Malignant lymphoma mimics miliary tuberculosis by diffuse micronodular radiographic findings

This case reports rare findings on computed tomography of a manifestation of malignant lymphoma, in which diffuse lung shadows appeared as miliary nodules distributed throughout the lungs bilaterally. The patient had a history of surgical treatment of rectal cancer and had received chemotherapy for suspicious liver metastasis. At her current presentation for evaluation suspected miliary tuberculosis on chest radiography, subsequent liver biopsy revealed a mass infiltration of atypical lymphocytes, which was diagnosed as follicular lymphoma. The miliary tuberculosis was suspected more than neoplastic lesions, such as metastatic rectal cancer or malignant lymphoma. Despite repeated bacteriologic tests of various samples, including sputum, urine, bronchial secretion, peripheral blood, bone marrow aspiration, and gastric lavage, all results were negative for mycobacterium tuberculosis. Finally, multiple, small, mass lesions of lymphocytes were demonstrated in the lung obtained from video-assisted thoracic surgery, and a diagnosis of follicular lymphoma was given. The final interpretations of liver mass and military lung lesions were tumor involvement by the follicular lymphoma. This radiologic findings of multiple miliary opacities throughout the whole lungs confused definite diagnosis because these images were remarkably similar with miliary tuberculous. This case reminds us to consider a wide variety of differential diagnoses even we assumed to be familiar with radiographic imaging at first glance.

In Vivo Ca2+ Imaging of the Insular Cortex during Experimental Tooth Movement

Pain and discomfort are common problems for patients undergoing orthodontic treatment. We have demonstrated that cortical excitation propagation in the somatosensory and insular cortices (IC) induced by electrical stimulation of the periodontal ligament (PDL) is facilitated 1 d after experimental tooth movement (ETM). However, it is necessary to examine ETM-induced changes in neural responses at a single-cell level to understand the mechanisms of cortical plastic changes, in which excitatory glutamatergic and inhibitory GABAergic neurons are intermingled to form cortical local circuits. We performed in vivo 2-photon Ca²⁺ imaging by loading the Ca²⁺ indicator Oregon Green BAPTA with the astrocyte marker sulforhodamine. We focused on the IC region that exhibited the largest neural response to maxillary PDL (mxPDL) stimulation using a VGAT-Venus transgenic rat that expresses venus fluorescent protein in GABAergic neurons and discerned changes in the neural activities of each cortical neuronal subtype before and during ETM treatment of the maxillary incisor and first molar. Notably, 1 d after ETM treatment (1d-ETM), the number of neurons responding to mxPDL stimulation increased from 47.6% to 64.2% in excitatory neurons and from 44.5% to 66.2% in inhibitory neurons. On the other hand, only 3% to 4% of excitatory and inhibitory neurons responded to mandibular molar PDL (mbPDL) stimulation in control rats, and the 1d-ETM group showed significant increases in excitatory (14.0%) and inhibitory neurons (22.5%) responding to mbPDL stimulation. Interestingly, most mbPDL-responding neurons also responded to mxPDL stimulation. The population of excitatory and inhibitory neurons that responded only to mxPDL stimulation was comparable between the control and 1d-ETM groups. The facilitative responses in the 1d-ETM group had almost recovered 7 d after ETM treatment. These results suggest that ETM induces parallel increases in PDL-responding neurons and changes some insensitive neurons to respond to both mxPDL and mbPDL stimulation.

Astrocytic phagocytosis is a compensatory mechanism for microglial dysfunction

Microglia are the principal phagocytes that clear cell debris in the central nervous system (CNS). This raises the question, which cells remove cell debris when microglial phagocytic activity is impaired. We addressed this question using Siglech^dtr mice, which enable highly specific ablation of microglia. Non‐microglial mononuclear phagocytes, such as CNS‐associated macrophages and circulating inflammatory monocytes, did not clear microglial debris. Instead, astrocytes were activated, exhibited a pro‐inflammatory gene expression profile, and extended their processes to engulf microglial debris. This astrocytic phagocytosis was also observed in Irf8‐deficient mice, in which microglia were present but dysfunctional. RNA‐seq demonstrated that even in a healthy CNS, astrocytes express TAM phagocytic receptors, which were the main astrocytic phagocytic receptors for cell debris in the above experiments, indicating that astrocytes stand by in case of microglial impairment. This compensatory mechanism may be important for the maintenance or prolongation of a healthy CNS.

Mapping of a New Deformation Region around ^{62}Ti

We performed the first direct mass measurements of neutron-rich scandium, titanium, and vanadium isotopes around the neutron number 40 at the RIKEN RI Beam Factory using the time-of-flight magnetic-rigidity technique. The atomic mass excesses of ^{58-60}Sc, ^{60-62}Ti, and ^{62-64}V were measured for the first time. The experimental results show that the two-neutron separation energies in the vicinity of ^{62}Ti increase compared to neighboring nuclei. This shows that the masses of Ti isotopes near N=40 are affected by the Jahn-Teller effect. Therefore, a development of Jahn-Teller stabilization appears below the Cr isotopes, and the systematics in Sc, Ti, and V isotopes suggest that ^{62}Ti is located close to the peak of the Jahn-Teller effect.

Influence of extended depth of focus intraocular lenses on visual field sensitivity

Purpose

To investigate the influence of EDOF IOLs, TECNIS Symfony^® (Johnson & Johnson Surgical Vision, Inc.), on visual field sensitivity and to compare the IOLs with other kinds of IOLs.

Methods

The subjects included the normal fellow eyes of patients who underwent the Humphrey Field Analyzer (HFA) 30–2 with Swedish Interactive Threshold Algorithm Fast within 6 months after cataract due to glaucoma or suspected glaucoma. Each parameter of HFA was compared among eyes implanted with TENIS Symfony^® (EDOF group), diffractive bifocal IOLs (bifocal group), and monofocal IOLs (monofocal group).

Results

The total of 76 eyes, including 24 eyes in the EDOF group, 26 eyes in the bifocal group, and 26 eyes in the monofocal group, were included in this study. Mean deviation (MD) of HFA was -0.24±0.58 dB in the EDOF group, -1.38±0.58 dB in the bifocal group, and 0.02±0.44 dB in the monofocal group. Foveal threshold (FT) of HFA was 35.8±1.6 dB in the EDOF group, 33.6±1.7 dB in the bifocal group, and 36.6±1.4 dB in the monofocal group. In both MD and FT, there was significant difference between the bifocal group and the others (p<0.001). There was no difference between the EDOF group and the monofocal group. Moreover, there was no significant difference between the three groups about pattern standard deviation (PSD) of HFA.

Conclusion

TECNIS Symfony^® may have little influence on visual field sensitivity, whereas diffractive bifocal IOLs decrease visual field sensitivity.

Study of factors related to social and emotional skills in early childhood in Japan

Background

There are numerous reports that social and emotional skills in early childhood have profound influence on lifelong health. The aim of this research is to determine the relation between the lifestyle and the social and emotional skills among children in present day Japan.

Methods

The object of analysis was a total of 110 parents of kindergarten students (56 boys, 48 girls,6 gender unknown) from 3 kindergartens in central Okinawa Island. The survey was conducted in mid-December 2019. Regarding the content of the survey, parents were asked to answer on a five-point scale, based on their subjective opinion, how good is their child, as compared to other children, in each of the 9 sub-scales of the social and emotional skills proposed in the 2015 OECD report, namely “perseverance,” “self-control,” “passion for goals,” “sociability,” “respect,” “caring,” “self-esteem,” “optimism,” “confidence.” Additionally, other question items were set, mainly to ask about the child's own lifestyle.

Results

The results of multivariate logistic regression analysis are following. As for “achieving goals:” 3 items for perseverance - “there are few likes and dislikes about food (OR:2.67, 95％CI:1.03～6.94, p=.043),” “Time for playing games on smartphone is determined (OR:3.21, 95％CI:1.19～8.68, p=.021),” “Eat more fruits (OR:3.03, 95％CI:1.24～8.26, p=.016),” are statistically significant. [Other results are omitted in this abstract]

Conclusions

It became clear that the acquisition of social and emotional skills during early childhood generally involves regular lifestyle and “discipline” at home as a whole. Besides, it is important for parent and child to do various activities together, including those aiming to increase cognitive skills. This study is considered to be a powerful evidence for the development of future intervention programme, aimed at acquiring social and emotional skills in early childhood.

Key messages

In early childhood family and kindergarten have to cooperate to foster social and emotional skills, important for lifelong health. This study is considered to be a powerful evidence for the development of future intervention programme, aimed at acquiring social and emotional skills in early childhood.

Endodermal Cyst with a Non-enhancing Nodule in the Quadrigeminal Cistern Developed in an Octogenarian

BACKGROUND

Intracranial endodermal cysts are congenital lesions that generally develop in the cerebellopontine angle and ventral brainstem of the posterior fossa, whereas endodermal cysts in the quadrigeminal cistern are very rare. We report a rare case of an endodermal cyst in the quadrigeminal cistern with a non-enhancing nodule that developed in patient over 80 years of age.

CASE DESCRIPTION

An 85-year-old man presented to our hospital with progressing gait disturbance and urinary incontinence. Preoperative images showed a cystic mass lesion with a nodule in the quadrigeminal cistern and hydrocephalus. There was no enhanced portion in the lesion, and the intensity of the cyst on magnetic resonance imaging revealed a high protein concentration. Subtotal resection was performed due to the adhesion of the cyst to the brainstem. It was diagnosed as an endodermal cyst. The postoperative course was uneventful, and hydrocephalus improved.

CONCLUSIONS

This is a rare case of an intracranial endodermal cyst in terms of location and age of onset compared with previous reports. This case demonstrates that endodermal cysts should be considered as a differential diagnosis for lesions in the quadrigeminal cistern with high protein concentration in the cyst and nodule representing chronic inflammation, regardless of enhancing effects.

RAD-seq-Based High-Density Linkage Map Construction and QTL Mapping of Biomass-Related Traits in Sorghum using the Japanese Landrace Takakibi NOG

Sorghum [Sorghum bicolor (L.) Moench] grown locally by Japanese farmers is generically termed Takakibi, although its genetic diversity compared with geographically distant varieties or even within Takakibi lines remains unclear. To explore the genomic diversity and genetic traits controlling biomass and other physiological traits in Takakibi, we focused on a landrace, NOG, in this study. Admixture analysis of 460 sorghum accessions revealed that NOG belonged to the subgroup that represented Asian sorghums, and it was only distantly related to American/African accessions including BTx623. In an attempt to dissect major traits related to biomass, we generated a recombinant inbred line (RIL) from a cross between BTx623 and NOG, and we constructed a high-density linkage map based on 3,710 single-nucleotide polymorphisms obtained by restriction-site-associated DNA sequencing of 213 RIL individuals. Consequently, 13 fine quantitative trait loci (QTLs) were detected on chromosomes 2, 3, 6, 7, 8 and 9, which included five QTLs for days to heading, three for plant height (PH) and total shoot fresh weight and two for Brix. Furthermore, we identified two dominant loci for PH as being identical to the previously reported dw1 and dw3. Together, these results corroborate the diversified genome of Japanese Takakibi, while the RIL population and high-density linkage map generated in this study will be useful for dissecting other important traits in sorghum.

AB0196 THE ASSOCIATION BETWEEN OSTEOPOROSIS AND FUNCTIONAL IMPAIRMENT EVALUATED BY THE LOCOMO25 IN RHEUMATOID ARTHRITIS

Background:

Locomotive syndrome is a condition in which activities of daily living are affected by impairment of the motor organs, most often due to rheumatoid arthritis (RA). Locomo25 is a new index developed for the early detection of locomotive syndrome. It consists of 25 items associated with pain, physical activity, and subjective state of health, with a score of 7 points or higher classed as Grade 1 locomotive syndrome and a score of 16 points or higher as Grade 2. In RA, joint impairment causes the appearance of problems affecting motor organs as a whole, as well as progressive functional impairment. As functional impairment progresses, it causes increasing immobility, which raises the risk of osteoporosis.

Objectives:

Locomo25 was used to investigate functional impairment and its association with RA disease activity and osteoporosis indicators.

Methods:

The subjects were 105 patients with RA (24 men and 81 women) with a mean age of 68.7 (28–91) years. In terms of staging, 25 were Stage I, 22 Stage II, 17 Stage III, and 41 Stage IV, and their motor disability was Steinbrocker Class 1 in 68 cases, Class 2 in 27, Class 3 in 9, and Class 4 in 1. Disease activity according to the Disease Activity Score 28 with erythrocyte sedimentation rate (DAS28 ESR) was assessed as remission in 44 cases, low disease activity in 24, moderate in 33, and high in 4. The associations between the Locomo25 score and disease activity indices, bone mineral density (BMD), and bone turnover markers (TRACP-5b, NTX, urinary DPD, BAP, total P1NP, and 25(OH)D) were investigated.

Results:

Locomo25 grade was 0 in 37 cases (35.2%), 1 in 24 (22.9%), and 2 in 44 (41.9%). Locomo25 grade was significantly associated with Steinbrocker class (r= 0.4299, Spearman’s rank correlation coefficient,p< 0.0001). DAS28 ESR and Health Assessment Questionnaire scores increased as locomotive syndrome progressed. There was no significant difference in eGFR between groups, but bone resorption markers (TRACP-5b, NTX, and urinary DPD) and a bone quality marker (pentosidine) decreased significantly as locomotive syndrome progressed. There were no significant differences in BMD or other bone turnover markers.

Conclusion:

The Locomo25 score was useful for evaluating functional impairment in RA. The prevalence of Grade 2 locomotive syndrome in the general population is reported to be around 25%, and many patients with RA had advanced locomotive syndrome. Although there was no significant difference in BMD, elevated bone resorption and deteriorating bone quality were associated with progressive functional impairment, suggesting that RA patients with advanced locomotive syndrome may be at risk of increasingly severe osteoporosis as a result of immobility.

References:

[1]Yoshimura Y, Ishijima M, Ishibashi M, Liu L, Arikawa-Hirasawa E, Machida S, Naito H, Hamada C, Kominami E. J Orthop Sci. 2019 Nov;24(6):1094-1104. doi: 10.1016/j.jos.2019.08.009. Epub 2019 Sep 3.

[2]Siu PPY, Cheung PWH, Cheung JPY. J Orthop Sci. 2019 Nov;24(6):1110-1117. doi: 10.1016/j.jos.2019.07.012. Epub 2019 Aug 14.

Disclosure of Interests:

None declared

AB0964 THE ASSOCIATION BETWEEN RESIDUAL SYMPTOMS AND CERVICAL SPINE LESIONS IN RHEUMATOID ARTHRITIS

Background:

Treatment outcomes in rheumatoid arthritis (RA) have been improved with advances in drug therapy. In daily clinical practice, the outcomes are assessed based on the presence of swollen or tender joints, global assessment using a visual analog scale by a patient (GVAS) and a physician (DrVAS), etc., in addition to inflammatory findings. Although inflammation and joint symptoms are suppressed, many patients show no improvement in GVAS scores. The reported residual RA symptoms include morning stiffness (MS), pain (P), and dullness (D), but their causes are not completely known. Latent cervical spine lesions sometimes exist in RA, but their association with residual RA symptoms is unknown.

Objectives:

We examined cervical spine lesions and residual symptoms in patients with RA who achieved the therapeutic goal.

Methods:

Of 124 patients with RA, 82 (25 men and 57 women) who achieved a low disease activity (LDA) state on the Disease Activity Score for 28 joints with erythrocyte sedimentation rate (DAS28-ESR) were included. The mean age was 65.7 (28- 83) years, and the disease stage was Stage I in 28 patients, Stage II in 14, Stage III in 13, and Stage IV in 27. Dysfunction was graded as Class 1 in 63 patients, Class 2 in 18, and Class 3 in one (Steinbrocker classification). Biopharmaceuticals had been administered in 27 patients. As for disease activity, the DAS28-ESR scores indicated complete remission in 54 patients and LDA in 28. The survey form was used to investigate the presence or absence/duration of MS, the presence or absence/severity of P (Pain VAS), and the presence or absence/severity of D (Dullness VAS). On lateral functional radiographs of the cervical spine, patients with spinal lesions were selected and divided into the asymptotic stability (ASS; atlantoaxial dislocation ≥3 mm) + vertical setting (VS; Ranawat value <13 mm) group, the cervical spondylolisthesis group (≥3 mm of slippage on dynamic radiographs), and the spondylolisthesis group (≥3 mm of slippage on dynamic radiographs). They were examined for association with residual symptoms.

Results:

According to cervical spine lesions, the patients who achieved the therapeutic goal were divided into the ASS+VS group comprising 15 patients (18.3%), the spondylolisthesis group comprising 11 (13.4%), and the stenosis group comprising 18 (22.0%). Among them, only the spondylolisthesis group showed significant differences in residual RA symptoms. In the spondylolisthesis group, the disease duration was longer, but there was no difference in age. MS, P, and D were significantly severer. The duration of MS was longer, and both Pain and Dullness VAS scores were higher. The score on each component of the DAS28 showed no difference in inflammatory findings. GVAS and DrVAS scores were higher. No common perceptions of spinal symptoms were shared between any patients with cervical spine lesions and physicians.

Conclusion:

Improved patient-reported outcomes (PROs) are considered to be important to achieve more complete remission. There are various reports on the causes of residual RA symptoms, but many aspects remain unknown. Based on the results of this study, because asymptomatic subaxial subluxation is one of concerns in patients with spondylolisthesis with dynamic instability of the cervical spine, cervical spine diseases should also be considered in patients with severe residual symptoms. Not only radiography but also magnetic resonance imaging needs to be performed.

Acknowledgments:

The authors wish to acknowledge Miss Sasaki

Disclosure of Interests:

None declared

AB0899 TREATMENT STATUS OF PATIENTS WITH GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN THE AKITA ORTHOPEDIC GROUP ON RHEUMATOID ARTHRITIS REGISTRY

Background:

Glucocorticoids (GC) have potent anti-inflammatory and immunosuppressive effects and are used to treat a variety of diseases. However, GC are associated with several adverse effects. Glucocorticoid-induced osteoporosis (GIO), a bone metabolism disorder, accounts for 25% of the side effects associated with GC, and long-term use of these agents leads to fragility fractures in 30 to 50% of patients [1]. GC are frequently used to treat rheumatoid arthritis (RA). No report on the current treatment status for glucocorticoid-induced osteoporosis (GIO) has been published following the publication of the new guidelines for the management and treatment of GIO issued by the Japanese Society for Bone Mineral Research provided in 2014 (Figure 1) [2].

Objectives:

The present study aimed to investigate the current treatment status of GIO patients in the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry.

Methods:

This retrospective, multicenter study included 683 patients (138 men, 545 women) with fracture risk factor scores ≥3 based on the new guidelines who were in the AORA registry. We examined patient characteristics, differences in patient backgrounds between treated and non-treated groups.

Results:

There were no significant differences in mean GC dose between men and women (4.0 ± 2.3 mg/day vs 3.6 ± 1.8 mg/day, p = 0.08). The mean disease duration of RA in women was significantly longer than in men (180.2 ± 140.2 months vs 143.8 ± 129.6 months, Untreated GIO patients were significantly more likely to be men and younger. The univariate analysis showed that clinic visits, male sex, younger age, and longer disease duration were significant risk factors for lack of therapeutic intervention for GIO. Multivariate analysis showed that being treated in a clinic, male sex, and younger age were significant risk factors for lack of therapeutic intervention for GIO.

Conclusion:

Our results emphasize the importance of considering the prevention and treatment of GIO in all patients with RA, including younger and male patients, who have lower intervention rates.

References:

[1]Weinstein RS. Clinical practice. Glucocorticoid-induced bone disease. New Engl J Med. 2011; 365(1): 62-70.

[2]Suzuki Y, Nawata H, Soen S, Fujiwara S, Nakayama H, Tanaka I, et al. Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab. 2014; 32(4): 337-350.

Disclosure of Interests:

None declared

How Different is the Core of ^{25}F from ^{24}O_{g.s.} ?

The structure of a neutron-rich ^{25}F nucleus is investigated by a quasifree (p,2p) knockout reaction at 270A  MeV in inverse kinematics. The sum of spectroscopic factors of π0d_{5/2} orbital is found to be 1.0±0.3. However, the spectroscopic factor with residual ^{24}O nucleus being in the ground state is found to be only 0.36±0.13, while those in the excited state is 0.65±0.25. The result shows that the ^{24}O core of ^{25}F nucleus significantly differs from a free ^{24}O nucleus, and the core consists of ∼35% ^{24}O_{g.s.}. and ∼65% excited ^{24}O. The result may infer that the addition of the 0d_{5/2} proton considerably changes neutron structure in ^{25}F from that in ^{24}O, which could be a possible mechanism responsible for the oxygen dripline anomaly.

Acetazolamide-Loaded Dynamic 7T MR Quantitative Susceptibility Mapping in Major Cerebral Artery Steno-Occlusive Disease: Comparison with PET

BACKGROUND AND PURPOSE

Dynamic changes in cerebrovascular reactivity after acetazolamide administration vary markedly among patients with major cerebral arterial steno-occlusive disease. MR quantitative susceptibility mapping can dynamically quantify the cerebral magnetic susceptibility. The purpose of this study was to determine whether dynamic changes in susceptibility after administration of acetazolamide on 7T quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in the cerebral hemispheres with major cerebral arterial steno-occlusive disease.

MATERIALS AND METHODS

Sixty-five patients underwent 7T MR imaging at baseline and at 5, 10, 15, and 20 minutes after acetazolamide administration. Differences between the susceptibility of venous structures and surrounding brain tissue were calculated in the quantitative susceptibility mapping images. Susceptibility differences at 5, 10, 15, and 20 minutes after acetazolamide administration relative to baseline were calculated in 97 cerebral hemispheres with major cerebral arterial steno-occlusive disease. CBV and the cerebral metabolic rate of oxygen were also calculated using ¹⁵O-gas PET in the resting state.

RESULTS

Dynamic changes of susceptibility after acetazolamide administration were classified into 3 patterns: abnormally increasing 5 or 10 minutes after acetazolamide administration; abnormally decreasing within 20 minutes after acetazolamide administration; and remaining unchanged after acetazolamide administration. CBV was significantly greater in the first pattern than in the latter 2. The cerebral metabolic rate of oxygen differed significantly in descending order from the first to middle to last pattern.

CONCLUSIONS

Dynamic changes of susceptibility after acetazolamide administration on 7T MR quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in major cerebral arterial steno-occlusive disease.

Evaluation of a receptor gene responsible for maternal blood IgY transfer into egg yolks using bursectomized IgY-depleted chickens

In avian species, maternal immunoglobulin Y (IgY) is transferred from the blood to the yolks of maturing oocytes; however, the mechanism underlying this transfer is unknown. To gain insight into the mechanisms of maternal IgY transfer into egg yolks, IgY-depleted chickens were generated by removing the bursa of Fabricius (bursectomy) during egg incubation, and their egg production and IgY transport ability into egg yolks were determined. After hatching, blood IgY concentrations of the bursectomized chickens decreased gradually until sexual maturity, whereas those of IgA remained low from an early stage of growth (from at least 2 wk of age). Chickens identified as depleted in IgY through screening of blood IgY and IgA concentrations were raised to sexual maturity. At 20 wk of age, both blood and egg yolk IgY concentrations in the IgY-depleted group were 600-fold lower than those of the control group, whereas egg production did not differ between the groups. Intravenously injected, digoxigenin-labeled IgY uptake into the egg yolk was approximately 2-fold higher in the IgY-depleted chickens than in the controls, suggesting that IgY depletion may enhance IgY uptake in maturing oocytes. DNA microarray analysis of the germinal disc, including the oocyte nucleus, revealed that the expression levels of 73 genes were upregulated more than 1.5-fold in the IgY-depleted group, although we could not identify a convincing candidate gene for the IgY receptor. In conclusion, we successfully raised IgY-depleted chickens presenting a marked reduction in egg yolk IgY. The enhanced uptake of injected IgY into the egg yolks of the IgY-depleted chickens supports the existence of a selective IgY transport mechanism in maturing oocytes and ovarian follicles in avian species.

Up-regulation of the pentose phosphate pathway and HIF-1α expression during neural progenitor cell induction following glutamate treatment in rat ex vivo retina

The metabolic state influences the regulation of neural stem/progenitor cells. The pentose phosphate pathway (PPP), an alternative metabolic pathway that operates parallel to glycolysis, not only provides key intermediates for biosynthetic reactions but also controls the fate of neural stem/progenitor cells. We have previously shown that glutamate application leads to the induction of neural progenitor cells in mature ex vivo rat retina. In this study, we investigated whether regulation of the PPP might be changed following glutamate treatment of the retina. Immunoblot analysis revealed that the amount of glucose-6-phosphate dehydrogenase (G6PD), the rate-limiting enzyme of the PPP as well as that of 6-phosphogluconate dehydrogenase (6PGD), another enzyme in this pathway, increased in the glutamate-treated retina. Consistent with the fact that both these enzymes generate reduced nicotinamide adenine dinucleotide phosphate (NADPH), the amount of NAPDH in the treated retina was significantly higher compared with that in the untreated retina. We also found that both DNA synthesis as well as the expression of fatty acid synthase (FASN) increased significantly in the glutamate-treated retina. Furthermore, hypoxia-inducible factor 1-α (HIF-1α), a positive transcriptional regulator of PPP enzymes, was up-regulated at both messenger RNA (mRNA) and protein levels. Finally, we found the interaction of HIF-1α with the M2 isozyme of pyruvate kinase (PKM2), with this interaction having been shown to contribute to a positive feedback loop in the control of glycolysis. Our results thus show that specific metabolic change in the PPP occurs in the process of neural progenitor cell induction in the mature rat retina.

Progressively Enlarged Convexity Arachnoid Cysts in Elderly Patients: A Report of 2 Cases

BACKGROUND

Generally, enlargement of arachnoid cysts (ACs) has been found mostly in cases occurring during early childhood. Therefore, progressively enlarged ACs found to be symptomatic in elderly patients are extremely rare, and the mechanisms have remained unexplored.

CASE DESCRIPTION

Our first patient was a 72-year-old woman with memory disturbance, who had presented with a large cyst beneath the right temporal convexity 9 years previously. The annual follow-up magnetic resonance imaging (MRI) studies had revealed that the cyst had progressively enlarged. In addition, her memory disturbance had become advanced. Endoscopic cyst fenestration was performed between the cyst and lateral ventricle, resulting in a reduction of her symptoms. Our second patient was a 79-year-old woman with unsteadiness, who had presented with a large cyst under the right parietal convexity 6 years previously. The annual follow-up MRI studies had shown that the cyst had gradually enlarged. She subsequently developed left hemiparesis. Because the pyramidal tract was located between the cyst and ventricle, a cyst-ventricle shunt was placed to allow the cystic fluid into the lateral ventricle, with complete resolution of her symptoms. In both cases, MRI showed obliteration of the subdural spaces around the cysts. Endoscopic observations revealed that the arachnoid membrane was lined under the surrounding brain, leading to the diagnosis of an AC.

CONCLUSION

The establishment of stable communication between a cyst and the normal cerebrospinal fluid space is important to treat symptomatic ACs characterized by progressive enlargement, even in elderly patients. The 1-way entry of the cerebrospinal fluid into the cyst and the closure of the surrounding subdural space might result in AC enlargement internally.

Light Dark Matter Search with Ionization Signals in XENON1T

We report constraints on light dark matter (DM) models using ionization signals in the XENON1T experiment. We mitigate backgrounds with strong event selections, rather than requiring a scintillation signal, leaving an effective exposure of (22±3) tonne day. Above ∼0.4  keV_{ee}, we observe <1  event/(tonne day keV_{ee}), which is more than 1000 times lower than in similar searches with other detectors. Despite observing a higher rate at lower energies, no DM or CEvNS detection may be claimed because we cannot model all of our backgrounds. We thus exclude new regions in the parameter spaces for DM-nucleus scattering for DM masses m_{χ} within 3-6  GeV/c^{2}, DM-electron scattering for m_{χ}>30  MeV/c^{2}, and absorption of dark photons and axionlike particles for m_{χ} within 0.186-1  keV/c^{2}.

Search for Light Dark Matter Interactions Enhanced by the Migdal Effect or Bremsstrahlung in XENON1T

Direct dark matter detection experiments based on a liquid xenon target are leading the search for dark matter particles with masses above ∼5  GeV/c^{2}, but have limited sensitivity to lighter masses because of the small momentum transfer in dark matter-nucleus elastic scattering. However, there is an irreducible contribution from inelastic processes accompanying the elastic scattering, which leads to the excitation and ionization of the recoiling atom (the Migdal effect) or the emission of a bremsstrahlung photon. In this Letter, we report on a probe of low-mass dark matter with masses down to about 85  MeV/c^{2} by looking for electronic recoils induced by the Migdal effect and bremsstrahlung using data from the XENON1T experiment. Besides the approach of detecting both scintillation and ionization signals, we exploit an approach that uses ionization signals only, which allows for a lower detection threshold. This analysis significantly enhances the sensitivity of XENON1T to light dark matter previously beyond its reach.

Pediatric Infections by Human mastadenovirus C Types 2, 89, and a Recombinant Type Detected in Japan between 2011 and 2018

Between 2011 and 2018, 518 respiratory adenovirus infections were diagnosed in a pediatric clinic in Shizuoka, Japan. Detection and typing were performed by partial sequencing of both hexon- and fiber-coding regions which identified: adenovirus type 1 (Ad-1, n = 85), Ad-2 (n = 160), Ad-3 (n = 193), Ad-4 (n = 18), Ad-5 (n = 27), Ad-11 (n = 2), Ad-54 (n = 3), and Ad-56 (n = 1). Considering previous reports of the circulation of an endemic recombinant Ad-2, e.g., Ad-89, 100 samples typed as Ad-2 were randomly selected for further molecular typing by sequencing the penton base-coding region. Despite the high nucleotide sequence conservation in the penton base- coding region, 27 samples showed 98% identity to Ad-2. Furthermore, 14 samples showed 97.7% identity to Ad-2 and 99.8% identity to Ad-89, while the remaining 13 samples showed an average 98% pairwise identity to other Ad-C types and clustered with Ad-5. The samples typed as Ad-89 (n = 14) and as a recombinant Ad type (P5H2F2) (n = 13) represented 27% of cases originally diagnosed as Ad-2, and were detected sporadically. Therefore, two previously uncharacterized types in Japan, Ad-89 and a recombinant Ad-C, were shown to circulate in children. This study creates a precedent to evaluate the epidemiology and divergence among Ad-C types by comprehensively considering the type classification of adenoviruses.