An extremely energetic cosmic ray observed by a surface detector array

Cosmic rays are energetic charged particles from extraterrestrial sources, with the highest-energy events thought to come from extragalactic sources. Their arrival is infrequent, so detection requires instruments with large collecting areas. In this work, we report the detection of an extremely energetic particle recorded by the surface detector array of the Telescope Array experiment. We calculate the particle's energy as [Formula: see text] (~40 joules). Its arrival direction points back to a void in the large-scale structure of the Universe. Possible explanations include a large deflection by the foreground magnetic field, an unidentified source in the local extragalactic neighborhood, or an incomplete knowledge of particle physics.

The identified clinical features of Parkinson's disease in homo-, heterozygous and digenic variants of PINK1

To investigate the prevalence and genotype-phenotype correlations of phosphatase and tensin homolog induced putative kinase 1 (PINK1) variants in Parkinson's disease (PD) patients, we analyzed 1700 patients (842 familial PD and 858 sporadic PD patients from Japanese origin). We screened the entire exon and exon-intron boundaries of PINK1 using Sanger sequencing and target sequencing by Ion torrent system. We identified 30 patients with heterozygous variants, 3 with homozygous variants, and 3 with digenic variants of PINK1-PRKN. Patients with homozygous variants presented a significantly younger age at onset than those with heterozygous variants. The allele frequency of heterozygous variants in patients with age at onset at 50 years and younger with familial PD and sporadic PD showed no differences. [¹²³I]meta-iodobenzylguanidine (MIBG) myocardial scintigraphy indicated that half of patients harboring PINK1 heterozygous variants showed a decreased heart to mediastinum ratio (12/23). Our findings emphasize the importance of PINK1 variants for the onset of PD in patients with age at onset at 50 years and younger and the broad spectrum of clinical symptoms in patients with PINK1 variants.

A comparative effectiveness pilot study of teriparatide for medication-related osteonecrosis of the jaw: daily versus weekly administration

We studied the effectiveness of teriparatide (TPTD) for treating medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis and examined differences in the clinical outcomes following daily versus weekly TPTD. The outcomes were significantly improved in the entire patient series and the daily group.

PURPOSE

Teriparatide (TPTD) treatment for Stage II-III medication-related osteonecrosis of the jaw (MRONJ) in osteoporotic patients has yielded promising results in uncontrolled studies. The daily administration and the weekly administration of TPTD have been reported to improve outcomes in MRONJ. Herein, we sought to identify differences in the clinical outcomes of MRONJ patients treated with daily TPTD versus weekly TPTD.

METHODS

We enrolled 13 patients and randomly assigned them to receive either of two treatments: 1×/week 56.5-μg TPTD injection for 6 months (weekly group; n = 6 patients after 1 dropout), or 20-μg TPTD injection daily for 6 months (daily group; n = 6 patients). Patients in both groups received conventional therapy plus intensive antibiotic therapy as necessary. We compared the changes in the patients' clinical stage of MRONJ, bone metabolism, percentage of bone formation, and bone turnover markers between the weekly and daily groups.

RESULTS

TPTD treatment with MRONJ led to partial remission or complete remission in 5 daily-group patients and 3 weekly-group patients. The MRONJ stage was significantly improved from baseline to 6 months of treatment in the entire series of 12 patients (p = 0.008); the weekly group did not show significant improvement, but the daily group did (p = 0.01).

CONCLUSIONS

This study provides the first comparison of clinical outcomes between MRONJ patients who received daily or weekly TPTD injections. Six months of treatment with TPTD realized a significant improvement of MRONJ stage in both the entire patient series and the daily group.

Suitable methods of measuring acceleration time in the diagnosis of internal carotid artery stenosis

Purpose

To enhance the utility of acceleration time (AcT) in the diagnosis of internal carotid artery (ICA) stenosis, we assessed the value of AcT measurements with different waveform patterns.

Methods

Ninety-three patients with acute atherothrombotic cerebral infarction were enrolled, and they underwent both carotid ultrasonography and digital subtraction angiography (DSA). AcT was determined by a conventional procedure (using the first peak point or the bending point) and the peak systolic velocity (PSV) procedure. The AcT ratio was calculated as (AcT of ICA)/(AcT of the ipsilateral common carotid artery). We evaluated the correlation of stenosis rate as assessed by the North American Symptomatic Carotid Endarterectomy Trial method using DSA (DSA-NASCET) with the AcT of ICA (ICA-AcT), the AcT ratio measured by the conventional procedure (conventional AcT ratio), and the AcT ratio measured by the PSV procedure (PSV AcT ratio). The area under receiver operating characteristic curves (AUC) for DSA-NASCET was calculated based on the ICA-AcT and AcT ratio.

Results

Forty-five vessels had 50% or greater ICA stenosis. DSA-NASCET was positively correlated with the conventional AcT ratio (r = 0.723), conventional ICA-AcT (r = 0.638), and PSV AcT ratio (r = 0.245). The corresponding AUCs for ICA stenosis ≥ 50% were 0.971, 0.886, and 0.572, respectively.

Conclusion

We demonstrated the usefulness of the conventional procedure for diagnosing stenosis of ICA origin using AcT and showed that the AcT ratio was a more beneficial parameter than AcT.

Estimating transboundary transported anthropogenic sulfate deposition in Japan using the sulfur isotopic ratio

High emissions of air pollutants from Northeast Asia are strongly influenced by air quality as well as by ecosystems. This study investigated the spatiotemporal variations in the sulfur isotopic ratio (δ³⁴S) in atmospheric deposition at eleven monitoring stations in Japan from 2011 to 2016 and estimated the amount of transboundary transported anthropogenic sulfate (TRB) deposition using mass balance calculations. The δ³⁴S of sulfate in precipitation ranged from -0.42 to +22.7‰. Sea salt (SS), TRB, and domestic anthropogenic sources (DOM) were the dominant sources of sulfate deposition in Japan. TRB sulfate deposition was largest on the Sea of Japan side, with an annual average value of 1.5 ± 0.3-6.9 ± 0.5 mg m^-2 d^-1 (36-44%), followed by Mt. Happo (4.5 ± 0.1 mg m^-2 d^-1; 88%), the Pacific Ocean side (1.5 ± 0.8, 4.3 ± 0.9 mg m^-2 d^-1; 24-50%), and the remote islands in the North Pacific Ocean (1.1 ± 0.2, 2.0 ± 0.8 mg m^-2 d^-1; 19-32%). TRB sulfate deposition on the Sea of Japan side was 2-12 times higher in winter and 1-2 times higher in summer than that of DOM. In contrast, TRB sulfate deposition on the Pacific Ocean side was 1.5-3 times higher in summer than in winter due to high precipitation levels. In Tokyo, the annual contribution from DOM sulfate deposition is approximately three times higher than that from TRB. Annual TRB sulfate deposition is lowest at Ogasawara at 1.1 ± 0.2 mg m^-2 d^-1, and the annual oceanic DMS contribution to sulfate deposition is high, accounting for 1.3 mg m^-2 d^-1 (20 ± 6%). The contribution of Asian dust was estimated to be 1-5.2 mg m^-2 d^-1(3-6%), which occurred in a single Asian dust event on the Sea of Japan side.

Dissipation, dehalogenation, and denitration of chloroaromatic compounds by Nocardioides sp. strain PD653: Characterization of the substrate specificity

The substrate range of Nocardioides sp. strain PD653, capable of mineralizing hexachlorobenzene, was investigated based on the dissipation of substrates and the liberation of halogen ions. Strain PD653 dehalogenated 10 out of 18 halophenol congeners; however, it could dehalogenate only hexachlorobenzene out of seven halobenzene congeners tested. Moreover, dehalogenation activities were shown for chloronitrobenzenes, along with an increase in the number of substituted chlorine atoms except for 2,3,4,5-tetrachloro-1-nitrobenzene. These results suggested that this strain might be applicable to remediate soil contaminated with these persistent chloroaromatic compounds.

Effect of surface charge, particle size, and modification by polyethylene glycol of liposomes on their association with Caco-2 cells across an unstirred water layer

For the development of orally available liposomes, understanding the interaction of liposomes with the intestinal mucosa is important. An unstirred water layer (UWL) on the intestinal epithelium surface is a considerable permeability barrier for lipophilic drugs. Therefore, the effects of an UWL on liposome transport across intestinal epithelial cells must be elucidated. We evaluated the effects of the surface charge, particle size, and polyethylene glycol (PEG) modification of liposomes on their association with Caco-2 cells across an UWL. When the association of cationic liposomes with Caco-2 cells was evaluated under a reduction in UWL thickness by shaking, the uptake and/or amount of surface-bound cationic liposomes in cells was increased significantly in a shaking rate-dependent manner. The uptake and/or amount of surface-bound neutral liposomes were increased only at the highest shaking rate. No significant differences in the cellular association of anionic liposomes and PEG-modified liposomes were observed with or without shaking. The association of large liposomes with Caco-2 cells was affected considerably by an UWL compared with that of small liposomes. These results suggest that an UWL affects the surface binding and subsequent uptake of liposomes in Caco-2 cells according to their particle size, surface charge, and PEG modification.

Identification and functional characterization of novel mutations including frameshift mutation in exon 4 of CSF1R in patients with adult-onset leukoencephalopathy with axonal spheroids and pigmented glia

Objective

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is caused by mutations in CSF1R. Pathogenic mutations in exons 12–22 including coding sequence of the tyrosine kinase domain (TKD) of CSF1R were previously identified. We aimed to identify CSF1R mutations in patients who were clinically suspected of having ALSP and to determine the pathogenicity of novel CSF1R variants.

Methods

Sixty-one patients who fulfilled the diagnostic criteria of ALSP were included in this study. Genetic analysis of CSF1R was performed for all the coding exons. The haploinsufficiency of CSF1R was examined for frameshift mutations by RT-PCR. Ligand-dependent autophosphorylation of CSF1R was examined in cells expressing CSF1R mutants.

Results

We identified ten variants in CSF1R including two novel frameshift, five novel missense, and two known missense mutations as well as one known missense variant. Eight mutations were located in TKD. One frameshift mutation (p.Pro104LeufsTer8) and one missense variant (p.His362Arg) were located in the extracellular domain. RT-PCR analysis revealed that the frameshift mutation of p.Pro104LeufsTer8 caused nonsense-mediated mRNA decay. Functional assay revealed that none of the mutations within TKD showed autophosphorylation of CSF1R. The p.His362Arg variant located in the extracellular domain showed comparable autophosphorylation of CSF1R to the wild type, suggesting that this variant is not likely pathogenic.

Conclusions

The detection of the CSF1R mutation outside of the region-encoding TKD may extend the genetic spectrum of ALSP with CSF1R mutations. Mutational analysis of all the coding exons of CSF1R should be considered for patients clinically suspected of having ALSP.

Electronic supplementary material

The online version of this article (10.1007/s00415-018-9017-2) contains supplementary material, which is available to authorized users.

Identification of the novel hcbB operon catalyzing the dechlorination of pentachlorophenol in the Gram-positive bacterium Nocardioides sp. strain PD653

While pcp genes are well known in Gram-negative bacteria to code for the enzymes responsible for pentachlorophenol (C₆HCl₅O; PCP) degradation, little is known about PCP-degrading genes in Gram-positive bacteria. Here we describe a novel gene operon possibly responsible for catalyzing the degradation of PCP in the Gram-positive bacterium Nocardioides sp. strain PD653, which is capable of mineralizing hexachlorobenzene (C₆Cl₆; HCB) via PCP. Transcriptome analysis based on RNA-Seq revealed overexpressed genes in strain PD653 following exposure to HCB. Based on in silico annotation, three open reading frames (ORFs) were selected as biodegrading enzyme candidates. Recombinant E. coli cells expressing candidate genes degraded approximately 9.4 µmol L^-1 PCP in 2 hr. Therefore, we designated these genes as hcbB1, hcbB2, and hcbB3. Interestingly, PCP-degrading activity was recorded when hcbB3 was coexpressed with hcbB1 or hcbB2, and the function of HcbB3 was expected to be similar to chlorophenol 4-monooxygenase (TftD).

Usefulness of acceleration time ratio in diagnosis of internal carotid artery origin stenosis

Purpose

The acceleration time (AcT) ratio of the internal carotid artery (ICA) is increased in ICA stenosis. However, there are few reports that have directly compared the AcT ratio to digital subtraction angiography (DSA) findings.

Methods

We evaluated 177 vessels with DSA and carotid artery ultrasonography. The AcT ratio was calculated as AcT of the ICA (ICA–AcT)/AcT of the ipsilateral common carotid artery (CCA). We evaluated the correlation of DSA–NASCET stenosis with the origin of the ICA or the peak systolic velocity (ICApsv) in the stenotic region, ICApsv/peak systolic velocity of the CCA (CCApsv), ICA–AcT, and AcT ratio. Sensitivity and specificity for stenosis ≥ 70% were calculated based on the ICApsv, ICApsv/CCApsv, ICA–AcT, and AcT ratio.

Results

Using NASCET criteria, 34 vessels had 70% or greater stenosis. DSA–NASCET showed a significant positive correlation with ICApsv, ICApsv/CCApsv, ICA–AcT, and AcT ratio (p < 0.0001). When the cut-off value for ICApsv was set at 176 cm/s, ICApsv/CCApsv at 2.42, ICA–AcT at 0.095 s, and the AcT ratio at 1.35, the sensitivity was 97.1, 97.1, 82.4, and 97.1%, and the specificity was 94.4, 91.0, 83.2, and 83.2%, for DSA–NASCET ≥ 70%, respectively.

Conclusion

The AcT ratio is a beneficial parameter for evaluating ICA stenosis as well as ICApsv and ICApsv/CCApsv.

[Human herpesvirus 6 encephalitis followed by acute disseminated encephalomyelitis in an immunocompetent adult]

A 26-year-old, otherwise healthy man presented with visual abnormality followed by loss of consciousness and convulsion. The patient then developed headache and fever 14 days later. Brain MRI showed hyperintensities in the left cingulate cortex. The cerrebrospinal fluid examinations showed mononuclear pleocytosis and positive PCR results for human herpesvirus 6 (HHV-6). A diagnosis of HHV-6 encephalitis and symptomatic epilepsy was made. The patient's clinical symptoms improved promptly following acyclovir treatment. However, 3 months later the patient noticed dysesthesia in the trunk, the left upper limb and the right lower limb. Brain and spine MRI showed multiple brain white matter lesions, the middle cerebellar peduncle and cervical spinal lesions. The symptoms resolved following methylprednisolone pulse therapy only. We report an adult patient with HHV-6 encephalitis followed by acute disseminated encephalomyelitis whose initial presentation was epilepsy. HHV-6 encephalitis should be included in the differential diagnosis of encephalitis of unknown etiology in an immunocompetent adult.

Increased maximum common carotid intima-media thickness is associated with smoking and hypertension in Tochigi Prefecture residents

OBJECTIVE

We investigated maximum intima-media thickness of the common carotid artery (IMT-C_max) in residents of Tochigi Prefecture, who have been reported to have high stroke mortality.

METHOD

Our study included 840 individuals. All participants underwent carotid ultrasonography and answered a questionnaire during participation in a health festival in Tochigi Prefecture. The questionnaire was designed to collect information on age, gender, and risk factors for stroke. IMT-C_max was measured. Statistical analyses were performed to identify factors contributing to IMT-C_max values ≥1.1 mm.

RESULTS

In total, 117 subjects had an IMT-C_max value ≥1.1 mm. IMT-C_max correlated significantly with age, current smoking, hypertension, diabetes mellitus, heart disease, and previous symptomatic stroke (p < 0.05) in univariate analysis. Current smoking (p < 0.001, odds ratio 3.88) and hypertension (p = 0.0070, odds ratio 1.83) were seen as significant contributing factors to IMT-C_max ≥1.1 mm in logistic regression analysis adjusted by age, gender, and previous symptomatic stroke.

CONCLUSION

We identified current smoking and hypertension as the most significant contributing factors to increased IMT-C_max in residents of Tochigi Prefecture, emphasizing the importance of routine blood pressure monitoring and anti-smoking education in this population.

The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study

BACKGROUND

There may be a link between right-to-left shunt (RLs) and brain white matter lesions (WMLs) in patients with migraine. In this study, we assessed the relationship between WMLs and RLs in Japanese migraine patients.

METHODS

A total of 107 consecutive patients with migraine with (MA) and without aura (MWOA) were included in this study. Contrast transcranial Doppler ultrasound was used to detect RLs. WMLs were graded using brain magnetic resonance imaging based on well-established criteria.

FINDINGS

The prevalence of RLs was significantly increased in the WMLs positive group (n = 24) compared with the WMLs negative group (n = 83) (75.0% vs. 47.0%, p = 0.015). In prevalence of WMLs between MA and MWOA patients, there were no statistical differences (p = 0.410). Logistic regression analysis adjusted by age and disease duration of migraine identified an RLs-positive status as the sole determinant for the presence of WMLs (OR = 6.15; 95% CI 1.82-20.8; p = 0.003) CONCLUSION: Our study suggests a possible link between RLs and WMLs in Japanese patients with migraine.

Prevalence of Right to Left Shunts in Japanese Patients with Migraine: A Single-center Study

Objective Several studies have shown an increased prevalence of right-to-left shunt (RLs) in migraine patients, particularly those with aura. However, the prevalence of RLs and its relation to Japanese patients with migraine are unknown. We investigated the prevalence of RLs in Japanese patients with migraine. Methods In total, 112 consecutive patients with migraine were recruited from our headache outpatient clinic. Migraine with aura (MA) and migraine without aura (MWOA) were diagnosed according to the International Classification of Headache Disorders, 3rd edition (beta-version). Contrast transcranial Doppler ultrasound was used to detect RLs, including patent foramen ovale (PFO). Then, the associations between RLs and patients' backgrounds and presence of aura were assessed. Results The overall prevalence of RLs and PFO in migraine patients was 54.5% and 43.8%, respectively. The prevalence of RLs and PFO in the MA group were significantly higher than in the MWOA group (RLs, 62.9% vs. 44.0%, p=0.046; PFO, 54.8% vs. 30.0%, p=0.008). There were no marked differences in the prevalence of large, middle and small shunts between MA and MWOA patients. Compared with the MWOA patients, the MA patients were younger (p=0.013) and had early onset age (p=0.013) and increased prevalence of photophobia (p=0.008). Conclusion RLs were found in over half of the Japanese patients with migraine. Our study suggests a possible link between RLs and MA.

OPTIMAL WAVELENGTH SELECTION ON HYPERSPECTRAL DATA WITH FUSED LASSO FOR BIOMASS ESTIMATION OF TROPICAL RAIN FOREST

Above-ground biomass prediction of tropical rain forest using remote sensing data is of paramount importance to continuous large-area forest monitoring. Hyperspectral data can provide rich spectral information for the biomass prediction; however, the prediction accuracy is affected by a small-sample-size problem, which widely exists as overfitting in using high dimensional data where the number of training samples is smaller than the dimensionality of the samples due to limitation of require time, cost, and human resources for field surveys. A common approach to addressing this problem is reducing the dimensionality of dataset. Also, acquired hyperspectral data usually have low signal-to-noise ratio due to a narrow bandwidth and local or global shifts of peaks due to instrumental instability or small differences in considering practical measurement conditions. In this work, we propose a methodology based on fused lasso regression that select optimal bands for the biomass prediction model with encouraging sparsity and grouping, which solves the small-sample-size problem by the dimensionality reduction from the sparsity and the noise and peak shift problem by the grouping. The prediction model provided higher accuracy with root-mean-square error (RMSE) of 66.16 t/ha in the cross-validation than other methods; multiple linear analysis, partial least squares regression, and lasso regression. Furthermore, fusion of spectral and spatial information derived from texture index increased the prediction accuracy with RMSE of 62.62 t/ha. This analysis proves efficiency of fused lasso and image texture in biomass estimation of tropical forests.

Development of high-order harmonic focusing system based on ellipsoidal mirror

We have developed a focusing system for extreme ultraviolet light produced by high-order harmonic generation. An ellipsoidal mirror with a precise surface shape was fabricated and installed into the focusing system. A rigid mirror manipulator and a beam profiler were employed to perform precise and stable mirror alignment. As a demonstration of the focusing performance, high-order harmonics in the wavelength range of 13.5-19.5 nm were successfully focused into a 2.4 × 2.3 μm(2) spot.

Production of secretory cutinase by recombinant Saccharomyces cerevisiae protoplasts

Background

During heterologous protein production using recombinant microbes, the protein tends to accumulate in the cell and may not be secreted. Here, we studied the production of secretory cutinase (heterologous protein) by recombinant Saccharomyces cerevisiae protoplasts.

Findings

Recombinant S. cerevisiae cells (i.e., cells into which the cutinase gene was transferred) secreted trace amounts of cutinase into the broth. Approximately 28 % of the cutinase produced in the cells localized to the cell walls and/or between cell wall and cell membrane (CW). In comparison with cell culture, protoplasts in a static culture secreted measurable amounts of cutinase into the broth. Protoplasts were protected from physical and osmotic stresses by entrapping them in a membrane capsule with a low-viscous liquid-core of 1.92 % w/v calcium-alginate. To increase secretory cutinase production, the entrapped protoplasts were cultivated in a shake flask at low osmotic pressure without disruption. During 60 h of cultivation, the extracellular cutinase activity of the free protoplasts at 29.3 atm and protoplasts entrapped in the capsule at 17.2 atm were 0.13 and 0.39 U/mL, respectively.

Conclusions

This is the first report which demonstrates that the efficient production of a secretable enzyme by using protoplasts isolated from recombinant microbes. This system described here is useful to produce products that accumulate in the CW.

Electronic supplementary material

The online version of this article (doi:10.1186/s40064-016-1806-4) contains supplementary material, which is available to authorized users.

Recurrent juvenile ischemic stroke caused by bow hunter's stroke revealed by carotid duplex ultrasonography

Bow hunter's stroke (BHS) is a rare cause of vertebrobasilar insufficiency due to rotational vertebral artery (VA) occlusion associated with head turning. We report a juvenile patient presenting with recurrent ischemic stroke caused by BHS, which was revealed by carotid duplex ultrasonography. Carotid duplex ultrasonography performed in the neutral position showed normal findings. However, disappearance of end-diastolic blood flow of contralateral VAs was observed with head rotation. Digital subtraction angiography confirmed occlusion at C1/2 levels in the VA contralateral to the head rotation, bilaterally. Importantly, our patient did not recognize the association of head rotation and previous episodes of stroke. We suggest that BHS should be considered in patients with cryptogenic stroke occurring in the vertebrobasilar artery territory.

Sleep apnoea headache in obstructive sleep apnoea syndrome patients presenting with morning headache: comparison of the ICHD-2 and ICHD-3 beta criteria

Background

Morning headache is associated with obstructive sleep apnoea syndrome (OSAS); however, OSAS patients present with various characteristics of morning headache, and they often do not fulfil the International Classification of Headache Disorders (ICHD)-2 criteria for “sleep apnoea headache”. The aims of this study were to assess the new ICHD-3 beta criteria for sleep apnoea headache in OSAS patients and to evaluate the differences with the ICHD-2.

Methods

We conducted a cross-sectional survey regarding morning and sleep apnoea headaches that included 235 OSAS outpatients receiving continuous positive airway pressure (CPAP) treatment. The presence of morning headache was evaluated by reviewing the medical records before administration of CPAP treatment.

Results

Of all of the OSAS patients, 48 (20.4 %) reported morning headaches. Of the 48 patients with morning headaches, 29 (60.4 %) and 39 (81.3 %) fulfilled the ICHD-2 and ICHD-3 beta criteria for sleep apnoea headache, respectively. The increased frequency of individuals who qualified for diagnosis was likely attributable to the extension of headache duration from 30 min to 4 h. The severity of OSAS was not associated with the presence of sleep apnoea headache.

Conclusions

The utilisation of ICHD-3 beta criteria is clinically useful for diagnosing sleep apnoea headache in patients with OSAS. Applying the ICHD-3 beta criteria was of clinical significance when considering the marked response of these headaches to CPAP therapy. The cause of sleep apnoea headache remains to be elucidated.

Post-irradiation Skin Changes Associated with Lumbosacral Radiculopathy

We herein describe the cases of two patients with post-irradiation lumbosacral radiculopathy. The patients underwent postoperative radiation therapy to the abdomen due to testicular neoplasms 20 and 25 years prior to the onset of weakness, respectively. On physical examinations, asymmetric lower limb weakness and areflexia without apparent sensory loss were observed in both patients. Interestingly, artificial and squared atrophy of the skin and subcutaneous tissue, thought to correspond to the radiation fields, were observed in the lower back, and electromyography revealed selective motor axon loss localized to the lower extremities. The detection of skin changes in the area being irradiated is a valuable clue for diagnosing post-irradiation lumbosacral radiculopathy.

[Lateral medullary infarction presenting with truncal lateropulsion and decreased pain and temperature sensation below T10 sensory level]

A 45-year-old man noted a tendency to fall to the left side on standing following headache and vomiting. Neurological findings were unremarkable except for truncal lateropulsion to the left side. Brain magnetic resonance imaging (MRI) showed a small infarct in the left inferolateral part of medulla. Clinical and imaging findings suggested vertebral artery dissection as the cause of stroke. On hospital day 6, the patient developed decreased pain and temperature sensation in the right side below T10 sensory level and decreased sweating on the left side of the face with miosis of the left pupil. Brain MRI revealed an expanded lesion of the left inferolateral part of medulla. In our patient, the involvement of the spinocerebellar tract and the lateral spinothalamic tract likely contributed to the development of truncal lateropulsion and sensory disturbance below thoracic levels, respectively. Our case is clinically important in understanding a correlation between clinical symptoms and lateral medullary lesions.

Expression of variant CD44, exon 6 in patients with metastatic pulmonary tumor

High expression ratios of CD44 variant 6 (CD44 V6) in patients with metastatic pulmonary tumor were found in those with primary lesions of cancer of the colon, uterus, larynx, liver and osteosarcoma. It was clarified that patients showing expression of CD44 variant 6 likely revealed pulmonary metastasis at earlier time following operations of primary cancer (p<0.05). CD44 V6, an adhesion molecule, was a factor to participate in pulmonary metastases from various organ cancers. No significant correlation was observed in survival between patients with CD44 V6 positive versus negative tumors, except laryngeal tumor after resection of primary or metastatic lung tumor. CD44 V6 related to its invasive and further metastatic functions in metastatic lung tumor. We suggest that cancer cells expressing the CD44 molecule especially V6 may adhere to vascular endothelium and hyaluronic acid in the lung. And cancer cells without this molecule liberated from the primary focuses hardly adhere to the pulmonary tissues supposedly resulting in delayed metastases and proliferations in the pulmonary tissues.

PP075. Endothelial dysfunction may be impaired by increased oxidative stress in preeclamptic women

INTRODUCTION

The essential pathogenesis in preeclampsia is vasospasm induced by endothelial cell injury. The vascular endothelium regulates vascular smooth muscle tone by producing vasoconstrictors and vasodilators, such as nitric oxide (NO). Recently, it has been reported that the levels of oxidative stress are increased and they may impair endothelial NO production and induce endothelial dysfunction in preeclampsia.

OBJECTIVES

To determine whether maternal release of oxygen free radical and antioxidants are associated with maternal vascular endothelial cell injury, we measured serum parameters of oxidative stress and endothelial function during pregnancy in women with or without preeclampsia.

METHODS

We evaluated 20 participants with uncomplicated pregnancies, 15 with mild preeclampsia, and 18 with severe preeclampsia. Plasma concentrations were measured for derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) as markers of oxygen free radicals and antioxidants, respectively. Flow-mediated vasodilation (FMD) was also assessed as a marker of endothelial function.

RESULTS

D-ROMs were increased in the maternal blood of the severe preeclamptic group compared with the control group (681.0±239.0 vs 478.6±101.4 CARR U, P<0.001), but not in the mild preeclamptic group (562.0±106.5 CARR U). Plasma BAP levels did not change significant in all three groups. The proportion of d-ROMs to BAP was higher in the severe preeclamptic group than in controls (0.28±0.11 vs 0.21±0.05, P<0.01), but not in the mild preeclamptic group (0.24±0.08). FMD was significantly decreased in both preeclamptic groups (severe, 4.3±3.3%, P<0.001; mild, 6.5±3.6%, P<0.001) compared with controls (10.5±2.3%), but FMD in the severe preeclamptic group was significantly greater than in the mild preeclamptic group. A negative correlation between FMD and d-ROM concentrations was observed in all participants (r=-0.376, P<0.05), and the ratio of serum d-ROMsto BAP correlated negatively with FMD (r=-0.413, P<0.05) in all participants.

CONCLUSION

We found that the production of oxygen free radicals increased, but not the production of antioxidants which decreased, as a result, an imbalance between reactive oxygen species formation and antioxidant defence mechanisms may have impaired endothelial function in preeclamptic women.

Video-assisted thoracic surgery for lung cancer in hemodialysis patients

INTRODUCTION

In recent years, the number of hemodialysis patients has been continuously increasing. At the same time, the use of video-assisted thoracic surgery (VATS) for lung cancer has also increased. However, reports of the outcome of VATS in hemodialysis patients are still quite rare.

METHODS

From 1995 to 2011, 14 patients with non-small cell lung cancer who were also receiving hemodialysis underwent lung resection by open thoracotomy or VATS at our institution. These patients were divided into two groups as follows: open (five men and four women, mean age: 68.7 years) and (2) VATS (three men and two women, mean age: 64.0 years). We compared the clinical outcomes of these two groups.

RESULTS

Lobectomy was performed in eight patients in the open group, including one patient who also underwent a pneumonectomy, and in four patients in the VATS group, including one who also underwent a wedge resection. There were no significant difference between the groups' operation times, intraoperative blood loss, length of postoperative chest drainage, and length of postoperative hospitalization. There were no hospital deaths in either group. The 5-year survival rate was 42.9% in the open group and 37.5% in the VATS group. This difference was not significant (P=0.73).

CONCLUSION

VATS lung resection for lung cancer patients on hemodialysis is considered an acceptable treatment modality, though the long-term survival rate of such patients is relatively low, which can be attributed to the diseases underlying the need for hemodialysis.

Prognosis of patients after pulmonary artery plasty for non-small cell lung cancer

OBJECTIVE

We evaluated the clinical outcomes of patients after lung resection with pulmonary artery (PA) plasty for non-small cell lung cancer (NSCLC).

METHODS

From 1995 to 2006, 36 patients (26 males and 10 females) with NSCLC underwent lobectomy or segmentectomy with PA plasty at our institution. The mean age of the patients was 65.9 years old (range 45-87 years old). There were 17 left upper lobectomies, 10 right upper lobectomies, five left lower lobectomies, two right upper-and-middle bilobectomies, one right lower lobectomy, and one left upper division segmentectomy. Both bronchoplasty and PA plasty were performed in 15 patients. Six patients received preoperative chemotherapy, and one had preoperative radiotherapy.

RESULTS

The postoperative morbidity rate was 27.8 % (10/36), and the mortality rate (30 days) was 2.8 % (1/36). One patient underwent completion pneumonectomy on postoperative day 13. Macroscopic residual cancer was identified in two patients at the thoracic wall and aorta, respectively; microscopic residual cancers were identified in two patients at the stumps of the pulmonary artery and in one patient at the bronchial stump. Postoperative radiation therapy was additionally given to those four patients, except one. The 5-year survival rate for all patients was 51.8 %. There was no significant difference in the 5-year survival rate between clinical N (cN) 0-1 patients and cN2 patients. However, in pathological N (pN) 0-1 patients, the 5-year survival rate was significantly better than that of pN2 patients (71.9 % versus 0.0 %; P < 0.001).

CONCLUSIONS

PA plasty for NSCLC is acceptable and highly recommended for pN0-1 patients. Strict patient selection should be considered so as to avoid surgical operations in patients with pN2 staging.

Determination of lead(II) in fly ash leachate using a newly developed simple spectrophotometric method

A new simple method for the spectrophotometric determination of Pb(II) in fly ash leachates was developed. These leachates tend to contain a large amount of Ca(II) and Zn(II); this interferes with spectrophotometric determination of Pb(II) when conventional colorimetric agents are used. A copolymer consisting of protoporphyrin IX disodium salt and acrylamide was synthesized as a colorimetric agent. A measuring reagent containing ethylenediamine-N,N'-dipropionic acid (EDDP) as a masking agent for Zn(II) and an appropriate amount of Ca(II) together with the copolymer was applied to determine Pb(II). The temporal change in the absorption spectrum of the measuring reagent was acquired with a newly developed portable spectrophotometer for this method. The composition of EDDP and Ca(II) in the measuring reagent was optimized to measure leachates contaminated with Ca(II) and Zn(II). The detection limit and relative standard deviation of Pb(II) measured using the optimized method were 0.05 mg L(-1) and 2.3%, respectively. The tolerance limits for Ca(II) and Zn(II) contaminants, where errors of less than 10% were allowed at a concentration of 0.5 mg L(-1) Pb(II), were 4000 and 4 mg L(-1), respectively. The determination of Pb(II) in various samples of actual leachates from incinerator fly ash was examined with this method. The obtained values correlated well with those obtained by flame atomic absorption spectroscopy.

Synthesis of porphyrin-incorporated polymers and their application for simultaneous detection of multimetal components by using spectrophotometry

For the purpose of detection of multimetal components in environment, alteration of the spectrophotometrical metal sensitivity of porphyrin was attempted. Two porphyrin-incorporated polymers were newly synthesized by the free radical copolymerization of protoporphyrin IX disodium salt and vinyl monomers, and their metal sensitivities were examined by measuring the difference absorption spectra. These porphyrin-incorporated polymers showed different metal sensitivities and their sensitivities were altered by change of pH. Three measuring reagents, which were different in the combination of the porphyrin-incorporated polymers and pH, were used for the simultaneous detection of multimetal components in metal ion mixtures. The difference spectra of these reagents showed the separate peaks corresponding to six metal ions, Bi(III), Co(II), Cu(II), Mn(II), Pb(II), and Zn(II). The spectra were acquired reproducibly by using standard normal variate (SNV) transformation. Furthermore, this method was applied to detect multimetal components in water samples such as tap water and industrial effluent.

Biodegradation of diphenylarsinic acid to arsenic acid by novel soil bacteria isolated from contaminated soil

Microorganisms capable of degrading diphenylarsinic acid (DPAA) were enriched from contaminated soil using the soil-charcoal perfusion method. Two novel bacterial strains, L2406 and L2413, that can degrade DPAA in a mineral salt medium supplemented with DPAA as the sole carbon source were isolated. Based on comparative morphology, physiology, and comparison of the 16S rRNA gene sequences, both were presumed to be species closely related to Ensifer adhaerens. As the metabolites, phenylarsonic acid (PAA) was determined by liquid chromatography-mass spectrometry analysis as well as three unknown peaks all of whose molecular weights were estimated to be 278. The increase of m/z = 16 from DPAA in the unknowns suggests monohydroxylation of DPAA at the 2-, 3- and 4-positions. The ability of strains L2406 and L2413 to degrade DPAA was suppressed in iron insufficient conditions, e.g. less than 7.2 muM iron in the culture medium. These facts strongly suggest the following hypothesis: Monooxygenase works at the initial degradation step of DPAA degradation by the isolates; and direct hydrolysis from DPAA to PAA is not likely to occur. In addition, release of arsenic acid from PAA by strain L2406 was confirmed by liquid chromatography-inductively coupled plasma mass spectrometry. From these results, strain L2406 was considered to be capable of degrading DPAA to arsenic acid via PAA when DPAA was supplied as the sole carbon source.

Cross-sectional study on respiratory effect of toner exposure

In this baseline study, part of a cohort study to clarify the effect of toner exposure on the respiratory system, we surveyed 803 male toner workers and 802 referents with regard to their subjective respiratory symptoms and chest X-ray results. We also examined individual exposure history, current working conditions, and personal exposure levels to toner. There was a significantly higher prevalence of "coughing and sputum" related complaints among toner-exposed workers in the 30 and 40-year age groups. The group with toner-exposure history showed a higher odds ratio, by logistic regression, in relation to all questions regarding coughing. Mild fibrotic changes were observed in the chest X-rays of four workers who had engaged in toner-exposure work for at least a decade or more, and all four had reported allergic disease. Although we observed a tendency of higher prevalence of "coughing and sputum" in toner-exposed workers, the possibility of information bias cannot be eliminated. It should also be noted that this tendency did not exceed that of the general public. Further analysis is required in this ongoing 10-year cohort study to clarify the effect of toner exposure on the respiratory system.