Survey of diversity awareness and environment among members of the Pediatric Rheumatology Association of Japan

BACKGROUND

Diversity management has gained traction in Japan. The Pediatric Rheumatology Association of Japan (PRAJ) has an Advisory Committee for Diversity Promotion with a broader focus on promoting diversity. The objectives of this study were to better understand the problems faced by PRAJ members regarding the work environment, childcare and nursing care, and work-life balance.

METHODS

A web-based questionnaire was administered to members of the PRAJ and 79 responses were evaluated.

RESULTS

Of the respondents, 73% were male and 27% were female. A total of 14% worked for more than 12 h on weekdays, and 22% worked for more than 60 h per week and 38% had fewer than 4 days off per month. Regarding childcare, 54% of the respondents were raising preschool children and 83% had taken parental leave for less than 1 year. A total of 17% of participants had family members in need of care. For both childcare and caregiving, the burden was greater for women. Only 18% of the respondents reported a well-balanced work-life balance, and the most common reasons for a lack of balance were not having enough time, heavy workload, and heavy housework load.

CONCLUSIONS

The working hours of the respondents were long, and female members had a greater burden of childcare and caregiving, which was considered a barrier to the career development of women. In the future, there will be a need to promote a sense of equality in diverse human resources, develop support for family life, and shorten working hours.

A case of cryopyrin-associated periodic fever syndrome during canakinumab administration complicated by inflammatory bowel disease

Cryopyrin-associated periodic fever syndrome (CAPS) is a highly debilitating disorder, which is characterized by unregulated interleukin-1β production driven by autosomal dominantly inherited mutations in the NLRP3 gene. Patients with CAPS often present with early-onset episodes of fever and rash. These patients also present with variable systemic signs and symptoms, such as arthritis, sensorineural hearing loss, chronic aseptic meningitis, and skeletal abnormalities, but minimal gastrointestinal symptoms. Recently, effective therapies for CAPS targeted against interleukin-1 have become available. We report a case of a young Japanese woman with CAPS who developed inflammatory bowel disease during canakinumab therapy. The patient had colostomy after intestinal perforation and changed canakinumab to infliximab. To the best of our knowledge, this is the first report of a case of inflammatory bowel disease secondary to CAPS complicated by gastrointestinal symptoms and arthritis which canakinumab could not control. Patients with CAPS who have symptoms that cannot be controlled by canakinumab should be considered for possible co-morbidities.

The Use of a Combination of a Sugar and Surfactant to Stabilize Au Nanoparticle Dispersion against Aggregation during Freeze-Drying

Drying a suspension of nanoparticles typically results in the irreversible aggregation of nanoparticles; however, solutions that contain unstable ingredients are often converted into dried powders to prolong their shelf lives. In this study, the use of a combination of a surface-active agent and sugar was investigated with regard to avoiding the aggregation of nanoparticles during drying. Suspensions of Au nanoparticles (∼60 nm diameter, AuNPs) were freeze-dried in the presence of different combinations of various sugars with a surfactant. Sucrose monopalmitate (SEC16) was mainly used as the surfactant, based on a comparison of antiaggregation effects conferred by various surfactants. The freeze-dried AuNP suspension was then reconstituted, and the avoidance of AuNP aggregation was then examined. The results demonstrated that the use of a combination of a small amount of SEC16 and sugar resulted in a greater redispersibility of AuNPs after freeze-drying than when the individual components were used. Repetition tests of freeze-drying and reconstitution were conducted. The sucrose/SEC16 mixture was freeze-dried on an electroless-plated Au film and then analyzed by infrared spectroscopy. Strong interactions between SEC16 and the Au surface were detected, and these interactions appear to play a crucial role in the antiaggregation of AuNPs during freeze-drying.

Immobilization of surface non-affinitive protein onto a metal surface by an external electric field

We investigated an alternate technique to coat the surface with a protein having no surface affinity, without the use of any exotic chemical agents. An external electric field was utilized to prepare the protein coating on a metal substrate. Stainless steel (St) substrate and lysozyme (LSZ) were used as the surface to be coated and the model non-adsorptive protein, respectively. Dynamics of the adsorption of LSZ on the St surface in the presence and absence of an external electric potential (EEP) were monitored by in-situ ellipsometry. Applying negative surface potential (-0.4 V vs Ag/AgCl) forced the adsorption of LSZ onto the St surface where LSZ did not adsorb without applying any EEP. The repetition of the EEP-application and -cut-off indicated the controllability of the LSZ coating amount depending on the total duration of the EEP-application. The coated LSZ largely remained bound to the surface even by the cut-off of the external electric field, the ratio of which to the detached amount was roughly constant (approximately 7:3). Furthermore, the LSZ coated surface on the St substrate was found to be reversibly switched between being affinitive and non-affinitive to a typical model protein adsorbate (bovine serum albumin) by the EEP-application and cut-off.

Picoliter enzyme reactor on a nanofluidic device exceeding the bulk reaction rate

A picoliter enzyme reactor using a trypsin immobilized nanochannel realized 25 times faster reaction than the bulk reaction.

Influence of an external electric field on removal of protein fouling on a stainless steel surface by proteolytic enzymes

Enzymatic cleaning is a potentially useful method for removing proteinaceous fouling from solid surfaces under mild conditions. Herein, the influence of an external electric field on the enzymatic cleaning of a metal surface fouled with a protein was investigated. The model fouling protein (BSA; lysozyme) was prepared on a stainless steel (St) surface, and the resulting surface subjected to enzymatic cleaning with an electric potential being applied to the St plate. Trypsin, α-chymotrypsin, and thermolysin were used as model proteases. The amounts of protein remaining on the plate before and during the cleaning process were measured by means of a reflection absorption technique using Fourier transform infrared spectroscopy. In the case for BSA fouling, the cleaning efficiency of the protease tended to increase at more negative applied potentials. Whereas, there was an optimum applied potential for removing the lysozyme fouling. Atomic force microscopy analyses indicated that applying an adequate range of electric potential enhanced the enzymatic removal of protein fouling inside scratches on the St plate surface. These findings suggest the existence of two modes of electrostatic interactions for the external electric field, one with protease molecules and the other with digested fragments of the fouling protein.

Characteristics of proteinaceous additives in stabilizing enzymes during freeze-thawing and -drying

Protein-stabilizing characteristics of sixteen proteins during freeze-thawing and freeze-drying were investigated. Five enzymes, each with different instabilities against freezing and dehydration, were employed as the protein to be stabilized. Proteinaceous additives generally resulted in greater enzyme stabilization during freeze-thawing than sugars while the degree of stabilization for basic lysozyme and protamine were inferior to that of neutral and acidic proteins. Freeze-drying-induced inactivation of enzyme was also reduced by the presence of a proteinaceous additive, the extent of which was lower than that for a sugar. In both freeze thawing and freeze drying, the enzymes stabilization by the proteinaceous additive increased with increasing additive concentration. The enhancement of enzyme inactivation caused by pH change was also reduced in the presence of proteinaceous additives. The combined use of a sugar such as sucrose and dextran tended to increase the stabilizing effect of the proteinaceous additive.

The use of a proteinaceous "cushion" with a polystyrene-binding peptide tag to control the orientation and function of a target peptide adsorbed to a hydrophilic polystyrene surface

In immobilizing target biomolecules on a solid surface, it is essential (i) to orient the target moiety in a preferred direction and (ii) to avoid unwanted interactions of the target moiety including with the solid surface. The preferred orientation of the target moiety can be achieved by genetic conjugation of an affinity peptide tag specific to the immobilization surface. Herein, we report on a strategy for reducing the extent of direct interaction between the target moiety and surface in the immobilization of hexahistidine peptide (6His) and green fluorescent protein (GFP) on a hydrophilic polystyrene (PS) surface: Ribonuclease HII from Thermococcus kodakaraensis (cHII) was genetically inserted as a "cushion" between the PS-affinity peptide tag and target moiety. The insertion of a cushion protein resulted in a considerably stronger immobilization of target biomolecules compared to conjugation with only a PS affinity peptide tag, resulting in a substantially enhanced accessibility of the detection antibody to the target 6His peptide. The fluorescent intensity of the GFP moiety was decreased by approximately 30% as the result of fusion with cHII and the PS-affinity peptide tag but was fully retained in the immobilization on the PS surface irrespective of the increased binding force. Furthermore, the fusion of cHII did not impair the stability of the target GFP moiety. Accordingly, the use of a proteinaceous cushion appears to be promising for the immobilization of functional biomolecules on a solid surface. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 32:527-534, 2016.

Prediction of long-term remission of oligo/polyarticular juvenile idiopathic arthritis with S100A12 and vascular endothelial growth factor

OBJECTIVES

This study aimed to evaluate the usefulness of S100A12 and vascular endothelial growth factor (VEGF) for predicting the stability of remission for discontinuing methotrexate (MTX) and/or biological agents in Japanese patients with oligo/polyarticular juvenile idiopathic arthritis (JIA).

METHODS

Forty-four patients with oligo/polyarticular JIA who received MTX with or without biological agents were enrolled. Serum concentration of both S100A12 and VEGF were simultaneously evaluated by ELISA in active and in remission phase determined by activity markers including DAS-28.

RESULTS

S100A12 and VEGF were correlated with DAS-28. Of the 22 patients with oligo/polyarticular JIA in clinical remission, 13 patients with low S100A12 and VEGF concentrations could discontinue treatment without relapse over 2 years. However, nine patients without low S100A12 and VEGF concentrations relapsed afterwards, even though they had been in clinical remission. The cut-off levels of S100A12 and VEGF for division into two groups of the maintenance remission and relapse groups were 177 ng/ml and 158 pg/ml, respectively.

CONCLUSIONS

S100A12 and VEGF are useful markers for assessing disease activity of oligo/polyarticular JIA in remission phase. These markers should be kept low when clinicians consider tapering or discontinuing treatments in oligo/polyarticular JIA patients.

Disease activity score in 28 joints at 3 months after the initiation of biologic agent can be a predictive target for switching to the second biologic agent in patients with polyarticular juvenile idiopathic arthritis

OBJECTIVE

To clarify polyarticular juvenile idiopathic arthritis (pJIA) patients who failed to maintain prolonged remission with the first biologic agent.

METHODS

Fourteen pJIA patients were observed for 47.5 months (median) after initiating the first biologic agent.

RESULTS

Eight maintained sustained clinical remission (median 47 months) with the first biologic agents, while the six switched to the second one due to lack of efficacy, thereafter. Receiver operating characteristic (ROC) analysis revealed that disease activity score in 28 joints (DAS28) of 2.37 at 3 months could distinguish between the two patient groups (p = 0.001).

CONCLUSION

pJIA patients with DAS28 >2.37 at 3 months of the initial biologic therapy may be considered to switch to the second biologics.

Purification and Characterization of a Novel Aminoacylase fromStreptomyces mobaraensis

A novel aminoacylase was purified to homogeneity from culture broth of Streptomyces mobaraensis, as evidenced by SDS-polyacrylamide gel electrophoresis (PAGE). The enzyme was a monomer with an approximate molecular mass of 100 kDa. The purified enzyme was inhibited by the presence of 1,10-phenanthroline and activated by the addition of Co2+. It was stable at temperatures of up to 60 degrees C for 1 h at pH 7.2. It showed broad substrate specificity to N-acetylated L-amino acids. It catalyzed the hydrolysis of the amide bonds of various N-acetylated L-amino acids, except for Nepsilon-acetyl-L-lysine and N-acetyl-L-proline. Hydrolysis of N-acetyl-L-methionine and N-acetyl-L-histidine followed Michaelis-Menten kinetics with K(m) values of 1.3+/-0.1 mM and 2.7+/-0.1 mM respectively. The enzyme also catalyzed the deacetylation of 7-aminocephalosporanic acid (7-ACA) and cephalosporin C. Moreover, feruloylamino acids and L-lysine derivatives of ferulic acid derivatives were synthesized in an aqueous buffer using the enzyme.

Enzymatic Synthesis of β-Lactam Antibiotics andN-Fatty-Acylated Amino Compounds by the Acyl-Transfer Reaction Catalyzed by Penicillin V Acylase fromStreptomyces mobaraensis

Penicillin V acylase from Streptomyces mobaraensis (Sm-PVA) showed high acyl-transfer activity in reactions using methyl esters of carboxylic acid (acyl donor) and amino compounds (nucleophile), to produce the corresponding amides. Moreover, Sm-PVA had broad substrate specificity, as indicated by the fact that it catalyzed the efficient synthesis of beta-lactam antibiotics, capsaicin derivatives, and N-fatty-acyl-amino acid/N-fatty-acyl-peptide derivatives.

Polymorphobacter multimanifer gen. nov., sp. nov., a polymorphic bacterium isolated from Antarctic white rock

A Gram-stain-negative, non-spore-forming, aerobic, oligotrophic bacterium (strain 262-7(T)) was isolated from a crack of white rock collected in the Skallen region of Antarctica. Strain 262-7(T) grew at temperatures between -4 and 30 °C, with optimal growth at 25 °C. The pH range for growth was between pH 6.0 and 9.0, with optimal growth at approximately pH 7.0. The NaCl concentration range allowing growth was between 0.0 and 1.0%, with an optimum of 0.5%. Strain 262-7(T) showed an unprecedented range of morphological diversity in response to growth conditions. Cells grown in liquid medium were circular or ovoid with smooth surfaces in the lag phase. In the exponential phase, ovoid cells with short projections were observed. Cells in the stationary phase possessed long tentacle-like projections intertwined intricately. By contrast, cells grown on agar plate medium or in liquid media containing organic compounds at low concentration exhibited short- and long-rod-shaped morphology. These projections and morphological variations clearly differ from those of previously described bacteria. Ubiquinone 10 was the major respiratory quinone. The major fatty acids were C(17 : 1)ω6c (28.2%), C(16 : 1)ω7c (22.6%), C(18 : 1)ω7c (12.9%) and C(15 : 0) 2-OH (12.3%). The G+C content of genomic DNA was 68.0 mol%. Carotenoids were detected from the cells. Comparative analyses of 16S rRNA gene sequences indicated that strain 262-7(T) belongs to the family Sphingomonadaceae, and that 262-7(T) should be distinguished from known genera in the family Sphingomonadaceae. According to the phylogenetic position, physiological characteristics and unique morphology variations, strain 262-7(T) should be classified as a representative of a novel genus of the family Sphingomonadaceae. Here, a novel genus and species with the name Polymorphobacter multimanifer gen. nov., sp. nov. is proposed (type strain 262-7(T) = JCM 18140(T) = ATCC BAA-2413(T)). The novel species was named after its morphological diversity and formation of unique projections.

Effect of daily sedative interruption on sleep stages of mechanically ventilated patients receiving midazolam by infusion

Daily sedative interruption (DSI) may reduce excessive sedation and shorten the duration of mechanical ventilation. It is not clear, however, how DSI affects sleep characteristics. For patients receiving mechanical ventilation, we compared the effect on sleep quality of DSI and continuous sedation (CS). Twenty-two mechanically ventilated patients who were receiving midazolam by infusion were randomly assigned to two groups, DSI (n = 11) or CS (n = 11). In the DSI group, sedatives were interrupted until the patients awoke and expressed discomfort, after which midazolam or opioids were administered intermittently as needed during the daytime (0600 to 2100 hours); during the night (2100 to 0600) midazolam was administered intravenously to maintain Ramsay sedation scale 4 to 5. In the CS group, the sedatives were titrated to obtain Ramsay sedation scale 4 to 5 throughout the day. The polysomnography of each patient was recorded continuously over a 24 hour period. Sleep stages were analysed using Rechtschaffen and Kales criteria. In the DSI group, the amount of stage 3 and 4 non-rapid eye movement sleep (slow wave sleep) was longer (6 vs 0 minutes, P = 0.04) and rapid eye movement sleep was longer than in CS (54 vs 0 minutes, P = 0.02). In the CS group, total sleep time during night-time was longer (8.7 vs 7.3 hours, P = 0.047) and frequency of arousal was lower (2.2 vs 4.4 event/hour, P = 0.03) than those in the DSI group. All mechanically ventilated patients demonstrated abnormal sleep architecture, but, compared with CS, DSI increased the amount of slow wave sleep and rapid eye movement sleep.

Reflection and self-directed and group learning improve OSCE scores

BACKGROUND

Reflection and self-directed learning have been emphasised as important in the process of learning, and are inevitably applied in medical education. The effectiveness of reflection on learning outcomes and its application in medical education must be investigated.

METHODS

In 2009, 86 fourth-year medical students at Kagoshima University took a course in basic clinical skills that included introductory lectures and small group training sessions. As part of these new educational interventions, the students received a lecture on reflective learning, wrote down their own reflections on skills training during the course, and voluntary participation in self- and group practice was promoted. Two weeks after the course, the students took six stations of the Objective Structured Clinical Examination (OSCE) via the Common Achievement Test. Each station and total score of the OSCE were compared with those from 2006-2008, and with national mean scores of the same station scenario in 2008.

RESULTS

Students wrote 966 reflection reports (11.2 reports per student), and actively used rooms and materials for self- and group practice. All station and total scores of the OSCE in 2009 were higher than those in 2008: the total scores of the OSCE, the physical examination (PE) station and suturing skills were significantly improved, but the scores for 'Interview' and 'Head and Neck' PE were not.

DISCUSSION

Our new educational intervention enabled students to experience some reflection on skills training, and facilitated students' experiential learning. We conclude that it was effective at least in the initial phase of basic clinical skills training. The students' reflection on communication skills needs to be improved.

Effects of Open Lung Approach Policy on Mechanical Ventilation Duration in Postoperative Patients with Chronic Thromboembolism with Pulmonary Hypertension: A Case-Matched Study

Patients with chronic thromboembolism with pulmonary hypertension (CTEPH) often develop severe hypoxaemia after pulmonary thromboendarterectomy. There is reluctance to apply high positive end-expiratory pressure (PEEP) to those patients, whereas high PEEP is important for acute hypoxaemic respiratory failure due to alveolar collapse. Open lung approach (OLA) policy, a combination of recruitment manoeuvre and PEEP titration, may improve oxygenation and lung mechanics in acute hypoxaemic respiratory failure, but the effect of OLA on the outcome is unknown. We designed a case-matched, retrospective study to investigate whether OLA policy improved the outcome of postoperative patients with CTEPH.

Among 113 postoperative patients with CTEPH, 40 were chosen before and after the introduction of an OLA policy to create 1:1 ratio of case-match according to gender, age and preoperative total pulmonary resistance index (conventional treatment group vs OLA group). In the OLA group, recruitment manoeuvre was applied and then PEEP was titrated to maintain oxygenation every 12 hours. Gas exchange and duration of mechanical ventilation were compared between the groups.

The OLA group showed higher PaO2/FiO2 ratio at 12 hours after the surgery than the conventional group (P=0.0021). In the OLA group, duration of mechanical ventilation was shorter than the conventional treatment group (median, 23.5 hours vs 43 hours, P=0.0064). The OLA group showed lower cardiac index, higher pulmonary artery pressure and higher total pulmonary resistance index after the surgery than the conventional group.

The introduction of the OLA policy may have shortened mechanical ventilation duration despite what appeared to be less favorable early postoperative hemodynamics in patients after the surgery for CTEPH.

Frequent methylprednisone pulse therapy is a risk factor for steroid cataracts in children

BACKGROUND

Pediatricians use corticosteroids for prolonged periods of time for the treatment of many diseases, including rheumatic disease. The side-effects of corticosteroids, especially cataracts, are widely recognized, but the predictive risk factors for steroid-induced cataracts have not yet been fully characterized.

METHODS

The relationship between the formation of cataracts and steroid therapy was evaluated in patients with rheumatic disease.

RESULTS

The initiation of steroid therapy in children under 12 years of age (P = 0.041) and i.v. methylprednisone pulse therapy (IVMP) (P = 0.046) are significant risk factors for inducing cataracts. In contrast, the cumulative corticosteroid dose, sex, and daily corticosteroid dose were not associated with cataract formation.

CONCLUSIONS

Younger children, who need frequent IVMP to treat their rheumatic diseases, should be examined by ophthalmologists frequently to avoid developing amblyopia from cataracts.

Development of ion source with a washer gun for pulsed neutral beam injection

A new type of economical neutral beam source has been developed by using a single washer gun, pulsed operation, and a simple electrode system. We replaced the conventional hot filaments for arc-discharge-type plasma formation with a single stainless-steel washer gun, eliminating the entire dc power supply for the filaments and the cooling system for the electrodes. Our initial experiments revealed successful beam extraction up to 10 kV and 8.6 A, based on spatial profile measurements of density and temperature in the plasma source. The system also shows the potential to control the beam profile by controlling the plasma parameters in the ion accumulation chamber.