Characteristics of iodine-bearing silver-impregnated alumina sorbents and their direct solidification via hot isostatic pressing

Waste management for radioiodine is a key issue for the sustainable nuclear fuel cycle. The iodine adsorption behavior on a bed column of a silver-impregnated alumina sorbent (AgA) under conditions designed to match those of the Rokkasho reprocessing facility dissolver off-gas (DOG) system was investigated using different volatilized iodine concentrations. Cross-sectional observations of iodine-bearing AgA grains revealed that iodine was adsorbed as silver iodide and silver iodate, and gradually distributed from the surface to the inside of the AgA. The iodine distribution throughout the AgA beds allowed us to estimate the length of the mass-transfer zone. This suggests that the iodine load fraction in AgA (adsorbed iodine/total impregnated silver) will be averaged to 50% in the expected facility equipment design. This study also describes the waste form durability after disposal. To reproduce the average iodine loading in the waste form, 100%-loaded AgA grains were mixed with an equal amount of commercially available alumina reagents and consolidated through hot isostatic pressing at 175 MPa and 1,325°C for 3 h. The resultant 50%-loaded solid was used for the static leaching test over 4.5 years, where the leached iodine was less than 0.2% under simple reducing conditions. This suggested that the HIPed solid of AgA from Rokkasho DOG showed preferable water resistance for after disposal safety.

Significant response to amantadine in a patient with malignant catatonia: A case report

Purpose

Catatonia is a complication of bipolar disorder, which is a constellation of symptoms such as catalepsy, mutism, and stupor. Standard therapy for catatonia contains benzodiazepines and electroconvulsive therapy. An uncomplicated catatonia is usually a benign condition. On the other hand, malignant catatonia is a life-threatening condition that is complicated with fever, autonomic instability, delirium, and rigidity. The syndrome is typically fulminant and progresses rapidly within a few days without appropriate intervention. Several previous reports suggested that some catatonia are associated with the overstimulation of N-methyl-D-aspartate (NMDA) receptor, and that amantadine may have an effectiveness for catatonia, as a NMDA receptor antagonist. We report a case of successful treatment for malignant catatonia refractory to benzodiazepines, by using amantadine.

Materials and methods/case

A 64-year-old Japanese woman with bipolar disorder was referred to our hospital because of 8-week prolonged fever. On admission, she was in febrile and stuporous states. Severe rigidity was observed in her extremities. Blood tests, lumbar puncture, and blood cultures were all negative. Brain MRI was normal. Consequently, we reached a diagnosis of malignant catatonia, and thus we gave additional benzodiazepines for her catatonic symptoms. However, there was no improvement, and we finally add a 50 mg/day amantadine for her malignant catatonic state.

Result

Her fever resolved in a few days. Gradual dose-titration of amantadine led her clinical manifestation to completely disappeared.

Conclusion

Amantadine can be a potential option as one of the pharmacological therapies for refractory malignant catatonia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Virtual pathology of cervical radiculopathy based on 3D MR/CT fusion images: impingement, flattening or twisted condition of the compressed nerve root in three cases

Background

There have been several imaging studies of cervical radiculopathy, but no three-dimensional (3D) images have shown the path, position, and pathological changes of the cervical nerve roots and spinal root ganglion relative to the cervical bony structure. The objective of this study was to introduce a technique that enables the virtual pathology of the nerve root to be assessed using 3D magnetic resonance (MR)/computed tomography (CT) fusion images that show the compression of the proximal portion of the cervical nerve root by both the herniated disc and the preforaminal or foraminal bony spur in patients with cervical radiculopathy.

Findings

MR and CT images were obtained from three patients with cervical radiculopathy. 3D MR images were placed onto 3D CT images using a computer workstation.

The entire nerve root could be visualized in 3D with or without the vertebrae. The most important characteristic evident on the images was flattening of the nerve root by a bony spur. The affected root was constricted at a pre-ganglion site. In cases of severe deformity, the flattened portion of the root seemed to change the angle of its path, resulting in twisted condition.

Conclusions

The 3D MR/CT fusion imaging technique enhances visualization of pathoanatomy in cervical hidden area that is composed of the root and intervertebral foramen. This technique provides two distinct advantages for diagnosis of cervical radiculopathy. First, the isolation of individual vertebra clarifies the deformities of the whole root groove, including both the uncinate process and superior articular process in the cervical spine. Second, the tortuous or twisted condition of a compressed root can be visualized.

The surgeon can identify the narrowest face of the root if they view the MR/CT fusion image from the posterolateral-inferior direction. Surgeons use MR/CT fusion images as a pre-operative map and for intraoperative navigation. The MR/CT fusion images can also be used as educational materials for all hospital staff and for patients and patients’ families who provide informed consent for treatments.

Current status of in-hospital donation coordinators in Japan: nationwide survey

OBJECTIVES

When the Japanese Organ Transplantation Act was issued, the Japanese Organ Transplantation Network (JOT) was established in 1997. JOT lists recipients, assesses and manages organ donors, and educates publics and headquarters for organ donations. JOT procurement transplant coordinators (PTC) play roles in obtaining consent from relatives for organ donation, donor evaluation and management, organ recovery management, organ transport, and care of donor families during and after donation. Every prefecture has at least one PTC who is mainly working in public education and hospital development. They also help the JOT PTC at the time of organ procurement. Most prefectures commission hospital staff in the procurement hospital to be an in-hospital PTC (In-Hp PTC), who make their hospital staff aware of organ donation and support organ procurement. Although the Act was revised in 2010 with brain-dead organ donation increased from 13 to 44 cases yearly, the number was still extremely smaller than other developed countries. In these circumstances, In-Hp PTC may play greater roles to increase donation and smooth procurement procedures Our primary aim was to describe the current status of In-Hp PTC in Japan.

MATERIALS AND METHODS

Between December 15, 2011, and January 31, 2012, we invited 1889 In-Hp PTC to complete a letter survey using a self-designed questionnaire. In all, 56 In-Hp PTC (40%) completed and returned it.

RESULTS

The occupation of the respondents was nurse (66%), physician (18%), or other (16%). Although 52% of respondents belonged to the hospital, which was designated for brain-death organ donation by the government, only 46% had any experience with a cadaveric donor. Only 2% were full-time In-Hp PTC. They mainly played a role in preparing their own manual for organ procurement (57%), providing in-hospital lectures (44%) or their own simulation exercise (29%), as well as coordinating donation cases. Although 77% had attended seminar about organ donation provided by JOT or the prefecture PTC, 93% wanted more professional education. However, it was difficult for them to attend these activities, to manage a rare and sudden donation case, and to find time to learn about organ donation because they had another post. The topics that they wanted to learn were donor family care (72%), overall organ/tissue donation procedures (65%), the role of In-Hp PTC (67%), simulations of donation (65%), legislation and social system of organ donation (61%), medical indications for donation (61%), current status of donation and transplantation in Japan (57%), donor management (56%), and case studies (49%). There were significant variations in the topics of interest among the occupations. As they had another post, they could find only a short period (1 or 2 days) to take professional education, such as lectures. Therefore, it was difficult for them to attend practical on-the-job training.

CONCLUSIONS

To establish an organ procurement system and increase organ donation, In-Hp PTC have important roles in Japan. However, none is a full-time In-Hp PTC. Most In-Hp PTC require more professional education. A systematic education program for each occupation must be established soon.

Use of in-vitro experimental results to model in-situ experiments: bio-denitrification under geological disposal conditions

Some of the low level radioactive wastes from reprocessing of spent nuclear fuels contain nitrates. Nitrates can be present in the form of soluble salts and can be reduced by various reactions. Among them, reduction by metal compounds and microorganisms seems to be important in the underground repository. Reduction by microorganism is more important in near field area than inside the repository because high pH and extremely high salt concentration would prevent microorganism activities. In the near field, pH is more moderate (pH is around 8) and salt concentration is lower. However, the electron donor may be limited there and it might be the control factor for microorganism's denitrification activities. In this study, in-vitro experiments of the nitrate reduction reaction were conducted using model organic materials purported to exist in underground conditions relevant to geological disposal. Two kinds of organic materials were selected. A super plasticizer was selected as being representative of the geological disposal system and humic acid was selected as being representative of pre-existing organic materials in the bedrock. Nitrates were reduced almost to N₂ gas in the existence of super plasticizer. In the case of humic acids, although nitrates were reduced, the rate was much lower and, in this case, dead organism was used as an electron donor instead of humic acids. A reaction model was developed based on the in-vitro experiments and verified by running simulations against data obtained from in-situ experiments using actual groundwaters and microorganisms. The simulation showed a good correlation with the experimental data and contributes to the understanding of microbially mediated denitrification in geological disposal systems.

[Outbreak of extensively drug-resistant pulmonary tuberculosis in a hemodialysis facility]

We experienced an outbreak of extensively drug-resistant pulmonary tuberculosis (XDR-TB) in a hemodialysis facility. The primary case involved a 51-year-old male hemodialysis patient, with a history of treatment for Mycobacterium tuberculosis infection seven years previously. There was no drug resistance, and the patient completely recovered after undergoing treatment with isoniazid (INH), rifampicin (RFP) and ethambutol (EB). He was admitted to another hospital due to a recurrence of pulmonary tuberculosis in June 2006. At first, he was treated with HRS [INH, RFP and streptomycin (SM)]; however, the drug regimen was changed to INH, EB, levofloxacin (LVFX) and kanamycin (KM) in August following the results of a drug susceptibility test. Although the patient was receiving outpatient tuberculous therapy, he was readmitted in June 2007 due to relapse and conversion of a sputum culture to positive status. Additionally, the XDR-TB organism was identified. Following these events, five staff members of the hemodialysis facility and a member of the patient's family were diagnosed with XDR-TB infection. The staffs who were infected with XDR-TB had worked in the same dialysis room, drug resistance was found in all cases and drug resistant gene mutations were found in three cases; therefore, we considered this to be an outbreak. As XDR-TB infection was suspected in all cases, no patients took drugs to treat latent tuberculosis infection (LTBI). Regarding the causes of the outbreak, the first is the delay of four months in making a diagnosis of re-exacerbation of tuberculosis. Second, in Case 2, the patient developed laryngeal and tracheobronchial tuberculosis after first being diagnosed with asthma, and the tuberculosis diagnosis was delayed. Third, the sputum smear of Case 2 was strongly positive. There is only one previously reported outbreak of XDR-TB in Japan; therefore, we consider this outbreak to be educational.

Oophorectomy for fertility preservation via reduced-port laparoscopic surgery

BACKGROUND

For fertility preservation of women patients scheduled to undergo chemotherapy or radiotherapy, unilateral oophorectomy was performed, and the ovary was cryopreserved.

METHODS

Two-port surgery was conducted in 3 patients, and single-port surgery using a single-incision laparoscopic surgery port in 3. An 18-G Cathelin needle equipped with a syringe was directly inserted transabdominally to reach the small follicle on the ovarian surface; then, follicular fluid was recovered by aspiration through the syringe as with in vitro fertilization procedures, and immature oocytes were collected from the resulting culture medium under microscopy and cryopreserved. Vitrification of the ovarian tissue was performed using the cryotissue method.

RESULTS

The operative time and estimated blood loss were 39.7 minutes (17-57) and 8.6 mL (2-20), and the numbers of ovarian cortical tissues and immature oocytes collected were 10.1 (5.5-15) and 16.3 (0-36), respectively.

CONCLUSIONS

It is suggested that fertility preservation operations before chemotherapy or radiotherapy can be safely done using reduced-port surgery.

Minimal ovarian stimulation combined with elective single embryo transfer policy: age-specific results of a large, single-centre, Japanese cohort

BACKGROUND

The two main complications associated with the use of assisted reproduction techniques, ovarian hyperstimulation syndrome and multiple pregnancies, could be eliminated by milder ovarian stimulation protocols and the increased use of a single embryo transfer (SET) policy. A retrospective, cohort study was performed in private infertility centre to evaluate the embryological and clinical results of a large exclusively SET program according to patient age (lower or equal 29, 30-34, 35-39, 40-44 and equal or higher 45 years).

MATERIALS

A total of 7,244 infertile patients have undergone 20,244 cycles with a clomiphene-based minimal stimulation or natural cycle IVF protocol during 2008. Following oocyte retrieval, fertilization and embryo culture a total of 10,401 fresh or frozen single embryo transfer procedures were performed involving cleavage-stage embryos or blastocysts.

RESULTS

Successful oocyte retrieval rate (78.0 %) showed no age-dependent decrease until 45 years. Fertilization (80.3 %) and cleavage (91.1 %) rates were not significantly different between age groups. Blastocyst formation (70.1 % to 22.8 %) and overall live birth rates (35.9 % to 2 %) showed an age-dependent decrease. Frozen-thawed blastocyst transfer cycles gave the highest chance of live birth per embryo transfer (41.3 % to 6.1 %).

CONCLUSIONS

High fertilization and cleavage rates were obtained regardless of age whereas blastocyst formation and live birth rates showed an age-dependent decrease. An elective single embryo transfer program based on a minimal ovarian stimulation protocol yields acceptable live birth rates per embryo transfer in infertile patients up until their mid-forties. However in very advanced age patients (equal or higher 45 years old) success rates fall below 1 %.

Prevention of mitochondrial disease inheritance by assisted reproductive technologies: prospects and challenges

BACKGROUND

Mitochondrial diseases are caused by the mutations in both nuclear and mitochondrial DNA (mtDNA) and the treatment options for patients who have mitochondrial disease are rather limited. Mitochondrial DNA is transmitted maternally and does not follow a Mendelian pattern of inheritance. Since reliable and predictable detection of mitochondrial disorders in embryos and oocytes is unattainable at present, an alternative approach to this problem has emerged as partial or complete replacement of mutated mtDNA with the wild-type mtDNA through embryo manipulations. Currently available methods to achieve this goal are germinal vesicle transfer (GVT), metaphase chromosome transfer (CT), pronuclear transfer (PNT) and ooplasmic transfer (OT).

SCOPE OF REVIEW

We summarize the state of the art regarding these technologies and discuss the implications of recent advances in the field for clinical practice.

MAJOR CONCLUSIONS

CT, PNT and GVT techniques hold promise to prevent transmission of mutant mtDNA through ARTs. However, it is clear that mtDNA heteroplasmy in oocytes, embryos and offspring produced by these methods remains as a legitimate concern.

GENERAL SIGNIFICANCE

New approaches to eliminate transmission of mutant mtDNA certainly need to be explored in order to bring the promise of clinical application for the treatment of mitochondrial disorders. This article is part of a Special Issue entitled Biochemistry of Mitochondria, Life and Intervention 2010.

A quantitative coronary angiography-matched comparison between a prospective randomised multicentre cutting balloon angioplasty and bare metal stent trial (REDUCE III) and the Rapamycin-Eluting Stent Evaluation At Rotterdam Cardiology Hospital (RESEARCH) study

AIMS

There remains significant concern about the long-term safety of drug-eluting stents (DES). However, bare metal stents (BMS) have been used safely for over two decades. There is therefore a pressing need to explore alternative strategies for reducing restenosis with BMS. This study was designed to examine whether IVUS-guided cutting balloon angioplasty (CBA) with BMS could convey similar restenosis rates to DES.

METHODS AND RESULTS

In the randomised REstenosis reDUction by Cutting balloon angioplasty Evaluation (REDUCE III) study, 521 patients were divided into four groups based on device and IVUS use before BMS (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up, the IVUS-CBA-BMS group had a significantly lower restenosis rate (6.6%) than the other groups (p=0.016). We performed a quantitative coronary angiography (QCA) based matched comparison between an IVUS-guided CBA-BMS strategy (REDUCE III) and a DES strategy (Rapamycin-Eluting-Stent Evaluation At Rotterdam Cardiology Hospital, the RESEARCH study). We matched the presence of diabetes, vessel size, and lesion severity by QCA. Restenosis (>50% diameter stenosis at follow-up) and target vessel revascularisation (TVR) were examined. QCA-matched comparison resulted in 120-paired lesions. While acute gain was significantly greater in IVUS-CBA-BMS than DES (1.65±0.41 mm vs. 1.28±0.57 mm, p=0.001), late loss was significantly less with DES than with IVUS-CBA-BMS (0.03±0.42 mm vs. 0.80±0.47 mm, p=0.001). However, no difference was found in restenosis rates (IVUS-CBA-BMS: 6.6% vs. DES: 5.0%, p=0.582) and TVR (6.6% and 6.6%, respectively).

CONCLUSIONS

An IVUS-guided CBA-BMS strategy yielded restenosis rates similar to those achieved by DES and provided an effective alternative to the use of DES.

[A case of hard metal lung disease in a man who worked as an iron grinder]

The patient was a man who had suffered from repeated pneumothoraces since August 2003, when he was 16 years old. A right pneumothorax was observed at age 21 years, in April 2008. At the same time, a dry cough began to appear and diffuse small nodular shadows in both lung fields were found on a chest X-ray film. Due to worsening symptoms and the chest X-ray findings, a transbronchial lung biopsy was performed in September 2008. Pathological examination showed mural type organization, and large numbers of multinucleated giant cells that were engulfing nucleated cells and had black pigment in their cytoplasm. Giant cell interstitial pneumonia and hard metal lung disease (HMLD) were suspected because of the patient's occupational history as a metal grinder, which included the use of a hard metal tool for three years since August 2005. In an elementary analysis using an electron probe microanalyzer, tungsten was detected in resected lung tissue obtained in April 2008 which confirmed the diagnosis. His symptoms improved after the initiation of corticosteroid therapy, which continued but with a gradual decrease in the dose. In this case, HMLD developed over a relatively short period despite the low level of dust dispersal of a hard-metal tool, perhaps because of a hypersensitivity of the patient to hard metal.

Natural IVF cycles may be desirable for women with repeated failures by stimulated IVF cycles

PURPOSE

Although many reports support stimulated in vitro fertilization, several patients do not respond to it well. Furthermore, stimulated treatment could be associated with reduced ovarian response. We describe three successful cases involving patients of advanced age from whom dominant follicles were retrieved during the natural cycle.

MATERIALS AND METHODS

All patients had failed to bear children through stimulated in vitro fertilization. In case 1, a follicle was retrieved after a gonadotropin-releasing hormone agonist was used to induce luteinizing hormone surge. In cases 2 and 3, pregnancy was achieved via completely natural cycles.

RESULTS

One embryo was transferred every 16 cycles. Ongoing pregnancy--defined as pregnancy progressing beyond gestation week 9--was established in three cycles. The patients successfully delivered and had uneventful neonatal courses.

CONCLUSION

Mature oocyte retrieval followed by natural rather than stimulated in vitro fertilization might be a potential treatment for patients of advanced age when stimulated in vitro fertilization has been repeatedly unsuccessful.