Negative Results of Nucleic Acid Amplification Test for SARS-CoV-2 in Clinical Practice May Vary among Six Molecular Assays in COVID-19 Patients

Several commercial nucleic acid amplification tests (NAAT) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed. We used six kits available in Japan in 13 NAAT-positive specimens with crossing point values >36 and 7 NAAT-negative specimens from patients with coronavirus disease (COVID-19); their results were compared. Specimens positive in ≥2 assays were considered true positive and examined for concordance with specimen results. The SARS-CoV-2 Detection Kit -Multi- (Toyobo M) (Toyobo, Osaka, Japan) using extracted RNA had the highest concordance (κ 1.00). This was followed by the cobas® SARS-CoV-2 (Cobas) (Roche, Basel, Switzerland) (κ 0.79). There was a weak correlation between number of negative results for each kit and days between onset and testing (Spearman rank correlation: ρ= 0.44; p<0.05). We believe that the variations in results among kits for specimens with low viral loads should not be problematic when these kits are used for screening infectious patients because these variations are more likely to be observed in specimens tested many days after onset (i.e., those that have lost their infectivity). However, for suspected late-stage COVID-19 with a low viral load, it may be better to use a test such as Toyobo M or Cobas.

Pre-operative Assessment of Psychological Characteristics and Mood States in Living Donor Kidney and Liver Transplantation

BACKGROUND

Past studies have indicated that psychological problems in both transplant recipients and donors increase during the pre-operative period. However, few studies have evaluated the pre-operative psychological status of both the recipient and the donor.

METHODS

This study included the donors and recipients of 36 adult living donor kidney transplants (LDKT) and 12 adult living donor liver transplants (LDLT) between January 2012 and December 2014. Their personalities were assessed using the Tokyo University Egogram (TEG) and the Yatabe-Guilford Personality Inventory (Y-G), while their mood states just before transplantation were evaluated via the Profile of Mood States (POMS).

RESULTS

On the TEG, the mean Adapted Child (AC) score of the LDLT recipient group was significantly lower than that of the LDKT recipient group. On the Y-G, no differences in the distribution of the five personality types were recognized among the four groups. POMS depression scores in the LDLT recipient group were significantly higher compared with the other groups.

CONCLUSION

LDLT recipients exhibited a depressive mood just before transplantation, and also had a low AC score. Therefore, clinicians should pay careful attention to potential medical non-adherence and post-operative depression in LDLT recipients. Based on these pre-operative assessments of personality and mood states, the transplant team should include post-operative care to support the quality of life of the recipients as well as the donors.

A multicenter randomized double-masked comparative study of different preparations of alendronate in osteoporosis - monthly (four weeks) intravenous versus once weekly oral administrations

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of intravenous alendronate (ALN) 900 µg every 4 weeks compared to oral ALN 35 mg once weekly.

METHODS

A 52-week, multicenter, randomized, double-masked, active-controlled, parallel-group, non-inferiority study was conducted in a total of 325 Japanese patients aged 48-87 years with osteoporosis. Patients were randomly assigned to an intravenous ALN (iv, n = 162) group or oral ALN (po, n = 163) group. The efficacy of the both formulations was assessed primarily by bone mineral density (BMD) measurement.

RESULTS

The percentage BMD change from baseline in lumbar spine (L2-L4) after 52 weeks of treatment was 6.4 ± 0.3% in the iv group and 6.0 ± 0.3% in the po group (least-squares mean ± SE). The inter-group difference in least-squares mean of percentage change from baseline in BMD was 0.37%, and its 95% confidence interval was -0.47% to 1.20%. The non-inferiority of the iv group was established against the po group with a prespecified non-inferiority margin (Δ) of 1.5%. In addition, the four bone turnover markers were reduced to a similar level by either treatment throughout the treatment period. The safety profile was also similar between the two treatment groups. Because of the limitations presented in this study, the results of the iv group may not apply to non-Japanese patients with osteoporosis.

CONCLUSIONS

The efficacy and safety of the intravenous ALN 900 µg once every 4 weeks were similar to those of the oral ALN 35 mg once weekly, indicating that intravenous administration of ALN is an effective treatment for osteoporosis and will provide a useful alternative to oral dosing.

Changes in the Muscle Fibre Properties of the Mouse Temporal Muscle after Weaning

To clarify changes in the muscle fibre properties of the temporal muscle related to the start of masticatory movement, we immunohistochemically investigated myosin heavy chain (MyHC) isoform protein expression using pre-weaning and post-weaning mice. In addition, we examined the expression of a gene coding for those MyHC proteins. Immediately after weaning, isoforms with fast and potent contractility were frequent. This suggests that the temporal muscle plays an important role in a marked functional change in the oral cavity from lactation to mastication, contributing to oral function in cooperation with other masticatory muscles.

Three-dimensional analysis of pulp chambers in maxillary second deciduous molars

OBJECTIVE

The purpose of this study was to clarify the positional relationship between the crown contour and the pulp chamber using micro-CT system for restorations of maxillary second deciduous molar.

METHODS

Five maxillary second deciduous molar teeth each from the deciduous dentition and the mixed dentition periods were used. The positional relationship between the crown contour and pulp chamber was three-dimensionally observed by micro-CT. In addition, the thickness of the dentin at each of the pulp horns and the volume ratio of the pulp chamber against the whole crown were measured.

RESULTS

In relationship to the crown contour and the pulp chamber, the pulp horn of the mesiobuccal cusp showed greatest protrusion and eminent swelling of its mesial wall in both the deciduous dentition and the mixed dentition periods. Furthermore, the pulp chamber was shifted to the mesial side. The volume ratio of the pulp chamber to the whole crown, the ratio in the mixed dentition period showed to be significantly smaller than in the deciduous dentition period. The dentin thickness at the mesiobuccal pulp horn was the thinest.

CONCLUSIONS

These results suggest that in preparation of cavities in maxillary second deciduous molars, care is necessary not to expose of the mesiobuccal pulp horn. Especially, the mesial wall of the mesiobuccal pulp horn should be noted.

Myosin heavy chain isoforms of the murine masseter muscle during pre- and post-natal development

Masticatory muscles that are derived from the branchial arches express different compositions of myosin heavy chain (MHC) isoforms during the transitional phase from suckling to mastication. To clarify the developmental changes of murine masseter muscle, the composition of MHC isoforms was examined using immunohistochemical staining and competitive reverse transcription PCR. We found that MHC1 was expressed transiently in the pre and post-natal stages. In the compositional change of isoforms, the embryonic type MHCp was expressed consistently, whereas the adult isoforms increased with the developmental process. In particular, a significant change was observed between embryonic days 14 and 16, a stage when murine facial development is conspicuous. This suggests that the development of murine masseter muscle is closely associated with facial development.

Glycemic control reverses increases in urinary excretions of immunoglobulin G and ceruloplasmin in type 2 diabetic patients with normoalbuminuria

To examine whether urinary excretions of plasma proteins with molecular radii of 45-55 A and different isoelectric points such as IgG (pI = 7.4) and ceruloplasmin (pI = 4.4) increase selectively in normoalbuminuric type 2 diabetic patients, urinary albumin excretion rate (AER), renal clearances of IgG, ceruloplasmin and alpha2-macroglobulin, and creatinine clearance (Ccr) were studied in timed overnight urine samples of 36 diabetic outpatients and 16 control subjects. Furthermore, to examine effect of glycemic control on these urinary protein excretions, the same analysis was performed before and after glycemic control in 17 diabetic inpatients admitted for glycemic control. Renal clearances of IgG and ceruloplasmin were significantly higher in diabetic outpatients than in the control group, whereas AER and renal clearance of alpha2-macroglobulin did not differ. Glycemic control caused significant decreases in renal clearances of IgG and ceruloplasmin, accompanied with tendency for Ccr to decrease (p = 0.055). The present results, together with our previous finding of selectively increased urinary excretions of 45-55 A sized plasma proteins in parallel with enhanced glomerular filtration rate after acute protein loading, led us to conclude that enhanced intraglomerular hydraulic pressure may cause increases in clearances of IgG and ceruloplasmin, and that this change can be reversed by strict glycemic control in normoalbuminuric diabetic patients.

[A case of laryngeal cancer treated for over 2 years with UFT and CBDCA alone]

A patient with early laryngeal cancer who rejected both radiation therapy and surgery was treated with only chemotherapy of UFT combined with CBDCA. UFT (tegafur 300 mg/day) was administered orally and CBDCA was injected intravenously at a dose of 300 mg/body every 1-2 months, 11 times. For over 2 years the patient has demonstrated gradual tumor growth, but has not complained of dyspnea and has worked every day. The chemotherapy has improved his quality of life.

Sudden recurrent laryngeal nerve paralysis due to apoplexy of parathyroid adenoma

Neoplastic lesions of the parathyroid are rare, and most of these are adenomas. Even rarer is a secondary involvement of the recurrent laryngeal nerve. A case is presented of sudden onset hoarseness in a 64-year-old man caused by acute vocal cord paralysis due to bleeding within an adenoma of the lower right parathyroid gland. Acute onset of vocal cord paralysis is rarely associated with benign processes; the current case is only the second report associated with parathyroid adenoma.

Abnormal gastric motility in liver cirrhosis: roles of secretin

Cutaneous electrogastrography (EGG) revealed that the power ratio, an indicator of rhythmicity of EGG waveforms was significantly less in liver cirrhosis (power ratio: 28.2+/-14.5%) than in normal subjects (power ratio: 45.6+/-16.2%) (P < 0.01), thus demonstrating dysrhythmic EGG waveforms for liver cirrhosis. Gastric emptying time (T1/2), calculated from the half-life of retained radioisotope (RI) in the region of interest (ROI) in the stomach following the ingestion of RI containing test meal was significantly prolonged in patients with liver cirrhosis compared to the control (liver cirrhosis vs controls 43.2+/-20.3 min vs 24.8+/-9.6 min, P < 0.01). Of the five gastrointestinal hormones-gastrin, secretin, motilin, cholecystokinin (CCK), and glucagon-serum secretin was significantly higher in liver cirrhosis than the control (P < 0.05) and negatively correlated with the power ratio (r = 0.51, P < 0.01). Normal, regular EGG waveforms (power ratio: 47.1+/-10.2%) became dysrhythmic in normal volunteers (power ratio: 34.1+/-12.4%), when their serum secretin was experimentally increased to essentially that in liver cirrhosis and possible roles of hypersecretinemia in abnormal gastric motility in liver cirrhosis are proposed.

Efficient protein production using a Bombyx mori nuclear polyhedrosis virus lacking the cysteine proteinase gene

Infection by a baculovirus (Bombyx mori nuclear polyhedrosis virus, BmNPV) in silkworm (Bombyx mori) larvae is highly efficient as an expression system for the production of useful proteins. However, the amount of the protein of interest expressed tends to decrease in the later stages of infection presumably due, in part, to a proteinase produced in the larval haemolymph. The N-terminal amino acid sequence of a proteinase purified from the haemolymph of BmNPV-infected larvae was identical to the internal amino acid sequence of the viral cysteine proteinase gene of BmNPV, suggesting that the cysteine proteinase in the haemolymph originated from the BmNPV gene. We constructed a mutant virus (CPd) which had a deletion in the cysteine proteinase gene. No proteinase activity corresponding to this proteinase was detected in the haemolymph of silkworm larvae infected with CPd. The firefly luciferase and the human growth hormone genes were separately introduced into CPd under control of the polyhedrin promoter. These constructs produced these proteins very efficiently, because of a greatly reduced degree of degradation of these proteins. A BmNPV vector system using CPd enhances the stability of foreign expressed proteins, especially for those that are cysteine proteinase-sensitive.

The effect of pH, hydrogen peroxide and temperature on the stability of human monoclonal antibody

The stability of human monoclonal antibody (C23), which is being developed as a passive immunotherapeutic agent against human cytomegalovirus, was investigated. C23 (about 2 mg ml-1) was incubated under sterile conditions for 14 days in buffers with different pH values (ranging from 4-10), in hydrogen peroxide solutions with different concentrations (0.01% or 0.1%), and in saline at 8 degrees C or 37 degrees C. Samples were collected on days 0, 3, 7 and 14, and various physicochemical or biological methods were used to determine the changes in in C23. These methods included turbidity (absorbance at 408 nm and transmittance at 580 nm), pH, size-exclusion high performance liquid chromatography (HPLC), hydroxyapatite HPLC, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, isoelectric focusing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and virus neutralization assay. Using these methods, the possible degradation processes of C23 were initially characterized. Deamidation, oxidation, fragmentation, covalent cross-links and aggregation were observed as major degradation routes. These results gave useful information for the manufacturing process and quality control of C23.

Do the effects of blood pressure control on the progression of diabetic nephropathy depend on disease stage?

To determine whether the control of blood pressure has a consistent effect on the progression of diabetic nephropathy with macroalbuminuria in diabetic patients with differing serum levels of creatinine, we evaluated the relationship between mean blood pressure and the yearly rate of increase in serum creatinine concentration in two groups: one with macroalbuminuria and a serum creatinine concentration less than 2 mg/100 ml (group 1), and the other with macroalbuminuria and a serum creatinine concentration of 2 mg/100 ml or more (group 2). Both groups showed a positive relationship between the mean blood pressure and the yearly rate of increase in serum creatinine concentration. However, when the yearly rate of increase in serum creatinine concentration was compared in patients from both groups with matched mean blood pressures of less than 100 mmHg, it was greater in patients of group 2 than in patients of group 1. Thus, although a beneficial effect of blood pressure control on the progression of diabetic nephropathy was found in both groups, the effect was less in patients with macroalbuminuria and a serum creatinine concentration of 2 mg/100 ml or more when mean blood pressure was controlled at less than 100 mmHg.

A radioimmunometric assay for urinary alpha 2-macroglobulin

To measure urinary alpha 2-macroglobulin levels, a sensitive radioimmunometric assay was established. The least detectable level of this assay was 225 pg/ml. A linear correlation between alpha 2-macroglobulin levels and serial dilution of urine samples was found. Western blot analysis and study on column chromatography revealed that the molecular weight of alpha 2-macroglobulin in urine was identical to that of serum alpha 2-macroglobulin. The findings suggested that urinary substance detected by the present assay was truly alpha 2-macroglobulin. Timed overnight urine samples from 49 diabetic patients with retinopathy and 20 healthy controls were measured by the present assay. Patients were classified as Albustix-negative and Albustix-positive patients. The highest urinary alpha 2-macroglobulin excretion rates (alpha 2-MER) was found in Albustix-positive patients followed by Albustix-negative patients and the healthy controls. In view of the fact that the stroke radius of alpha 2-macroglobulin (88A) is larger than that of the restrictive pore (56A), the present finding suggests that leakage of alpha 2-macroglobulin in urine may be induced by defect of non-discriminatory pores in the glomerular basement membrane proposed by Deen and colleagues.

Urinary excretion rate of ceruloplasmin in non-insulin-dependent diabetic patients with different stages of nephropathy

The level of ceruloplasmin, which is a more negatively charged protein than albumin, was measured by an immunoradiometric assay in timed overnight urine and serum samples from patients with non-insulin-dependent diabetes mellitus and healthy controls. None of the plasma proteins examined showed any cross-reactivity in this assay. A linear correlation was seen between the ceruloplasmin level and the serial dilution of the sample. Western blot analysis using concentrated urine samples showed that the molecular weight of ceruloplasmin in the urine sample was the same as that of ceruloplasmin in the serum and standard samples. These findings indicated that the substance detected by this assay was truly ceruloplasmin. The urinary ceruloplasmin excretion rate (CER) and clearance of ceruloplasmin increased in parallel with the progression of albuminuria. The highest CER was found in macroalbuminuric patients, followed by micro- and normoalbuminuric patients and the healthy control subjects, the differences between the groups being significant. In view of the fact that the isoelectric point of ceruloplasmin (4.4) is more acidic than that of albumin, the present findings suggested that an enhanced CER was due either to the alteration of charge selectivity in the glomerular basement membrane with unaltered tubular function or to a defect of the non-discriminatory pores (shunt pathway) with unaltered tubular function.

[Manometric study of the biliary sphincter zone: a comparison between the length of phasic activity and the narrow distal segment]

Motor activity of the sphincter of Oddi has been evaluated in 26 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a single end-lumen perfused catheter. The number of successive 3 mm spaced black marks, observed during the pull-through from the first appearance of the proximal sphincter activity to that of duodenal pressure, was used to measure the length of the sphincter zone. In 14 of 26 patients, the length of phasic activity zone of the sphincter of Oddi was 9 mm. However, the narrow distal segment of the common bile duct was 15.1 +/- 3.6 mm in length. In same patients, the length of phasic activity zone was shorter than the anatomical one. The mean sphincter of Oddi pressure (SOP) at the distance of 6 mm from the papillary pore (77.8 +/- 22.1 mmHg) was greater than that of 9 mm (58.4 +/- 27.0 mmHg) and 12 mm (51.0 +/- 16.9 mmHg). These results suggest that the location of the orifice of catheter should be taken into consideration when comparing the SOP.

[Effect of specific desensitization therapy in combination with an immunopotentiator, Neurotropin, on perennial nasal allergy--with special reference to mite specific IgG and IgG4 antibody levels]

We treated perennial nasal allergy with specific desensitization in combination with or without Neurotropin injections (NSP) from March 1983 to September 1984, and analyzed blood anti-mite IgG and IgG4 levels in relation to therapeutic efficacy. Desensitization and NSP were given once a week and seventy subjects (33 from the desensitization group and 37 from the desensitization + NSP group) were evaluated at 24, 36 and 48 weeks. 1) In total cases clinical usefulness showed no significant difference between the desensitization group and combined group at 24 weeks, while in "useful or more" cases significantly better results were attained in the latter at 24 weeks and 48 weeks (p less than 0.05, respectively). 2) Dermatophagoides pteronyssinus (D.p.) specific IgG antibody showed no significant difference between both groups as well as in each group during the overall examination period. 3) In total cases both D.p. specific and D. farinae (D.f.) specific IgG4 were significantly higher in the combined group at 24 and 36 weeks (D.p.: p less than 0.01 and D.f.: p less than 0.05, respectively), whereas in "useful or more" cases only D.p. specific IgG4 showed a significant elevation in the combined group at 24 weeks (p less than 0.05). These results suggest that specific desensitization in combination with NSP can promote early production of mite specific IgG4, which tend to rise in correlation with clinical efficacy.

Ventilatory and heart rate chemosensitivity in track-and-field athletes

Fifty-four male track-and-field athletes and 18 male non-athletes were examined by isocapnic progressive hypoxia and CO2 rebreathing tests. Ventilatory and heart rate (HR) responses to hypoxia were analysed by a hyperbolic relationship and the ventilatory response to hypercapnia by a linear regression. The results showed that ventilatory sensitivity during hypoxia was significantly attenuated in the long-distance runners and sprinters compared to the non-athletes. Although heart rate sensitivity during hypoxia in none of the athletes showed a significant difference compared to that of the non-athletes, baseline HR in the long-distance runners was significantly lower than that of the non-athletes. None of the athletes showed significant differences in ventilatory sensitivity during hypercapnia compared to the non-athletes.

Diagnostic standards for occupational nasal allergy

Based on studies of 70 outpatients having occupational nasal allergy as well as mass examinations of workers in two industries, diagnostic standards for this condition were evaluated. In practice, interviews concerning the causal relation, frequency, latent period and atopic disposition often provide suggestions, but sometimes give unreliable evidence for the basis by which to diagnose occupational nasal allergy. Both rhinoscopy and nasal smear test for eosinophilia are available, but these only distinguish allergy from non-allergy. Therefore, examinations, such as skin tests, nasal tests and determination of the IgE antibody level, using allergen extract of good quality, are necessary for a final diagnosis.

Histological and immunological studies on eosinophilic granuloma of soft tissue, so-called Kimura's disease

Increase of serum IgE with frequent localization of IgE in the germinal centres, mast cell hyperplasia in lymph nodes and changes of specific granules in the infiltrated eosinophils, such as roughness of the matrix and appearance of tubular structures together with fusing and disappearance of the core, were demonstrated in eosinophilic granuloma of the soft tissue, so-called Kimura's disease, in association with increase of anti-Candida IgE antibody. It is suggested that this disease may be due to atopic allergy to Candida albicans.