Current treatment status of IgA nephropathy in Japan: a questionnaire survey

BACKGROUND

In 2020, the Committee of Clinical Practical Guideline for IgA Nephropathy (IgAN) revised the clinical practice guidelines. Herein, we conducted a questionnaire survey to assess the potential discrepancies between clinical practice guidelines and real-world practice in Japan.

METHODS

A web-based survey of members of the Japanese Society of Nephrology was conducted between November 15 and December 28, 2021.

RESULTS

A total of 217 members (internal physicians: 203, pediatricians: 14) responded to the questionnaire. Of these respondents, 94.0% answered that the clinical practice guidelines were referred to "always" or "often." Approximately 66.4% respondents answered that histological grade (H-Grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" and the "Oxford classification" were used for pathological classification. Moreover, 73.7% respondents answered that the risk grade (R-grade) derived from the "Clinical Guidelines for IgA nephropathy in Japan, 3rd version" was referred to for risk stratification. The prescription rate of renin-angiotensin system blockers increased based on urinary protein levels (> 1.0 g/day: 88.6%, 0.5-1.0 g/day: 71.0%, < 0.5 g/day: 25.0%). Similarly, the prescription rate of corticosteroids increased according to proteinuria levels (> 1.0 g/day: 77.8%, 0.5-1.0 g/day: 52.8%, < 0.5 g/day: 11.9%). The respondents emphasized on hematuria when using corticosteroids. In cases of hematuria, the indication rate for corticosteroids was higher than in those without hematuria, even if the urinary protein level was 1 g/gCr or less. Few severe infectious diseases or serious deterioration in glycemic control were reported during corticosteroid use.

CONCLUSION

Our questionnaire survey revealed real-world aspects of IgAN treatment in Japan.

Predictive Modeling of Radiation Pneumonitis Induced by Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer Using Radiomics and Clinical Features

PURPOSE/OBJECTIVE(S)

The purpose of this study is to establish a prediction model for the development of grade 2 or higher radiation pneumonitis (RP) using radiomics analysis of pretreatment CT images, PET images, and dose distribution, in addition to clinical factors, in patients with locally advanced non-small cell lung cancer (NSCLC) treated with radical chemoradiotherapy.

MATERIALS/METHODS

We retrospectively evaluated 128 cases of locally advanced NSCLC treated with radical radiotherapy at our institution from 2008 to 2021. Clinical factors included age, sex, performance status (PS), KL-6, smoking history, histological type, clinical stage, and total radiation dose. Radiomics analysis was performed by analyzing treatment planning CT images, PET images, and dose distribution, and Rad-score (Radiomics-score) was calculated for the extracted features using Lasso-Cox regression. Rad-score (Radiomics-score) was calculated by Lasso-Cox regression for the extracted features. Risk factors were selected by univariate/multivariate analysis of clinical factors and Rad-score. Three models for predicting RP were developed from the identified risk factors using Nomogram: Clinical, Rad-score, and Combined model. The model was evaluated using area under the curve (AUC) based on receiver operating characteristic (ROC) curves and concordance index (C-index). RP was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The cumulative incidence of Grade 2 or higher RP was evaluated using the Kaplan-Meier method.

RESULTS

Of the 128 cases, grade 2 or higher RP was observed in 50 cases (39%). Regarding clinical factors, gender, smoking status, and histology were selected as significant predictors of RP. Lasso-Cox analysis of radiomics features selected 11 features from CT images, 7 features from PET images, and 16 features from dose distribution as predictors of RP, yielding a total of 34 factors. The combined model (C-index: 0.96, AUC: 0.92) showed the best discrimination performance compared to the clinical model (C-index: 0.73, AUC: 0.56) and the Rad-score model (C-index: 0.87, AUC: 0.92). Risk classification using the combined model showed that the 1-year cumulative incidence of grade 2 or higher RP was 65% in the high-risk group, significantly higher than 15% in the low-risk group (p<0.001).

CONCLUSION

The combined model with Rad-score and clinical factors can predict grade 2 or higher RP in NSCLC patients with high accuracy.

Synthesis and Light-Harvesting Functions of Ring-Shaped Re(I) Trinuclear Complexes Connected with an Emissive Ru(II) Complex

Ring-shaped Re(I) multinuclear complexes (Re(I) rings) in which Re(I)-diimine-biscarbonyl complexes are connected to each other through bisphosphine bridging ligands exhibit very suitable photophysical and electrochemical properties as redox photosensitizers. We developed two approaches for synthesizing Re(I) rings connected with a Ru(II) complex: cyclization of a linear Re(I) trinuclear complex connected with a Ru(II) complex and Mizoroki-Heck coupling of a ring-shaped Re(I) trinuclear complex and a Ru(II) complex. Photophysical measurements of these heteromultinuclear complexes and comparisons with their model complexes indicated that they exhibit efficient light-harvesting abilities, where energy transfer from the excited ring-shaped Re(I) trinuclear complex unit to the Ru(II) complex unit proceeds efficiently.

Factors determining formation efficiencies of one-electron-reduced species of redox photosensitizers

Improvement in the photochemical formation efficiency of one-electron-reduced species (OERS) of a photoredox photosensitizer (a redox catalyst) is directly linked to the improvement in efficiencies of the various photocatalytic reactions themselves. We investigated the primary processes of a photochemical reduction of two series [Ru(diimine)₃]²⁺ and [Os(diimine)₃]²⁺ as frequently used redox photosensitizers (PS²⁺), by 1,3-dimethyl-2-phenyl-2,3-dihydro-1H-benzo[d]imidazole (BIH) as a typical reductant in detail using steady-irradiation and time-resolved spectroscopies. The rate constants of all elementary processes of the photochemical reduction of PS²⁺ by BIH to give the free PS•⁺ were obtained or estimated. The most important process for determining the formation efficiency of the free PS•⁺ was the escape yield from the solvated ion pair [PS•⁺-BIH•⁺], which was strongly dependent on both the central metal ion and the ligands. In cases with the same central metal ion, the system with larger -ΔG_bet, which is the free energy change in the back-electron transfer from the OERS of PS•⁺ to BIH•⁺, tended to lower the escape yield of the free OERS of PS²⁺. On the other hand, different central metal ions drastically affected the escape yield even in cases with similar -ΔG_bet; the escape yield in the case of RuH²⁺ (-ΔG_bet = 1.68 eV) was 5-11 times higher compared to those of OsH²⁺ (-ΔG_bet = 1.60 eV) and OsMe²⁺ (-ΔG_bet = 1.71 eV). The back-electron transfer process from the free PS•⁺ to the free BIH•⁺ could not compete against the further reaction of the free BIH•⁺, which is the deprotonation process giving BI•, in DMA for all examples. The produced BI• gave one electron to PS²⁺ in the ground state to give another PS•⁺, quantitatively. Based on these findings and investigations, it is clarified that the photochemical formation efficiency of the free PS•⁺ should be affected not only by -ΔG_bet but also by the heavy-atom effect of the central metal ion, and/or the oxidation power of the excited PS²⁺, which should determine the distance between the excited PS and BIH at the moment of the electron transfer.

Improved two-dimensional electrophoretic mapping of Japanese human hair proteins; application to curved and straight Japanese human hairs; and protein identification by MALDI MS and MS/MS quadrupole time-of-flight mass spectrometry

OBJECTIVES

To evaluate improved protein extraction and two-dimensional electrophoresis (2DE) separation methods with Japanese reference human hair (JRH); to determine whether fibre curvature is related to protein composition in curly and straight Japanese women's human hair (JHH) samples; and to identify proteins from JRH 2DE maps and expression differences between curly and straight JHH.

METHODS

Hair keratin and keratin-associated proteins (KAPs) were extracted intact with dithiothreitol or tris(2-carboxyethyl) phosphine from JRH or from curved or straight JHH. Extracted proteins were isoelectric-focused on first-dimensional pH gradient gel strips, then separated by molecular weight on laboratory-made, second-dimension, large format gels. The software compared protein abundance between duplicate 2DE gels of curved and straight JHH. Thirty-eight proteins from a JRH 2DE gel were enzyme-cleaved for MALDI-TOF-MS analysis to determine peptide composition, and where possible, de novo sequencing gave peptide sequence data. An in-house human hair protein database incorporating ninety-eight annotated protein sequences assisted MS analysis.

RESULTS

2DE gels of tris(2-carboxyethyl) phosphine-extracted JRH improved keratin and KAP resolution and number compared to those of dithiothreitol-extracted JRH and published commercially made second-dimensional gels. Silver-stained 2DE gels of the straight or curved JHH sets were remarkably similar. Over-staining to reveal basic proteins caused poor resolution of the major acidic protein classes. Software comparisons of fifty-nine resolved proteins revealed two were significantly different in abundance between curved and straight hairs but in insufficient amounts for MS analysis. MS identified twelve proteins from a JRH CBBG-stained 2DE gel: six type II keratins, three type I keratins and three high sulphur proteins. A further eight were potential conformational isoforms and isoelectric variants of the identified proteins bringing the total to twenty identified or partially identified proteins.

CONCLUSION

Root-end human hair extraction with tris(2-carboxyethyl) phosphine improves protein resolution and visualizes more proteins on large format 2DE gels. The two minor protein differences between duplicate straight or curved JHH 2DE gels were unlikely to change fibre structure from straight to curved hair. MS results confirmed that multiple isoforms exist of various hair proteins. Low sequence coverage prevented distinction between members in rows of homologous protein spots of similar molecular weight.

Development and validation of a model to predict the need for emergency front-of-neck airway procedures in trauma patients

The present study aimed to develop and validate a model for predicting the need for emergency front-of neck airway (eFONA) procedures among trauma patients. This was a multicentre retrospective cohort study using data from the Japan Trauma Data Bank between January 2004 and December 2017. Only adult trauma patients were included. The cohort was divided into development and validation cohorts. A simple scoring system was developed to predict the necessity for emergency front-of neck airway procedures in the development cohort using a logistic regression model. The external validity and diagnostic ability of the scoring system was assessed in the validation cohort. In total, 198,182 out of 294,274 patients were included; emergency front-of-neck airway occurred in 467 patients (0.24%) they were divided into development (n = 100,120 with 0.22% undergoing emergency front-of neck airway) and validation (n = 98,062 with 0.25% undergoing emergency front-of neck airway) cohorts. The 'eFONA' prediction scoring system was developed in the development cohort, with a score of +1 for each of the following: Eye opening (no eye opening in response to any stimuli); Fall from height or motor bike; Oral-maxillofacial injury; Neck tracheal injury; and Airway management by paramedics. In the validation cohort, the C-statistic of the scoring system was 0.820. Setting the cut-off value at one for rule-out, the sensitivity and negative likelihood ratios were 0.86 and 0.22, respectively. Setting the cut-off value at two for rule-in, the specificity and positive likelihood ratios were 0.91 and 6.6, respectively. The present scoring system may assist in predicting the need for emergency front-of neck airway procedures among the general trauma population.

Kinetics and Mechanism of Intramolecular Electron Transfer in Ru(II)-Re(I) Supramolecular CO2-Reduction Photocatalysts: Effects of Bridging Ligands

The supramolecular photocatalysts in which a Ru(II) complex as a molecular redox photosensitizer unit and a Re(I) complex as a molecular catalyst unit are connected with a various alkyl or ether chain have attracted attention because they can efficiently photocatalyze CO₂ reduction with high durability and high selectivity of CO formation, especially on various solid materials such as semiconductor electrodes and mesoporous organosilica. The intramolecular electron transfer from the one-electron reduced photosensitizer unit to the catalyst unit, which follows excitation of the photosensitizer unit and subsequent reductive quenching of the excited photosensitizer unit by a reductant, is one of the most important processes in the photocatalytic reduction of CO₂. We succeeded in determining the rate constants of this intramolecular electron transfer process by using subnanosecond time-resolved IR spectroscopy. The logarithm of rate constants shows a linear relationship with the lengths of the bridging chain in the supramolecular photocatalysts with one bridging alkyl or ether chain. In conformity with the exponential decay of the wave function and the coupling element in the long-distance electron transfer, the apparent decay coefficient factor (β) in the supramolecular photocatalysts with one bridging chain was determined to be 0.74 Å^-1. In the supramolecular photocatalyst with two ethylene chains connecting between the photosensitizer and catalyst units, on the other hand, the intramolecular electron transfer rate is much faster than that with only one ethylene chain. These results strongly indicate that the intramolecular electron transfer from the one-electron reduced species of the Ru photosensitizer unit to the Re catalyst unit proceeds by the through-bond mechanism.

Electron microscopy and tomography reveal that sodium 2-naphthalene sulfonate incorporated into perming solutions swells and tilts trichocyte intermediate filaments causing straightening of curly Japanese human hair

OBJECTIVE

A new hair-care process has been specifically developed for the straightening of curved Japanese woman's hair . The process included sodium 2-naphthalene sulfonate (SNS) in the reduction and oxidation steps of a conventional perming process. Our objective was to develop an understanding of how this process caused hair straightening by measuring the changes to morphology and ultrastructure between untreated, conventionally permed and SNS permed hair. Untreated and SNS permed Merino wool fibres were used to confirm structural changes.

METHODS

Japanese hair samples were measured for single-fibre curvature before and after perming treatments. A silver staining method was developed to stain hair fibres without changing fibre curvature so that transmission electron microscopy could be used to measure changes in the lateral dimensions of all structural components from the cellular to protein filament level. Electron tomography determined intermediate filament slopes and slope changes after SNS perming relative to the central longitudinal axis of the fibre.

RESULTS

SNS perming was found to cause greater lateral swelling than conventional perming of: the paracortical cells of wool; the cuticle, the cuticular cell membrane complex and the macrofibrillar centre-to-centre distance of hair; and of the intermediate filaments in wool and hair. In curved hair, SNS perming caused the intermediate filaments of the helical macrofibrils to simultaneously swell and to tilt further, resulting in the slight longitudinal contraction of the macrofibrils. The overall swelling and tilting was greatest in the helical macrofibrils of Type B cortical cells predominately located in the convex fibre half. The presence of a higher percentage of helical macrofibrils in the convex fibre half than in the concave fibre half caused a contraction differential between the two halves leading to straighten of the curved fibre. A mechanical model was proposed to explain how SNS perming straightened curly hair.

CONCLUSION

The effects of conventional and SNS perming on the morphological and ultrastructural components of curved Japanese hair and high-curl Merino wool fibres have given clear insights into understanding the mechanism of fibre curvature change.

Direct Measurement of Intramolecular Electron Transfer in a Series of Artificial Photosynthesis Processes

We have directly determined the intramolecular electron transfer rate and revealed its mechanism in supramolecular complexes during CO2 photoreduction by time-resolved infrared spectroscopic measurements over a wide temporal range.

Disappearance of perihepatic lymph node enlargement after hepatitis C viral eradication with direct-acting antivirals

Perihepatic lymph node enlargement (PLNE) which has been shown to be negatively associated with hepatocellular carcinoma (HCC) occurrence is frequently observed in chronic liver disease; however, changes in the state of perihepatic lymph nodes after eradication of hepatitis C virus (HCV) have not been investigated yet. We aimed to evaluate this issue. We enrolled 472 patients with chronic HCV infection who achieved viral eradication with direct-acting antivirals (DAA). We investigated whether the status of perihepatic lymph nodes changed before and after HCV eradication (primary endpoint). We also evaluated the association between PLNE and clinical findings such as liver fibrosis or hepatocellular injury before HCV eradication (secondary endpoint). Perihepatic lymph node enlargement was detected in 164 of 472 (34.7%) patients before DAA treatment. Surprisingly, disappearance of PLNE was observed in 23.8% (39 patients) of all PLNE-positive patients after eradication of HCV. Disappearance of PLNE was not associated with baseline clinical parameters or changing rates of clinical findings before and after DAA treatment. At baseline, presence of PLNE was significantly associated with a lower serum HCV-RNA level (P = .03), a higher serum AST level (P = .004) and a higher ALT level (P < .001) after adjustment for sex and age. In conclusion, PLNEs became undetectable after DAA treatment in 23.8% of PLNE-positive patients. Further study with a longer follow-up period is needed to clarify the clinical importance of this phenomenon especially in relationship with the risk of HCC development.

Investigation of excited state, reductive quenching, and intramolecular electron transfer of Ru(ii)-Re(i) supramolecular photocatalysts for CO2 reduction using time-resolved IR measurements

Supramolecular photocatalysts in which Ru(ii) photosensitizer and Re(i) catalyst units are connected to each other by an ethylene linker are among the best known, most effective and durable photocatalytic systems for CO2 reduction. In this paper we report, for the first time, time-resolved infrared (TRIR) spectra of three of these binuclear complexes to uncover why the catalysts function so efficiently. Selective excitation of the Ru unit with a 532 nm laser pulse induces slow intramolecular electron transfer from the 3MLCT excited state of the Ru unit to the Re unit, with rate constants of (1.0-1.1) × 104 s-1 as a major component and (3.5-4.3) × 106 s-1 as a minor component, in acetonitrile. The produced charge-separated state has a long lifetime, with charge recombination rate constants of only (6.5-8.4) × 104 s-1. Thus, although it has a large driving force (-ΔG0CR ∼ 2.6 eV), this process is in the Marcus inverted region. On the other hand, in the presence of 1-benzyl-1,4-dihydronicotinamide (BNAH), reductive quenching of the excited Ru unit proceeds much faster (kq[BNAH (0.2 M)] = (3.5-3.8) × 106 s-1) than the abovementioned intramolecular oxidative quenching, producing the one-electron-reduced species (OERS) of the Ru unit. Nanosecond TRIR data clearly show that intramolecular electron transfer from the OERS of the Ru unit to the Re unit (kET > 2 × 107 s-1) is much faster than from the excited state of the Ru unit, and that it is also faster than the reductive quenching process of the excited Ru unit by BNAH. To measure the exact value of kET, picosecond TRIR spectroscopy and a stronger reductant were used. Thus, in the case of the binuclear complex with tri(p-fluorophenyl)phosphine ligands (RuRe(FPh)), for which intramolecular electron transfer is expected to be the fastest among the three binuclear complexes, in the presence of 1,3-dimethyl-2-phenyl-2,3-dihydro-1H-benzo[d]imidazole (BIH), kET was measured as kET = (1.4 ± 0.1) × 109 s-1. This clearly shows that intramolecular electron transfer in these RuRe binuclear supramolecular photocatalysts is not the rate-determining process in the photocatalytic reduction of CO2, which is one of the main reasons why they work so efficiently.

Association between hospital volume and in-hospital mortality following radiofrequency ablation for hepatocellular carcinoma

Background

Radiofrequency ablation (RFA) is a minimally invasive treatment for hepatocellular carcinoma (HCC). There is increasing evidence of an association between increasing hospital volume and lower postoperative mortality for many surgical procedures, but this is difficult to establish with minimally invasive treatments, where postoperative mortality is low. The aim of this study was to investigate the relationship between hospital volume and in-hospital mortality following RFA using a Japanese nationwide database.

Methods

Data from the Diagnostic Procedure Combination database were analysed from 1 July 2010 to 31 March 2012. Multivariable logistic regression was used to analyse the relationship between hospital volume and in-hospital mortality following RFA, with adjustment for patient background.

Results

Some 36 675 patients with HCC were identified in the database. The overall in-hospital mortality rate from RFA was 0·31 per cent. In-hospital mortality was significantly higher in low-volume than high-volume hospitals (odds ratio 2·57, 95 per cent c.i. 1·61 to 4·09; P < 0·001). Higher in-hospital mortality was significantly associated with older age and a higher Charlson Co-morbidity Index score.

Conclusion

RFA for HCC was associated with acceptably low mortality in Japan, but in-hospital mortality following RFA was affected by hospital procedural volume.

Photochemical Processes in a Rhenium(I) Tricarbonyl N-Heterocyclic Carbene Complex Studied by Time-Resolved Measurements

We carried out time-resolved infrared (TR-IR) and emission lifetime measurements on a Re(I) carbonyl complex having an N-heterocyclic carbene ligand, namely, fac-[Re(CO)₃(PyImPh)Br], under photochemically reactive (in solution in acetonitrile) and nonreactive (in solution in dichloromethane) conditions to investigate the mechanism of photochemical ligand substitution reactions. The TR-IR measurements revealed that no reaction occurs on a picosecond time scale and the cationic product, namely, fac-[Re(CO)₃(PyImPh)(MeCN)]⁺, is produced on a nanosecond time scale only in solution in acetonitrile, which indicates that the reaction proceeds thermally from the excited state. Because no other products were observed by TR-IR, we concluded that this cationic product is an intermediate species for further reactions. The measurements of the temperature-dependent emission lifetime and analysis using transition-state theory revealed that the photochemical substitution reaction proceeds from a metal-to-ligand charge transfer excited state, the structure of which allows the potential coordination of a solvent molecule. Thus, the coordinating capacity of the solvent determines whether the reaction proceeds or not. This mechanism is different from those of photochemical reactions of other types of Re(I) carbonyl complexes owing to the unique characteristics of the carbene ligand.

Hybridization of silver orthophosphate with a melilite-type phosphor for enhanced energy-harvesting photocatalysis

A water-resistant Sr₂MgSi₂O₇:Eu²⁺,Dy³⁺ long-lasting phosphor was hybridized with visible-light active Ag₃PO₄ to achieve enhanced photocatalysis and energy-harvesting long lasting photocatalysis.