We report on a 17-year-old girl with absence status epilepticus who developed recurrent motionless confusional state and continuous generalised 3-4 Hz rhythmic delta waves on electroencephalogram (EEG). The patient had no history of absence, myoclonus or generalised convulsion. Her seizure was resistant to a combination of antiepileptic drugs including carbamazepine. Ictal positron emission tomography using [F]fluorodeoxyglucose ([F]FDG-PET) revealed hypermetabolism of the bilateral thalamus and cerebellum and hypometabolism of the frontal, parietal and posterior cingulate cortices. We diagnosed her seizure as absence status and obtained remission by changing medication. The findings of ictal metabolic alteration in previous studies and in our case confirm the pathogenic importance of the thalamus in absence status and that associated cortical deactivation and cerebellar activation may be related to the generation or maintenance of epileptic EEG discharges.

Mesna (2‐mercaptoethane sulfonate Na), a drug that alleviates cyclophosphamide (CYC)‐induced hemorrhagic cystitis, is frequently used to treat cancer and collagen diseases. A 33‐year‐old woman presented with high fever during CYC‐based induction therapy for systemic lupus erythematosus. Her final diagnosis was mesna‐induced drug hypersensitivity. Although mesna is widely used, allergic reactions are rare. This may be because of misdiagnosis as a primary disease flare‐up, infection, or CYC‐induced hypersensitivity reaction, which are commonly reported. Thus, accurate diagnosis is important for completion of the CYC‐based regimen.

This study investigated cost‐effective energy strategies for realizing net zero CO2 emissions in Japan by 2050, employing an energy system optimization model with hourly electricity balances. The detailed temporal resolution enables the model to capture the intermittency of variable renewable energy (VRE) and the costs of system integration measures. Siting constraints on VRE, such as prohibiting solar PV and onshore wind developments in forests and offshore wind developments inside fishery rights areas, are incorporated in the model to reflect the environmental protection and social acceptance perspectives. Simulation results imply that a well‐balanced power generation mix, combining renewables, nuclear, gas‐fired with carbon capture and storage, as well as ammonia‐fired, would contribute to curbing mitigation costs. In contrast, a simulation case with very high VRE penetration poses economic challenges. The average shadow price of electricity in 2050 in a 100% renewables case (RE100) is projected to be more than doubled from a reference case which is based on middle‐of‐the‐road assumptions. Marginal CO2 abatement cost in 2050 increases from 49,200 JPY/tCO2 in the reference case to 75,300 JPY/tCO2 in the RE100 case. The economic viability of high VRE penetration is improved by relaxing the siting constraints, although it may raise environmental and social concerns.

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