Inhaled nitric oxide therapy for preterm infants after 7 days of age: a scoping review protocol

INTRODUCTION

Inhaled nitric oxide (iNO) use is recommended for persistent pulmonary hypertension of the newborn in term and late preterm infants. Recently, iNO therapy to prevent bronchopulmonary dysplasia (BPD) or rescue for hypoxic respiratory failure and pulmonary hypertension secondary to BPD has increasingly been used in preterm infants after 7 days of postnatal age (in the postacute phase), despite its off-label use. However, the initiation criteria of iNO therapy for preterm infants in the postacute phase are varied. The aim of this scoping review is to identify the clinical and/or echo findings at the initiation of iNO therapy in preterm infants in the postacute phase.

METHODS AND ANALYSIS

We will search PubMed, Embase and the Japanese database 'Ichushi.' The following studies will be included in the review: randomised controlled trials, prospective/retrospective cohort studies, case-control studies and case series on iNO therapy for preterm infants in the postacute phase; studies published between January 2003 and August 2023; studies conducted in developed countries and studies written in English or Japanese. We will independently screen, extract and chart data using the population-concept-context framework following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will summarise the characteristics and findings of the included studies.

ETHICS AND DISSEMINATION

Obtaining an institutional review board approval is not required because of the nature of this review. A final report of review findings will be published and disseminated through a peer-reviewed journal and presentation at relevant conferences.

TRIAL REGISTRATION NUMBER

UMIN000051498.

Trans-pacific multicenter collaborative study of minimally invasive proximal versus total gastrectomy for proximal gastric and gastroesophageal junction cancers

BACKGROUND

The current standard operation for proximal gastric and gastroesophageal junction (P/GEJ) cancers with limited esophageal extension is total gastrectomy (TG). TG is associated with impaired appetite and weight loss due to the loss of gastric functions such as production of ghrelin and with anemia due to intrinsic factor loss and vitamin B12 malabsorption. Theoretically, proximal gastrectomy (PG) can mitigate these problems by preserving gastric function. However, PG with direct esophagogastric reconstruction is associated with severe postoperative reflux, delayed gastric emptying, and poor quality of life (QoL). Minimally invasive PG (MIPG) with antireflux techniques has been increasingly performed by experts but is technically demanding owing to its complexity. Moreover, the actual advantages of MIPG over minimally invasive TG (MITG) with regards to postoperative QoL are unknown. Our overall objective of this study is to determine the short-term QoL benefits of MIPG. Our central hypotheses are that MIPG is safe and that patients have improved appetite after MIPG with effective antireflux techniques, which leads to an overall QoL improvement when compared with MITG.

METHODS

Enrollment of a total of 60 patients in this prospective survey-collection study is expected. Procedures (MITG versus MIPG, antireflux techniques for MIPG [double-tract reconstruction versus the double-flap technique]) will be chosen based on surgeon and/or patient preference. Randomization is not considered feasible because patients often have strong preferences regarding MITG and MIPG. The primary outcome is appetite level (reported on a 0-10 scale) at 3 months after surgery. With an expected 30 patients per cohort (MITG versus MIPG), this study will have 80% power to detect a one-point difference in appetite level. Patient-reported outcomes will be longitudinally collected (including questions about appetite and reflux), and specific QoL items, body weight, body mass index and ghrelin, albumin, and hemoglobin levels will be compared.

DISCUSSION

Surgeons from the US, Japan, and South Korea formed this collaboration with the agreement that the surgical approach to P/GEJ cancers is an internationally important but controversial topic that requires immediate action. At the completion of the proposed research, our expected outcome is the establishment of the benefit and safety of MIPG.

TRIAL REGISTRATION

This trial was registered with Clinical Trials Reporting Program Registration under the registration number NCI-2022-00267 on January 11, 2022, as well as with ClinicalTrials.gov under the registration number NCT05205343 on January 11, 2022.

Congenital Maxillomandibular Synechia with Multiple Malformations in a Very-Low-Birth-Weight Infant: A Case Report

Congenital maxillomandibular synechia is a rare malformation that is characterized by a fusion of the maxilla and mandible. The fusion is fibrous or bony and prevents mouth opening, which causes difficulties in feeding and occasionally in breathing. Although extremely rare, neonatologists must understand the disease because it can be fatal and require emergency treatment after birth. We report the case of a very-low-birth-weight (VLBW) infant with congenital maxillomandibular synechia and other malformations, including cleft palate, syndactyly, and cryptorchidism. The patient presented with extremely limited mouth opening, and endotracheal intubation seemed impossible; fortunately, the patient did not have respiratory distress syndrome. The patient underwent surgical release of the fibrous bands on days 10 and 17, and good mouth opening was achieved. The patient was able to consume breast milk orally and was discharged home at a corrected gestational age of 1 month without recurrence of difficulty in mouth opening or any sequelae. This is the first reported case of a VLBW infant with congenital maxillomandibular synechia who required more complicated management of feeding, surgical intervention, and anesthesia.

The ratio of plant 137Cs to exchangeable 137Cs in soil is a crucial factor in explaining the variation in 137Cs transferability from soil to plant

To mitigate radioactive cesium from soil to plant, increasing and maintaining the exchangeable potassium (ExK) level during growth is widely accepted after Tokyo Electric Company's Fukushima Dai-ichi Nuclear Plant accident in Japan. This is because the antagonistic relationship between soil solution K and ¹³⁴Cs + ¹³⁷Cs (RCs) concentrations changes the transfer factor (TF: designated as the ratio of radioactivity of plant organ to soil) of RCs. As the relationship between ExK and TF depends on the soil types, crop species, and other environmental factors, the required amount of ExK should be set to a safe side. Eleven years after the accident, as the activity of ¹³⁴Cs was almost negligible, ¹³⁷Cs became the main RCs in most of the agricultural fields in Fukushima Prefecture. We propose a new indicator, the concentration ratio of plant ¹³⁷Cs to soil exchangeable ¹³⁷Cs (Ex¹³⁷Cs), instead of TF, which showed a better correlation with ExK even among soils with different properties (or mineralogy).

Predictive capability of material screening by fast neutron activation analysis using laser-driven neutron sources

Bright, short-pulsed neutron beams from laser-driven neutron sources (LANSs) provide a new perspective on material screening via fast neutron activation analysis (FNAA). FNAA is a nondestructive technique for determining material elemental composition based on nuclear excitation by fast neutron bombardment and subsequent spectral analysis of prompt γ-rays emitted by the active nuclei. Our recent experiments and simulations have shown that activation analysis can be used in practice with modest neutron fluences on the order of 10⁵ n/cm², which is available with current laser technology. In addition, time-resolved γ-ray measurements combined with picosecond neutron probes from LANSs are effective in mitigating the issue of spectral interference between elements, enabling highly accurate screening of complex samples containing many elements. This paper describes the predictive capability of LANS-based activation analysis based on experimental demonstrations and spectral calculations with Monte Carlo simulations.

Combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomy: a novel approach for cervicomediastinal goiters

PURPOSE

After our group described the first remote-access thyroidectomy series in 2000, the procedure has been further developed. Although a thoracoscopic approach with a conventional open cervical incision for thyroid goiters with mediastinal extension has been performed at many institutions, remote-access thyroidectomy for cervicomediastinal goiters has not been established. We have performed combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomies (axillo-thoracic endoscopic thyroidectomies). Here, we describe a novel technique for performing a remote-access thyroidectomy for a cervicomediastinal goiter (CMG).

PATIENTS AND METHODS

The patients with CMGs who agreed to an axillo-thoracic endoscopic thyroidectomy at one of two hospitals in Japan underwent a remote-access thyroidectomy.

RESULTS

We performed the axillo-thoracic endoscopic right or left hemithyroidectomy successfully, but most of the patients did not require the thoracoscopic procedure. None of the patients had complications, and none was converted to an open thyroidectomy.

CONCLUSIONS

Most thyroid goiters with substernal extension can be removed by the axillary approach, but some cases require a thoracoscopic approach. The novel approach described herein (axillo-thoracic endoscopic thyroidectomy) enables the safe excision of a CMG with high patient satisfaction for selected patients.

Effectiveness of non-exchangeable potassium quantified by mild tetraphenyl‑boron extraction in estimating radiocesium transfer to soybean in Fukushima

Non-exchangeable K released from soil minerals can reduce radiocesium transfer to plants, as well as exchangeable K. We investigated the effect of non-exchangeable K on radiocesium transfer to soybean, and the non-exchangeable K extraction method most suitable for estimating the transfer risk. In Fukushima Prefecture, Japan, 106 soils were collected from 89 soybean fields during 2014-2018 to analyze non-exchangeable K contents using three methods: boiling nitric acid extraction, tetraphenyl‑boron extraction, and mild tetraphenyl‑boron extraction. The non-exchangeable K contents quantified by the former two methods were dependent on the amount of micas, which are K-bearing minerals. The non-exchangeable K content by mild tetraphenyl‑boron extraction depended on the amount of K fertilizer application and K-fixing minerals but not on micas, indicating that it reflects fertilizer K fixed by the minerals. The soil-to-plant transfer factor of radiocesium was most correlated with the non-exchangeable K content by the mild extraction (rs = -0.67). This correlation was also stronger than that between exchangeable K and the transfer factor (rs = -0.40). As non-exchangeable K content increased, the exchangeable radiocesium fraction decreased, indicating that radiocesium was fixed together with K. Additionally, multiple regression analysis indicated that non-exchangeable K by the mild extraction significantly decreased the transfer factor even if the exchangeable radiocesium fraction was kept constant. Thus, the fixed K was considered to repress radiocesium transfer to soybean through both radiocesium fixation and K supply. With the criterion of total extracted K, the sum of exchangeable and non-exchangeable K, as 65 mg K2O 100 g-1 by the mild extraction, fields with high and low transfer factors were able to be differentiated more effectively than with a current criterion of exchangeable K as 50 mg K2O 100 g-1. The results revealed that mild tetraphenyl‑boron extraction is effective for estimating radiocesium transfer to soybean.

A scoping review of approaches used for remote-access parathyroidectomy: A contemporary review of techniques, tools, pros and cons

After our coauthors described the first remote-access parathyroidectomy (RAP) series in 2000, several other approaches were developed. No systematic review has been performed to classify and evaluate RAP techniques. We performed a literature search using PubMed and Cochrane Library (CENTRAL). A total of 71 studies met our inclusion/exclusion criteria. RAP can be categorized into five approaches: (1) endoscopic and robotic axillary, (2) anterior chest, (3) transoral, (4) retroauricular, and (5) a combination of these approaches. The limited data in the literature suggest that the cure rates and safety of RAP are in no way inferior to those of open parathyroidectomy. Each approach has its advantages and disadvantages, and the recommendations for the selection of each approach are listed. The selection of approach methods might depend on the surgeon's experience and familiarity and the patient's preference and disease status.

Pancreatic serous cystadenocarcinoma diagnosed with liver metastasis at 7 years after the resection of the primary serous neoplastic lesion

Pancreatic serous neoplasms are rare tumors that are usually benign. However, histopathological differentiation between benign (serous cystadenoma) and malignant (serous cystadenocarcinoma) lesions is difficult. We present the case of a patient with pancreatic serous cystadenocarcinoma that was diagnosed with liver metastasis 7 years after the resection of the primary serous neoplastic lesion. A woman in her 60 s was diagnosed with pancreatic serous cystadenoma based on imaging and histopathological examination findings. The tumor was resected, and the patient was followed up every 6 months to monitor tumor progression. At 7 years after the resection of the primary lesion, liver tumors showing marked flare-like contrast enhancements were detected on arterial phase computed tomography findings and on dynamic magnetic resonance imaging findings acquired 60 s after the administration of a contrast agent. Laparoscopic segmental hepatectomy of S4 and S6 was performed to resect these tumors. Histopathological examination revealed that these tumors were metastatic and developed from the primary lesion. Therefore, a diagnosis of serous cystadenocarcinoma was confirmed. The flare-like contrast enhancement around the metastatic liver lesions on computed tomography and dynamic magnetic resonance images may be an indicator of serous cystadenocarcinoma with liver metastasis that could assist in diagnosis.

Use of Ultra-high-frequency Ultrasound for Aplasia Cutis Congenita of the Scalp

Aplasia Cutis Congenita (ACC) in the scalp is a rare congenital malformation. The treatment for ACC with large defects involving the scalp, bone, and the dura is challenging. Local debridement of necrotic tissue is important to prevent lethal complications such as infection and meningitis. However, debridement has the risk of damaging the sagittal sinus or the dura. Recent developments in ultra-high-frequency ultrasound(US) systems provide frequencies of 70 MHz and capability resolution as fine as 30 μm, which could allow precise imaging of small and thin anatomical structures. The study aimed to describe the methods of precise evaluation of the defect in the scalp and safe debridement using ultra-high-frequency US. This is the first report on direct observation of a newborn’s brain using ultra-high-frequency US. The boy was delivered spontaneously with a large defect of the scalp and bone. After 14 days, due to signs of infection, local debridement was performed carefully under ultra-high-frequency US-based evaluation. The dura, the sagittal sinus, and the small anatomical structures such as arachnoid granulations could be observed. Because the brain herniation gradually aggravated, dural reconstruction using fascia lata and scalp reconstruction using transposition flap was performed. Finally, good skin coverage over the defects was obtained. This method minimizes the risk of damaging the sagittal sinus and the brain parenchyma, which may cause fatal complications. Although further clinical investigations will be required to confirm its efficacy, ultra-high-frequency US has the potential to be a useful device for ACC treatment.

Association of symptomatic gallstones and primary hyperparathyroidism: a propensity score-matched analysis

If the prevalence of primary hyperparathyroidism (PHPT) in patients with symptomatic gallstones is higher than that in the general population, PHPT screening could reveal important clinical implications. We observed that the prevalence of PHPT in these patients was higher compared to that of healthy matched controls.

Survival Outcomes of Two-Stage Intracardiac Repair in Large Ventricular Septal Defect and Trisomy 18

BACKGROUND

Surgical management has not been encouraged in patients with trisomy 18 (T18) and congenital heart diseases due to poor survival. This study aimed to investigate (1) the appropriateness of palliative surgeries followed by intracardiac repair (ICR) (i.e., two-stage ICR) for patients with a large ventricular septal defect (VSD) and T18, and (2) its impact on their long-term outcomes.

METHODS

Medical charts of patients with VSD and T18 who underwent two-stage ICR at the Japanese Red Cross Medical Center between January 2005 and December 2019 were retrospectively reviewed. Demographic data, timing, and types of palliative surgeries, information related to ICR, peri- and postoperative clinical information, postoperative survival, and cause of death were collected. The long-term prognosis of patients treated with two-stage ICR was compared with that of patients treated with primary ICR and palliative surgery without ICR.

RESULTS

Overall, 18 (2 male, 16 female) patients underwent two-stage ICR. Pulmonary artery banding was the initial palliative surgery in all patients after a median duration of 19.5 (range 6-194) days of life. The median age and the mean body weight at the time of ICR were 18.2 (7.6-50.7) months and 6.0 ± 1.0 kg, respectively. The mean pulmonary artery pressure and pulmonary vascular resistance index before ICR were 19.1 ± 7.3 mmHg and 3.4 ± 2.0 U m², respectively. Overall, 17/18 (94%) patients were discharged after ICR. Fourteen (78%) patients were alive during data collection. None of the patients died of cardiac insufficiency, and the median duration of survival was 46.3 (14.3-186.4) months since birth. Most patients required cardiac medications rather than pulmonary vasodilators at the last follow-up. During the study period, three patients underwent primary ICR, and 46 underwent palliative surgery without ICR. Of those who underwent primary ICR, two died in the hospital on the first and 48^th day following ICR, and the third died 179 days after the ICR. The Log-rank test revealed a significantly longer survival for the patients treated with two-stage ICR compared with those treated with palliative surgery without ICR (P = 0.003).

CONCLUSION

Two-stage ICR improves the long-term survival of patients with VSDs and T18. This safe surgical strategy can also prevent pulmonary hypertension in such patients.

Total endoscopic thyroidectomy after open neck biopsy of the follicular lymphoma of the thyroid gland

Remote-access total endoscopic thyroidectomy (TET) is a recently established approach that can avoid producing scars in the neck. There are no clear surgical indications for TET for benign nodules or for malignant tumors at present. We report a successful TET in a 50-year-old Japanese woman with follicular lymphoma of the thyroid gland after an open neck biopsy. She had been referred to us with a neck tumor noted 2 months earlier. Because of adhesion, we performed a combined resection of the thyroid and partial right sternohyoid muscle. To the best of our knowledge, there is no other report of a TET performed after open neck surgery. Our patient's case demonstrates that (a) the cosmetic outcome of TET is clearly superior to that of conventional open neck surgery, and (b) a TET can be suitable even for reoperation if carefully selected.

Is total endoscopic parathyroidectomy an acceptable treatment for patients with primary hyperparathyroidism due to a presumed solitary adenoma?-comparison of minimally invasive total endoscopic parathyroidectomy and open minimally invasive parathyroidectomy

Background

Remote-access thyroidectomy and its cosmetic merit have been widely accepted, but remote-access parathyroidectomy has not become common. There are few reports about the risks and effectiveness of a remote-access endoscopic parathyroidectomy. Herein, we evaluated the risks and benefits of total endoscopic parathyroidectomy (TEP) for patients with primary hyperparathyroidism (PHPT). We retrospectively compared the surgical outcomes of TEP and open minimally invasive parathyroidectomy (MIP).

Methods

We analyzed the cases of 28 patients with PHPT who were scheduled to undergo a MIP at Mita Hospital (Tokyo) during the period from April 2015 to March 2019, all of whom were presumed preoperatively to have a single adenoma.

Results

Eleven of the patients underwent a TEP (10 females, one male; mean age 54.2 years). The other 17 patients underwent an open MIP (11 females, 6 males; mean age 63.5 years). The younger patients and the females tended to select endoscopic surgery as their treatment. The operation time was significantly longer in the TEP group compared to the open MIP group (106 vs. 50 min; P<0.001). Common postoperative complications (such as recurrent laryngeal nerve paralysis and seroma) did not occur in this series. For the TEP patients who did not undergo a partial thyroidectomy, the mean amount of drainage on the first postoperative day was only 19±10 mL. The operative cure rate of the minimally invasive parathyroidectomies was 96.4%.

Conclusions

TEP is a good surgical procedure for hyperparathyroidism caused by a single adenoma, and it achieves superior cosmetic results without increasing the rate of complications.

Advanced approach for screening soil with a low radiocesium transfer to brown rice in Fukushima based on exchangeable and nonexchangeable potassium

Phytoavailable K in soil is a key to control the transfer factor of radiocesium from soil to brown rice. The transfer factors were determined for paddy fields cultivated in 2017 and 2018 under different K fertilization regimes in Fukushima Prefecture, Japan. Two phytoavailable forms of K, the exchangeable and nonexchangeable K contents were investigated for the surface soil sampled after the transplanting and fertilization as well as after harvest of rice in the same paddy fields. The exchangeable K content largely decreased from after transplanting and fertilization to after harvest, and the exchangeable K of the soil after harvest was negatively correlated with the transfer factor (r_s = -0.70, p < .001). Most soil samples after harvest showed that the transfer factors exponentially increased as the exchangeable K decreased; however, some of the samples indicated considerably low transfer factors (<0.005) despite being exchangeable K deficient, i.e., exchangeable K < 25 mg K₂O 100 g^-1. Even though this value before usual fertilization has been effectively used as a threshold to determine whether supplemental K fertilization is required to reduce the radiocesium content in brown rice, additional screening was needed to estimate this radiocesium transfer more precisely. Thus, we found that not only the exchangeable K but also nonexchangeable K contents had a negative correlation with the transfer factor (r_s = -0.60, p < .001) of the soil samples after harvest but were not correlated with each other (r_p = -0.10). Furthermore, the results revealed that soil with nonexchangeable K > 50 mg K₂O 100 g^-1 indicated a considerably low transfer factor, even if exchangeable K deficient. Thus, via our field-scale experiments, we concluded that the criterion nonexchangeable K > 50 mg K₂O 100 g^-1 can be used as another threshold for use along with that of exchangeable K to differentiate soil with a low radiocesium transfer rate from exchangeable K deficient soil.

Asian dust increases radiocesium retention ability of serpentine soils in Japan

Radiocesium (RCs) is selectively adsorbed on interlayer sites of weathered micaceous minerals, which can reduce the mobility of RCs in soil. Therefore, soils developed from mica-deficient materials (e.g. serpentine soils) may have a higher risk of soil-to-plant transfer of RCs. Soils were collected from three serpentine soil profiles; Udepts in Oeyama, Japan, and Udepts and Udox in Kinabalu, Malaysia. Soil was sampled every 3 cm from 0 to 30 cm depth and sieved to isolate soil particles of ≤20 μm diameter for the assessment of radiocesium interception potential (RIP) after a series of pretreatments. One subset was treated with H₂O₂ to remove organic matter (OM). Another subset was further treated with hot sodium citrate to remove hydroxy-Al polymers (Al(OH)x). RIP_untreated was <0.4 mol kg^-1 whereas mica-K content was <0.02% by weight for ≤20-μm soil particles from Udepts and Udox in Kinabalu, Malaysia, values as low as those of non-micaceous minerals (e.g. kaolinite and smectite). Neither OM nor Al(OH)x removal resulted in a large increase in RIP value for these soils. These results clearly indicated that serpentine soils in Malaysia have very few RCs selective adsorption sites due to the absence of micaceous minerals. In contrast, soil from Udepts in Oeyama, Japan showed average RIP_untreated of 5.6 mol kg^-1 and mica-K content of 0.72% by weight for the ≤20-μm particles. Furthermore, the RIP value was significantly increased to an average of 22.5 mol kg^-1 after removing both OM and Al(OH)x. These results strongly suggest that weathered micaceous minerals primarily control the ability to retain RCs. These micaceous minerals cannot originate from serpentine minerals, and are probably incorporated as an exotic material, such as Asian dust. This hypothesis is supported by the δ¹⁸O value of quartz isolated from the ≤20-μm soil particles from Oeyama, Japan (+16.13‰±0.11‰), very similar to that of Asian dust. In conclusion, serpentine soils in Japan may exhibit a reduced risk of soil-to-plant transfer of RCs due to the historical deposition of Asian dust.

Prostaglandin E-major urinary metabolite as a noninvasive surrogate marker for infantile necrotizing enterocolitis

BACKGROUND

Early definitive diagnosis of necrotizing enterocolitis (NEC) based on Bell's staging criteria is difficult because there are few observable changes on abdominal imaging and blood chemistry tests at the onset of the disease.

PURPOSE

To investigate whether prostaglandin E-2 major urinary metabolite (PGE-MUM) can be a useful surrogate marker reflecting the disease state and severity of NEC in infants.

METHODS

Infants were enrolled in this study between January 2014 and December 2016. NEC diagnosis was based on Bell's staging criteria > Stage II or necrotic bowel observed at surgery. After diagnosis, PGE-MUM level was measured and compared with that of the other disease and healthy infant groups.

RESULTS

Median PGE-MUM value was highest in the NEC group (576 [65-3672] μg/g•Cre/BSA × 1000), followed by the other disease group (94 [57-296] μg/g•Cre/BSA × 1000) and the healthy infant group (19 [10-44] μg/g•Cre/BSA × 1000) (sensitivity: 92.3%, specificity: 81.5%, accuracy: 85.0%; p < 0.01). PGE-MUM level correlated with improved status of NEC, length of necrotic intestine, and Bell's staging criteria.

CONCLUSIONS

PGE-MUM level may be a useful surrogate biomarker reflecting the disease state of NEC. The method of urine sample collection is also advantageous, being noninvasive for infants. This is the first study reporting PGE-MUM level in NEC.

TYPE OF STUDY

Study of diagnostic test.

LEVEL OF EVIDENCE

LEVEL II.

Phytoavailability of 137Cs and stable Cs in soils from different parent materials in Fukushima, Japan

Weathered micaceous minerals (micas) are able to release potassium ion (K⁺) and fix caesium-137 (¹³⁷Cs), both of which reduce soil-to-plant transfer of ¹³⁷Cs. Among micas, trioctahedral micas such as biotite is expected to have a stronger ability to supply nonexchangeable K⁺ and a higher amount of Cs fixation sites than dioctahedral micas such as illite. Although biotite is predominant in granitic soils (G soils), illite is mainly dominant in sedimentary rock soils (S soils). Therefore, we hypothesized that G soils have a lower ¹³⁷Cs transfer risk than S soils because of this difference in mineralogy. The objective of the present study was to determine the transfer factor (TF) of ¹³⁷Cs and stable Cs (SCs) and to elucidate the determinant factors of TFs for G and S soils in Fukushima, Japan. Pot experiments were carried out with rice (Oryza sativa L. cv. Hokuriku 193) in G and S soils to determine the TF of ¹³⁷Cs (TF-¹³⁷Cs) and stable Cs (TF-SCs) under K-deficient conditions. TF-¹³⁷Cs and TF-SCs were highly correlated, and both were significantly lower for G soils than for S soils. Higher TF values were shown for soils with lower amounts of exchangeable and nonexchangeable K or with higher percentages of exchangeable ¹³⁷Cs (ex¹³⁷Cs). The percentage of ex¹³⁷Cs was negatively correlated with the amount of Cs fixation sites, represented by the radiocaesium interception potential. Thus, we concluded that smaller TF values for G soils were caused by a stronger ability to supply nonexchangeable K⁺ and a higher amount of Cs fixation sites. These findings will contribute to the establishment of soil screening techniques based on ¹³⁷Cs transfer risk in Fukushima prefecture.

Standardization of nitric oxide inhalation in extremely preterm infants in Japan

BACKGROUND

In perinatal medicine, inhaled nitric oxide (iNO) has been an important tool for the treatment of full-term and late-preterm infants with persistent pulmonary hypertension of the newborn (PPHN) and hypoxemic respiratory failure (HRF). Its use in more premature infants, however, is controversial. To evaluate the current clinical practices regarding use of acute iNO in extremely preterm infants, a nationwide survey was conducted in Japan.

METHODS

A questionnaire survey was conducted from May to September, 2015. Questionnaires about PPHN and iNO treatment were sent to the doctor in charge of the neonatal care unit in 213 perinatal medical centers (PMC) that possessed iNO equipment in Japan.

RESULTS

A total of 143 of the 213 PMC provided responses (67.1%). A diagnosis of PPHN was made exclusively on echocardiography in all PMC. On definitive PPHN diagnosis, iNO was selected in the majority of the PMC (72%) and started from ≤10 p.p.m. in most PMC (49.7%) for extremely preterm infants. During iNO therapy, cardiac function was checked on echocardiography by a neonatologist every ≤8 h. iNO weaning was started when differential peripheral oxygen saturation (SpO₂ ) disappeared, or when SpO₂ reached 100% and so on. After iNO concentration reached 5 p.p.m., it was decreased gradually and carefully in five steps, taking 12-24 h to go from 5 to 0 p.p.m.

CONCLUSIONS

Inhaled nitric oxide was predominantly used in extremely preterm infants as early rescue therapy for PPHN based on echocardiography performed by a neonatologist.

Genesis of ultra-high-Ni olivine in high-Mg andesite lava triggered by seamount subduction

The Kamchatka Peninsula is a prominent and wide volcanic arc located near the northern edge of the Pacific Plate. It has highly active volcanic chains and groups, and characteristic lavas that include adakitic rocks. In the north of the peninsula adjacent to the triple junction, some additional processes such as hot asthenospheric injection around the slab edge and seamount subduction operate, which might enhance local magmatism. In the forearc area of the northeastern part of the peninsula, monogenetic volcanic cones dated at <1 Ma were found. Despite their limited spatiotemporal occurrence, remarkable variations were observed, including primitive basalt and high-Mg andesite containing high-Ni (up to 6300 ppm) olivine. The melting and crystallization conditions of these lavas indicate a locally warm slab, facilitating dehydration beneath the forearc region, and a relatively cold overlying mantle wedge fluxed heterogeneously by slab-derived fluids. It is suggested that the collapse of a subducted seamount triggered the ascent of Si-rich fluids to vein the wedge peridotite and formed a peridotite–pyroxenite source, causing the temporal evolution of local magmatism with wide compositional range.

Age-Adjusted Glycated Albumin at Diagnosis is more Correlated with the Product of Age and Plasma Glucose than Plasma Glucose Alone in Patients with Neonatal Diabetes Mellitus

BACKGROUND

We previously showed that glycated albumin (GA) is a useful glycemic control indicator in patients with neonatal diabetes mellitus (NDM), and that age-adjusted GA (Aa-GA) can reflect more accurately glycemic control status. Here, we investigated whether the age at diagnosis influences Aa-GA at diagnosis of NDM.

METHODS

Eight patients with NDM whose GA was measured at diagnosis (age at diagnosis: 39 ± 18 days; GA: 31.3 ± 7.6%; Aa-GA: 47.1 ± 10.3%; plasma glucose: 525 ± 194 mg/dl) were included. Aa-GA was calculated as follows: Aa-GA = GA × 14.0/[1.77 × log-age (days) + 6.65]. Correlations of GA or Aa-GA at diagnosis with its logarithmically transformed age in days (log-age), plasma glucose, and their product were investigated.

RESULTS

GA at diagnosis was not significantly correlated with log-age or plasma glucose. On the other hand, Aa-GA at diagnosis was significantly positively correlated with plasma glucose (R = 0.75, P = 0.031) and was more strongly positively correlated with the product of plasma glucose and log-age (R = 0.82, P = 0.012) although it was not correlated with log-age.

CONCLUSION

Aa-GA at diagnosis is influenced by both age in days and plasma glucose. This finding is likely to show the aspect that age in days is almost equal to diabetes duration because glycemic control indicators including GA reflect the weighted mean of plasma glucose.

Graft-infiltrating host dendritic cells play a key role in organ transplant rejection

Successful engraftment of organ transplants has traditionally relied on preventing the activation of recipient (host) T cells. Once T-cell activation has occurred, however, stalling the rejection process becomes increasingly difficult, leading to graft failure. Here we demonstrate that graft-infiltrating, recipient (host) dendritic cells (DCs) play a key role in driving the rejection of transplanted organs by activated (effector) T cells. We show that donor DCs that accompany heart or kidney grafts are rapidly replaced by recipient DCs. The DCs originate from non-classical monocytes and form stable, cognate interactions with effector T cells in the graft. Eliminating recipient DCs reduces the proliferation and survival of graft-infiltrating T cells and abrogates ongoing rejection or rejection mediated by transferred effector T cells. Therefore, host DCs that infiltrate transplanted organs sustain the alloimmune response after T-cell activation has already occurred. Targeting these cells provides a means for preventing or treating rejection.

Age-adjusted glycated albumin accurately reflects blood glucose in patients with neonatal diabetes mellitus: comparison with calculated glycated albumin determined by past blood glucose concentrations

Background

Glycated albumin is a useful glycaemic control indicator for neonatal diabetes mellitus. However, glycated albumin concentrations in infants are lower than those in adults and increase in an age-dependent manner. Based on our investigation of non-diabetic subjects, we proposed the possibility that the reference range for adults may be used regardless of age, provided that age-adjusted glycated albumin is employed. In the present study, we evaluate the usefulness of age-adjusted glycated albumin in neonatal diabetes mellitus patients.

Methods

Six neonatal diabetes mellitus patients (four patients with permanent neonatal diabetes mellitus and two patients with transient neonatal diabetes mellitus) were included. Measured glycated albumin or age-adjusted glycated albumin was compared to calculated glycated albumin, which was determined using calculation formulae we had reported based on past blood glucose over the 50 days before measurement of glycated albumin.

Results

Measured glycated albumin was significantly lower than calculated glycated albumin (20.5 ± 4.9% versus 28.2 ± 6.1%; p < 0.0001), whereas age-adjusted glycated albumin was equivalent to calculated glycated albumin, showing no significant difference (27.5 ± 6.8% versus 28.2 ± 6.1%). Measured glycated albumin concentrations in patients with transient neonatal diabetes mellitus in remission were lower than the reference range for adults, whereas age-adjusted glycated albumin concentrations were within the reference range for adults.

Conclusion

We demonstrated that age-adjusted glycated albumin concentrations were consistent with calculated glycated albumin. Age-adjusted glycated albumin is therefore a useful glycaemic control indicator for neonatal diabetes mellitus patients.

Relationships between Paddy Soil Radiocesium Interception Potentials and Physicochemical Properties in Fukushima, Japan

The radiocesium interception potential (RIP) of bulk soil (RIP) can reliably be used to predict the magnitude of soil-to-plant radiocesium transfer. There has been some controversy about which soil properties control the RIP, although the RIP is theoretically proportional to the amount of frayed edge sites in micaceous clay minerals. The RIP was determined for 97 paddy soils in three regions (Hama-dori, Naka-dori, and Aizu) in Fukushima Prefecture, Japan, and the relationships between selected physicochemical properties and the RIP were analyzed. The mean (± standard deviation) of the RIP for the 97 soils was 1.67 (±0.87) mol kg, and the range was 0.34 to 5.36 mol kg. Pearson correlation analysis revealed that the RIP positively correlated best ( < 0.01) with the clay fraction K content as a mass fraction of the bulk soil (clay-K) and negatively correlated with the total C content and the phosphate absorption coefficient ( < 0.05). Therefore, clay-K, an indicator of the amount of micaceous clay minerals in a soil, was confirmed as being useful for estimating the magnitude of the RIP for paddy soils in Fukushima. The RIP was invariably low if either the total C content exceeded 6.0% or the phosphate absorption coefficient exceeded 1500 mg kg, suggesting that these parameters could be useful for screening soils with particularly low RIP values.

The circadian clock functions as a potent regulator of allergic reaction

Symptoms and laboratory parameters of allergic diseases exhibit prominent ~24-h variations. For instance, in most allergic rhinitis patients, symptoms worsen overnight or early in the morning. Accordingly, there are benefits to nighttime dosing of anti-allergy medications in such patients. Although the circadian pathophysiology of allergic diseases is well documented, the biological basis of this phenomenon remains poorly understood. Recent studies have begun to reveal that the internal timekeeping system termed the circadian clock plays a key role in temporal regulation of allergic reaction, and may therefore underlie the circadian pathophysiology of allergic diseases. Here, we review new knowledge that highlights the emerging role of the circadian clock as a potent regulator of allergic reactions. Given the strong influence of circadian rhythms on allergic diseases, we believe that research on how the time of day impacts allergic reaction which we may call 'chronoallergology' will provide new insight into previously unknown aspects of the biology of allergies. Such knowledge should facilitate novel strategies for prevention and treatment of these diseases.

Positive association between serum thymic stromal lymphopoietin and anti-citrullinated peptide antibodies in patients with rheumatoid arthritis

Thymic stromal lymphopoietin (TSLP) has been suggested recently to play an important role in the pathophysiology of rheumatoid arthritis (RA). However, there is little information on serum TSLP concentrations in RA and its clinical significance. The present study investigated whether serum TSLP concentrations were affected in patients with RA. Using an enzyme-linked immunosorbent assay (ELISA), we measured TSLP concentrations in the serum obtained from 100 patients with RA, 60 patients with osteoarthritis (OA) and 34 healthy volunteers. We also investigated the correlation between serum TSLP concentrations and clinical parameters of disease activity in RA [disease activity score using 28 joint counts (DAS28)-C-reactive protein (CRP), DAS28-erythrocyte sedimentation rate (ESR), Clinical Disease Activity Index (CDAI]), patient's/-physician's Visual Analogue Scale (VAS), swollen joints count, tender joints count, CRP, ESR and matrix metalloproteinase-3 (MMP-3) concentrations]. In addition, we investigated the correlation between serum TSLP concentrations and anti-citrullinated peptide antibody (ACPA) and serum tumour necrosis factor (TNF)-α. Serum TSLP levels in patients with RA were significantly higher than those in patients with OA and in healthy volunteers. Interestingly, serum TSLP concentrations were correlated significantly with ACPA titres, but not with other clinical parameters. There was a significant increase in serum TSLP concentrations in patients with RA, which was correlated positively with serum ACPA titres. These findings suggest that in patients with RA, TSLP may play a role in ACPA production by B cells.

Allergen-specific basophil reactivity exhibits daily variations in seasonal allergic rhinitis

It remains poorly understood how symptoms in allergic rhinitis are most severe during overnight or early in the morning. The circadian clock consisting of a network of several ‘clock genes’ including Clock drives daily rhythms in physiology. This study showed that allergen-induced surface CD203c expression on basophils in seasonal allergic rhinitis caused by Japanese cedar pollen exhibited a time-of-day-dependent variation associated with temporal variations in canonical circadian clock gene expression. We also found that bone-marrow-derived basophils (BM basophils) generated from wild-type mice exhibited a time-of-day-dependent variation in IgE-mediated IL-4 and histamine production, which was not observed in BM basophils generated from Clock-mutated mice. Therefore, allergen-specific basophil reactivity shows daily variations depending on the circadian clock activity in basophils, which could partly explain temporal symptomatic variations in allergic rhinitis. Additionally, circadian variations in CD203c expression should be considered for interpretation of this biomarker in clinical research.

Relationship between the radiocesium interception potential and the transfer of radiocesium from soil to soybean cultivated in 2011 in Fukushima Prefecture, Japan

The concentration of radiocesium ((134)Cs and (137)Cs) in agricultural fields around Fukushima Dai-ichi Nuclear Power Plant (FDNPP) was elevated after the accident in March 2011. Evaluation of soil properties that influence phytoavailability of radiocesium is important for optimal soil management to minimize radiocesium transfer to crops. In this study, soybean grain and soil samples (0-15 cm) were collected from 46 locations in Fukushima Prefecture in 2011, and (137)Cs concentrations were measured. (137)Cs concentration ranges were 11-329 Bq kg(-1)-dry in soybean grain samples, and 0.29-2.49 kBq kg(-1)-dry in soil samples. The radiocesium interception potential (RIP) values in the soil samples ranged from 0.30 to 8.61 mol kg(-1). RIP negatively correlated with total carbon content and oxalate-extractable Si and Al + 1/2 Fe in the soils, suggesting that soils rich in organic matter and poorly crystalline clays tended to have lower RIP in this region. The soil-to-plant transfer factor for (137)Cs, analyzed in relation with various soil characteristics, varied by two orders of magnitude and was significantly negatively correlated with RIP and exchangeable K concentration in soil. The results show that RIP is useful for evaluating the efficiency of radiocesium transfer from soil to plants in this region.

HbA1c can be a useful glycemic control marker for patients with neonatal diabetes mellitus older than 20 weeks of age

BACKGROUND

The accuracy of most HbA1c analysis methods is affected by the presence of increased fetal hemoglobin (HbF). The objective of this study was to investigate the age at which HbA1c measurements become useful for monitoring glycemic control in patients with neonatal diabetes mellitus (NDM).

METHODS

We retrospectively analyzed the data of 5 NDM patients diagnosed at 38±20 days of age, who each had several available HbA1c measurements during the first year of life, with a control group of HbA1c values over the course of 1 year for 13 patients with type 1 diabetes mellitus (T1DM). Mean blood glucose (MBG) levels derived from premeal or premeal plus bedtime blood glucose measurements prior to HbA1c measurements were compared to HbA1c values.

RESULTS

The NDM patients' age at which the difference in the HbA1c/MBG ratios became not significant between the NDM patients and the T1DM patients was 21 weeks of age and over. Even after the HbA1c was adjusted for HbF, this ratio was significantly lower in the NDM patients at <21 weeks of age than in the T1DM patients.

CONCLUSIONS

HbA1c can be a useful glycemic control marker for NDM patients >20 weeks of age.

Radiocesium sorption in relation to clay mineralogy of paddy soils in Fukushima, Japan

Relationships between Radiocesium Interception Potential (RIP) and mineralogical characteristics of the clay fraction isolated from 97 paddy soils (Hama-dori, n = 25; Naka-dori, n = 36; Aizu, n = 36) in Fukushima Prefecture, Japan were investigated to clarify the mineralogical factors controlling the (137)Cs retention ability of soils (half-life 30.1 y). Of all the fission products released by the Fukushima accident, (137)Cs is the most important long-term contributor to the environmental contamination. The RIP, a quantitative index of the (137)Cs retention ability, was determined for the soil clays. The composition of clay minerals in the soil clays was estimated from peak areas obtained using X-ray diffraction (XRD) analyses. The predominant clay mineral was smectite in soils from Hama-dori and Aizu, while this was variable for those from Naka-dori. Native K content of the soil clays was found to be an indicator of the amount of micaceous minerals. The average RIP for the 97 soil clays was 7.8 mol kg(-1), and ranged from 2.4 mol kg(-1) to 19.4 mol kg(-1). The RIP was significantly and positively correlated with native K content for each of the geographical regions, Hama-dori (r = 0.76, p < 0.001), Naka-dori (r = 0.43, p < 0.05), and Aizu (r = 0.76, P < 0.001), while it was not related to the relative abundance of smectite. The linear relationship between RIP and native K content not only indicate a large contribution of micaceous minerals to the (137)Cs retention ability of the soil clays, but also could be used to predict the (137)Cs retention ability of soil clays for other paddy fields in Fukushima and other areas.

Examination of the percentage of immature platelet fraction in term and preterm infants at birth

Background:

Reticulated platelets (RPs) are newly synthesized platelets. Recently, an automatic method was established to detect RPs as a percentage of the immature platelet fraction (IPF%). Although, neonates often develop thrombocytopenia at some time during their hospitalization, the details of IPF% in neonates remain unclear. We, therefore, studied the relations between IPF% and other factors to gain a more detailed understanding of IPF% in neonates.

Methods:

The following clinical data were obtained from the medical records of 105 neonates who met our inclusion criteria: Gestational age, birth weight, IPF% and platelet count of neonatal peripheral blood at birth, and perinatal data. The subjects were divided into three groups: Group A, birth weight standard deviation score (SDS) ≥ −2 standard deviation (SD) and ≤ +2 SD; Group S, < −2 SD; and Group L, > +2 SD.

Results:

IPF% correlated negatively with platelet count at birth in the whole study population. IPF% was 2.8 ± 1.3% in term neonates, and IPF correlated negatively with gestational age and birth weight. Platelet count correlated positively with birth weight SDS in the whole study population and in Group S. IPF% correlated negatively with birth weight SDS in the whole study population and in Group S. In neonates with a platelet count below 25 × 10⁴/μl, IPF% correlated negatively with platelet count. Among other neonates, however, IPF% remained almost constant.

Conclusion:

Monitoring of IPF% is useful for estimating the function of thrombocytopoiesis in neonates and preterm infants.

Value of peritoneal cytology in potentially resectable pancreatic cancer

BACKGROUND

Peritoneal lavage cytology (CY) is used in the diagnosis and staging of various cancers. The clinical significance of positive cytology results in patients with pancreatic cancer is yet to be determined.

METHODS

Peritoneal washing samples were collected from consecutive patients with pancreatic cancer between July 1991 and December 2012. The correlations between cytology results, clinicopathological parameters and recurrence patterns were evaluated. The prognostic impact of CY status, regarding resectability and the effectiveness of adjuvant chemotherapy, were analysed.

RESULTS

Of 523 included patients, 390 underwent resection. Patients with tumours at least 2 cm in diameter were more likely to have CY+ status than patients with tumours smaller than 2 cm (48 of 312 versus 3 of 78 respectively; P = 0·005) and there was a significant correlation between CY+ status and tumour invasion of the anterior pancreatic capsule (43 of 276 versus 8 of 113 with no invasion of the capsule; P = 0·030). Although the overall survival of patients with resected CY+ tumours was worse than that of patients with resected CY- tumours, it was significantly better than the survival of unresected patients regardless of CY status. Multivariable analysis of all patients who had pancreatectomy did not identify CY+ as an independent prognostic factor. Patients with CY+ tumours tended to develop peritoneal metastasis more often than those with CY- tumours, although not significantly so. The median survival time of 34 patients with resected CY+ tumours who received adjuvant chemotherapy was better than that of 17 patients who had surgery alone, although this was not statistically significant (15·3 versus 10·0 months; P = 0·057).

CONCLUSION

CY+ status is not clinically equivalent to gross peritoneal metastasis in patients with pancreatic cancer. Curative resection is still recommended regardless of CY status.

Photophysical, amplified spontaneous emission and charge transport properties of oligofluorene derivatives in thin films

We investigate the charge transport, photophysical and amplified spontaneous emission properties of a series of monodisperse solution-processable oligofluorenes functionalized with hexyl chains at the C9 position of each fluorene unit.

Pancreatic agenesis with congenital diaphragmatic hernia and congenital heart disease: a case report

Pancreatic agenesis is a rare disease that causes neonatal diabetes mellitus and exocrine pancreatic insufficiency. We report the case of a very low birth weight infant with congenital diaphragmatic hernia, and congenital heart disease (ventricular septal defect and patent ductus arteriosus). Failure to gain weight, despite well-managed respiratory and heart failure, was improved by infusion of subcutaneous insulin, administration of pancreatic enzyme, and nutrition of medium-chain-triglyceride -enriched formula. This is the first case of pancreatic agenesis with both malformations where the patient is discharged from the hospital. Early diagnosis and adequate treatments to compensate pancreatic function may prevent mortality and improve growth.

Time-dependent changes of phytoavailability of Cs added to allophanic Andosols in laboratory cultivations and extraction tests

Although it is well known that phytoavailability of radiocaesium is gradually lost after its deposition on the ground by fixation to soil minerals, the decreasing rates during early period after the deposition is not yet quantitatively evaluated. In this study, stable Cs was added to 5 types of soil, including Andosols, a sand-dune regosol and a smectic lowland soil, in a laboratory soil incubation experiment to assess the aging effect of radiocaesium. Aliquots of a soil sample were put into pots and incubated in an artificial climate chamber. Orchardgrass or red clover was cultivated for 28 d in soil pots containing one of the allophanic Andosol samples seven times during about 1200 d using new pots for each cultivation. The soil-to-plant transfer factors of Cs declined exponentially until about 100 d and were almost constant thereafter. The extractabilities of Cs by water and 1 M NH4OAc solution from this allophanic Andosol soil sample also decreased with time and their decreasing patterns were similar to that of the transfer factor. The temporal changes of extractabilities of Cs in other soil samples were also examined 6 times during about 600 d. Rate of decline for the extracted yield of the added Cs by 1 M NH4OAc varied widely among all the soil types. Two allophanic Andosol samples showed relatively higher extractabilities in comparison with the other soils throughout the incubation experiment, which may be attributable to the lower contribution of Cs specific sorption sites to total cation exchange capacity of the allophonic Andosol soil samples.

[Assessment of oral health using the general oral health assessment index in patients with overactive bladder]

Patients administered anti-cholinergic agents, as first-line therapy for an overactive bladder (OAB) are often unable to continue medical treatment because of dry mouth. We assessed oral health in patients with OAB using the General Oral Health Assessment Index (GOHAI), an oral health-related quality of life questionnaire. We investigated 75 patients with OAB who were receiving continuous administration of anti-cholinergic agents. The OAB symptom score, as well as GOHAI and our original dry mouse score were determined by self-administered questionnaires. The mean age of the subjects was 70.9±10.2 years, the median period of anti-cholinergic agent use was 20 (1-116) months and the mean OAB symptom score was 6.3±3.1. The GOHAI score for all patients was 51.9±8.4 and not significantly different from the national normal value (p＝0.22). On the other hand, the score in patients with a severely dry mouth was 49.2±8.6, which was worse than the national normal value (p＝0.04). The psychosocial functioning score in patients with a severely dry mouth was significantly lower than in those with a slightly dry mouth (p＝0.02). Our results indicate that dry mouth in patients with OAB is significantly associated with worsening of oral health. GOHAI is useful as a screening test to assess the quality of life in patients with OAB.

Biological clock dysfunction exacerbates contact hypersensitivity in mice

BACKGROUND

Immediate-type skin allergic reactions, such as passive cutaneous anaphylactic reaction, are associated with circadian rhythm, but the role of circadian mechanisms on delayed-type skin allergic reactions, such as contact hypersensitivity (CHS), remains uncertain. In mice, CHS, a T-cell-mediated immune response, is a classic model of human allergic contact dermatitis.

OBJECTIVES

  We investigated whether biological clock dysfunction affects CHS pathogenesis in CLOCK mutant mice compared with wild-type (WT) mice.

METHODS

 Mice were treated with 2,4,6-trinitro-1-chlorobenzene (TNCB) on the abdominal skin on day 0 (sensitization) and then treated with TNCB on the ears on day 5 (challenge).

RESULTS

We found that biological clock dysfunction resulted in severe inflammation. Ear swelling, serum immunoglobulin E level and mast cell number were significantly increased in CLOCK mutant mice compared with WT mice. These results provide evidence that CLOCK mutation promotes the T-helper type 2 immune response and exacerbates CHS. Corticosterone has a protective effect on CHS. The serum corticosterone level lost rhythmicity and showed a decreased daily level in CLOCK mutant mice compared with WT mice, supporting the exacerbating effect of CLOCK mutation on CHS. Adrenalectomy markedly worsened TNCB-induced CHS in WT mice but not in CLOCK mutant mice. In addition, dramatic dexamethasone-induced protection of CHS was observed in CLOCK mutant mice compared with WT mice.

CONCLUSIONS

 The present results suggest that circadian rhythm might be an important factor in the regulation of CHS via corticosterone rhythmicity and/or level.

Nitrite reduces acute lung injury and improves survival in a rat lung transplantation model

Ischemia/reperfusion injury (IRI) is the most common cause of early mortality following lung transplantation (LTx). We hypothesized that nitrite, an endogenous source of nitric oxide (NO), may protect lung grafts from IRI. Rat lung grafts were stored in preservation solution at 4°C for 6 hours. Both grafts and recipients were treated with nitrite. Nitrite treatment was associated with significantly higher levels of tissue oxygenation, lower levels of cytokines and neutrophil/macrophage infiltration, lower myeloperoxidase activity, reduced oxidative injury and increased cGMP levels in grafts than in the controls. Treatment with either a nitric oxide scavenger or a soluble guanylyl cyclase (sGC) inhibitor diminished the beneficial effects of nitrite and decreased cGMP concentrations. These results suggest that nitric oxide, generated from nitrite, is the molecule responsible for the effects of nitrite via the nitric oxide/sGC/cGMP pathway. Allopurinol, a xanthine oxidoreductase (XOR) inhibitor, abrogated the protective effects of nitrite, suggesting that XOR is a key enzyme in the conversion of nitrite to nitric oxide. In vitro experiments demonstrated that nitrite prevented apoptosis in pulmonary endothelial cells. Nitrite also exhibits longer survival rate in recipients than control. In conclusion, nitrite inhibits lung IRI following cold preservation and had higher survival rate in LTx model.

Peierls mechanism of the metal-insulator transition in ferromagnetic hollandite K2Cr8O16

Synchrotron x-ray diffraction experiment shows that the metal-insulator transition occurring in a ferromagnetic state of a hollandite K(2)Cr(8)O(16) is accompanied by a structural distortion from the tetragonal I4/m to monoclinic P112(1)/a phase with a √2×√2×1 supercell. Detailed electronic structure calculations demonstrate that the metal-insulator transition is caused by a Peierls instability in the quasi-one-dimensional column structure made of four coupled Cr-O chains running in the c direction, leading to the formation of tetramers of Cr ions below the transition temperature. This provides a rare example of the Peierls transition of fully spin-polarized electron systems.

Impact of novel oncolytic virus HF10 on cellular components of the tumor microenviroment in patients with recurrent breast cancer

Oncolytic viruses are a promising method of cancer therapy, even for advanced malignancies. HF10, a spontaneously mutated herpes simplex type 1, is a potent oncolytic agent. The interaction of oncolytic herpes viruses with the tumor microenvironment has not been well characterized. We injected HF10 into tumors of patients with recurrent breast carcinoma, and sought to determine its effects on the tumor microenvironment. Six patients with recurrent breast cancer were recruited to the study. Tumors were divided into two groups: saline-injected (control) and HF10-injected (treatment). We investigated several parameters including neovascularization (CD31) and tumor lymphocyte infiltration (CD8, CD4), determined by immunohistochemistry, and apoptosis, determined by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Median apoptotic cell count was lower in the treatment group (P=0.016). Angiogenesis was significantly higher in treatment group (P=0.032). Count of CD8-positive lymphocytes infiltrating the tumors was higher in the treatment group (P=0.008). We were unable to determine CD4-positive lymphocyte infiltration. An effective oncolytic viral agent must replicate efficiently in tumor cells, leading to higher viral counts, in order to aid viral penetration. HF10 seems to meet this criterion; furthermore, it induces potent antitumor immunity. The increase in angiogenesis may be due to either viral replication or the inflammatory response.

Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

AIMS/HYPOTHESIS

It is difficult to use HbA(1c) as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal haemoglobin (HbF) remaining in the blood. In this study, glycated albumin (GA), which is not affected by HbF, and HbA(1c) were compared to evaluate whether they reflect glycaemic control in patients with NDM.

METHODS

This study included five patients with NDM. Age at diagnosis was 38 ± 20 days. Insulin therapy was started in all patients, and levels of GA, HbA(1c) and HbF were measured monthly for 6 months. One-month average preprandial plasma glucose (aPPG) was calculated using self-monitoring of blood glucose.

RESULTS

Plasma glucose and GA were elevated (29.7 ± 13.1 mmol/l [n = 5] and 33.3 ± 6.9% [n = 3], respectively) but HbA(1c) was within normal limits (5.4 ± 2.6% [35.5 ± 4.9 mmol/mol]; n = 4) at diagnosis. With diabetes treatment, aPPG (r = -0.565, p = 0.002), GA (r = -0.552, p = 0.003) and HbF (r = -0.855, p < 0.0001) decreased with age, whereas HbA(1c) increased (r = 0.449, p = 0.004). GA was strongly positively correlated with aPPG (r = 0.784, p < 0.0001), while HbA(1c) showed no correlation with aPPG (r = 0.221, p = 0.257) and was significantly inversely correlated with HbF (r = -0.539, p = 0.004).

CONCLUSIONS/INTERPRETATION

GA is a useful indicator of glycaemic control in patients with NDM, whereas HbA(1c) is influenced by age-related changes in HbF and does not accurately reflect glycaemic control.