Central Tokyo Research Articles

2329. What Causes a Cluster to Grow? Factors Associated with a Nosocomial COVID-19 Cluster at a University Hospital in Central Tokyo

Abstract Background Coronavirus disease 2019 (COVID-19) remains a significant threat to hospital infection control. Despite the decrease in severity and mortality associated with changes in the variants of concern and increased vaccination, SARS-CoV-2 transmissibility remains high, and nosocomial clusters continue to be reported in various countries. Although COVID-19 may be detected in multiple patients and healthcare workers (HCWs) in a given ward within a few days, it is uncertain whether these cases will develop into a large cluster. Methods The present, retrospective cohort study of nosocomial COVID-19 clusters was conducted at Tokyo Medical and Dental University Hospital from January 2022 to January 2023 using data from the hospital’s infection prevention and control team. A nosocomial COVID-19 cluster was defined as consisting of more than 2 COVID-19 cases occurring within 5 days in the same ward. Cases with a clear epidemiological link and clusters outside the ward were excluded. We collected information regarding community trends, the index case details, and each cluster's ward profile. Predictors of cluster expansion to more than 5 cases were also examined. Results 66 clusters were identified at the hospital during the study period. The median number of COVID-19 cases per cluster was 3 (range: 2-22), and their median duration was 5 days (range: 1-27). 37 (56.1%), 25 (37.9%), and 4 (6.1%) clusters comprised both inpatients and HCWs, only HCWs, and only patients, respectively. The index case of 51 clusters (77.3%) was a HCW. 18 (27.3%) and 47 (72.7%) clusters contained > 5 and < 5 cases, respectively. No significant intergroup difference was found in terms of community prevalence, index case and ward characteristics, the rate of close contact or history of previous clusters. However, “clusters occurring during the non-epidemic period” and “infections > 3 occurring within 3 days” tended to develop into clusters containing more than 5 cases. Conclusion Nosocomial clusters can occur anywhere, and predicting them is challenging. Further research is needed to identify the factors leading to cluster development and to establish effective infection prevention and control measures. Disclosures All Authors: No reported disclosures

The Association between the Severity of Dysmenorrhea and Psychological Distress of Women Working in Central Tokyo-A Preliminary Study.

This study aims to clarify the association between the severity of dysmenorrhea and psychological distress among working women in central Tokyo and examine the effect modification of job stressors. The participants in this cross-sectional study were 312 women who had undergone health check-ups in the "Marunouchi Hokenshitsu" project. The severity of dysmenorrhea was defined as the degree of daily life disturbance with menstrual pain, and the outcome variable was the K6 scores. To assess the association of psychological distress with the severity of dysmenorrhea, multiple regression analyses were performed. The results revealed that 18.3% of the 289 working women were in the moderate/severe group of dysmenorrhea. In multiple regression analysis, moderate/severe dysmenorrhea was significantly associated with higher levels of psychological distress, but the significance disappeared after adjusting for gynecology such as premenstrual syndrome (PMS) and workplace-related factors. The degree of job control was significantly associated with lower levels of psychological distress and may modify psychological distress caused by dysmenorrhea. Moderate/severe dysmenorrhea may be associated with higher levels of psychological distress in working women, and psychological symptoms of PMS) and the degree of job control were possible effect factors, and there may be effect modification by the degree of job control.

Decarbonisation technologies can halve the nonlinear increase in electricity demand in densely populated areas due to climate change

This study projects past and future net electricity consumption (EC) in the Tokyo metropolitan area under various global warming scenarios (ranging from -1.0 °C to +3.0 °C in 0.5 °C increments) using fine-scale temperature sensitivity data (on the order of a few kilometers). The results reveal that EC for space-cooling escalates nonlinearly from present to future climates due to climate change. Conversely, EC for space-heating diminishes. As a result, the net EC grows nonlinearly. The change in EC is minor in regions with lower population densities, such as the northern Kanto region. However, in areas with high population densities, such as the Tokyo 23 wards of central Tokyo, EC surges with warming. Within these wards, EC varies based on building use, with business and commercial districts being particularly sensitive to global warming. Meanwhile, residential areas display fewer changes in EC. Implementing measures in business and commercial districts, which are more vulnerable to global warming, could be instrumental in decarbonisation and urban heat island mitigation. Our projections also indicate that the adoption of increased building insulation, enhanced air conditioning efficiency, and reductions in internal heat gains could halve the anticipated increase in EC.

Decision Tree Analysis Accurately Predicts Discharge Destination After Spinal Cord Injury Rehabilitation

ObjectivesTo predict discharge destination after spinal cord injury (SCI) rehabilitation. Study DesignA retrospective, single-center study. We collected the following data from medical charts: age, sex, living arrangement before injury, acute length of stay (LOS), level of injury on admission, American Spinal Injury Association Impairment Scale (AIS) on admission, Upper Extremity Motor Score (UEMS) on admission, Lower Extremity Motor Score on admission (LEMS), Spinal Cord Independence Measure (SCIM) scores on admission and discharge, and discharge destination. A decision tree algorithm was used to establish prediction models in a train-test split manner using features on admission or discharge. SettingA spinal center in Tokyo, Japan. ParticipantsParticipants were individuals with SCI admitted to our hospital from March 2016 to October 2021 for the first rehabilitation after the injury. The study included 210 participants divided into 2 groups: training (n=140) and testing (n=70). Random sampling without replacement was used. InterventionsNot applicable. Main Outcome MeasuresPrediction accuracy was evaluated with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (AUC). ResultsAIS was significantly different between the groups. The prediction model using total SCIM scores on discharge (D-Classification and Regression Tree [CART]) revealed that a cut-off value of 40 accurately predicted the discharge destination. In contrast, the prediction model using features on admission (A-CART) revealed that subtotal SCIM mobility scores of 5, age of 74 years, and UEMS of 23 were significant predictors. Sensitivity, specificity, PPV, NPV, and AUC of D-CART and A-CART were 0.837, 0.810, 0.911, 0.680, and 0.832 and 0.857, 0.810, 0.913, 0.708, and 0.869, respectively. ConclusionsD-CART and A-CART showed comparable prediction accuracies. This suggests that, even during the early stages of rehabilitation, it is possible to predict the discharge destination.

Functional Outcome Prediction After Spinal Cord Injury Using Ensemble Machine Learning

ObjectivesTo establish a machine learning model to predict functional outcomes after SCI with Spinal Cord Independence Measure (SCIM) using features present at the time of rehabilitation admission. Study DesignA retrospective, single-center study. The following data were collected from the medical charts: age, sex, acute length of stay (LOS), level of injury, American Spinal Injury Association Impairment Scale (AIS), motor scores of each key muscle, Upper Extremity Motor Score (UEMS), Lower Extremity Motor Score (LEMS), SCIM total scores, and subtotal scores on admission and discharge. Based on the multivariate linear regression analysis, age, acute LOS, UEMS, LEMS, and SCIM subtotal scores were selected as features for machine learning algorithms. Random forest, support vector machine, neural network, and gradient boosting were used as the base models and combined using ridge regression as a metamodel. SettingA spinal center in Tokyo, Japan. ParticipantsParticipants were individuals with SCI admitted to our hospital from March 2016 to October 2021 for the first rehabilitation after the injury. They were divided into 2 groups: training (n=140) and testing (n=70). InterventionsNot applicable. Main Outcome MeasuresThe root-mean-square error (RMSE), R2, and Mean Absolute Error (MAE) were used as accuracy measures. ResultsRMSE, R2, and MAE of the meta-model using the testing group were 9.7453, 0.8835, and 7.4743, respectively, outperforming any other single base model. ConclusionsOur study revealed that functional prognostication could be achieved using machine-learning methods with features present at the time of rehabilitation admission. Goals can be set at the beginning of rehabilitation. Moreover, our model can be used to evaluate advanced medical treatments, such as regenerative medicine.

Simulating Strong Ground Motion from the Great 1923 Kanto Earthquake in the Tokyo Metropolitan Area Based on Source Model Derived from Seismic Intensity Data

ABSTRACT This study simulates strong ground motions in the Tokyo metropolitan area during the 1923 Kanto earthquake using the stochastic Green’s function method. Source characteristics were modeled using seismic intensity inversion analysis, and path and site characteristics were modeled using inhomogeneous attenuation structure and empirical amplification factors. The results of these simulations were consistent with seismic intensities estimated based on the collapse rate of wooden houses. The distribution of pseudovelocity response spectra averaged at periods of 1–2 s was large: ∼200 cm/s in southern Kanagawa and southern Chiba prefectures, ∼100–200 cm/s in eastern Tokyo, and ∼50–100 cm/s in eastern Saitama prefecture despite its distance from strong-motion generation areas (SMGAs). The simulation results were regressed on site characteristics and fault distance, and the residuals were interpolated using the Kriging method to estimate detailed maps of seismic intensity and response spectra on an ∼250 m mesh reflecting site-specific characteristics. The following conclusions can be made: (1) all SMGAs, other than those in northern Tokyo Bay, were located near large slip areas based on coseismic geodetic and seismic waveform data. Although the SMGAs in the northern part of Tokyo Bay exerted little influence on the southern part of the Kanto region, their consideration was required to reproduce the seismic intensity at the northwest Tokyo and Saitama; (2) intense strong motion in central Tokyo occurred at the back marsh, delta, coastal lowlands, and filled lands, whereas low levels of strong motion were determined at terraces covered with volcanic ash soil. Combined with building distribution, this indicates areas of high seismic risk; (3) the seismic intensity and response spectra in the Tokyo metropolitan area obtained through this simulation were larger than those obtained from seismic records of the 2011 Tohoku earthquake—the most recent megathrust earthquake.

Kantō Daikasai: The Great Kantō Fire Following the 1923 Earthquake

ABSTRACT The 1923 Great Kantō earthquake is one of the most deadly and destructive natural disasters in history. As the name connotes, fire is less considered in examinations of this event even though fire was responsible for the vast majority of death and destruction. Moreover, destruction of Tokyo by fire following an earthquake was foreseen and foretold as early as 1905, yet no actions were taken to reduce the risk. We therefore focus on fire aspects of the 1 September event with special attention to the capital Tokyo. Shaking intensities varied significantly across central Tokyo, with ∼100 ignitions distributed in all parts of the city occurring within the first hour. These rapidly grew into large fires due to the prevailing flammable wood-framed construction, high winds, and lack of firefighting water caused by breaks in water mains. However, even with adequate water, firefighters would likely still have been overwhelmed given the adverse meteorological conditions. The large fires soon merged into very large conflagrations that created their own localized high winds, further feeding the fires to the extent that fire whirls were created. The worst of these occurred in an area where many people were sheltering, causing 40,000 deaths. Even without this particularly tragic occurrence, the deaths due to fires were still greater than due to building collapse and other causes. Why the prescient warning issued years earlier went unheeded, what the social and political impact of the disaster and its aftermath was, and how fire and seismic risk reduction awareness influenced postdisaster reconstruction, are all questions we address. Although Japan since 1923 has implemented many measures to improve earthquake and postearthquake fire preparedness, the risk of fire following an earthquake remains significant in Japan as well as elsewhere.

The Relationship between the Evaluation of Public Transport Services and Travel-Based CO2 Emissions from Private Transport Modes in Regional and Metropolitan Areas in Japan

Promoting public transport use is expected to contribute to reducing CO2 emissions in the transport sector. Using Okayama City and Central Tokyo as representative case studies of regional and metropolitan areas in Japan, this study examines the impact of the evaluation of the ‘hard’ and ‘soft’ attributes of rail and bus services on the overall evaluation. This study then explores the relationship between the overall evaluation and usage frequency of rail and bus services, as well as the relationship between the usage frequency and travel-based CO2 emissions from private transport modes. Furthermore, this study investigates whether the emissions cause differences in the evaluation of the ‘hard’ and ‘soft’ attributes of public transport services. The findings suggest prioritising an improvement in ‘hard’ rather than ‘soft’ attributes in order to reduce emissions through the use of public transport in regional areas. However, in metropolitan areas, no relationship was found between the evaluation of public transport services and emissions, presumably because of the lower ownership rate of private cars that residents can use freely and the markedly higher level of rail and bus services. This study provides a methodological reference for analysing the potential to reduce travel-based emissions from private transport modes by enhancing public transport service contents.

Barriers encountered by nurses in the care of walk-in international patients in an emergency department in Japan

BackgroundAn increasing number of international patients continue to visit emergency departments (EDs) in Japanese hospitals. However, nurses in Japan perceive challenges when caring for patients from other countries. This study explored ED nurses’ perceptions of barriers when caring for walk-in international patients. MethodsFive semi-structured online focus group interviews involving 15 registered nurses with experience in caring for patients in an ED at a university referral hospital located in the center of Tokyo were conducted. Thematic analysis was used to identify patterns from the interviews. ResultsThe themes that emerged were as follows: (1) hesitation to engage with patients due to ambiguity, (2) loss of harmony in the ED, (3) difficulty with mutual goal settings, and (4) decreased professional self-efficacy. ConclusionThe findings provide an understanding of the challenges faced when caring for walk-in international patients. Educational interventions for ED nurses and other strategies, such as the use of interpreters, can enhance nurses’ abilities to improve patient safety and maintain equality.

High doses of opioids usage for amyotrophic lateral sclerosis patients with non-invasive ventilation.

While opioids have been found to be useful in relieving suffering in amyotrophic lateral sclerosis (ALS), there is a lack of evidence concerning how and how much to use them in practice. This study was conducted to clarify how opioids were used for patients with ALS. We performed a retrospective case-based analysis at a single tertiary neurology center in Tokyo from 2010 to 2018. We enrolled patients with ALS who had died before the end of 2018. We examined the opioid dosage equivalent of morphine hydrochloride and patients' clinical backgrounds, focusing on ventilatory support. Morphine was administered in 110 patients with ALS, and 84 were followed up until their death. Of these 84 patients, 57 (69.9%) did not use mechanical ventilation until death (no-MV group), and 21 (22.9%) utilized only non-invasive ventilation (NIV group). Final morphine dosage in the NIV group was significantly higher (mean 65.7mg [SD 54.6], range 10-200mg) than in the no-MV group (mean 31.7mg [SD 26.9], range 0-120mg; p = 0.015, Welch's t-test). The NIV group needed psychotropic drugs more frequently than the no-MV group (62% [n = 13] vs. 35% [n = 20]). Patients in the NIV group used opioids for a statistically significantly longer time and at a higher dose than those in the no-MV group. Symptom control with opioids alone may be difficult, and the development of multifaceted evaluation and care is desirable.

Visualising temporal changes in visitors’ areas of interest using online geotagged photographs

ABSTRACT Geotagged social media records can be used to capture the digital footprint of human spatial behaviour within a city. In particular, the photosharing service Flickr is useful for capturing the distribution of tourists' areas of interest (AOIs). The aim of this study is to visualise the spatial patterns in the AOIs of foreign visitors in central Tokyo. In particular, we paid special attention to how AOIs differ between visitors' home countries as well as how the distribution of the AOIs change. We selected Tokyo's top three major tourism sites (Shinjuku, Ginza, and Asakusa). Data used in this study was derived from geotagged photos on Flickr uploaded in 2014 and 2018. Among them, we collected photos taken within 1.5 km of three transportation stations located in the primary tourist sites. We chose 12,014 photos taken by visitors from Asian (excluding Japan) and European countries. Three types of maps (hot spot map, heat map, and difference map) were complementarily employed to visualise the visitor's different home countries and temporal changes between 2014 and 2018. To construct the hot spot map, point features were aggregated into a rectangular polygon with a 100-m grid square, and hot spot analysis was applied. The heat map was constructed using kernel density estimation. The difference map was employed to visualise the spatial pattern of the visitor's different home countries and any temporal changes between the examined years. The results show differences in the distribution of AOIs between visitors from Asia and Europe. This may reflect a cultural difference in the preference for tourism sites and travel behaviour as well as the amount of information available. Further, the distribution of AOIs changed between 2014 and 2018, which reflects environmental changes due to a redevelopment project.

Tokyo's COVID-19: An urban perspective on factors influencing infection rates in a global city

This research investigates the relationship between COVID-19 and urban factors in Tokyo. To understand the spread dynamics of COVID-19, the study examined 53 urban variables (including population density, socio-economic status, housing conditions, transportation, and land use) in 53 municipalities of Tokyo prefecture. Using spatial models, the study analysed the patterns and predictors of COVID-19 infection rates. The findings revealed that COVID-19 cases were concentrated in central Tokyo, with clustering levels decreasing after the outbreaks. COVID-19 infection rates were higher in areas with a greater density of retail stores, restaurants, health facilities, workers in those sectors, public transit use, and telecommuting. However, household crowding was negatively associated. The study also found that telecommuting rate and housing crowding were the strongest predictors of COVID-19 infection rates in Tokyo, according to the regression model with time-fixed effects, which had the best validation and stability. This study's results could be useful for researchers and policymakers, particularly because Japan and Tokyo have unique circumstances, as there was no mandatory lockdown during the pandemic.

Durability and determinants of anti-SARS-CoV-2 spike antibodies following the second and third doses of mRNA COVID-19 vaccine

ObjectivesTo examine the differences in durability and its determinants of humoral immunity following 2- and 3-dose COVID-19 vaccination. MethodsThroughout the pandemic, we evaluated the anti-spike IgG antibody titers of 2- and 3-dose mRNA vaccine recipients over time among the staff of a medical and research center in Tokyo. Linear mixed models were used to estimate trajectories of antibody titers from 14 to 180 days after the last immune-conferred event (vaccination or infection) and compare antibody waning rates across prior infection and vaccination status, and across background factors in infection-naïve participants. ResultsA total of 6901 measurements from 2964 participants (median age, 35 years; 30% male) were analyzed. Antibody waning rate (percentage per 30 days [95% CI]) was slower after 3 doses (25% [23–26]) than 2 doses (36% [35–37]). Participants with hybrid immunity (vaccination and infection) had further slower waning rates: 2-dose plus infection (16% [9–22]); 3-dose plus infection (21% [17–25]). Older age, male sex, obesity, coexisting diseases, immunosuppressant use, smoking, and alcohol drinking were associated with lower antibody titers, whereas these associations disappeared after 3 doses, except for sex (lower in female participants) and immunosuppressant use. Antibody waned slightly faster in older participants, females, and alcohol drinkers after 2 doses, whereas it did not differ after 3 doses across except sex. DiscussionThe 3-dose mRNA vaccine conferred higher durable antibody titers, and previous infection modestly enhanced its durability. The antibody levels at a given time point and waning speed after 2 doses differed across background factors; however, these differences mostly diminished after 3 doses.

Emergence of community-associated methicillin-resistant Staphylococcus aureus ΨUSA300 among Japanese people with HIV, resulted from stepwise mutations in 2010s

Although infection with the methicillin-resistant Staphylococcus aureus (MRSA) clone USA300 is extremely rare in Japan, the uniquely evolved clone ΨUSA300 has been reported in Japan. An outbreak of a distinct USA300 clone was recently reported in an HIV/AIDS referral hospital in Tokyo. The present study investigated the evolutionary origin and genetic diversity of USA300-related clones causing regional outbreaks among people living with HIV (PLWHIV) in Tokyo. MRSA isolates collected from PLWHIV in an HIV/AIDS referral center in Tokyo were subjected to whole-genome sequencing and their genetic features were compared with those of previously described USA300 MRSA genomes. Of the 28 MRSAs isolated in 2016–2019, 23 (82.1%) were identified as USA300, with 22 (95.6%) of the latter identified as ΨUSA300. Although the genomic structure of ΨUSA300 was identical to the structures of reference USA300 strains, one clade (cluster A) was found to have acquired 29 previously identified lineage-specific mutations in a stepwise manner. The estimated divergence dates of ΨUSA300 and Cluster A were 2009 and 2012, respectively. These findings suggested that the ΨUSA300 clone had spread among PLWHIVs in Tokyo in the early 2010s, with stepwise acquisition of lineage-specific nonsynonymous mutations.

Changes in the residents’ step counts before and after a railway improvement project

IntroductionIn many Japanese cities, local governments have been planning compact city policies to reduce environmental impact and financial costs. The resulting walkable urban form, where people live near railway stations, could potentially contribute to residents' health as a secondary effect. In this longitudinal study, we investigated changes in residents’ walking behavior in an area subject to a railway improvement project, using large-scale data on step counts. MethodsWe compared the changes in daily step counts of middle-aged and older adults in Yokohama City before and after a railway improvement project. The project aimed to improve traveling convenience to central Tokyo by developing a railway line that directly connects the existing suburban stations to central Tokyo with no transfers to shorten travel time and by opening a new station in an inconvenient area. Comparing residents’ step counts in the project intervention area (N = 733 on average) and other areas (N = 2,914 on average) before and after the project, the effect of the project intervention was examined through difference-in-differences analysis using generalized linear mixed models. ResultsAfter the project, older residents aged 75–84 years living close to the new station walked approximately 400 steps more than their counterparts with the same level of step counts before the project. Moreover, older residents aged 75–84 years living around the existing stations, which benefitted from the direct connecting service, walked approximately 200 steps more than their counterparts. However, women aged 45–64 years living around the existing stations walked approximately 200 steps less than their counterparts. ConclusionThe railway improvement project promoted older adults’ walking behavior, supporting the worldwide trend toward transit-oriented development from the population health perspective. However, the project had an adverse effect on middle-aged women. Planners should consider that the impact of projects varies according to age and gender.

Increased SARS-CoV-2 seroprevalence and spread of infection without awareness among healthcare workers through 2020–2022 in a Japanese medical center

Despite Japan’s high vaccination coverage, daily numbers of new COVID-19 cases have been high. However, studies on the seroprevalence among Japanese people and the causative factors for rapid spread have remained limited. In this study, we aimed to examine the seroprevalence and associated factors in healthcare workers (HCWs) of a medical center in Tokyo using blood samples drawn at annual check-ups from 2020 to 2022. We found that of the 3,788 HCWs in 2022 (by mid-June), 669 were seropositive for N-specific antibodies (tested by Roche Elecsys Anti-SARS-CoV-2 assay); the seroprevalence surged from 0.3% in 2020 and 1.6% in 2021 to 17.7% in 2022. Notably, our study found 325 (48.6%; 325/669) cases were infected without awareness. Among those with a previously PCR-confirmed SARS-CoV-2 infection during the past three years, 79.0% (282/357) were found after January 2022, after the Omicron variant was first detected in Tokyo at the end of 2021. This study indicates the fast spread of the SARS-CoV-2 among HCWs during the Omicron surge in Japan. The high percentage of infection without awareness may be a key driving factor causing rapid person-to-person transmission, as shown in this medical center with high vaccination coverage and strict infection control measures.

Analysis of Previous Infection, Vaccinations, and Anti–SARS-CoV-2 Antibody Titers and Protection Against Infection With the SARS-CoV-2 Omicron BA.5 Variant

This cohort study examines whether preinfection anti–SARS-CoV-2 spike antibody titer is associated with protection against Omicron BA.5 infection among staff members of a medical and research center in Tokyo, Japan.

Functions, spatial characteristics, and project management features of the "Temporary Plaza Utilization" on privately-owned land in central Tokyo

本研究の目的は、東京都心部における民間事業者による「広場の暫定利用」の機能的・空間的特徴、およびプロジェクトマネジメントの特徴を明らかにした。研究の方法は、文献調査により常設・仮設の機能・空間構成要素を整理し、事業者へのヒアリングにより事業運営の特徴を整理した。結論では、その後の開発事業を見据え、地域住民を対象とした機能やローコストな暫定活用の整備、事業理念への共感が事業協力者の優先的な判断基準であることが明らかになった。さらに、プロジェクトの企画・管理・運営に携わる事業者との関係性によって管理運営上の特徴を類型化した。

SHINTO SHRINE RENOVATION IN THREE WARDS IN CENTRAL TOKYO AND THE USE OF VARIOUS URBAN DEVELOPMENT RULES

This study focuses on the relationship between urban development and Shinto shrine renovations. In the case of Tokyo Metropolitan Area, Shinto shrines in three wards in the central Tokyo have been renovated in compliance with various rules of urban development. To understand the ways in which development has been successfully completed in each case, we carried out a detailed literature review and interviews. By establishing an overview of cases, we identified common factors as well as the post-development process of spatial formation and rationale for design. Our findings show that Shinto shrines are protected from the threat of development.

DEVELOPMENT OF DAMPED BRACED TUBE SYSTEM AND APPLICATION TO ACTUAL PROJECT

A new vibration control system, Damped braced tube system, is developed for adopting on super high-rise buildings in central Tokyo. This system consists of tube frame using elastic braces and damped slit where a portion of braces are replaced by dampers. Damped slit acting as link beam of coupled shear wall system can dissipate seismic energy very efficiently and contribute to succeeding to meet higher seismic criteria. This paper describes system outline and efficiency through numerical analysis of actual high-rise project expected to be one of the tallest towers in central Tokyo.