P6524The comparison of radial artery occlusion rate after distal radial artery puncture between hemodialysis and non-hemodialysis patients

Background

In recent years it has been attempted to use a distal radial artery (DRA) as a puncture site for cardiac catheterization and intervention. A patency of radial artery is important in hemodialysis patients because the radial artery is source as an arteriovenous shunt. However, the incidence of radial artery occlusion (RAO) is not known after DRA puncture.

Purpose

To compare RAO rates after DRA puncture between dialysis and non-dialysis patients.

Method

This was retrospective, observational and single center study. All consecutive 1,533 patients undergoing DRA puncture were analyzed. The primary endpoint is RAO rates. The secondary endpoint is composite bleeding adverse event rates. These endpoints were evaluated by a vascular echocardiography several hours or the next day after the procedure.

Result

Among 1,533 patients, 26 were dialysis patients and 1,504 were non-dialysis patients. 1,386 people (90.5%) succeeded in puncture. Radial artery occlusion occurred in 7 patients (0.4%), all of whom were non-dialysis patients. There was no significant difference of RAO rate in dialysis patients and non-dialysis patients.

Conclusion

When performing DRA puncture, the probability of radial artery occlusion is not higher in dialysis patients than non-dialysis patients. The DRA puncture may be one of the option as puncture site even in dialysis patients.

Oral environment and taste function of Japanese HIV-infected patients treated with antiretroviral therapy

The aim of the study was to evaluate the oral environment and the taste function of Japanese HIV-infected patients treated with antiretroviral therapy. Their median age of 73 patients taking anti-HIV drugs was 46 years. The median period of taking anti-HIV drugs was 30 months. The oral condition was evaluated by measurement of oral moisture, amount of saliva secretion, the number of oral bacteria, presence of oral candida, a taste test, and the number of missing teeth. The levels of oral moisture and secreted saliva were significantly lower in the HIV-infected group than in the healthy volunteer (control) group. The HIV-infected group showed a more robust decrease in taste sensation than the control group. The number of missing teeth was significantly higher in the HIV-infected group than in the control group. Furthermore, all of the evaluated oral conditions were worse in the HIV-infected patients whose CD4+ T lymphocyte counts were less than 500/mm³ than in the control group. It became clear that the patients taking anti-HIV drugs, especially the CD4+ count < 500/mm3 group, had a deteriorated oral environment and dysgeusia, suggesting that the management of oral hygiene is necessary to maintain oral health, which leads to systemic health.

All-polarization-maintaining Er-doped dual comb fiber laser using single-wall carbon nanotubes

We demonstrated a bi-directional, Er-doped dual comb fiber laser consisting of all-polarization-maintaining fiber devices. Polyimide films in which single-wall carbon nanotubes (SWNTs) were dispersed were used as the in-line saturable absorber. In order to avoid synchronization of the two combs and associated damage to the SWNT film, a two-branch configuration with two SWNT films was employed. Soliton pulses with almost the same optical spectra were generated stably in each direction, and dual comb beats were observed simply by overlapping the two outputs. The repetition frequency was 28 MHz, and the frequency difference was 105-140 Hz. Thanks to the small frequency difference, dual comb beats corresponding to the whole optical spectrum were observed without any overlapping. Fourier transform spectroscopy using the developed dual comb source was examined, and the characteristics of an optical filter were successfully obtained.

A novel thin section preparation and staining protocol to increase contrast and resolution of cell details for light microscopy

We developed a novel sectioning and staining method to make high contrast, high resolution sections of plant tissue for light microscopy. Specimens of teosinte (Zea mays L., ssp. mexicana) root tips were fixed and embedded in Technovit 7100™ plastic resin. Thin sections, 1-2.5 μm, were cut and mounted on glass slides. The sections were either treated with RNase or not, then stained with 0.1% toluidine blue O and observed through ∞/0 objective lenses. For light microscopy, the enzyme staining procedure increased resolution and contrast. High magnification ∞/0 objective lenses produced high quality images for digital photography without using a coverslip or immersion oil. Our slide preparation and microscopic analysis were less labor intensive and more rapid than previous methods and enabled rapid and precise alignment of serial transverse sections for both tracking cell lineages and tissue measurements.

Adjustment of Anaesthesia Depth Using Bispectral Index Prolongs Seizure Duration in Electroconvulsive Therapy

Electroconvulsive therapy (ECT) under propofol anaesthesia induces relatively shorter seizures compared to barbiturate anaesthesia. Since significant correlation between seizure duration and bispectral index (BIS) value immediately before electrical stimulus has been reported among patients, adjustment of anaesthesia depth as determined by BIS may be effective in obtaining a longer seizure length. In the present study, we examined this hypothesis in those patients whose muscular seizure duration was less than 40s.

ECT was prescribed to 20 patients suffering from endogenous depression. General anaesthesia was induced with propofol 1 mg/kg. Succinylcholine chloride 1 mg/kg was then given. The efficacy of electrical stimulation was determined using a tourniquet technique, electromyogram, and electroencephalography. When a patient had a seizure less than 40s in their second ECT treatment, the subsequent treatment was modified such that the electrical stimulus was given after waiting for a higher BIS value (+10-20). Intensity of electrical stimulus and anaesthesia conditions were identical in the two treatments.

All 20 patients had longer seizures as determined by the electromyogram and/or electroencephalography when the stimulus was delivered at the higher BIS value. Seizure duration measured by muscle movement was 31±5s when the stimulus was delivered without waiting and 46±10s when delivered after waiting. There was a significant difference in seizure duration between the two treatments (P<0.01).

Waiting for a recovery in BIS value before electrical stimulation can prolong seizure duration.

Correlation and Linear Regression between Blood Pressure Decreases after a Test Dose Injection of Propofol and that following Anaesthesia Induction

Propofol reduces systemic vascular resistance and suppresses cardiac function when injected rapidly. In this study we investigated whether blood pressure decrease after a minimal dose (test-dose) injection of propofol correlates with that after an induction-dose injection.

Patients were randomly divided into two groups; anaesthesia was induced in group A (n=60) using 1.5 mg/kg propofol and in group B (n=61) using 2.0 mg/kg. Blood pressure reduction after a minimal dose injection (0.4 mg/kg) was examined non-invasively prior to anaesthetic induction. Bispectral Index monitoring was measured and sedation level scored to evaluate anaesthetic depth.

After the minimal dose injection, 18 of 121 patients showed behaviour suggesting minor disinhibition, five patients were sedated and seven were drowsy. Oxygen saturation was not significantly changed after test-dose injection. Reduction in systolic blood pressure (mean±SD) was 17±11 mmHg after the minimal dose injection, 42±20 mmHg after a 1.5 mg/kg induction dose injection, and 42±22 mmHg after a 2.0 mg/kg induction-dose injection. In both groups, blood pressure after induction was significantly lower than the control value (P<0.05). In both groups, a positive correlation was observed between blood pressure reduction after the minimal dose injection and that after the induction-dose injection [P<0.01, R value for systolic blood pressure correlation in group A 0.712 (P<0.01) and in group B 0.758 (P<0.01)].

We concluded there was a positive correlation between blood pressure reduction after a minimal (test-dose) injection and that after an induction-dose injection.

Is the Degree of Sensitivity to Nondepolarizing Muscle Relaxants Related to Requirements for Postoperative Ventilation in Patients with Myasthenia Gravis?

The purpose of this study was to examine whether the degree of sensitivity to nondepolarizing muscle relaxants is related to the requirement for postoperative ventilatory support in patients with myasthenia gravis.

Thirty-six patients with myasthenia gravis undergoing trans-sternal thymectomy were monitored by electromyography in order to assess the neuromuscular response to vecuronium. After calibration to 100% of baseline electromyographic response values using an EMG monitor, incremental doses of 5, 10 and 20 μg/kg of vecuronium were administrated to produce 95% neuromuscular blockade and to obtain a cumulative dose-response curve for each patient. A univariable logistic regression with odds ratio was used to examine the predictive variables of prolonged postoperative ventilation. Depending on their postoperative ventilatory needs, patients were divided into an early extubation group and a prolonged ventilatory group.

There were no significant differences between the two groups in terms of vecuronium ED95 (prolonged ventilation group: 23.2±18 μg/kg; early extubation group: 23.2±18 μg/kg, P=0.129) and vecuronium requirement to maintain less than 25% neuromuscular blockade (prolonged ventilation group: 2.4±1.7 mg/kg; early extubation group: 3.8±4.5 mg/kg, P=0.249). There were, however, significant differences in the incidence of a history of previous respiratory crises and the presence of bulbar palsy between the early extubation and prolonged ventilation groups. History of previous respiratory crisis (odds ratio (OR), 3.5; 95% confidence interval (CI), 1.0-13; P=0.03) and presence of bulbar palsy (OR, 3.7; 95%CI, 0.9-15; P=0.049) were associated with the need for prolonged postoperative ventilation. However, we failed to demonstrate that the degree of sensitivity to nondepolarizing muscle relaxants was related to an increased requirement for postoperative ventilation in patients with myasthenia gravis.

Fungicide Resistance in Botrytis cinerea Populations in California and its Influence on Control of Gray Mold on Stored Mandarin Fruit

Gray mold caused by Botrytis cinerea is an emerging postharvest disease affecting stored mandarin fruit in California. To develop effective control programs, fungicide sensitivities to four citrus postharvest fungicides were determined. One hundred B. cinerea isolates each in 2015 and 2016 were obtained from decayed fruit collected within packinghouses and tested for resistance to the fungicides. Sensitivity to azoxystrobin was examined based on the point mutation in the cyt b gene using PCR, while resistance to fludioxonil, pyrimethanil, and thiabendazole was examined on fungicide-amended media. For azoxystrobin, 83 and 98% of the isolates were resistant in 2015 and 2016, respectively. For pyrimethanil, 71 and 93% were resistant in 2015 and 2016, respectively. For thiabendazole, 63 and 68% were resistant in 2015 and 2016, respectively. No fludioxonil resistance was detected in both years. Five fungicide-resistant phenotypes were detected, and the most common phenotype was triple resistance to azoxystrobin, pyrimethanil, and thiabendazole, accounting for 59 and 65% in 2015 and 2016, respectively. Of the 200 B. cinerea isolates, 5, 23.5, and 62% were resistant to one, two, or three classes of fungicides, respectively. Inoculation tests were conducted to evaluate if the fungicides at label rates controlled various resistant phenotypes on fruit. Most fungicides failed to control gray mold on mandarin fruit inoculated with the respective fungicide resistant phenotypes. Our results suggest that alternative control methods need to be integrated into existing decay control programs to target this emerging disease on mandarin fruit.

Pharmacokinetics and safety/efficacy of levodopa pro-drug ONO-2160/carbidopa for Parkinson's disease

We conducted a phase I study investigating the efficacy, safety, and tolerability of ONO-2160, a newly developed levodopa pro-drug, and carbidopa compared with levodopa and carbidopa to stabilize levodopa plasma concentration fluctuations in Japanese patients with Parkinson's disease. In an open-label two-period design, patients (n = 12) with Parkinson's disease received levodopa and carbidopa for 3 days before 7 days of treatment with ONO-2160 and carbidopa. Patients were primarily evaluated using the Unified Parkinson's Disease Rating Scale Part III, a Parkinson's disease symptom diary, and analysis of adverse events. Pharmacokinetic analysis of plasma levodopa concentration was also performed.

ONO-2160 and carbidopa therapy stabilized effective plasma levodopa concentration. No adverse events with safety concerns were observed. The combination of ONO-2160 and carbidopa produced a prolonged and stable plasma levodopa concentration with a reduction in Unified Parkinson's Disease Rating Scale Part III total scores. The combination was well tolerated, with no safety concerns, when administered to Japanese patients with Parkinson's disease.

A Novel Missense Mutation in Two Families with Congenital Plasminogen Deficiency: Identification of an Ala675 to Thr675 Substitution

We used a polymerase chain reaction (PCR) strategy and restriction fragment polymorphism analysis to evaluate all 19 exons of the plasminogen (PLG) gene in a Japanese patient with congenital PLG deficiency and her family members (family C). Sequence analysis following amplification of each exon and its flanking regions showed a single G to A transition in exon 17, resulting in the conversion of an Ala675 codon (GCT) to Thr675 codon (ACT). Since this mutation generates a new Mae III site, the Mae III digestion patterns of the PCR-amplified exon 17 fragments from each family member were analyzed. In all cases, the patterns correlated with the activities and antigen levels of plasma PLG in those members. The identical G to A transition in the same codon of exon 17 was detected by a Mae III digestion experiment in another proband and her family members with congenital PLG deficiency (family K). Furthermore, 20 normal individuals examined had no Mae III restriction site at this location. We conclude that a G to A transition in exon 17 is responsible for the congenital PLG deficiency inherited in these two Japanese families.

Protein S Tokushima: An Abnormal Protein S Found in a Japanese Family with Thrombosis

An abnormal protein S (PS) was found in a Japanese family with a high incidence of thrombosis. The proband is a woman who was born in Tokushima Prefecture. She had superior sagittal sinus thrombosis, thrombophlebitis of the left leg, and thrombosis of the placenta. She had a normal plasma level of free PS antigen but decreased PS activity. Her mother and aunt also had thrombophlebitis of the leg, and together with four other family members also showed a normal level but decreased activity of PS. This suggests that hereditary dysfunction of PS is inherited in this family as an autosomal dominant trait. The proband’s PS appears to have a slightly higher molecular weight than normal PS both in the intact and modified form, suggesting that it has a molecular defect on the carboxyl-terminal side of the thrombin-sensitive site. This abnormal PS with apparently unique characteristics was named PS Tokushima.

Type I Congenital Plasminogen Deficiency Is not a Risk Factor for Thrombosis

The risk of thrombosis in type I congenital plasminogen (PLG) deficiency has been suggested, but is still not confirmed. We studied 40 members of two unrelated families with this disease, and found that 21 were heterozygotes of type I congenital PLG deficiency. Three of them had thrombosis, but the other 18 had no thrombosis. The percentages of family members with no history of thrombosis up to a given age among subjects with type I congenital PLG deficiency and healthy controls were analyzed by the Kaplan-Meier method. No significant difference between the two groups was observed by the generalized Wilcoxon test (p = 0.23). These results suggest that there is no significant correlation between type I congenital PLG deficiency and thrombosis.

Depressive symptoms and hazardous/harmful alcohol use are prevalent and correlate with stigma among TB-HIV patients in Lesotho

SETTING

Limited data exist on the prevalence and correlates, including stigma, of mental health conditions, including depressive symptoms and alcohol use, among patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) in sub-Saharan Africa, despite their negative impact on health outcomes.

OBJECTIVE

To assess the prevalence and correlates of depressive symptoms and hazardous/harmful alcohol use among TB-HIV patients in the Start TB patients on ART and Retain on Treatment (START) study.

DESIGN

START, a mixed-methods cluster-randomized trial, evaluated a combination intervention package vs. standard of care (SOC) to improve treatment outcomes in TB-HIV co-infected patients in Lesotho. Moderate/severe depressive symptoms and hazardous/harmful alcohol use were measured using baseline questionnaire data collected from April 2013 to March 2015. Demographic, psychosocial, and TB- and HIV-related knowledge and attitudes, including stigma, were assessed for association with both conditions using generalized linear mixed models.

RESULTS

Among 371 participants, 29.8% reported moderate/severe depressive symptoms, and 24.7% reported hazardous/harmful alcohol use; 7% reported both. Depressive symptoms were significantly associated with less education, more difficulty understanding written medical information, non-disclosure of TB, greater TB stigma, and the SOC study arm. Hazardous/harmful alcohol use was significantly associated with male sex, as well as greater TB and external HIV stigma.

CONCLUSION

Prevalence of depressive symptoms and hazardous/harmful alcohol use were high, suggesting a need for routine screening for, and treatment of, mental health disorders in TB-HIV patients.

Pulmonary tuberculosis diagnostic practices among people living with the human immunodeficiency virus in Lesotho

SETTING

Twelve health facilities in Berea District, Lesotho, that participated in the Start TB Patients on ART and Retain on Treatment (START) Study, a mixed-methods cluster-randomized trial evaluating a combination intervention package to improve early initiation of antiretroviral therapy (ART) and anti-tuberculosis treatment success among patients with tuberculosis (TB) and human immunodeficiency virus (HIV).

OBJECTIVE

To assess TB and HIV diagnostic practices among TB-HIV patients.

DESIGN

A standardized survey assessed services at each facility at baseline. Routine clinical data were abstracted for all newly registered adult TB-HIV patients during the study period. Descriptive statistics were used to assess TB diagnostic practices, timing of the HIV diagnosis, and ART status at TB treatment initiation.

RESULTS

Between April 2013 and March 2015, 1233 TB-HIV patients were enrolled. Among 1215 patients with available data, 87.2% had pulmonary TB, of which 34.8% were bacteriologically confirmed, 40.9% tested negative and 24.3% were not tested. Among 1138 patients with available data, 53.3% had an existing HIV diagnosis, of whom 39.3% were ART-naïve.

CONCLUSIONS

The majority of pulmonary TB patients were clinically diagnosed, and many were unaware of their HIV status or were ART-naïve despite known status. The Test and Treat Strategy holds promise to prevent TB and reduce TB-related mortality among people living with HIV; however, enhanced TB diagnostic capacity and improved HIV case detection are urgently needed.

Search for γ-Ray Line Signals from Dark Matter Annihilations in the Inner Galactic Halo from 10 Years of Observations with H.E.S.S

Spectral lines are among the most powerful signatures for dark matter (DM) annihilation searches in very-high-energy γ rays. The central region of the Milky Way halo is one of the most promising targets given its large amount of DM and proximity to Earth. We report on a search for a monoenergetic spectral line from self-annihilations of DM particles in the energy range from 300 GeV to 70 TeV using a two-dimensional maximum likelihood method taking advantage of both the spectral and spatial features of the signal versus background. The analysis makes use of Galactic center observations accumulated over ten years (2004-2014) with the H.E.S.S. array of ground-based Cherenkov telescopes. No significant γ-ray excess above the background is found. We derive upper limits on the annihilation cross section ⟨σv⟩ for monoenergetic DM lines at the level of 4×10^{-28}  cm^{3} s^{-1} at 1 TeV, assuming an Einasto DM profile for the Milky Way halo. For a DM mass of 1 TeV, they improve over the previous ones by a factor of 6. The present constraints are the strongest obtained so far for DM particles in the mass range 300 GeV-70 TeV. Ground-based γ-ray observations have reached sufficient sensitivity to explore relevant velocity-averaged cross sections for DM annihilation into two γ-ray photons at the level expected from the thermal relic density for TeV DM particles.

Inversion of Qubit Energy Levels in Qubit-Oscillator Circuits in the Deep-Strong-Coupling Regime

We report on experimentally measured light shifts of superconducting flux qubits deep-strongly coupled to LC oscillators, where the coupling constants are comparable to the qubit and oscillator resonance frequencies. By using two-tone spectroscopy, the energies of the six lowest levels of each circuit are determined. We find huge Lamb shifts that exceed 90% of the bare qubit frequencies and inversions of the qubits' ground and excited states when there are a finite number of photons in the oscillator. Our experimental results agree with theoretical predictions based on the quantum Rabi model.