The Prospective Natural History Study of Patients with Intractable Venous Malformation and Klippel-Trenaunay Syndrome to Guide Designing a Proof-of-Concept Clinical Trial for Novel Therapeutic Intervention

Background: The natural history of venous malformation (VM) and Klippel-Trenaunay Syndrome (KTS) has not been quantitatively studied. To obtain benchmarks to guide designing clinical trials to assess safety and efficacy of novel drug candidates, the clinical course of the patients was followed for 6 months. Methods and Results: This is a multicenter prospective observational study evaluating the change rate in lesion volume from baseline with magnetic resonance images, as the primary endpoint. In addition, disease severities, performance status (PS), pain visual analog scale (VAS) score, quality of life (QoL), infections, and coagulation markers were also evaluated. Thirty-four patients (VM = 17, KTS = 17, 1-53 of age; median 15.9 years) with measurable lesion volume were analyzed. There was no statistically significant difference in the lesion volume between baseline and day 180, and the mean change rate (standard deviation) was 1.06 (0.28). There were no baseline characteristics that affected the change in lesion volume over 6 months. However, there were patients who showed more than 20% volume change and it was suggested that the lesion volume was largely impacted by local infection. There were no statistically significant changes in pain VAS score, severity, PS, QoL score, D-dimer, and platelet count over 6 months within all patients analyzed. Conclusion: The results showed the representative natural course of VM and KTS for a 6-month period with objective change of lesion volume and other factors, suggesting that it is scientifically reasonable to conduct a Phase 2 proof-of-concept study without a placebo arm, using the results of this study as the control. Clinical Trial Registration: NCT04285723, NCT04589650.

Longitudinal MR Quantification of the Fat Fraction within the Supraspinatus and Infraspinatus Muscles in Patients with Shoulder Pain

RATIONALE AND OBJECTIVES

Knowing the natural history of fatty degeneration of rotator cuff muscles is important for estimating the risk and rate of progression to cuff tear arthropathy (CTA). The purpose of this study was to investigate the changes in rotator cuff muscle fatty degeneration over time quantitatively in patients treated conservatively for shoulder pain.

MATERIALS AND METHODS

Thirty patients with a baseline and follow-up shoulder MRI, including a 2-point Dixon sequence, which were performed at least 1 year apart, were included. We classified patients into 3 groups: "full-thickness tear" (n = 7), "partial-thickness tear" (n = 13), and "no-tear" (n = 10) groups. The fat fraction in the supra- and infraspinatus muscles, and the rate of change in the fat fraction (ΔFfr) were calculated using the formula "fat fraction of follow-up MRI/fat fraction of initial MRI." We investigated the difference in ΔFfr among the 3 groups and the degree of progression to CTA.

RESULTS

Statistically significant differences in ΔFfr within the supraspinatus and infraspinatus muscles were found among full-thickness, partial-thickness, and no-tear groups (2.54 vs 1.02 vs 0.75, p < 0.001 and 1.96 vs 1.07 vs 0.73, p = 0.021, respectively). Overall, 71.4% of the full-thickness tear group showed progression of CTA, and 28.6% of the full-thickness tear group needed reverse shoulder arthroplasty within an average follow-up period of 34 months.

CONCLUSIONS

MR quantification, together with the knowledge of change in fatty degeneration over time, may be useful for the management of patients with shoulder pain.

Review of Quantitative Knee Articular Cartilage MR Imaging

Osteoarthritis (OA) is one of the most prevalent disorders in today’s society, resulting in significant socio-economic costs and morbidity. MRI is widely used as a non-invasive imaging tool for OA of the knee. However, conventional knee MRI has limitations to detect subtle early cartilage degeneration before morphological changes are visually apparent. Novel MRI pulse sequences for cartilage assessment have recently received increased attention due to newly developed compositional MRI techniques, including: T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), sodium MRI, diffusion-weighted imaging (DWI)/ diffusion tensor imaging (DTI), ultrashort TE (uTE), and glycosaminoglycan specific chemical exchange saturation transfer (gagCEST) imaging. In this article, we will first review these quantitative assessments. Then, we will discuss the variations of quantitative values of knee articular cartilage with cartilage layer (depth)- and angle (regional)-dependent approaches. Multiple MRI sequence techniques can discern qualitative differences in knee cartilage. Normal articular hyaline cartilage has a zonal variation in T2 relaxation times with increasing T2 values from the subchondral bone to the articular surface. T1rho values were also higher in the superficial layer than in the deep layer in most locations in the medial and lateral femoral condyles, including the weight-bearing portion. Magic angle effect on T2 mapping is clearly observed in the both medial and lateral femoral condyles, especially within the deep layers. One of the limitations for clinical use of these compositional assessments is a long scan time. Recent new approaches with compressed sensing (CS) and MR fingerprinting (MRF) have potential to provide accurate and fast quantitative cartilage assessments.

Quantitative MRI Analysis of the Talocrural and Talonavicular Joints in Ballet Dancers

The ankles of ballet dancers are routinely under heavy loading that may lead to osteoarthritic changes. It would be clinically useful to identify such pathology as early as possible in a dancer's career. Therefore, the purpose of this study was to compare quantitative measurements in magnetic resonance (MR) images of the talocrural and talonavicular joints in ballet dancers and healthy non-dancers for use in formulating prediction of chronic injury and degenerative joint disease in these locations. Quantitative measurements in MR images of the talocrural and talonavicular joints were compared in 10 female ballet dancers, 10 healthy female non-dancers, and nine male ballet dancers. Fat-suppressed density-weighted proton, T1rho, and T2 mapping images were acquired with a 3.0 T MR scanner. Medial and lateral subchondral bone distance between the tibia and talus (MSBD and LSBD), axial navicular-talus axis angle (ANT angle), sagittal talar neck angle against the posterior talocalcaneal joint (TN angle), and curvature of navicular surface at the talonavicular joint were measured on sagittal images. The medial subchondral bone distance was found to be significantly larger in female dancers than female non-dancers (4.05 mm vs. 2.75 mm, p < 0.05), whereas there were no significant differences in LSBD (2.63 mm vs. 2.63 mm, p = 0.87). Axial navicular talus angles in female dancers were significantly larger than those in female non-dancers (38.9° vs. 24.3°, p < 0.05). There was a tendency for the TN angle to be smaller and navicular curvature (NC) to be larger in female dancers compared to female non-dancers, though the differences were not significant (TN angle: 16.6° vs. 22.3°, p = 0.09, and NC: 0.186 vs. 0.165, p = 0.28). There were no significant differences in T1rho or T2 values of talonavicular joint cartilage. These results show that the bony anatomy of dancers' ankles may adapt to the stresses placed on them by ballet.

Prediction of Stress Distribution Applied to the Triangular Fibrocartilage Complex: A Finite Element Analysis

Purpose

The triangular fibrocartilage complex (TFCC) is an important tissue stabilizer for the distal radioulnar joint, but stress distribution on the TFCC is not clear. The purpose of this study was to report the stress distribution of the TFCC using finite element analysis (FEA).

Methods

Pathological specimens of the wrist joint from an 80-year-old man were imported into a finite element analysis software package, and regions of interest including bone, soft tissue, and TFCC were extracted to create a 3-dimensional model. The material properties were obtained from previous research using cadaver specimens. To allow large deformations, we used hyperelastic elements to model the TFCC and soft tissue. Bone was defined as a uniform tissue that did not break. With the carpals and radius constrained, the rotation axis was set at the center of the ulnar head and a force was applied to move the ulnar head in pronation and supination. Under these boundary conditions, the behavior of the TFCC was extracted as a moving image. The average value of the maximum principal stress for each component of the TFCC was extracted and graphed.

Results

In the supinated position, the maximum principal stress was found on the palmar side of the TFCC (eg, on the tension side). In pronation, the maximum principal stress was found on the dorsal side.

Conclusions

This study clearly showed the 3-dimensional structure of the TFCC and analyzed its stress distribution under load. In supination, mean values of the maximum principal stress were greater on the palmar fibers than the dorsal fibers. In pronation, mean maximum principal stress was greater on the dorsal fibers than the palmar fibers.

Clinical relevance

Knowing the distribution of stresses in the TFCC is an important factor in developing treatment strategies for a pathologic TFCC.

There are no three physiological narrowings in the upper urinary tract: a new concept of the retroperitoneal anatomy around the ureter

The widely held dogma of three physiological narrowings in the upper urinary tract has proven incorrect by recent several studies using computed tomography images. There are only two common obstruction sites: the upper ureter and the ureterovesical junction. The second narrowing, where the ureter crosses the iliac vessels, cannot be regarded anymore as a common obstruction site. The mechanism by which stones lodge in the upper ureter is explained anatomically by the change in ureteral mobility and compliance at the level where the ureter exits the perirenal space. This level can be identified radiologically as the point where the ureter crosses under the ipsilateral gonadal veins, termed the “crossing point”. Kinking of the upper ureter is another manifestation of this anatomical phenomenon, visible in radiological images. It is caused by loosening of the ureter at or above the crossing point (within the perirenal space), corresponding with renal descent such as during the inspiratory phase. This new anatomical discovery in the retroperitoneum will not only bring about a paradigm shift in terms of the physiological narrowings in the upper urinary tract, but may also lead to the development of new surgical concepts and approaches in the area.

Comparison of visibility of ulnar sided triangular fibrocartilage complex (TFCC) ligaments between isotropic three-dimensional and two-dimensional high-resolution FSE MR images

OBJECTIVES

Assessment of the ulnar attachment of the triangular fibrocartilage complex (TFCC) in a neutral forearm position remains challenging. Our study aims to evaluate the visibility of ulnar sided TFCC on 3 T MRI and compare isotropic 3D FSE sequences utilizing multiplanar reformation (MPR) with standard high-resolution 2D FSE sequences.

METHODS

Ninety-nine MRI wrist studies in patients with wrist pain were retrospectively analyzed. Patients were scanned with a neutral forearm position and reviewed with isotropic 3D coronal FSE proton density-weighted images (PDWI) and 2D coronal FSE PDWI. MPR was used for 3D assessment. Visibility of the dorsal radioulnar ligament (DRUL), triangular ligament (TL), and volar radioulnar ligament (VRUL) was assessed by three raters utilizing a five-point grading scale. Grades were compared between 2D and 3D sequences. Intrarater and interrater reliability for the delineation of anatomic structures was measured by Spearman's rank correlation coefficient, Cohen's kappa, and percentage of exact agreement/agreement within a range of ±1 score point.

RESULTS

Visibility grades in 3D were statistically significantly higher than those in 2D in all ligaments by all raters (p < 0.01). In Spearman's rank correlation coefficient and Cohen's kappa analysis, interrater correlations and agreements are variable but tended to be higher on 3D than on 2D. Both 2D and 3D sequences showed high intrarater exact agreement in all ligaments (80-91 % on 2D and 88-95 % on 3D). All exact interrater agreements on 3D were acceptable for TL (83-93 %) and acceptable to close to acceptable for VRUL (72-96 %).

CONCLUSION

The utilization of isotopic 3D imaging combined with MPR function significantly improves visibility of ulnar attachment of the TFCC.

T1rho and T2 mapping of ankle cartilage of female and male ballet dancers

BACKGROUND

Since ballet dancers begin their training before skeletal maturity, accurate and non-invasive identification of cartilage diseases is clinically important. Angle-dependent analysis of T1rho and T2 sequences can be useful for quantification of the composition of cartilage.

PURPOSE

To investigate the angle-dependent T1rho and T2 profiles of ankle cartilage in non-dancers and dancers.

MATERIAL AND METHODS

Ten female non-dancers, ten female dancers, and 9 male dancers were evaluated using T1rho and T2 mapping sequences. Manual segmentation of talar and tibial cartilage on these images was performed by two radiologists. Inter- and intra-rater reliabilities were calculated using intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Mean thickness and volume of cartilage were estimated. Angle-dependent relaxation time profiles of talar and tibial cartilage were created.

RESULTS

ICCs of the number of segmented pixels were poor to excellent. Bland-Altman plots indicated that differences were associated with segment sizes. Segmented cartilage on T1rho demonstrated larger thickness and volume than those on T2 in all populations. Male dancers showed larger cartilage thickness and volume than female dancers and non-dancers. Each cartilage demonstrated angular-dependent T1rho and T2 profiles. Minimal T1rho and T2 values were observed at approximately 180°-200°; higher values were seen at the angle closer to the magic angle. Minimal T2 value of talar cartilage of dancers was larger than that of non-dancers.

CONCLUSION

In this small cohort study, regional and sex variations of ankle cartilage T1rho and T2 values in dancers and non-dancers were demonstrated using an angle-dependent approach.

Anatomical relationship between the morphology of the styloid process of the ulna and the attachment of the radioulnar ligaments

The radioulnar ligaments are the major stabilizers of the distal radioulnar joint under dynamic loading; however, anatomical detail regarding their attachment on the middle and distal thirds of the styloid process of the ulna remains unclear. Because previous anatomical studies included only old cadavers, their anatomical findings might not reflect the morphological features of younger and healthy specimens. This study investigated the anatomical features of the distal ulna, particularly the styloid process, to determine the attachment of the radioulnar ligaments to the styloid process and verified their direction and attachment to the styloid process in younger and healthy donors using magnetic resonance imaging (MRI). We investigated the morphological features of the distal ulna of 12 cadaveric wrists using micro-computed tomography (micro-CT). We also visualized and measured the distribution of the cortical bone thickness. We histologically analyzed three specimens in the axial plane and macroscopically analyzed seven specimens to examine the attachment of the radioulnar ligaments to the styloid process. In addition, we evaluated five wrists from living volunteers using 3.0 Tesla MRI. The distal ulna has a ridge on the dorsoradial aspect of the styloid process that corresponds to the attachment of the radioulnar ligaments. Micro-CT images after data processing revealed that the cortical thickness of the dorsoradial quadrant was thicker than that of the other quadrant at the proximal slice of the styloid process (p < 0.01), and that of the dorsoulnar (p = 0.021) and ulnopalmar (p < 0.01) quadrants at the middle slice. Histological analyses showed that the radioulnar ligaments were attached to the middle and distal thirds of the styloid process via chondral-apophyseal entheses. The direction of the fiber was dorsal in the middle third of the styloid process and changed to palmar in the distal third of the styloid process. The direction and attachment of the radioulnar ligaments on the styloid process were confirmed using MRI for younger and healthy participants. The radioulnar ligaments were attached to the dorsoradial ridge of the styloid process, which was confirmed by cortical bone thickening, histology at the attachment sites, and in vivo MR imaging. The directions of the radioulnar ligaments sterically intersected, which would satisfy both slipping stability and rotational mobility. These anatomical findings may provide the basis for biomechanical consideration of distal radioulnar joint stabilization.

Topological charge transport by mobile dielectric-ferroelectric domain walls

The concept of topology has been widely applied in condensed matter physics, leading to the identification of peculiar electronic states on three-dimensional (3D) surfaces or 2D lines separating topologically distinctive regions. In the systems explored so far, the topological boundaries are built-in walls; thus, their motional degrees of freedom, which potentially bring about new paradigms, have been experimentally inaccessible. Here, working with a quasi-1D organic material with a charge-transfer instability, we show that mobile neutral-ionic (dielectric-ferroelectric) domain boundaries with topological charges carry strongly 1D-confined and anomalously large electrical conduction with an energy gap much smaller than the one-particle excitation gap. This consequence is further supported by nuclear magnetic resonance detection of spin solitons, which are required for steady current of topological charges. The present observation of topological charge transport may open a new channel for broad charge transport-related phenomena such as thermoelectric effects.

Evidence for solitonic spin excitations from a charge-lattice-coupled ferroelectric order

Topological defects have been explored in different fields ranging from condensed matter physics and particle physics to cosmology. In condensed matter, strong coupling between charge, spin, and lattice degrees of freedom brings about emergent excitations with topological characteristics at low energies. One-dimensional (1D) systems with degenerate dimerization patterns are typical stages for the generation of topological defects, dubbed "solitons"; for instance, charged solitons are responsible for high electrical conductivity in doped trans-polyacetylene. Here, we provide evidence based on a nuclear magnetic resonance (NMR) study for mobile spin solitons deconfined from a strongly charge-lattice-coupled spin-singlet ferroelectric order in a quasi-1D organic charge-transfer complex. The NMR spectral shift and relaxation rate associated with static and dynamic spin susceptibilities indicate that the ferroelectric order is violated by dilute solitonic spin excitations, which were further demonstrated to move diffusively by the frequency dependence of the relaxation rate. The traveling solitons revealed here may promise the emergence of anomalous electrical and thermal transport.

Extrahepatic Collateral Artery Extravasation in Patients with Ruptured Hepatocellular Carcinoma

This report describes 3 patients with previously untreated hepatic tumors who underwent embolization for the treatment of extravasation from extrahepatic arteries. Although development of extrahepatic collateral blood supply is well known, its importance in the presentation of rupture of liver tumors may be underrecognized. Findings that suggest bleeding from extrahepatic arteries include a discrepancy in the pattern of extravasation on computed tomography vs hepatic angiography and a lack of stabilization of vital signs after embolization of hepatic arteries. To achieve successful hemostasis in embolization, the potential involvement of such extrahepatic arteries should be accurately recognized, suggestive imaging findings considered, and the occult vessels selected and embolized.

Strong polarization switching with low-energy loss in hydrogen-bonded organic antiferroelectrics

The electric-field-induced phase transition from antipolar to polar structures is at the heart of antiferroelectricity. We demonstrate direct evidence of antiferroelectricity by applying a strong electric field to two antipolar crystals of squaric acid (SQA) and 5,5'-dimethyl-2,2'-bipyridinium chloranilate. The field-induced polarization of SQA is quite large and reasonably explained by the theoretically calculated polarization on the hydrogen-bonded sheet sublattice. The pseudo-tetragonal lattice of SQA permits unique switching topologies that produce two different ferroelectric phases of low and high polarizations. By tilting the applied field direction, the electrical switching mechanism can be attributed to a 90° rotation of the sheet polarization. From the viewpoint of applications, the strong polarization, high switching field, and quite slim hysteresis observed in the polarization versus electric field curve for SQA are advantageous for excellent-efficiency energy storage devices.

Mucin-poor and aggressive mucinous tubular and spindle cell carcinoma of the kidney: Two case reports

Mucinous tubular and spindle cell carcinoma (MTSCC) is a relatively rare renal epithelial neoplasm. Although MTSCC is considered to be a low-grade and indolent neoplasm, aggressive cases have been recently reported. The present study discussed two additional cases of high-grade MTSCC causing multiple distant metastases with a fatal course. In case 1, a 71-year-old patient presented with hematuria and pyuria. Computed tomography (CT) scan of the right kidney revealed a mass lesion, for which partial nephrectomy was performed. However, a follow-up CT imaging revealed distant metastases in the liver, the paraaortic lymph nodes and the bone. Despite molecular targeted therapy and irradiation, the patient succumbed due to tumor progression. In case 2, a 64-year-old patient presented with an incidentally identified mass lesion in the right kidney. A laparoscopic nephrectomy was performed, and a follow-up CT imaging revealed metastases in the skin and lungs. The cytology of pleural effusion revealed pleuritis carcinomatosa. Histologically, both cases were diagnosed as mucin-poor MTSCC with high-grade transformation, which comprised uniform tumor cells primarily forming slender tubules. The tumors contained low- and high-grade regions. In addition, venous invasion and necrosis were observed. The tumor cells also demonstrated increased Ki-67 labeling indices and cellular tumor antigen p53 (p53) nuclear accumulation. High-grade transformation, large tumor size, necrosis, venous invasion, high Ki-67 labeling index and p53 nuclear accumulation are generally predictive findings for aggressive behavior of malignant tumors. In the current report, it was emphasized that MTSCC possesses a wide spectrum of clinicopathological features. Thus, careful postoperative investigation is required for MTSCC with high-grade elements due to its aggressive nature.

Shift current photovoltaic effect in a ferroelectric charge-transfer complex

Shift current is a steady-state photocurrent generated in non-centrosymmetric single crystals and has been considered to be one of the major origins of the bulk photovoltaic effect. The mechanism of this effect is the transfer of photogenerated charges by the shift of the wave functions, and its amplitude is closely related to the polarization of the electronic origin. Here, we report the photovoltaic effect in an organic molecular crystal tetrathiafulvalene-p-chloranil with a large ferroelectric polarization mostly induced by the intermolecular charge transfer. We observe a fairly large zero-bias photocurrent with visible-light irradiation and switching of the current direction by the reversal of the polarization. Furthermore, we reveal that the travel distance of photocarriers exceeds 200 μm. These results unveil distinct features of the shift current and the potential application of ferroelectric organic molecular compounds for novel optoelectric devices.The bulk photovoltaics refers to an effect whereby electrons move directionally in non-centrosymmetric crystals upon light radiation. Here, Nakamura et al. observe this effect in a ferroelectric organic charge-transfer complex, which shows large diffusion distance of photogenerated electrons over 200 µm.

Ultrafast Photoinduced Electric-Polarization Switching in a Hydrogen-Bonded Ferroelectric Crystal

Croconic acid crystals show proton displacive-type ferroelectricity with a large spontaneous polarization reaching 20  μC/cm^{2}, which originates from the strong coupling of proton and π-electron degrees of freedom. Such a coupling makes us expect a large polarization change by photoirradiations. Optical-pump second-harmonic-generation-probe experiments reveal that a photoexcited croconic-acid crystal loses the ferroelectricity substantially with a maximum quantum efficiency of more than 30 molecules per one absorbed photon. Based on density functional calculations, we theoretically discuss possible pathways toward the formation of a one-dimensional domain with polarization inversion and its recovery process to the ground state by referring to the dynamics of experimentally obtained polarization changes.

Novel PAX9 Mutations Cause Non-syndromic Tooth Agenesis

PAX9 is a transcription factor expressed in the tooth mesenchyme during tooth morphogenesis. In Pax9-null mice, tooth development is arrested at the bud stage. In humans, heterozygous mutations in PAX9 have been associated with non-syndromic tooth agenesis, predominantly in the molars. Here, we report 2 novel mutations in the paired domain of PAX9, a three-nucleotide deletion (73-75 delATC) and a missense mutation (C146T), in two unrelated Japanese patients with non-syndromic tooth agenesis. The individual with the 73-75del ATC mutation was missing all maxillary molars and mandibular second and third molars. The individual with the C146T mutation was missing the mandibular central incisors, maxillary second premolars, and first molars, along with all second and third molars. Both mutations affected amino acids that are highly conserved among different species and are critical for DNA binding. When both mutants were transfected to COS7 cells, nuclear localization of PAX9 proteins was not affected. However, reduced expression of the mutant proteins and almost no transcriptional activity of the target BMP4 gene were observed, suggesting haploinsufficiency of PAX9 as the cause of non-syndromic tooth agenesis.

Type 1 Pili Enhance the Invasion ofSalmonella braenderupandSalmonella typhimuriumto HeLa Cells

The relationship between type 1 pili-associated adhesion and invasion to HeLa cells by Salmonella braenderup and S. typhimurium was studied. When the clinical isolates of these strains were grown in L-broth, they showed both type 1 pili formation and mannose-sensitive adhesion to HeLa cells. On the other hand, the type 1 pili-defective mutants, which were obtained either by repeated subcultures on L-agar plates or by the transposon Tn1-insertion mutagenesis of the S. braenderup and S. typhimurium strains, concomitantly lost mannose-sensitive adhesion to HeLa cells. When the HeLa cells were incubated with Salmonella, the type 1 piliated strains invaded the HeLa cells with much higher infection rate than did the type 1 pili-defective strains. The invasion of type 1 piliated strains to HeLa cells was markedly inhibited in the presence of D-mannose. The infectivity of the strain, which lost type 1 pili but still had mannose-resistant adhesion, was slightly higher than that of the strains defective in both mannose-sensitive and mannose-resistant adhesion. These results suggested that type 1 pili have a role in enhancing the invasion of S. braenderup and S. typhimurium to HeLa cells.

Advanced Glycation End Products (AGE)-Modified Proteins and Their Potential Relevance to Atherosclerosis

Modification of proteins by long-term incubation with glucose leads, through the formation of early products such as Schiff base and Amadori rearrangement products, to the formation of advanced glycation end products (AGE). AGE-modified proteins are characterized physicochemically by fluorescence, brown coloration, and intramolecular or intermolecular cross-linking. Biologically, they are specifically recognized by the AGE receptors of the cell surface membrane. Recent studies have provided evidence for the involvement of AGE proteins in atherosclerosis. First, in vitro experiments using Chinese hamster ovary cells overexpressing the macrophage scavenger receptor (MSR) and peritoneal macrophages from MSR-knockout mice demonstrated that MSR plays a major role as the AGE receptor in the endocytotic uptake of AGE by macrophages. Second, immunohistochemical studies using anti-AGE antibody and anti-MSR antibody revealed the presence of AGE proteins in human atherosclerotic lesions in arterial walls. Because MSR is closely associated with the formation of early atherosclerotic lesions, these results suggest a potential role played by AGE proteins or their interaction with MSR in the atherosclerotic process. (Trends Cardiovasc Med 1996;6:163-168).

Domain and Interface Structures of Epitaxial PtSi

The crystalline perfection of epitaxial PtSi thin films and the microstructure of the PtSi/Si interface have been examined using transmission electron microscopy (TEM), including lattice image techniques. Epitaxial PtSi layers grow with domains which have three different positions on a (111) Si substrate. Inside a domain the crystalline perfection is high, and at the domain boundary no intermediate region has been observed. The undulation of the PtSi/Si interface is larger than that of other epitaxial silicide/Si interfaces. Despite the large undulation, a cross-sectional lattice image shows the epitaxial layer extends to the interface. The interface is abrupt in the epitaxial PtSi/Si system.

Electric-field control of solitons in a ferroelectric organic charge-transfer salt

The role of solitons in transport, dielectric, and magnetic properties has been revealed for the quasi-one-dimensional organic charge-transfer salt, TTF-QBrCl3 [tetrathiafulvalene (TTF)-2-bromo-3,5,6-trichloro-p-benzoquinone (QBrCl3)]. The material was found to be ferroelectric and hence the solitons should be located at the boundary of the segments with opposite electric polarization. This feature enabled the electric-field control of soliton density and hence the clear-cut detection of soliton contributions. The gigantic dielectric response in the ferroelectric phase is ascribed to the dynamical bound and creeping motions of spinless solitons.

Stress analysis in the mandibular condyle during prolonged clenching: a theoretical approach with the finite element method

Parafunctional habits, such as bruxism and prolonged clenching, have been associated with functional overloading in the temporomandibular joint (TMJ), which may result in internal derangement and osteoarthrosis of the TMJ. In this study, the distributions of stress on the mandibular condylar surface during prolonged clenching were examined with TMJ mathematical models. Finite element models were developed on the basis of magnetic resonance images from two subjects with or without anterior disc displacement of the TMJ. Masticatory muscle forces were used as a loading condition for stress analysis during a 10 min clenching. In the asymptomatic model, the stress values in the anterior area (0.100 MPa) and lateral area (0.074 MPa) were relatively high among the five areas at 10 min. In the middle and posterior areas, stress relaxation occurred during the first 2 min. In contrast, the stress value in the lateral area was markedly lower (0.020 MPa) than in other areas in the symptomatic model at 10 min. The largest stress (0.050 MPa) was located in the posterior area. All except the anterior area revealed an increase in stress during the first 2 min. The present result indicates that the displacement of the disc could affect the stress distribution on the condylar articular surface during prolonged clenching, especially in the posterior area, probably leading to the cartilage breakdown on the condylar articular surface.

Advanced glycation end product is implicated in amyloid‐related kidney complications

BACKGROUND

Kidney failure is a common complication in familial amyloidotic polyneuropathy (FAP). It has been suggested that advanced glycation end products (AGEs) play an important role in the development and pathogenesis of FAP.

MATERIAL AND METHODS

To evaluate the impact of AGEs on FAP patients' kidney dysfunction, we measured AGE in serum and urine of 28 FAP patients and 18 healthy controls by AGE-specific enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry utilizing antibodies to AGE and the receptor for AGE (RAGE) were used on kidney tissue from 3 FAP patients and 3 diabetic patients to disclose a correlation between amyloid deposits and AGE-RAGE.

RESULTS

The glomeruli of FAP patients were heavily deposited with amyloid and the glomerular size was enlarged. The space between Bowman's capsule and glomerulus was totally covered by the enlarged glomerulus. AGE and RAGE were deposited in glomeruli and tubuli and correlated with amyloid deposits. Decreased AGE levels in the liver-transplanted FAP patients' serum compared with that of non-transplanted patients were noted, and AGE concentration in serum tended to be higher in non-transplanted FAP patients compared with normal control subjects. There were no differences in the AGE urine levels in FAP patients compared with controls. No correlation could be found between AGE in urine and serum compared with serum albumin, serum creatinine and creatinine clearance.

CONCLUSIONS

The accumulation of AGE, RAGE and amyloid in the kidney of FAP patients suggests that these molecules play an important role in the origin and pathogenesis of renal failure in FAP patients.

Dynamical disorder of pi-molecular structures induced by proton dynamics in an organic ferroelectric compound

We have investigated the optical response resulting from the proton-pi-electron-molecular-skeleton coupled dynamics in an organic ferroelectric 55DMBP-Hia. Upon the ferroelectric-to-paraelectric transition, almost all of the vibrational modes below 500 cm;{-1} are anomalously blurred and amalgamated into the high-frequency tail of the polarization-relaxation mode. This indicates that the constituent molecular shape is no more well defined around T_{C} due to the dynamical disorder of the pi-conjugated structure originating from proton delocalization on the intermolecular bifurcated hydrogen bond.

Characterization of the immune escape phenotype of human gastric cancers with and without high-frequency microsatellite instability

Gastric cancers with and without high-frequency microsatellite instability (MSI-H) represent distinctive pathways of carcinogenesis. The aim of this study was to clarify if human leukocyte antigen (HLA) class I antigen subunits and antigen processing machinery (APM) components are differentially downregulated in these two groups of tumours. Using reverse transcription PCR (RT-PCR), loss of heterozygosity (LOH) analysis, methylation-specific PCR (MSP), DNA sequencing, immunohistochemistry, and flow cytometry, we analysed expression and/or alteration of HLA class I antigen subunits and APM components, including low molecular weight polypeptide proteasome subunit (LMP)2, LMP7, LMP10, transporter associated with antigen processing (TAP)1, TAP2, tapasin, proteasome activator (PA) 28alpha, and PA28beta in two stage-matched panels of 30 MSI-H and 30 microsatellite stable (MSS) gastric cancers. Mutations at coding microsatellites (cMS) located within beta2-microglobulin (beta2m) and genes encoding APM components, including endoplasmic reticulum (ER) chaperone protein genes, such as calnexin, SEC63, SEC31, and P4HB (p55), were also analysed. HLA class Ia transcripts were totally downregulated in 18.3% of cancer cases. Locus-specific downexpression of HLA-A, -B, and -C was detected in 41.7%, 45.0%, and 31.7% of cases. Loss of HLA-A was significantly more frequent in MSI-H cancers. The LOH ratios of the HLA-A, -B, and -C loci microsatellite markers were relatively low: 5/32 (15.6%) for D6S306, 4/32 (12.5%) for D6S258, 4/33 (12.1%) for D6S273, and 4/30 (13.3%) for D6S1666. Methylation of HLA-A, -B, and -C was detected in 38.3%, 40.0%, and 28.3% of cases. A significant association between methylation and reduction in expression was observed in gastric cancer tissues. Mutations at cMS of beta2m and APM components were detected in 3.3-46.7% of MSI-H cancers but in none of MSS cancers. These data show that gastric cancers have various defects in HLA class I antigen subunits and APM components and that the MSI phenotype is associated with frequent HLA-A inactivation and frameshift mutations of the beta2m and APM genes.

Intake of purple sweet potato beverage affects on serum hepatic biomarker levels of healthy adult men with borderline hepatitis

OBJECTIVE

To examine the effect of purple sweet potato (PSP) beverage rich in acylated anthocyanins on serum hepatic biomarkers in healthy Japanese men.

DESIGN

A randomized, double-blind, placebo-controlled, parallel study.

SETTING

Kumamoto in Japan.

SUBJECTS

Healthy adult men (30-60 years) with borderline hepatitis who had one or more of serum gamma-glutamyl transferase (GGT), aspertate aminotransferase (AST) and alanine aminotransferase (ALT) levels over normal ranges, and who were negative for hepatitis virus were openly recruited by an advertisement. Of the 48 persons enrolled, 38 (mean age 43.0 years (30-54 years)) completed the study.

METHODS

The subjects were randomly assigned to the PSP group and the placebo group. During the 8-week intervention, the subjects in the PSP group consumed two bottles of the PSP beverage with acylated anthocyanins (200.3 mg anthocyanins per 125 ml per bottle) per day, and the subjects in the placebo group, two bottles of a placebo beverage (1.7 mg anthocyanins per 125 ml per bottle). All of the data measured were analyzed by two-way repeated measures analysis of variance (ANOVA) with groups and times. The data of the hepatic markers were analyzed using the Dunnett multiple comparison among the time points and t-test between groups at the same time point. Two-sided P<0.05 were defined as the level of significance.

RESULTS

Serum GGT, AST and ALT levels showed interactions (P<0.05) between the beverage groups and time; the others were not affected. The PSP beverage group showed lower hepatic marker levels than the placebo group during the ingestion period, particularly the GGT level (-14.1 IU/l, 95% Confidence intervel (CI) -25.4 to -2.7, P=0.017 at 2 weeks; -16.8 IU/l, 95% CI -36.2 to 2.5, P=0.081 at 4 weeks; -26.7 IU/l, 95% CI -47.6 to -5.7, P=0.014 at 6 weeks and -27.9 IU/l, 95% CI -49.9 to -5.9; P=0.014 at 8 weeks). No correlation between alcohol consumption and each hepatic biomarker level before and after the ingestion was observed.

CONCLUSION

The intake of the PSP beverage significantly decreased the serum levels of hepatic biomarkers, particularly the GGT level, in healthy men with borderline hepatitis.

K-ras mutation in the endometrium of tamoxifen-treated breast cancer patients, with a comparison of tamoxifen and toremifene

The putative presence of a mutation in codon 12 of the K-ras gene was investigated in the endometrium of tamoxifen (TAM) and toremifene (TOR)-treated breast cancer patients. DNA was extracted from fresh cytologic samples of the endometrium in 86 TAM and 21 TOR-treated breast cancer patients. Mutations were detected by enriched PCR and an enzyme-linked mini-sequence assay (ELMA). K-ras mutation was found in 35 TAM-treated endometrial samples, and in only one TOR-treated endometrium (P<0.003). In 24 premenopausal patients, K-ras mutation was found in seven (43.8%) of 16 patients with less than 47 months of TAM treatment, while none was found in eight patients with more than 48 months of TAM treatment (P<0.03). In 62 postmenopausal-amenorrheic patients, K-ras mutation was found in three (15.8%) of 19 patients with less than 23 months of TAM treatment, while it was found in 16 (61.5%) of 26 patients with 24–47 months of TAM treatment and nine (52.9%) of 17 patients with more than 48 months of TAM treatment (P=0.002). The presence of K-ras mutation is significantly influenced by the duration of TAM treatment and menstrual status of the patients. TOR may have a lower potential genotoxicity than TAM.

Renal clearance of glycolaldehyde- and methylglyoxal-modified proteins in mice is mediated by mesangial cells through a class A scavenger receptor (SR-A)

AIMS/HYPOTHESIS

Glomerular mesangial expansion is a characteristic feature of diabetic nephropathy, and the accumulation of AGE in the mesangial lesion has been implicated as one of its potential causes. However, the route for the AGE accumulation in mesangial lesions in diabetic patients is poorly established.

METHODS

Glycolaldehyde-modified BSA (GA-BSA) and methylglyoxal-modified BSA (MG-BSA) were prepared as model AGE proteins, and their in vivo plasma clearance was examined in mice, and renal uptake by in vitro studies with isolated renal mesangial cells.

RESULTS

Both (111)In-GA-BSA and (111)In-MG-BSA were rapidly cleared from the circulation mainly by both the liver and kidney. Immunohistochemical studies with an anti-GA-BSA antibody demonstrated that intravenously injected GA-BSA accumulated in mesangial cells, suggesting that such cells play an important role in the renal clearance of circulating AGE proteins. Binding experiments at 4 degrees C using mesangial cells isolated from mice showed that (125)I-GA-BSA and (125)I-MG-BSA exhibited specific and saturable binding. Upon incubation at 37 degrees C, (125)I-GA-BSA and (125)I-MG-BSA underwent endocytic degradation by these cells. The binding of the ligands to these cells was inhibited by several ligands for scavenger receptors. The endocytic degradation of GA-BSA by mesangial cells from class A scavenger receptor (SR-A) knock-out mice was reduced by 80% when compared with that of wild-type cells. The glomerular accumulation of GA-BSA after its intravenous administration was attenuated in SR-A knock-out mice, as evidenced by immunohistochemical observations.

CONCLUSIONS/INTERPRETATION

These results raise the possibility that circulating AGE-modified proteins are subjected to renal clearance by mesangial cells, mainly via SR-A. This pathway may contribute to the pathogenesis of AGE-induced diabetic nephropathy.

Near-field optical microscope observation of dye-containing nano-domains

A novel method for forming dye-containing nano-domains in thin films using a polymer alloy system has been developed. The polymer alloy system (PS-b-PMMA), which consists of polystyrene (PS) and polymethyl methacrylate (PMMA), forms microphase separation in thin films. The film was treated using a previously reported technique under vacuum conditions, and an organic dye was selectively dispersed into the PS. Selective association of the dye (diarylethene; cis-1, 2-dicyano-1, 2-bis (2,4,5-trimethyl-3-thienyl) ethene) with the PS nano-domains was then observed, with both transmission electron microscopy and scanning near-field optical microscopy with an absorption spectrum.

Application of monoclonal antibody libraries for the measurement of glycation adducts

Immunological approaches have been used to demonstrate the presence of advanced glycation end-products (AGEs) in several human and experimental animal tissues. We previously prepared polyclonal and monoclonal anti-AGE antibodies by immunizing AGE-modified proteins such as BSA and RNase. Although these antibodies contributed to demonstrate the presence of AGE-modified protein in vivo, the epitope structure of these antibodies had not been identified. We subsequently prepared several antibodies against AGE structures such as pentosidine, pyrraline, 3-deoxyglucosone imidazolone and N∊-(carboxyethyl)lysine by immunizing single AGE structures. These structure-specific antibodies have greatly helped broaden our understanding of AGE structures in aging and age-enhanced disease process. Monoclonal anti-AGE antibody is also used for the identification of major AGE structures in some pathological tissues, such as human atherosclerosis lesions. Based on the strategy, we successfully identified a novel AGE structure named glycolaldehyde-pyridine, which is the major antigenic AGE derived from glycolaldehyde. Therefore a monoclonal antibody library for AGE structures has served an important role in the elucidation of the biological significance of AGE.

Mechanisms involved in the stimulatory effect of advanced glycation end products on growth of rat aortic smooth muscle cells

Hyperglycemia is an important cause of accelerated atherosclerosis in diabetic patients. We examined the effect of hyperglycemia and advanced glycation end products (AGE) on proliferation of rat aortic smooth muscle cells (SMC) in culture; in vivo, this event is believed to contribute importantly to atherogenesis in diabetes mellitus. Glucose itself dose-dependently inhibited thymidine uptake by SMC, but AGE increased thymidine uptake, suggesting that SMC proliferation is accelerated by AGE. To examine possible mechanisms for this effect, we studied nuclear factor-kappa B (NF-kappaB) activation and the tyrosine phosphorylation pathway; AGE stimulated NF-kappaB activity, but phosphorylation of the platelet-derived growth factor (PDGF) receptor was unchanged. In Chinese hamster ovary (CHO) cells overexpressing galectin-3, an AGE receptor related to atherosclerosis, AGE increased thymidine uptake. This suggests SMC proliferation is enhanced by AGE via galectin-3. As pathways involving AGE-galectin-3 interaction thus may be involved in macroangiopathy, AGE appears to be important to the role of SMC in accelerated atherosclerosis associated with diabetes mellitus.

Scavenger receptors for oxidized and glycated proteins

Our present knowledge on chemically modified proteins and their receptor systems is originated from a proposal by Goldstein and Brown in 1979 for the receptor for acetylated LDL which is involved in foam cell formation, one of critical steps in atherogenesis. Subsequent extensive studies using oxidized LDL (OxLDL) as a representative ligand disclosed at least 11 different scavenger receptors which are collectively categorized as "scavenger receptor family". Advanced glycation endproducts (AGE) and their receptor systems have been studied independently until recent findings that AGE-proteins are also recognized as active ligands by scavenger receptors including class A scavenger receptor (SR-A), class B scavenger receptors such as CD36 and SR-BI, type D scavenger receptor (LOX-1) and FEEL-1/FEEL-2. Three messages can be summarized from these experiments; (i) endocytic uptake of OxLDL and AGE-proteins by macrophages or macrophage-derived cells is mainly mediated by SR-A and CD36, which is an important step for foam cell formation in the early stage of atherosclerosis, (ii) selective uptake of cholesteryl esters of high density lipoprotein (HDL) mediated by SR-BI is inhibited by AGE-proteins, suggesting a potential pathological role of AGE in a HDL-mediated reverse cholesterol transport system, (iii) a novel scavenger receptor is involved in hepatic clearance of plasma OxLDL and AGE-proteins.