring 2019 and the equivalent period in 2021, during which COVID-19 related restrictions were in place in the United Kingdom. This study used a validated assessment tool that was self-administered via an online survey platform in 2021. Anonymised data was collected from undergraduate medical students from all years of training and results compared with previous data collected in 2019. The belongingness assessment tool described here had validity in undergraduate medical students studying at the University of Exeter and identified statistically significant changes in belongingness (as measured with this tool) between 2019 and the period during which COVID-19 restrictions were in place. These results suggest that belongingness – in undergraduate medical students fluctuates and varies under different conditions and that there was a statistically significant change during the period of lockdown restrictions. The ability to measure this key facet of educational development has the potential to monitor teaching environments to ensure optimal learning conditions for all students. Further work is required to assess whether the impacts of lockdown restrictions are transient or persist beyond the period of teaching restrictions and to determine any association with academic outcomes.