VKH-Like Uveitis after Nivolumab and Ipilimumab Administration

Nivolumab and ipilimumab are widely used immune checkpoint inhibitors (ICPIs) for the treatment of metastatic melanoma. ICPIs cause an array of side effects called immune-related adverse events (IRAEs) due to activation of an immune response. ICPI-uveitis can cause irreversible vision loss if untreated. There are few reports of recurrent Vogt-Koyanagi-Harada (VKH) disease-like uveitis induced by nivolumab and ipilimumab. We report a case of VKH disease-like uveitis recurrence after resuming ICPIs. A 73-year-old man with advanced melanoma was referred to our clinic with visual loss 25 days after starting nivolumab/ipilimumab. His corrected visual acuity was 0.5 in the right eye and 0.02 in the left eye. Enhanced-depth imaging optical coherence tomography (EDI-OCT) showed marked choroid thickening. The patient was diagnosed with VKH disease-like uveitis due to IRAEs. Subtenon injection of triamcinolone acetonide was performed, and nivolumab/ipilimumab was suspended, but serous retinal detachment (SRD) markedly worsened and choroidal detachment appeared. With 2 courses of steroid pulse therapy and oral steroids, SRD disappeared, and corrected visual acuity recovered in both eyes. Five months after the first injection, exacerbation of melanoma was observed, and nivolumab and oral steroids were restarted. Six weeks later, an increase in choroidal thickness was observed with EDI-OCT and diagnosed as a recurrence of VKH disease-like uveitis. Monitoring for the recurrence of VKH disease-like uveitis during the administration of ICPIs, even after uveitis is treated, is essential. Assessment of choroidal thickness with EDI-OCT may be useful for detecting early signs of VKH disease-like uveitis

Lift and thrust generation by a butterfly-like flapping wing-body model: immersed boundary-lattice Boltzmann simulations

The flapping flight of tiny insects such as flies or larger insects such as butterflies is of fundamental interest not only in biology itself but also in its practical use for the development of micro air vehicles (MAVs). It is known that a butterfly flaps downward for generating the lift force and backward for generating the thrust force. In this study, we consider a simple butterfly-like flapping wing body model in which the body is a thin rod and the rectangular rigid wings flap in a simple motion. We investigate lift and thrust generation of the model by using the immersed boundary lattice Boltzmann method. First, we compute the lift and thrust forces when the body of the model is fixed for Reynolds numbers in the range of 50-1000. In addition, we estimate the supportable mass for each Reynolds number from the computed lift force. Second, we simulate free flights when the body can only move translationally. It is found that the expected supportable mass can be supported even in the free flight except when the mass of the body relative to the mass of the fluid is too small, and the wing body model with the mass of actual insects can go upward against the gravity. Finally, we simulate free flights when the body can move translationally and rotationally. It is found that the body has a large pitch motion and consequently gets off-balance. Then, we discuss a way to control the pitching angle by flexing the body of the wing body model.ArticleJOURNAL OF FLUID MECHANICS. 767:659-695 (2015)journal articl

A neural network system for transformation of regional cuisine style

We propose a novel system which can transform a recipe into any selected regional style (e.g., Japanese, Mediterranean, or Italian). This system has two characteristics. First the system can identify the degree of regional cuisine style mixture of any selected recipe and visualize such regional cuisine style mixtures using barycentric Newton diagrams. Second, the system can suggest ingredient substitutions through an extended word2vec model, such that a recipe becomes more authentic for any selected regional cuisine style. Drawing on a large number of recipes from Yummly, an example shows how the proposed system can transform a traditional Japanese recipe, Sukiyaki, into French style

Intestinal Perforation by Ingested Foreign Bodies

Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%

Variation of Heating Efficiency of Magnetically Sheared CHS Plasmas by Polarization Control of 106GHz EC-Wave

To clarify the effect of polarization on electron cyclotron heating (ECH) in magnetized plasmas, experiment controlling the polarization of injected EC-waves is carried out in Compact Helical System (CHS). In the experiment, plasmas are generated and sustained only with 106.4 GHz ECH power. Magnetic field at the magnetic axis is 1.9 T so that the wave frequency is second harmonic. The optimum direction of linear polarization for the shortest time-delay of density start-up from the start of power injection and the optimum direction for the highest electron temperature and plasma stored energy during plasma duration show clear difference. The difference is attributed to the CHS magnetic configuration with strong shear and the plasma volume expansion from magnetic axis to the last closed flux surface

Determination of the Major Impurity Radiators in the Reheat Mode Discharges in the Compact Helical System

Radiation brightness and impurity behaviors have been studied for reheat mode discharges in the Compact Helical System (CHS) by three different types of impurity diagnostics. Total radiation power measured by a pyroelectric detector significantly reduces after entering the reheat mode, whereas the line-averaged radiation brightness measured by an absolute extreme ultraviolet (AXUV) photodiode array increases especially for a center viewing chord due to the impurity accumulation in the plasma core. One possible reason for this opposite behavior between the two bolometric detectors is the reduced sensitivity of the AXUV photodiode for lower energy photons in vacuum ultraviolet (VUV) region. This speculation is supported by temporal evolutions of VUV spectra measured by a grazing incidence spectrometer. These results demonstrate that the comparison of three impurity diagnostics would be beneficial to the determination of the major impurity radiators and a comprehensive understanding of impurity behaviors in the reheat mode discharges

Optical transmittance investigation of 1-keV ion-irradiated sapphire crystals as potential VUV to NIR window materials of fusion reactors

We investigate the optical transmittances of ion-irradiated sapphire crystals as potential vacuum ultraviolet (VUV) to near-infrared (NIR) window materials of fusion reactors. Under potential conditions in fusion reactors, sapphire crystals are irradiated with hydrogen (H), deuterium (D), and helium (He) ions with 1-keV energy and ∼ 1020-m-2 s-1 flux. Ion irradiation decreases the transmittances from 140 to 260 nm but hardly affects the transmittances from 300 to 1500 nm. H-ion and D-ion irradiation causes optical absorptions near 210 and 260 nm associated with an F-center and an F+-center, respectively. These F-type centers are classified as Schottky defects that can be removed through annealing above 1000 K. In contrast, He-ion irradiation does not cause optical absorptions above 200 nm because He-ions cannot be incorporated in the crystal lattice due to the large ionic radius of He-ions. Moreover, the significant decrease in transmittance of the ion-irradiated sapphire crystals from 140 to 180 nm is related to the light scattering on the crystal surface. Similar to diamond polishing, ion irradiation modifies the crystal surface thereby affecting the optical properties especially at shorter wavelengths. Although the transmittances in the VUV wavelengths decrease after ion irradiation, the transmittances can be improved through annealing above 1000 K. With an optical transmittance in the VUV region that can recover through simple annealing and with a high transparency from the ultraviolet (UV) to the NIR region, sapphire crystals can therefore be used as good optical windows inside modern fusion power reactors in terms of light particle loadings of hydrogen isotopes and helium.Iwano K., Yamanoi K., Iwasa Y., et al. Optical transmittance investigation of 1-keV ion-irradiated sapphire crystals as potential VUV to NIR window materials of fusion reactors. AIP Advances 6, 105108 (2016); https://doi.org/10.1063/1.4965927

Isotope effects on particle transport in the Compact Helical System

The hydrogen isotope effects of particle transport were studied in the hydrogen and deuterium dominant plasmas of the Compact Helical System (CHS). Longer decay time of electron density after the turning-off of the gas puffing was observed in the deuterium dominant plasma suggesting that the recycling was higher and/or the particle confinement was better in the deuterium dominant plasma. Density modulation experiments showed the quantitative difference of the particle transport coefficients. Density was scanned from 0.8  ×  1019 m−3 to 4  ×  1019 m−3 under the same magnetic field and almost the same heating power. In the low density regime (line averaged density  2.5  ×  1019 m−3) no clear difference was observed. This result indicates that the isotope effects of particle transport exist only in the low density regime. Comparison with neoclassical transport coefficients showed that the difference of particle transport is likely to be due to the difference of turbulence driven anomalous transport. Linear character of the ion scale turbulence was studied. The smaller linear growth rate qualitatively agreed with the reduced particle transport in the deuterium dominant plasma of the low density regime