B-1 derived anti-Thy-1 B cells in old aged mice develop lymphoma/leukemia with high expression of CD11b and Hamp2 that different from TCL1 transgenic mice

Human old aged unmutated chronic lymphocytic leukemia U-CLL are the TCL1+ZAP70+CD5+ B cells. Since CD5 makes the BCR signaling tolerance, ZAP70 increased in U-CLL not only TCL1+ alone. In mice, TCL1 (TCL1A) is the negative from neonate to old aged, as TC-. VH8-12/Vk21-5 is the anti-thymocyte/Thy-1 autoreactive ATA B cell. When ATA μκTg generation in mice, ATA B cells are the neonate generated CD5+ B cells in B-1, and in the middle age, CD5+ can be down or continuously CD5+, then, old aged CLL/lymphoma generation with increased CD11b in TC-ZAP70-CD5- or TC-ZAP70+CD5+. In this old aged TC-ATA B microarray analysis showed most similar to human CLL and U-CLL, and TC-ZAP70+CD5+ showed certain higher present as U-CLL. Original neonate ATA B cells showed with several genes down or further increase in old aged tumor, and old aged T-bet+CD11c+, CTNNB1hi, HMGBhi, CXCR4hi, DPP4hi and decreased miR181b. These old aged increased genes and down miR181b are similar to human CLL. Also, in old age ATA B cell tumor, high CD38++CD44++, increased Ki67+ AID+, and decreased CD180- miR15Olow are similar to U-CLL. In this old aged ATA B, increased TLR7,9 and Wnt10b. TC+Tg generated with ATAμκTg mice occurred middle age tumor as TC+ZAP70-CD5+ or TC+ZAP70+CD5+, with high NF-kB1, TLR4,6 and Wnt5b,6 without increased CD11b. Since neonatal state to age with TC+Tg continuously, middle age CLL/lymphoma generation is not similar to old aged generated, however, some increased in TC+ZAP70+ are similar to the old age TC- ATA B tumor. Then, TC- ATA B old age tumor showed some difference to human CLL. ATA B cells showed CD11b+CD22++, CD24 down, and hepcidin Hamp2++ with iron down. This mouse V8-12 similar to human V2-5, and V2-5 showed several cancers with macrophages/neutrophils generated hepcidin+ ironlow or some showed hepcidin- iron+ with tumor, and mouse V8-12 with different Vk19-17 generate MZ B cells strongly increased macrophage++ in old aged and generated intestine/colon tumor. Conclusion, neonate generated TC-ATA B1 cells in old aged tumor generation are CD11b+ in the leukemia CLL together with lymphoma cancer with hepcidin-related Hamp2++ in B-1 cell generation to control iron.

Pla2g2a promotes innate Th2-type immunity lymphocytes to increase B1a cells

Newborns require early generation of effective innate immunity as a primary physiological mechanism for survival. The neonatal Lin28⁺Let7^– developmental pathway allows increased generation of Th2-type cells and B1a (B-1 B) cells compared to adult cells and long-term maintenance of these initially generated innate cells. For initial B1a cell growth from the neonatal to adult stage, Th2-type IL-5 production from ILC2s and NKT2 cells is important to increase B1a cells. The Th17 increase is dependent on extracellular bacteria, and increased bacteria leads to lower Th2-type generation. Secreted group IIA-phospholipase A2 (sPLA2-IIA) from the Pla2g2a gene can bind to gram-positive bacteria and degrade bacterial membranes, controlling microbiota in the intestine. BALB/c mice are Pla2g2a⁺, and express high numbers of Th2-type cells and B1a cells. C57BL/6 mice are Pla2g2a-deficient and distinct from the SLAM family, and exhibit fewer NKT2 cells and fewer B1a cells from the neonatal to adult stage. We found that loss of Pla2g2a in the BALB/c background decreased IL-5 from Th2-type ILC2s and NKT2s but increased bacterial-reactive NKT17 cells and MAIT cells, and decreased the number of early-generated B1a cells and MZ B cells and the CD4/CD8 T cell ratio. Low IL-5 by decreased Th2-type cells in Pla2g2a loss led to low early-generated B1a cell growth from the neonatal to adult stage. In anti-thymocyte/Thy-1 autoreactive μκ transgenic (ATAμκ Tg) Pla2g2a⁺ BALB/c background C.B17 mice generated NKT2 cells that continuously control CD1d⁺ B1 B cells through old aging and lost CD1d in B1 B cells generating strong B1 ATA B cell leukemia/lymphoma. Pla2g2a-deficient ATAμκTg C57BL/6 mice suppressed the initial B1a cell increase, with low/negative spontaneous leukemia/lymphoma generation. These data confirmed that the presence of Pla2g2a to control bacteria is important to allow the neonatal to adult stage. Pla2g2a promotes innate Th2-type immunity lymphocytes to increase early generated B1a cells.

Post COVID-19 condition of the Omicron variant of SARS-CoV-2

Objectives

To investigate the prevalence of post coronavirus disease (COVID-19) condition of the Omicron variant in comparison to other strains.

Study design

A single-center cross-sectional study.

Methods

Patients who recovered from Omicron COVID-19 infection (Omicron group) were interviewed via telephone, and patients infected with other strains (control group) were surveyed via a self-reporting questionnaire. Data on patients’ characteristics, information regarding the acute-phase COVID-19, as well as presence and duration of COVID-19-related symptoms were obtained. Post COVID-19 condition in this study was defined as a symptom that lasted for at least 2 months, within 3 months of COVID-19 onset. We investigated and compared the prevalence of post COVID-19 condition in both groups after performing propensity score matching.

Results

We conducted interviews for 53 out of 128 patients with Omicron and obtained 502 responses in the control group. After matching cases with controls, 18 patients from both groups had improved covariate balance of the factors: older adult, female sex, obesity, and vaccination status. There were no significant differences in the prevalence of each post COVID-19 condition between the two groups. The number of patients with at least one post COVID-19 condition in the Omicron and control groups were 1 (5.6%) and 10 (55.6%) (p = 0.003), respectively.

Conclusions

The prevalence of post Omicron COVID-19 conditions was less than that of the other strains. Further research with a larger sample size is needed to investigate the precise epidemiology of post COVID-19 condition of Omicron, and its impact on health-related quality of life and social productivity.

Nanosecond Random Telegraph Noise in In-Plane Magnetic Tunnel Junctions

We study the timescale of random telegraph noise (RTN) of nanomagnets in stochastic magnetic tunnel junctions (MTJs). From analytical and numerical calculations based on the Landau-Lifshitz-Gilbert and the Fokker-Planck equations, we reveal mechanisms governing the relaxation time of perpendicular easy-axis MTJs (p-MTJs) and in-plane easy-axis MTJs (i-MTJs), showing that i-MTJs can be made to have faster RTN. Superparamagnetic i-MTJs with small in-plane anisotropy and sizable perpendicular effective anisotropy show relaxation times down to 8 ns at negligible bias current, which is more than 5 orders of magnitude shorter than that of typical stochastic p-MTJs and about 100 times faster than the shortest time of i-MTJs reported so far. The findings give a new insight and foundation in developing stochastic MTJs for high-performance probabilistic computers.

Relationship between cardiac magnetic resonance derived extracellular volume fraction and myocardial strain in patients with non-ischemic dilated cardiomyopathy

Background

The feature tracking (FT) technique has been proposed as a robust method to evaluate the myocardial strain using conventional cine magnetic resonance imaging (MRI) of the left ventricle. Data is limited regarding the relationship between FT-derived myocardial strain and diffuse myocardial fibrosis evaluated by T1 mapping in patients with non-ischemic dilated cardiomyopathy (NIDCM).

Purpose

The aim of this study was to evaluate the correlation between extracellular volume (ECV) by T1 mapping and myocardial strain by FT in patients with NIDCM.

Methods

A total of sixty-four patients with NIDCM (62±12 years) and 15 controls (62±11 years) were studied. Using a 1.5T MR scanner, pre- and post- T1 mapping images of LV wall at mid-ventricular level was acquired to calculate ECV by modified Look-Locker inversion recovery (MOLLI) sequence. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was assessed by FT technique. ECV and myocardial strain were compared using a 6-segment model at mid-ventricular level.

Results

Compared to the controls, the NIDCM patients had a significantly higher ECV (0.30±0.02 vs. 0.24±0.01, p<0.001) and impaired myocardial strain (RS, 24.2±3.0 vs. 52.2±6.2, p<0.001; CS, −7.5±2.1 vs. −15.3±2.2, p<0.001; LS −10.4±3.5 vs. −20.2±4.7, p<0.001, respectively). Similar results were obtained when comparing all 6 myocardial segments (segment 7–12) (all p values <0.001). In a segment-based analysis, a significant positive correlation was found between the ECV and CS (r=0.26 to 0.41; all p values <0.05), a negative correlation was found between the ECV and RS (r=−0.31 to −0.41; all p values <0.05). In a patient-based analysis, there were significant positive correlations between the ECV and CS (r=0.45, p<0.001), ECV and LS from 2-chamber view (r=0.30, p=0.006), ECV and LS from 4-chamber view (r=0.37, p<0.001). There was a significant negative correlation between the ECV and RS (r=−0.43, p<0.001) (FIGURE)

Conclusions

In NIDCM patients, severity of myocardial fibrosis evaluated by T1 mapping is associated with impaired myocardial strain by FT technique.

Correlation between the ECV and strain

Funding Acknowledgement

Type of funding source: None

Extracellular volume fraction by T1 mapping predicts omprovement of left ventricular ejection fraction after catheter ablation in patients with non-ischemic cardiomyopathy and atrial fibrillation

Background

The Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial has shown that the catheter ablation (CA) for atrial fibrillation (AF) significantly reduced the risk of death and hospitalization for heart failure in patients with non-ischemic dilated cardiomyopathy (NIDCM) and AF (N Engl J Med 2018; 378:417–27). In addition, the Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction (CAMERA-MRI) study demonstrated that the absence of myocardial fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is associated with improvement of left ventricular systolic function after CA in NIDCM patients with AF (J Am Coll Cardiol 2017; 70:1949–61). Extracellular volume fraction (ECV) by T1 mapping has emerges as a non-invasive mean to quantify diffuse myocardial fibrosis.

Purpose

The aim of this study was to compare the predictive value of LGE-MRI and ECV by T1 mapping for the prediction of improvement of LVEF after CA in NIDCM patients.

Methods

A total of twenty-eight patients with NIDCM and AF (age: 67±10 years; 25 (89%) male; LVEF: 34.1±8.8%) were studied. Using a 1.5T MR scanner and 32 channel cardiac coils, cine MRI, LGE-MRI, pre- and post- T1 mapping images of LV wall at mid-ventricular level (modified Look-Locker inversion recovery sequence) were acquired. Myocardial fibrosis on LGE was defined as area with >5SD signal intensity of normal myocardium. ECV from six segments of mid ventricular level were averaged for each patient. All patients underwent CA for AF, and the improvement of LVEF before and after CA were evaluated by echocardiography.

Results

All patients restored sinus rhythm after CA at the time of echocardiography. The mean LVEF was 34.1±8.8% before CA and 49.1±12.0% after CA (p<0.001), resulting an improvement of 15.0±11.8%. Significant correlation was found between improvements in LVEF and amount of fibrosis on LGE-MRI (r=−0.40, p=0.034), improvement of LVEF and ECV (r=−0.55, p=0.008). In the ROC analysis, ECV had a higher discriminative ability for the improvement of LVEF after CA compared with amount of fibrosis on LGE-MRI (AUC 0.885 vs 0.650) (Figure).

Conclusions

In NIDCM patients with AF, ECV by T1 mapping had better predictive ability for improvement of LVEF after CA in comparison to LGE-MRI.

ROC curves of ECV and LGE-MRI

Funding Acknowledgement

Type of funding source: None

Effect of densification technique and carrier concentration on the thermoelectric properties of n-type Cu1.45Ni1.45Te2 ternary compound

Cu_1.45Ni_1.45Te₂ ternary compound was synthesized by solid-state ball-milling method and densified via spark plasma sintering (SPS) and cold-pressing with annealing (CPA) techniques.

Adherence to personal protective equipment use among nurses in Japanese tertiary care hospitals: what determines variability?

BACKGROUND

Though nurses have frequent contact with patients, their personal protective equipment (PPE) compliance rate is low, which poses a significant challenge in infection control.

AIM

To investigate the relative influence of specific factors on PPE compliance.

METHODS

A sequential two-stage mixed-methods design was applied. In a qualitative study, semi-structured interviews were conducted from May to July 2018. In a quantitative study, a nationwide, cross-sectional survey was conducted from January to March 2019, in which a questionnaire was mailed to 735 nurses in 28 tertiary care hospitals in Japan.

FINDINGS

In the quantitative study, 435 (59.2%) analysable responses were obtained. In the linear regression analysis, the lack of the knowledge that 'standard precaution was the fundamental infection countermeasure applied when patients had signs of infections, and these countermeasures could be terminated if there was no infection found' was significantly associated with decreased PPE adherence, whereas an antimicrobial-resistant bacteria outbreak or a ward shutdown due to an outbreak and the belief 'I must never be the cause of spreading infection' were significantly associated with increased PPE adherence. The β of standard coefficients and t-values of the items were -0.344, -7.784, 0.090, 2.089, 0.088, 2.018, respectively.

CONCLUSION

This survey systematically identified nursing-associated factors that contribute to PPE compliance. As a practical approach to ensure positive outcomes, we suggest educating nurses by providing adequate knowledge on appropriate PPE use and sharing outbreak or ward shutdown experiences.

Crucial Role of Increased Arid3a at the Pre-B and Immature B Cell Stages for B1a Cell Generation

The Lin28b⁺Let7⁻ axis in fetal/neonatal development plays a role in promoting CD5⁺ B1a cell generation as a B-1 B cell developmental outcome. Here we identify the Let7 target, Arid3a, as a crucial molecular effector of the B-1 cell developmental program. Arid3a expression is increased at pro-B cell stage and markedly increased at pre-B and immature B cell stages in the fetal/neonatal liver B-1 development relative to that in the Lin28b⁻Let7⁺ adult bone marrow (BM) B-2 cell development. Analysis of B-lineage restricted Lin28b transgenic (Tg) mice, Arid3a knockout and Arid3a Tg mice, confirmed that increased Arid3a allows B cell generation without requiring surrogate light chain (SLC) associated pre-BCR stage, and prevents MHC class II cell expression at the pre-B and newly generated immature B cell stages, distinct from pre-BCR dependent B development with MHC class II in adult BM. Moreover, Arid3a plays a crucial role in supporting B1a cell generation. The increased Arid3a leads higher Myc and Bhlhe41, and lower Siglec-G and CD72 at the pre-B and immature B cell stages than normal adult BM, to allow BCR signaling induced B1a cell generation. Arid3a-deficiency selectively blocks the development of B1a cells, while having no detectable effect on CD5⁻ B1b, MZ B, and FO B cell generation resembling B-2 development outcome. Conversely, enforced expression of Arid3a by transgene is sufficient to promote the development of B1a cells from adult BM. Under the environment change between birth to adult, altered BCR repertoire in increased B1a cells occurred generated from adult BM. However, crossed with B1a-restricted V_H/D/J IgH knock-in mice allowed to confirm that SLC-unassociated B1a cell increase and CLL/lymphoma generation can occur in aged from Arid3a increased adult BM. These results confirmed that in fetal/neonatal normal mice, increased Arid3a at the pre-B cell and immature B cell stages is crucial for generating B1a cells together with the environment for self-ligand reactive BCR selection, B1a cell maintenance, and potential for development of CLL/Lymphoma in aged mice.

Early Generated B-1-Derived B Cells Have the Capacity To Progress To Become Mantle Cell Lymphoma-like Neoplasia in Aged Mice

In mice, fetal/neonatal B-1 cell development generates murine CD5⁺ B cells (B1a) with autoreactivity. We analyzed B1a cells at the neonatal stage in a V_H11/D/J_H knock-in mouse line (V_H11t) that generates an autoreactive antiphosphatidylcholine BCR. Our study revealed that antiphosphatidylcholine B1a cells develop in liver, mature in spleen, and distribute in intestine/colon, mesenteric lymph node (mLN), and body cavity as the outcome of B-1 cell development before B-2 cell development. Throughout life, self-renewing B-1 B1a cells circulate through intestine, mesenteric vessel, and blood. The body cavity-deposited B1a cells also remigrate. In old age, some B1a cells proceed to monoclonal B cell lymphocytosis. When neonatal B-1 B1a cells express an antithymocyte/Thy-1 autoreactivity (ATA) BCR transgene in the C.B17 mouse background, ATA B cells increase in PBL and strongly develop lymphomas in aging mice that feature splenomegaly and mLN hyperplasia with heightened expression of CD11b, IL-10, and activated Stat3. At the adult stage, ATA B cells were normally present in the mantle zone area, including in intestine. Furthermore, frequent association with mLN hyperplasia suggests the influence by intestinal microenvironment on lymphoma development. When cyclin D1 was overexpressed by the Eμ-cyclin D1 transgene, ATA B cells progressed to further diffused lymphoma in aged mice, including in various lymph nodes with accumulation of IgM^hiIgD^loCD5⁺CD23^-CD43⁺ cells, resembling aggressive human mantle cell lymphoma. Thus, our findings reveal that early generated B cells, as an outcome of B-1 cell development, can progress to become lymphocytosis, lymphoma, and mantle cell lymphoma-like neoplasia in aged mice.

Spatial variations of 226Ra, 228Ra, 134Cs, and 137Cs concentrations in western and southern waters off the Korean Peninsula in July 2014

We examined the spatial distributions of ²²⁶Ra, ²²⁸Ra, ¹³⁴Cs, and ¹³⁷Cs concentrations (activities) in seawater off the western and southern Korean Peninsula in July 2014. Radium-228 (and ²²⁶Ra) concentrations in water samples varied widely from 5 to 14 mBq/L (2-4 mBq/L), showing a negative correlation with salinity, particularly at the surface off the western Korean Peninsula. This indicates that the seawaters in this area are fundamentally comprised of ²²⁸Ra-poor and high-saline Kuroshio Current water and ²²⁸Ra-rich and low-saline water (e.g., continental shelf water), with various mixing ratios. Although Fukushima Dai-ichi Nuclear Power Plant (FDNPP)-derived ¹³⁴Cs was below the detection limit (<0.08 mBq/L) in waters off the western Korean Peninsula, low level ¹³⁴Cs (0.1-0.2 mBq/L) was detected in waters off the southern Korean Peninsula accompanied by higher ¹³⁷Cs concentrations (1.6-1.9 mBq/L) relative to that off the western Korean Peninsula. Combined with the lower radium concentrations, the detection of ¹³⁴Cs is explained by mixing of FDNPP-derived radiocesium-contaminated Kuroshio Current water.

Adherence to contact precautions by different types of healthcare workers through video monitoring in a tertiary hospital

BACKGROUND

Contact precautions are required to prevent transmission of multi-drug-resistant organisms; however, reports on adherence rates vary. This study used video monitoring to evaluate adherence to the use of personal protective equipment (PPE) by different types of healthcare workers.

METHODS

This observational study was conducted in a 781-bed tertiary hospital from July 2016 to March 2017. Cameras were installed in areas where staff don PPE. Infection control teams observed the videos and assessed adherence rates.

RESULTS

In total, 1097 opportunities for donning PPE were observed. Most staff observed were nurses and nursing assistants (Ns/Nsas) (880/1097, 80.2%). Overall, the adherence rate to appropriate PPE use was 34.0%. The adherence rate among Ns/Nsas was lower (239/858, 27.9%) compared with infectious disease doctors (18/18, 100%) and cleaning staff (42/49, 85.7%). The adherence rate for PPE use for Clostridium difficile infection (CDI) with toxin detection was significantly higher than that for CDI without toxin detection and multi-drug-resistant organisms (P<0.001 for both). The adherence rate for patients with an independent functional status was higher than that for patients with a dependent functional status (P=0.018). The adherence rate was lower in the intensive care unit (ICU) than in non-ICU wards (27.6% vs 36.5%; P=0.006).

CONCLUSION

Video monitoring is a useful tool for monitoring adherence to PPE use, facilitating observation of more PPE opportunities than direct observation. Adherence to contact precautions varied by occupation; however, overall adherence was insufficient. The lower adherence rate in nurses might be due to more frequent care visits.

NLR Nod1 signaling promotes survival of BCR-engaged mature B cells through up-regulated Nod1 as a positive outcome

The microenvironment, including microbial products, plays a role in mature B cell survival. Hayakawa et al. show that B cell antigen receptor ligand–mediated Nod1 up-regulation in vivo in B cell development leads to preferential mature B cell survival as a competitive survival, increasing the Nod1⁺ B cell pool with age.

Although B cell development requires expression of the B cell antigen receptor (BCR), it remains unclear whether engagement of self-antigen provides a positive impact for most B cells. Here, we show that BCR engagement by self-ligand during development in vivo results in up-regulation of the Nod-like receptor member Nod1, which recognizes the products of intestinal commensal bacteria. In anti-thymocyte/Thy-1 autoreactive BCR knock-in mice lacking self–Thy-1 ligand, immunoglobulin light chain editing occurred, generating B cells with up-regulated Nod1, including follicular and marginal zone B cells with natural autoreactivity. This BCR editing with increased Nod1 resulted in preferential survival. In normal adult mice, most mature B cells are enriched for Nod1 up-regulated cells, and signaling through Nod1 promotes competitive survival of mature B cells. These findings demonstrate a role for microbial products in promoting survival of mature B cells through up-regulated Nod1, providing a positive effect of BCR engagement on development of most B cells.

Zebrafish B Cell Development without a Pre-B Cell Stage, Revealed by CD79 Fluorescence Reporter Transgenes

CD79a and CD79b proteins associate with Ig receptors as integral signaling components of the B cell Ag receptor complex. To study B cell development in zebrafish, we isolated orthologs of these genes and performed in situ hybridization, finding that their expression colocalized with IgH-μ in the kidney, which is the site of B cell development. CD79 transgenic lines were made by linking the promoter and upstream regulatory segments of CD79a and CD79b to enhanced GFP to identify B cells, as demonstrated by PCR analysis of IgH-μ expression in sorted cells. We crossed these CD79-GFP lines to a recombination activating gene (Rag)2:mCherry transgenic line to identify B cell development stages in kidney marrow. Initiation of CD79:GFP expression in Rag2:mCherry⁺ cells and the timing of Ig H and L chain expression revealed simultaneous expression of both IgH-μ- and IgL-κ-chains, without progressing through the stage of IgH-μ-chain alone. Rag2:mCherry⁺ cells without CD79:GFP showed the highest Rag1 and Rag2 mRNAs compared with CD79a and CD79b:GFP⁺ B cells, which showed strongly reduced Rag mRNAs. Thus, B cell development in zebrafish does not go through a Rag^hi CD79⁺IgH-μ⁺ pre-B cell stage, different from mammals. After the generation of CD79:GFP⁺ B cells, decreased CD79 expression occurred upon differentiation to Ig secretion, as detected by alteration from membrane to secreted IgH-μ exon usage, similar to in mammals. This confirmed a conserved role for CD79 in B cell development and differentiation, without the requirement of a pre-B cell stage in zebrafish.

Early generated B1 B cells with restricted BCRs become chronic lymphocytic leukemia with continued c-Myc and low Bmf expression

Hayakawa et al. show that distinctive B-lineage progression from B-1 development allows for generation of B1a cells with restricted BCRs and self-renewal capacity, both contributing to potential for CLL progression.

In mice, generation of autoreactive CD5⁺ B cells occurs as a consequence of BCR signaling induced by (self)-ligand exposure from fetal/neonatal B-1 B cell development. A fraction of these cells self-renew and persist as a minor B1 B cell subset throughout life. Here, we show that transfer of early generated B1 B cells from Eμ-TCL1 transgenic mice resulted in chronic lymphocytic leukemia (CLL) with a biased repertoire, including stereotyped BCRs. Thus, B1 B cells bearing restricted BCRs can become CLL during aging. Increased anti-thymocyte/Thy-1 autoreactive (ATA) BCR cells in the B1 B cell subset by transgenic expression yielded spontaneous ATA B-CLL/lymphoma incidence, enhanced by TCL1 transgenesis. In contrast, ATA B-CLL did not develop from other B cell subsets, even when the identical ATA BCR was expressed on a Thy-1 low/null background. Thus, both a specific BCR and B1 B cell context were important for CLL progression. Neonatal B1 B cells and their CLL progeny in aged mice continued to express moderately up-regulated c-Myc and down-regulated proapoptotic Bmf, unlike most mature B cells in the adult. Thus, there is a genetic predisposition inherent in B-1 development generating restricted BCRs and self-renewal capacity, with both features contributing to potential for progression to CLL.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Mr Imaging of Chronic Alcoholism

We evaluated the brain lesions of patients with chronic alcoholism (n = 34) in comparison with age- and sex-matched controls (n = 40) by MR imaging. T1-weighted sagittal and axial images and T2-weighted axial images were obtained with a 0.5 T superconducting MR unit. Various brain measurements were then performed, and the presence of regions of abnormal signal intensity was also compared between the two groups. The brain measurements revealed significant cerebral atrophy (characterized by lateral and 3rd ventricular dilatation, and widening of the interhemispheric fissure) as well as significant cerebellar atrophy (represented by 4th ventricular dilatation) in the alcoholic group. These changes were more prominent in patients in their fifties and sixties than in those aged in the thirties and forties. Focal hypointense lesions were observed in 20.6% of the alcoholics and in 5% of the controls (p < 0.01), while focal hyperintense lesions were observed in 61.8% of the alcoholics and in 20% of the controls (p < 0.001). The severity of these MR findings correlated well with the age of the patients. These observations suggest that alcohol is an important promotor of brain aging.

Effect of Iodinated Contrast Media on Ionic Calcium

This study was conducted to characterize the alterations in serum ionized calcium induced by contrast media (CM) and to determine the cause of the change. Fresh human blood samples as well as an electrolyte solution (ES) containing 1.2 mM calcium ions were diluted with CM and alterations in ionized calcium were measured using an electrometer. The CM tested were diatrizoate, iopamidol, iohexol, ioxaglate, isotonic saline, Na2-Ca-EDTA and pure meglumine. When CM were mixed with blood, ionic CM produced a greater decrease in ionized calcium than nonionic CM or saline. When mixed with ES, a significant reduction of ionized calcium was induced by ioxaglate and diatrizoate in comparison with saline. Na2-Ca-EDTA and meglumine caused no reduction in ionized calcium. Ioxaglate and diatrizoate caused calcium binding due to anions; binding induced by the latter was more prominent than that by the former. These observations suggest that a nonionic CM is more desirable for coronary arteriography of high-risk patients.

Blood-Brain Barrier Injury following Intracarotid Injection of Radiographic Contrast Media

Changes in signal intensity of the brain at magnetic resonance (MR) imaging before and after Gd-DTPA were used for in vivo quantification of injury to the blood-brain barrier (BBB). Immediately following intracarotid injection of 2 ml/kg of radiographic contrast medium (CM) 0.4 mmol/kg of Gd-DTPA was injected intravenously. MR imaging was performed with a 400/25 partial saturation pulse sequence. The maximum percentage changes (mean ± SD) in signal intensity of the brain after CM and Gd-DTPA were 1.6±1.6% with saline, 3.2 ± 2.0% with iotrolan, 4.3 ± 1.7% with iohexol, 6.6 ± 3.6% with ioxaglate and 8.2 ± 3.6% with diatrizoate. Not only the osmolality but also the ionicity and chemotoxicity seemed to influence Gd-DTPA leakage. A subtle BBB injury had a stronger tendency to occur in the basal ganglia than in the cerebral cortex. MR enhancement is proposed as a sensitive method for in vivo quantification of the BBB injury caused by intracarotid CM injection.

Contrast Media Induced Ventricular Fibrillation during Coronary Angiography in Dogs

This study is designed to determine which is more critical for contrast media induced ventricular fibrillation (VF), hyperosmolality or lack of sodium ions. The right coronary artery in the canine model was infused continuously with contrast media (CM) for 25 seconds or until ventricular fibrillation occurred. The test solutions included isotonic saline, 305 mg I/ml of meglumine diatrizoate, 370 mg I/ml of meglumine/Na diatrizoate and 370 mg I/ml of metrizamide. The incidence of VF with meglumine/Na diatrizoate was significantly higher than with metrizamide (p<0.05). These observations suggest that the hyperosmolality is more critical than the lack of sodium ions in CM when metrizamide is compared with conventional ionic CM. On the other hand, the results showing that contact time until VF was shorter with meglumine diatrizoate than with meglumine/Na diatrizoate may reflect the importance of sodium ions in CM with similar osmolality.

Acute Electrolyte Disturbances in Coronary Sinus during Left Coronary Arteriography in Man

Electrolyte disturbances, particularly reduction of ionized calcium, induced by iodinated contrast media (CM) are important considerations in coronary arteriography. A study was conducted in 24 patients to evaluate the acute electrolyte alterations in the coronary sinus during left coronary arteriography. During left coronary arteriography, coronary sinus blood was withdrawn for measurement of electrolytes. The CM used were diatrizoate, ioxaglate, iohexol, and iopamidol. The hematocrit was decreased moderately by all 4 CM used at 5 s and returned to the control level at 15 s. The level of ionized calcium was decreased by all CM at 5 s. Prolonged reduction of ionic calcium was observed with diatrizoate and ioxaglate at 15 s. The level of potassium was almost unchanged by diatrizoate and ioxaglate in spite of hemodilution, which may lead us to a hypothesis that potassium can be released from the intracellular spaces such as red blood cells and vascular endothelial cells. Thus the depression of left ventricular function might be caused not only by reduction of ionized calcium, but also by a relative increase in the level of serum potassium.

Effects of Contrast Media on the RR and QT Interval during Coronary Arteriography

During coronary arteriography, transient prolongation of the RR and QT intervals can be observed to occur. Animal experiments have suggested that low-osmolality contrast media have less effect, but there have been few clinical studies of this phenomenon. We analyzed 95 electrocardiographic records from patients who had undergone coronary arteriography and assessed the maximal prolongation of the RR and QT intervals. The contrast media used for arteriography included meglumine sodium diatrizoate, iopamidol, iohexol, and meglumine sodium ioxaglate. Diatrizoate caused the greatest electrocardiographic changes. Among the low osmolality contrast media, ioxaglate caused the smallest bradycardial effect and iohexol the smallest prolongation of the QT interval. It appears necessary to consider some additional factors for osmolality or ionicity, such as the chemotoxicity of the chemical structure of the iodinated contrast medium moiety, when assessing their potential adverse effect on the cardiac conduction system.

Opening of the Blood-Brain Barrier by Intravenous Contrast Media in Euvolemic and Dehydrated Rabbits

It has been suggested that intravenous injections of hypertonic contrast media when used in computed tomography and digital subtraction angiography might raise plasma osmolality sufficiently to open the blood-brain barrier (BBB). The current investigation establishes the threshold of plasma osmolality that causes the the opening of the BBB in euvolemic and dehydrated rabbits. Euvolemic rabbits were allowed food and water ad libitum. Dehydrated rabbits received 4.0 mg/kg of furosemide intramuscularly and were deprived of water for 72 hours. Meglumine/sodium diatrizoate 76 per cent (n=28) or mannitol 20 per cent (n= 12) was administrated intravenously, at a rate of 25 mmol/kg body weight/hour for 2, 3 or 4 hours. Plasma osmolality, blood iodine concentration, blood pressure, heart rate and hematocrit were assessed at regular intervals. Evans blue and 99Tcm-DTPA were used simultaneously as tracers for BBB opening. Rating of BBB opening with 99Tcm-DTPA correlated well with Evans blue staining (r=0.863, p<0.001; n=42). BBB opening was related to plasma osmolality and was similar for both contrast media and mannitol. Widespread BBB opening occurred above 400 mmol/kg while focal BBB opening occurred above 370 mmol/kg. Dehydration per se increased plasma osmolality but did not reduce the threshold for BBB opening.

Perspectives on fetal derived CD5+ B1 B cells

CD5(+) B-cell origins and their predisposition to lymphoma are long-standing issues. Transfer of fetal and adult liver BM Pro-B cells generates B cells with distinct phenotypes: fetal cells generate IgM(high) IgD(low) CD5(+) , whereas adult cells IgM(low) IgD(high) CD5(-) . This suggests a developmental switch in B lymphopoiesis, similar to the switch in erythropoiesis. Comparison of mRNA and miRNA expression in fetal and adult Pro-B cells revealed differential expression of Lin28b mRNA and Let-7 miRNA, providing evidence that this regulatory axis functions in the switch. Recent work has shown that Arid3a is a key transcription factor mediating fetal-type B-cell development. Lin28b-promoted fetal development generates CD5(+) B cells as a consequence of positively selected self-reactivity. CD5(+) B cells play important roles in clearance of apoptotic cells and in protective immune responses, but also pose a risk of progression to leukemia/lymphoma. Differential Lin28b expression in fetal and adult human B-cell precursors showed that human B-cell development may resemble mouse, with self-reactive "innate-like" B cells generated early in life. It remains to be determined whether such human B cells have a higher propensity to leukemic progression. This review describes our recent research with CD5(+) B cells and presents our perspective on their role in disease.

Selection of natural autoreactive B cells

Natural antibodies produced by CD5+ B1 B cells include anti-thymocyte autoantibody (ATA). Transgenic mice bearing the Ig-μ heavy chain of a prototypic ATA, V(H)3609Vκ21c, demonstrated a critical requirement for self-antigen in the accumulation of ATA B cells and production of high levels of serum ATA. Further work with ATA-μκ transgenic mice revealed that, while development of most B cells were blocked at an immature stage in spleen, some mature ATA B cells were present. ATA-μκ transgenic mice with varying levels of Thy-1 autoantigen showed a clear relationship between BCR crosslinking and B cell fate, with low levels generating marginal zone ATA B cells and complete antigen absence allowing maturation to follicular ATA B cells. Finally, different fates of developing ATA B cells encountering high levels self-antigen may be accounted for by variations in the response of newly formed B cells arising from foetal and adult development.

B cells generated by B-1 development can progress to chronic lymphocytic leukemia

B cells generated early during fetal/neonatal B-1 development in mice include autoreactive cells with detectable CD5 upregulation induced by B cell receptor (BCR) signaling (B1a cells). A fraction of B1a cells are maintained by self-renewal for life, with the potential risk of dysregulated growth and progression to chronic lymphocytic leukemia (CLL)/lymphoma during aging. In studies using the Eμ-hTCL1 transgenic mouse system, it became clear that this B1a subset has a higher potential than other B cell subsets for progression to CLL. We have generated several autoreactive germline BCR gene models to compare B cells generated under conditions of natural exposure to autoantigen. Analysis of the mice has been key in understanding the importance of the BCR and BCR signaling for generating different B cell subsets and for investigating the cellular origin of B-CLL.

Lin28b promotes fetal B lymphopoiesis through the transcription factor Arid3a

Zhou et al. demonstrate a requirement for the Let-7–Lin28b axis regulating a shift in development between fetal liver and bone marrow B lymphocyte progenitors in the generation of B1 versus B2 B cells. Specifically, the transcription factor Arid3a, induced by Lin28b and a target of Let-7 miRNA, is sufficient to recapitulate fetal B cell development from bone marrow progenitors.

Mouse B cell precursors from fetal liver and adult bone marrow (BM) generate distinctive B cell progeny when transplanted into immunodeficient recipients, supporting a two-pathway model for B lymphopoiesis, fetal “B-1” and adult “B-2.” Recently, Lin28b was shown to be important for the switch between fetal and adult pathways; however, neither the mechanism of Lin28b action nor the importance of B cell antigen receptor (BCR) signaling in this process was addressed. Here, we report key advances in our understanding of the regulation of B-1/B-2 development. First, modulation of Let-7 in fetal pro-B cells is sufficient to alter fetal B-1 development to produce B cells resembling the progeny of adult B-2 development. Second, intact BCR signaling is required for the generation of B1a B cells from Lin28b-transduced BM progenitors, supporting a requirement for ligand-dependent selection, as is the case for normal B1a B cells. Third, the V_H repertoire of Lin28b-induced BM B1a B cells differs from that of normal B1a, suggesting persisting differences from fetal progenitors. Finally, we identify the Arid3a transcription factor as a key target of Let-7, whose ectopic expression is sufficient to induce B-1 development in adult pro-B cells and whose silencing by knockdown blocks B-1 development in fetal pro-B cells.

Natural anti-intestinal goblet cell autoantibody production from marginal zone B cells

Expression of a germline VH3609/D/JH2 IgH in mice results in the generation of B1 B cells with anti-thymocyte/Thy-1 glycoprotein autoreactivity by coexpression of Vk21-5/Jk2 L chain leading to production of serum IgM natural autoantibody. In these same mice, the marginal zone (MZ) B cell subset in spleen shows biased usage of a set of Ig L chains different from B1 B cells, with 30% having an identical Vk19-17/Jk1 L chain rearrangement. This VH3609/Vk19-17 IgM is reactive with intestinal goblet cell granules, binding to the intact large polymatrix form of mucin 2 glycoprotein secreted by goblet cells. Analysis of a μκ B cell AgR (BCR) transgenic (Tg) mouse with this anti-goblet cell/mucin2 autoreactive (AGcA) specificity demonstrates that immature B cells expressing the Tg BCR become MZ B cells in spleen by T cell-independent BCR signaling. These Tg B cells produce AGcA as the predominant serum IgM, but without enteropathy. Without the transgene, AGcA autoreactivity is low but detectable in the serum of BALB/c and C.B17 mice, and this autoantibody is specifically produced by the MZ B cell subset. Thus, our findings reveal that AGcA is a natural autoantibody associated with MZ B cells.

Influence of genetic and environmental factors on oral diseases and function in aged twins

This study was conducted to quantify the genetic and environmental contributions to oral disease and function in twins. Participants were middle-aged and old twins, 116 monozygotic and 16 dizygotic pairs whose mean age was 66·1 ± 10·3 (SD) years. Number of teeth, percentage of decayed, filled and missing teeth and periodontal status were recorded as indicators of oral disease. The widths of upper and lower dental arch served as indicators of morphological figures. Furthermore, stimulated salivary flow rate, occlusal force and masticatory performance were measured as indicators of oral function. Univariate genetic analysis with monozygotic and dizygotic twin pairs was conducted to detect the fittest structural equation model of each outcome. Both number of teeth and periodontal status fitted the model composed of common environmental factor and unique environmental factor. Decayed, filled and missing teeth, morphological figures and measurements of oral function fitted the model composed of additive genetic factor and unique environmental factor. The model fitting of each measurement suggested that periodontal disease was mainly affected by environmental factors, while morphological figures and oral functions were influenced by both genetic and environmental factors.

Two cases of Zika fever imported from French Polynesia to Japan, December 2013 to January 2014

We present two cases of imported Zika fever to Japan, in travellers returning from French Polynesia, where an outbreak due to Zika virus (ZIKV) is ongoing since week 41 of 2013. This report serves to raise awareness among healthcare professionals, that the differential diagnosis of febrile and subfebrile patients with rash should include ZIKV infection, especially in patients returning from areas affected by this virus.

Neurotransmitters, psychotropic drugs and microglia: clinical implications for psychiatry

Psychiatric disorders have long and dominantly been regarded to be induced by disturbances of neuronal networks including synapses and neurotransmitters. Thus, the effects of psychotropic drugs such as antipsychotics and antidepressants have been understood to modulate synaptic regulation via receptors and transporters of neurotransmitters such as dopamine and serotonin. Recently, microglia, immunological/inflammatory cells in the brain, have been indicated to have positive links to psychiatric disorders. Positron emission tomography (PET) imaging and postmortem studies have revealed microglial activation in the brain of neuropsychiatric disorders such as schizophrenia, depression and autism. Animal models of neuropsychiatric disorders have revealed the underlying microglial pathologies. In addition, various psychotropic drugs have been suggested to have direct effects on microglia. Until now, the relationship between microglia, neurotransmitters and psychiatric disorders has not been well understood. Therefore, in this review, at first, we summarize recent findings of interaction between microglia and neurotransmitters such as dopamine, serotonin, norepinephrine, acetylcholine and glutamate. Next, we introduce up-to-date knowledge of the effects of psychotropic drugs such as antipsychotics, antidepressants and antiepileptics on microglial modulation. Finally, we propose the possibility that modulating microglia may be a key target in the treatment of various psychiatric disorders. Further investigations and clinical trials should be conducted to clarify this perspective, using animal in vivo studies and imaging studies with human subjects.

Mechanosensitive channels are activated by stress in the actin stress fibres, and could be involved in gravity sensing in plants

Mechanosensitive (MS) channels are expressed in a variety of cells. The molecular and biophysical mechanism involved in the regulation of MS channel activities is a central interest in basic biology. MS channels are thought to play crucial roles in gravity sensing in plant cells. To date, two mechanisms have been proposed for MS channel activation. One is that tension development in the lipid bilayer directly activates MS channels. The second mechanism proposes that the cytoskeleton is involved in the channel activation, because MS channel activities are modulated by pharmacological treatments that affect the cytoskeleton. We tested whether tension in the cytoskeleton activates MS channels. Mammalian endothelial cells were microinjected with phalloidin-conjugated beads, which bound to stress fibres, and a traction force to the actin cytoskeleton was applied by dragging the beads with optical tweezers. MS channels were activated when the force was applied, demonstrating that a sub-pN force to the actin filaments activates a single MS channel. Plants may use a similar molecular mechanism in gravity sensing, since the cytoplasmic Ca(2+) concentration increase induced by changes in the gravity vector was attenuated by potential MS channel inhibitors, and by actin-disrupting drugs. These results support the idea that the tension increase in actin filaments by gravity-dependent sedimentation of amyloplasts activates MS Ca(2+) -permeable channels, which can be the molecular mechanism of a Ca(2+) concentration increase through gravistimulation. We review recent progress in the study of tension sensing by actin filaments and MS channels using advanced biophysical methods, and discuss their possible roles in gravisensing.

Treatment results for Stage Ib cervical cancer after stage subdivision by MRI evaluation

PURPOSE OF INVESTIGATION

The authors analyzed treatment results for cervical cancer after subdividing Stage Ib into Stages Ib1 and Ib2 according to magnetic resonance imaging (MRI) information.

MATERIALS AND METHODS

The subjects comprised 40 cases of Stage Ib cervical cancer treated by definitive radiotherapy in Kitasato University hospital and Tokyo University hospital from January 2000 to December 2008. The patients' ages ranged from 28 to 85 years (median: 68 years). The maximum tumor diameter measured with MRI ranged from undetectable to 60 mm (median: 25 mm). The authors classified tumors with the greatest dimension less than 40 mm as Stage Ib1 (29 cases) and those with the greatest dimension more than 40 mm as Ib2 (11 cases). All cases were treated with a combination of external beam irradiation and high-dose-rate intra-cavitary brachytherapy. Chemotherapy was combined with radiotherapy in 11 cases.

RESULTS

The follow-up time was from four to 109 months (median: 53 months). At the time of last observation, 37 cases survived, local recurrence was seen in none, and two cases showed distant metastasis. The two- and five-year overall survival rates of all cases were 97.5% and 89.5%, respectively. When a stage was subdivided and examined, the five-year overall survival rate of Stage Ib1 was 100% and that of Stage Ib2 was 50.5% (p = 0.001).

CONCLUSION

The authors suggest that the subdivision of stages using image information reflects the prognosis of Stage Ib cervical cancer.

228Ra/226Ra ratio and 7Be concentration in the Sea of Japan as indicators for water transport: comparison with migration pattern of Fukushima Dai-ichi NPP-derived 134Cs and 137Cs

To assess the migration patterns of radiocesium emitted from the Fukushima Dai-ichi Nuclear Power Plant (FDNPP), we analyzed (228)Ra/(226)Ra ratios and (7)Be concentrations and compared them with (134)Cs and (137)Cs concentrations in seawater samples collected within the Sea of Japan before and after the FDNPP accident (i.e., during the period 2007-2012) using low-background γ-spectrometry. The (228)Ra/(226)Ra ratios in surface waters exhibited lateral and seasonal variations, reflecting the flow patterns of surface water. This indicates the transport patterns of the FDNPP-derived radiocesium by surface water. Cosmogenic (7)Be (half-life: 53.3 d) exhibited markedly high concentrations (5-10 mBq/L) at depths shallower than 50 m, with concentrations decreasing steeply (0.2-2 mBq/L) at depths of 50-250 m. The distribution of (7)Be concentrations suggests that the downward delivery of the FDNPP-derived radiocesium to below 50 m depth was negligible for a few months prior to its removal from the Sea of Japan.