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LILRB4 (B4, also known as ILT3/CD85k) is an immune checkpoint of myeloid lineage cells, albeit its mode of function remains obscure. Our recent identification of a common ligand for both human B4 and its murine ortholog gp49B as the fibronectin (FN) N-terminal 30 kDa domain poses the question of how B4/gp49B regulate cellular activity upon recognition of FN in the plasma and/or the extracellular matrix. Since FN in the extracellular matrix is tethered by FN-binding integrins, we hypothesized that B4/gp49B would tether FN in cooperation with integrins on the cell surface, thus they should be in close vicinity to integrins spatially. This scenario suggests a mode of function of B4/gp49B by which the FN-induced signal is regulated. The FN pull-down complex was found to contain gp49B and integrin β 1 in bone marrow-derived macrophages. The confocal fluorescent signals of the three molecules on the intrinsically FN-tethering macrophages were correlated to each other. When FN-poor macrophages adhered to culture plates, the gp49–integrin β 1 signal correlation increased at the focal adhesion, supporting the notion that gp49B and integrin β 1 become spatially closer to each other there. Adherence of RAW264.7 and THP-1 cells to immobilized FN induced phosphorylation of spleen tyrosine kinase, whose level was augmented under B4/gp49B deficiency. Thus, we concluded that B4/gp49B can co-tether FN in cooperation with integrin in the cis configuration on the same cell, forming a B4/gp49B–FN–integrin triplet as a regulatory unit of a focal adhesion-dependent pro-inflammatory signal in macrophages.

Natural killer (NK) cells play pivotal roles in innate immunity as well as in anti-tumor responses via natural killing, while their activity is tightly regulated by cell-surface inhibitory receptors. Immunoglobulin (Ig)-like transcript 3/leukocyte Ig-like receptor B4 (ILT3/LILRB4, also known as gp49B in mice) is an inhibitory receptor expressed on activated NK cells as well as myeloid-lineage cells. The common physiologic ligand of human LILRB4 and gp49B is identified very recently as fibronectin (FN), particularly the N-terminal 30 kDa domain (FN30). We hypothesized that LILRB4 could bind FN on target cells in trans together with integrin, a classical FN receptor, in cis and deliver an inhibitory signal in NK cells, leading to attenuated natural killing. Flow cytometric and confocal microscopic analyses of NK cell-surface gp49B and integrin suggested that these novel and classical FN receptors, respectively, co-engage FN immobilized on a culture plate. Biochemical analyses indicated that tyrosine phosphorylation of spleen tyrosine kinase was augmented in gp49B-deficient NK cells upon binding to the immobilized FN. While surface FN-poor YAC-1 cells were evenly sensitive as to natural killing of both gp49B-positive and -negative NK cells, the killing of FN-rich Lewis lung carcinoma cells, but not the FN30-knockout cells, was augmented among gp49B-deficient NK cells. These results suggest that the natural cytotoxicity of NK cells is negatively regulated through LILRB4/gp49B sensing FN on target cells, which sheds light on the unexpected role of LILRB4 and FN as a potential attenuator of NK cell cytotoxicity in the tumor microenvironment.

A myeloid immune checkpoint, leukocyte immunoglobulin-like receptor (LILR) B4 (B4, also known as ILT3/CD85k in humans and gp49B in mice) is expressed on dendritic cells (DCs). However, a mode of regulation of DCs by B4/gp49B is not identified yet in relation to the ligand(s) as well as to the counteracting, activation-type receptor. Our recent identification of the physiological/pathological ligand for B4/gp49B as the fibronectin (FN) N-terminal 30-kDa domain poses the question of the relationship between B4/gp49B and a classical FN receptor/cellular activator, integrin, on DCs. Here we showed that FN is not constitutively tethered on the surface of bone marrow-derived cultured DCs (BMDCs) or splenic DCs, even though the FN receptor integrin and gp49B are co-expressed on these cells. Confocal laser scanning microscopic analysis, however, revealed weak correlation of fluorescent signals between gp49B and integrin β

This study aimed to delineate the decline in public interest toward the March 2011 Great East Japan Earthquake (GEJE) and the Fukushima Daiichi nuclear power plant (FNPP) accident in Japan over a ten-year period. In this longitudinal descriptive study, we searched for publications within a ten-year period in Letters to the Editor that mentioned the GEJE, the FNPP accident, or the January 1995 Great Hanshin-Awaji Earthquake (GHAE) that occurred in Japan, using the official databases of the three largest Japanese newspapers. The GEJE- and GHAE-related publications (4,809 and 2,092, respectively) are depicted as scatter plots. The results show a gradual decrease in the publications mentioning GEJE or GHAE. The impact of GEJE and FNPP on Japanese society was enormous, but the public interest waned over time. Communication strategies that maintain a high public interest in previous disasters may be necessary.

Introduction Future time perspective (FTP) means the capacity to foresee, anticipate, and plan for future desired outcomes, and it contributes to persistent treatment for type 2 diabetes mellitus (T2DM). However, the components of FTP specific to T2DM patients have not been clarified. This study aimed to explore the components of FTP and to examine the associations between such components and persistent/impersistent diabetes treatment. Methods In this cross-sectional study, using qualitative and quantitative methods, 106 T2DM patients were enrolled by purposive sampling. The participants were interviewed in October and November 2018 by public health nurses in Koriyama City Public Health Center, Japan. In addition to the participants’ status of treatment engagement (persistent/impersistent), their responses regarding reasons for persistent/impersistent treatment were collected and then summarized into nine subthemes, which were then merged into two main themes according to the presence or absence of FTP with a sense of T2DM ownership for analysis. Results The main theme, “presence of FTP with a sense of T2DM ownership,” included subthemes such as “securing social independence,” “planning on living a long and healthy life,” “prioritizing avoiding being a burden on family and friends,” “valuing improvement of diabetes,” “avoiding tragic results,” “optimistically viewing treatment as a form of self-development,” and “improving mental health,” whereas the main theme, “absence of FTP with a sense of T2DM ownership,” included “lack of consciousness of disease” and “living a dissipated life.” The association between the presence of FTP with a sense of T2DM ownership and persistent treatment for T2DM was found using Fisher’s exact test (p

BACKGROUND Children with Down syndrome (DS) have different growth rates compared with normal children. The present study examined the reliability of a general formula, Uemura's formula, utilized in normal Japanese children to estimate renal function (estimated glomerular filtration rate - eGFR) in children with DS. METHODS This study included 758 children aged 2-18 years with DS who visited our medical center. Patients with congenital heart disease, or congenital anomalies of the kidney or urinary tract detected via abdominal ultrasonography, chronic glomerulonephritis, and vesicoureteral reflux, etc., were excluded. Height and serum creatinine data gathered from 2421 examinations of 379 children with DS (224 boys and 155 girls) were used to evaluate Uemura's formula. RESULTS The mean eGFR was lower in children with DS than in children without DS. Stage II chronic kidney disease was indicated in 44.6% of examinations and stage III in 0.8%. The association of eGFR with age differed between sexes. Boys with DS showed a significant but weak negative correlation between eGFR and age (r = -0.273, P

The extracellular matrix (ECM) is the basis for virtually all cellular processes and is also related to tumor metastasis. Fibronectin (FN), a major ECM macromolecule expressed by different cell types and also present in plasma, consists of multiple functional modules that bind to ECM-associated, plasma, and cell-surface proteins such as integrins and FN itself, thus ensuring its cell-adhesive and modulatory role. Here we show that FN constitutes an immune checkpoint. Thus, FN was identified as a physiological ligand for a tumor/leukemia/lymphoma- as well as autoimmune-associated checkpoint, ILT3/LILRB4 (B4, CD85k). Human B4 and the murine ortholog, gp49B, bound FN with sub-micromolar affinities as assessed by bio-layer interferometry. The major B4-binding site in FN was located at the N-terminal 30-kDa module (FN30), which is apart from the major integrin-binding site present at the middle of the molecule. Blockade of B4–FN binding such as with B4 antibodies or a recombinant FN30-Fc fusion protein paradoxically ameliorated autoimmune disease in lupus-prone BXSB/Yaa mice. The unexpected nature of the B4–FN checkpoint in autoimmunity is discussed, referring to its potential role in tumor immunity.

Although many pediatric nephrologists consider focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD) as separate clinical entities, whether the initial histology could affect clinical courses in children with steroid-resistant nephrotic syndrome (SRNS) suspected of having an immune-based etiology remains unknown, especially for long-term outcomes. We retrospectively reviewed long-term outcomes (> 3 years; median follow-up, 9.1 years) of 21 children with initial SRNS (FSGS, N = 9; MCD, N = 12) who achieved complete remission with immunosuppressive agents, including cyclosporine. At NS onset, incidence of acute kidney injury (67% vs. 8%, P

Background: Field trips to disaster-affected areas (FTDAs) with no specific purpose, such as medical cooperation, are widely undertaken in medical education. Although the educational effects of fieldwork where students may be assigned duties such as medical collaboration or support have been already revealed, those of these FTDAs remain unclear. The present study aimed to clarify what medical students gain from FTDAs.Methods: Subjects were five medical students who participated in an FTDA at the Fukushima Daiichi Nuclear Power Plant (FDNPP) in Japan, at which hydrogen explosions occurred following the Great East Japan Earthquake, causing severe radiation contamination, to learn about the health concerns of restoration workers. The students went in 2017, and a retrospective group interview was conducted approximately two years later. Narratives about what they gained from the FTDA were extracted using open coding and interpreted.Results: The following four main themes were identified: “Spirit of scientific inquiry,” which represents the knowledge and mindset required to read and examine the prevailing notions and government announcements critically; “Foundation for lifelong education and personal growth,” which represents that the experience of the FTDA was associated with recognising the importance of lifelong learning; “Diverse professionalism,” which suggests that the students gained insights into essential elements of becoming a medical doctor, and various perspectives on their future career choices; and “Importance of practicing medicine in the community setting,” which represents students’ recognition that, in the future, they may work in a region surrounding or near the FDNPP and that they may feel compelled to contribute to the region.Conclusions: The students gained a broader perspective on their future jobs and careers through the FTDA. Medical educators should be aware of the educational benefits of FTDAs and employ them in their educational practices. Note that FTDA sites are not limited to the FDNPP. If medical educators can explain the importance of FTDAs to the residents of a disaster site and gain their understanding, various disaster-affected areas can be potential locations. Medical educators should understand the educational effects of FTDAs on students’ growth and effectively install FTDAs in their educational practices.

This study developed and tested a new measurement instrument, the Systematic Workplace-Improvement Needs Generation (SWING), to identify workplace-improvement needs. The participants were 53 workers in a Japanese nursing home for the elderly. The respondents used the SWING questionnaire to self-generate five ‘cues’ they considered important to improve the workplace. The workers determined each cue’s sufficiency level and weight balance (importance), and then we summarised the 265 cues into 21 categories for workplace improvements. The respondents identified the following items as the most important and the least sufficiently provided areas for workplace improvement: ‘interaction with customers’, ‘physical and psychological harassment’, ‘rewarding and challenging work’, and ‘sharing goals and objectives’. Although the workplace-improvement recommendations differed greatly from person to person, SWING prioritised the items by weight (importance) and sufficiency (current status), allowing organisations to address the needed improvements systematically. The SWING tool effectively elicited and prioritised respondents’ recommendations for improving the workplace. Because its items are self-generated by the respondents, SWING can be used for any occupation or workplace. Visualisation with bubble plots to clarify the improvement needs is incorporated into SWING.

Mizoribine may be a safe and effective treatment for children with steroid-dependent nephrotic syndrome (SDNS). However, predictors of treatment response and long-term outcomes after mizoribine discontinuation remain unknown. We retrospectively reviewed the clinical course of 22 children aged ≤ 10 years (median age, 5.3 years) with SDNS who received high-dose mizoribine as the initial steroid-sparing agent (SSA). Mizoribine was administered at a single daily dose of 10 mg/kg (maximum, 300 mg/day) after breakfast. The dose was adjusted to maintain 2-h post-dose mizoribine levels of3 μg/mL and was tapered off after 12 months of steroid-free remission. Patients who regressed to SDNS were switched from mizoribine to other SSAs. The primary endpoint was probability of survival without regression to SDNS after mizoribine initiation. Ten patients were able to discontinue SDNS (response group), whereas twelve were switched from mizoribine to other SSAs (non-response group) during a median observation period of 6.0 years after mizoribine. The steroid-dependent dose prior to mizoribine was significantly lower in the response group than in the non-response group (p0.05). The Kaplan-Meier analysis revealed that the probability of regression-free survival was significant higher in patients with steroid-dependent dose of0.25 mg/kg/day than in those with steroid-dependent dose of ≥ 0.25 mg/kg/day (p0.05). During a median follow-up of 5.5 years after mizoribine discontinuation, all but one patient did not develop SDNS. High-dose mizoribine may be an attractive treatment option as initial SSA in young children with low steroid-dependent dose for improved long-term outcomes.

Introduction: Decision-making regarding treatment at the end-of-life stage is an important issue for the elderly and their families. Such decision-making may be influenced by activities that promote communication and physical health. The purpose of this study was to examine the association between participation in sports club activities and decision-making regarding life-prolonging treatment among the general community-dwelling Japanese elderly. Methods: In this cross-sectional study, which used stratified random sampling, 1,603 elderly people aged 65 years or older as of January 2016, living in Fukushima prefecture, Japan were enrolled. Data was collected by a self-completed questionnaire (effective response rate: 53.4%). The association of sports club activity participation with a preference for accepting or declining life-prolonging treatment was analyzed by multinomial logistic regression analysis. Results: Of those participating in sports club activities, the results revealed an odds ratios of 1.812 for participants declining life-prolonging treatment (95% CI=1.325 to 2.477) and 1.948 for those who preferred life-prolonging treatment (95% CI=1.160 to 3.271). Conclusions: The present study suggests that participation in sports club activities is associated with articulating decisions about life-prolonging treatment in end-of-life care. Consideration of patient involvement in daily activities in non-medical settings may enhance decision-making for end-of-life care planning.

Background Leukocyte immunoglobulin-like receptor B4 (LILRB4) is one of the inhibitory receptors in various types of immune cells including macrophages. Previous reports suggested that LILRB4 could be involved in a negative feedback system to prevent excessive inflammatory responses. However, its role has been unclear in chronic obstructive pulmonary disease (COPD), in which macrophages play a crucial role in the pathogenesis. In this study, we aimed to examine the changes of LILRB4 on macrophages both in the lung specimens of COPD patients and the lungs of a mouse emphysema model. We then tried to compare the differences in both inflammation and emphysematous changes of the model between wild-type and LILRB4-deficient mice in order to elucidate the role of LILRB4 in the pathogenesis of COPD. Methods We prepared single-cell suspensions of resected lung specimens of never-smokers (n = 21), non-COPD smokers (n = 16), and COPD patients (n = 14). The identification of LILRB4-expressing cells and the level of LILRB4 expression were evaluated by flow cytometry. We analyzed the relationships between the LILRB4 expression and clinical characteristics including respiratory function. In the experiments using an elastase-induced mouse model of emphysema, we also analyzed the LILRB4 expression on lung macrophages. We compared inflammatory cell accumulation and emphysematous changes induced by elastase instillation between wild-type and LILRB4-deficient mice. Results The levels of surface expression of LILRB4 are relatively high on monocyte linage cells including macrophages in the human lungs. The percentage of LILRB4+ cells in lung interstitial macrophages was increased in COPD patients compared to non-COPD smokers (p = 0.018) and correlated with the severity of emphysematous lesions detected by CT scan (rs = 0.559, p p = 0.008). LILRB4-deficient mice showed severer emphysematous lesions with increased MMP-12 expression in the model. Conclusions LILRB4 on interstitial macrophages was upregulated both in human COPD lungs and in a mouse model of emphysema. This upregulated LILRB4 may have a protective effect against emphysema formation, possibly through decreasing MMP-12 expression in the lungs.

ObjectivesSubjective sleep quality (SSQ) is defined by the satisfaction of one’s overall sleep experience and is composed of sleep depth and restfulness. It has not been clarified how poor SSQ is associated to changes in lifestyles. The purpose is to reveal the association of lifestyle pattern changes and poor SSQ.DesignA cross-sectional study.SettingThe data on basic attributes, SSQ and lifestyle such as presence/absence of smoking, exercise, physical activity, supper time close to bedtime, drinking habits and alcohol intake amount per day were obtained from database and questionnaire of specified medical check-ups in fiscal year 2014–2015 in Japan. The analysis was conducted in 2019.ParticipantsThe subjects comprised 49 483 residents (26 087 men and 23 396 women), aged 40–74 years who had undergone an annual specified medical check-up from 2014 to 2015 in Fukushima Prefecture, Japan.Outcome measureStatus of SSQ in 2015 was assessed using a question asking whether or not the subjects usually got enough sleep. Poor SSQ in 2015 and lifestyle pattern changes in 2014–2015 were compared between those who were in healthy status both in 2014 and 2015 (referent) and non-referent, using binary logistic regression analysis.ResultsUnhealthy lifestyle pattern for 2014–2015 was significantly associated to poor SSQ in 2015: ‘absent to absent’ in exercise for men (OR=1.472; 95% CI 1.316 to 1.647) and women (OR=1.428; 95% CI 1.285 to 1.587), physical activity for men (OR=1.420; 95% CI 1.270 to 1.588) and women (OR=1.471; 95% CI 1.322 to 1.638) and ‘present to present’ in supper time for men (OR=1.149; 95% CI 1.020 to 1.294) and women (OR=1.288; 95% CI 1.102 to 1.505).ConclusionsHealthcare workers may be able to contribute to the improvement of SSQ, focusing on changeable lifestyles.

The study investigates the association between weight gain perception and weight change over time among Japanese adults. Data were from specific health checkups held in 2013, 2014, and 2015 by National Health Insurance in Fukushima Prefecture, Japan. We included 3677 participants who gained more than 3.0kg between 2013 and 2014. Weight gain perception was asked in 2014 using a questionnaire. The participants who perceived their weight gain of more than 3kg were categorized in the accurate group and those who did not were in the inaccurate group. Multiple linear regression models were used to assess associations between weight gain perception in 2014 and weight change between 2014 and 2015. The models were adjusted for gender, age, weight in 2014, regular physical exercise, daily physical activity, and medication. Results showed that the accurate group (β=0.217; 95% confidence interval=0.037, 0.397; P=0.018) had significantly less weight loss than those in the inaccurate group. We concluded that accurate weight gain perception was associated with an increased risk of future weight gain among Japanese adults.

Heat-related illness (HRI) is a common occupational injury, especially in construction workers. To explore the factors related to HRI risk in construction workers under hot outdoor working conditions, we surveyed vital and environmental data of construction workers in the summer season. Sixty-one workers joined the study and the total number of days when their vital data during working hours and environmental data were recorded was 1165. Heart rate with high-risk HRI was determined using the following formula: 180 − 0.65 × age. As a result of the logistic regression analysis, age, working area, maximum skin temperature, and heart rate immediately after warming up were significantly positively related, and experience of construction was significantly negatively related to heart rate with high-risk HRI. Heart rate immediately after warming up may indicate morning fatigue due to reasons such as insufficient sleep, too much alcohol intake the night before, and sickness. Asking morning conditions may lead to the prevention of HRI. For occupational risk management, monitoring of environmental and personal conditions is required.

AbstractImmune homeostasis is critically regulated by the balance between activating and inhibitory receptors expressed on various immune cells such as T and B lymphocytes, and myeloid cells. The inhibitory receptors play a fundamental role in the immune checkpoint pathway, thus maintaining peripheral tolerance. We recently found that expression of leukocyte immunoglobulin-like receptor (LILR)B4, an inhibitory member of the human LILR family, is augmented in auto-antibody-producing plasmablasts/plasma cells of systemic lupus erythematosus (SLE) patients. However, the mechanism behind the ‘paradoxical’ up-regulation of this inhibitory receptor upon pathogenic antibody-secreting cells is yet to be known. To this end, in this study, we examined if glycoprotein 49B (gp49B), the murine counterpart of human LILRB4, is also elevated in auto-antibody-producing cells in several SLE mouse models, and tried to clarify the underlying mechanism. We found that gp49B is expressed on plasma cells of lupus-prone models but not of healthy C57BL/6 mice, and the level was positively correlated to the anti-double-stranded DNA IgG titer in serum. Gp49B genetic deletion, however, did not abolish the serum auto-antibodies or fully ameliorate the lethal glomerulonephritis, indicating that gp49B is not the sole regulator of lupus but a pathogenic element in the disease. We conclude that the elevated expression of this inhibitory receptor on pathogenic plasma cells was also relevant upon the murine SLE model. The mechanism of gp49B underlying the disease progression in lupus-prone mice has been discussed.

Aim Polypharmacy in elderly people is a social issue and has been reported to cause not only drug adverse events, but also falls, dysfunction and cognitive decline. Those events may trigger prolonged length of hospitalization. Therefore, the aim of this study was to investigate whether polypharmacy has a prolonging effect on hospitalization. Methods The study subjects were 584 patients in a university hospital in Japan who had been admitted for hepatectomy, pancreaticoduodenectomy, gastrectomy or colectomy, and to whom clinical pathways had been applied. In this study, polypharmacy was defined as taking five or more regular oral medications, and prolonged hospitalization was defined as hospitalization longer than that determined by the clinical pathway. Multiple logistic regression analysis was performed to investigate whether polypharmacy affects the length of hospitalization. Results The subjects were 348 males and 236 females, mean ± SD age of 65.8 ± 12.9 years. Among all subjects, 228 (39.0%) were receiving polypharmacy at admission, and the number of patients with prolonged hospitalization was 262 (44.9%). Multiple logistic regression analysis revealed that the following variables were significantly associated with prolonged hospitalization; polypharmacy (odds ratio = 1.532; 95% confidence interval = 1.010–2.327), age 50–59; 2.971 (1.216–7.7758), age 60–69; 2.405 (1.059–5.909), organ pancreas; 0.298 (0.122–0.708), operation time ≥386 min; 2.050 (1.233–3.432), intraoperative bleeding volume ≥401 mL; 2.440 (1.489–4.038), postoperative delirium; 2.395 (1.240–4.734), postoperative infection; 10.715 (4.270–33.059). Conclusion The current study revealed that polypharmacy at admission was an independent factor for prolonged hospitalization. In future, measures against polypharmacy are required, collaborating with outpatient clinics, family doctors and dispensing pharmacies. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2020; ••: ••–••.

The purpose of this study is to clarify the characteristics of awareness and behavior for falling accident prevention according to medical profession. We used a questionnaire called “Self-Evaluation of Awareness and Behavior for Falling Accident Prevention,” which was originally designed for nurses. In October and November 2016, the questionnaire was administered to 1,670 medical staff (nurses, doctors, lab technicians, nursing assistants, radiological technicians, pharmacists, physical therapists, nutritionists, and occupational therapists, among others) at a hospital in Japan, using a 5-step scale and a not applicable (N/A) option. Valid responses were obtained from 923 (55.3%) participants, and all seven factors extracted by factor analysis had Cronbach’s α coefficients of greater than 0.9. Using cluster analysis based on principal component analysis, four categories were identified. According to the results of the N/A χ(2) (chi-square) test question item and occupation, nurses answered N/A the least, followed by doctors, physical therapists, and occupational therapists. Nursing assistants’ awareness and behavior were both low, suggesting the necessity of education on preventing falling accidents. By applying the “Self-Evaluation of Awareness and Behavior for Falling Accident Prevention” to all medical staff, we succeeded in clarifying their characteristics of awareness and behavior for falling accident prevention.

Anti-rituximab antibodies (ARA) are associated not only with adverse events, such as infusion reactions (IR) and serum sickness, but also with rituximab efficacy. However, the clinical relevance of ARA in children with steroid-dependent nephrotic syndrome (SDNS) remains unknown. We retrospectively reviewed clinical outcomes of 13 children with complicated SDNS receiving repeated single-dose rituximab treatments at 375 mg/m2 to assess whether ARA formation could impact toxicity and efficacy of additional rituximab. Pre-rituximab 22 samples collected from patients who developed IR during the second or subsequent rituximab doses were measured by electrochemiluminescence analysis. ARA were identified in 5 of 13 patients (9 of 22 samples). Median time to recovery of CD19+ B cells to > 1% of total lymphocytes and median relapse-free time after rituximab treatment were significantly shorter in the 9 ARA-positive samples than the 13 ARA-negative samples (41 vs. 100 days, p < 0.01 and 119 vs. 308 days, p < 0.05, respectively). Kaplan–Meier analysis showed that time to CD19+ B cell recovery after rituximab was significantly shorter in ARA-positive samples than in ARA-negative samples (p < 0.005). Severe IR developed in two ARA-positive patients and serum sickness in one ARA-positive patient. The incidence of ARA formation was high in the pre-rituximab samples of patients with complicated SDNS who developed IR during the second or subsequent rituximab doses, suggesting that ARA formation might have an unfavorable impact on the toxicity and efficacy of additional rituximab doses in these patients.

Aim The aim of the present study was to examine whether behavioral and psychological symptoms of dementia at the time of admission could be a predictor of falls in older people with dementia residing in geriatric health service facilities. Methods Three geriatric health services facilities located in Fukushima Prefecture, Japan, were the targeted facilities. Of the 305 people admitted between May 2013 and November 2014, 242 (74 men, 168 women) who scored ≤20 points on the Hasegawa Dementia Scale-Revised were targeted for analysis. A total of 15 items from the Long-term Care Certification Questionnaire Group 4 were used to assess behavioral and psychological symptoms of dementia, and were compared by the presence or absence of falls. Results Of the 242 participants, 153 were non-fallers and 89 were fallers. After adjusting for sex, age, Revised Hasegawa Dementia Scale-Revised, degree of care (which showed a significant relationship with falls in univariate analysis), activities of daily living and history of falls, the influence of behavioral and psychological symptoms of dementia on falls was examined, and showed a significant association with falls and a significant increase of hazard ratio for the behavioral symptoms "wandering" 2.23 (95% confidence interval 1.35-3.68) and "agitation" 1.94 (95% confidence interval 1.24-3.04). Conclusions Because the risk of falling is high for residents who at the time of admission have the behavioral and psychological symptoms of dementia of "wandering" and "agitation," it is necessary to predict the possibility of falling at an early stage, monitor the residents and adjust the environment. Geriatr Gerontol Int 2018; 18: 1573-1577.

Unique and complex post-translational modifications are present in the outer leaflet of the plasma membrane. Glycosylphosphatidylinositol (GPI) anchoring is essential for the expression of several outer membrane proteins on the cell surface. A common GPI anchor structure is constituted by glycan moiety, lipid moiety, phosphate and ethanolamine. GPI-anchored proteins (GPI-APs) are observed among eukaryotic species. Abnormal GPI anchoring of proteins is thought to cause various diseases such as paroxysmal nocturnal hemoglobinuria. Recently, many inherited GPI deficiencies (IGDs) have been reported to cause epilepsy, mental retardation, coarse facial features, and multiple organ anomalies. Diseases caused by abnormal GPI anchoring will probably continue to increase, because it is still unknown how many causative genes of IGDs are present. Therefore, in order to study these diseases, the analytical methods of GPI-APs will become important in the future. To date, many methods have been developed for analysis of GPI- APs. In this review, we attempt to summarize the present knowledge about comprehensive analytical methods of GPI-APs and introduce briefly some GPI anchor-related diseases.

Objectives: The purpose of the present study was to obtain knowledge for improvement of the housing and life among radiation decontamination workers by examining the effect of housing type on anxiety over lack of privacy. Methods: This cross-sectional study comprised 544 male radiation decontamination workers in Fukushima Prefecture who anonymously answered self-administered questionnaires in 2013, including measurement of privacy anxiety, housing type, career change, social support, and sociodemographics. Chi-square tests and binary logistic regression analysis were used to evaluate the associations between these factors and anxiety over lack of privacy. Results: The number of workers who had anxiety over lack of privacy was 93 (17.1%), and the number of workers who were living in owner-occupied housing, rental housing, company dormitories, and hotels was 165 (30.3%), 177 (32.5%), 168 (30.9%), and 34 (6.3%), respectively. The presence of anxiety was significantly associated with housing type (p