Suffering of patients developing lymphedema following gynecological cancer surgery

Objective

Lymphedema developing in the lower extremities following gynecological cancer surgery (LE-GCS) produces various kinds of sufferings, including impacts on quality of life (QOL) and body image. This research will serve as a basic resource for the care of patients with this type of lymphedema (LE).

Patients and Methods

A qualitative discursive research method: Thirteen patients suffering from LE-GCS were interviewed in a semi-organized manner. Analysis involved extracting and codifying from transcripts and expressions related to the suffering of LE. Next, these codes were arranged into categories and subcategories under the supervision of qualitative researchers. Furthermore, this study was conducted with the approval of the Research Ethics Review Specialist Committee, which targets individuals affiliated with the public university corporation of Shiga Prefectural University.

Results

Based on the interviews with 13 patients aged 47-79 (median age 62), two core categories were created: 1). Suffering of LE Developing in Lower Extremities (570 codes, seven categories, 23 subcategories); and 2). Supports that Allow Patients to Face Suffering of LE (254 codes, four categories, 14 subcategories).

Conclusion

Patients with LE-GCS live with the fear that LE exacerbation will produce adverse life changes, and this may exceed the fear of cancer itself. The aggravation of their condition results in immense pain as well as reduced mobility, change in appearance, and loss of self-worth. The symptoms fluctuate, and may lead to chronic misery, which does not manifest, but occasionally flares-up because of both, worsening physical disability as well as ordinary events. Additionally, every patient subjectively described the strength they found within themselves to face the suffering. They cited the support of family and friends, existence of compassionate therapists and doctors, acquisition of knowledge, and self-care.

Efficacy of repeated administration of intravenous acetaminophen for pain management after total knee arthroplasty

Intravenous acetaminophen is an integral component of multimodal postoperative pain management. This prospective study aims to assess the efficacy of the repeated administration of intravenous acetaminophen and the impact on postoperative patient satisfaction with postoperative pain management after total knee arthroplasty (TKA). We enrolled 98 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals (AAP group) or not to receive intravenous acetaminophen (control group). All patients underwent single-shot femoral nerve block after general anesthesia, as well as intraoperative periarticular infiltration of analgesia prior to implantation. The primary outcome was the postoperative numerical rating scale (NRS) pain score at rest. The NRS score was measured just before the administration of study drugs, immediately after arrival in the ward (time 0), and at 6, 12, 18, 24, and 48 h (time 1 to time 5, respectively) postoperatively. We also evaluated the mean doses of rescue opioid use for 24 h postoperatively. At time 5, the AAP group had significantly improved mean NRS score than controls (3.0 vs. 4.0; P < 0.01). Rescue opioid use was significantly lower in the AAP group for 24 hours compared to controls (0.3 μg vs. 0.9 μg; P < 0.01). Repeated intravenous acetaminophen administration after TKA may provide better analgesia and reduce opioid use.

A Histogram Analysis of the Pixel Grayscale (Luminous Intensity) of B-Mode Ultrasound Images of the Subcutaneous Layer Predicts the Grade of Leg Edema in Pregnant Women

The technique most widely used to quantitatively measure leg edema is only a pitting edema method. It has recently become possible to digitize B-mode ultrasound images and accurately quantify their brightness using an image-analysis software program. The purpose of this study was to find new indices of the grade of leg skin, to study whether or not analyses of the subcutaneous layer of leg skin on ultrasound images using image-editing software program can be used to evaluate it and to digitize it. Images of 282 subcutaneous layers of leg skin in 141 pregnant women were obtained using a B-scan portable ultrasound device. Rectangular photographs (vertical: skin thickness; horizontal: width of probe) were obtained using an image-editing program, and the luminous intensity (pixel grayscale: 0-255) and thickness of the skin were calculated using a histogram. We investigated the correlation between these parameters and the grade of pitting edema (0-3). There was a significant positive correlation between the grade of pitting edema and the average luminous intensity value, its standard deviation, and the skin thickness (ρ = 0.36, ρ = 0.22, ρ = 0.51, p < 0.0001, respectively). In particular, there was strong positive correlation between the grade of pitting edema and both the total number of pixels in a rectangle × (multiplied by) the average luminous intensity value and the total number of pixels in a rectangle × the standard deviation of the average luminous intensity value (ρ = 0.58 and ρ = 0.59, p < 0.0001, respectively). We could quantitatively evaluate the grade of leg edema by analyzing ultrasound photographs of the subcutaneous layer of the leg skin using an image-editing software program and found new indices to digitize it.

Inner southern magnetosphere observation of Mercury via SERENA ion sensors in BepiColombo mission

Mercury's southern inner magnetosphere is an unexplored region as it was not observed by earlier space missions. In October 2021, BepiColombo mission has passed through this region during its first Mercury flyby. Here, we describe the observations of SERENA ion sensors nearby and inside Mercury's magnetosphere. An intermittent high-energy signal, possibly due to an interplanetary magnetic flux rope, has been observed downstream Mercury, together with low energy solar wind. Low energy ions, possibly due to satellite outgassing, were detected outside the magnetosphere. The dayside magnetopause and bow-shock crossing were much closer to the planet than expected, signature of a highly eroded magnetosphere. Different ion populations have been observed inside the magnetosphere, like low latitude boundary layer at magnetopause inbound and partial ring current at dawn close to the planet. These observations are important for understanding the weak magnetosphere behavior so close to the Sun, revealing details never reached before.

Measurement of Skin Thickness Using Ultrasonography to Test the Usefulness of Elastic Compression Stockings for Leg Edema in Pregnant Women

Background: One of the most common treatments for leg edema during pregnancy is the use of compression stockings. The purpose of this study was to evaluate the objective effectiveness in pregnant women, by measuring the changes of skin thickness using ultrasonography. Methods: Pregnant women were diagnosed with leg edema using the pitting edema method at 36 weeks of gestation. Twenty-four pregnant women (48 legs) with leg edema spent time without wearing elastic stockings at 36−37 weeks of gestation. Then, they wore elastic stockings for one week at 37−38 weeks of gestation. We measured the grade of edema (from 0 to 3) and the skin thickness of the lower leg by portable ultrasonography at 36, 37, and 38 weeks of gestation (a before-and-after study). Results: In 24 pregnant women, thigh edema was not detected in any of the 48 legs before or after the use of elastic stockings. All 48 legs in 24 pregnant women had physiological lower leg edema, but not thigh edema. The average grade of pitting edema in each lower leg significantly decreased after using the stockings (36 weeks, 1.77 ± 0.85; 37 weeks, 1.79 ± 0.77; 38 weeks, 1.04 ± 0.74, p < 0.0001). In addition, the skin thickness of the lower legs was significantly decreased after the use of elastic stockings (36 weeks, 7.47 ± 2.45 mm; 37 weeks, 7.93 ± 2.83 mm; 38 weeks, 7.15 ± 2.35 mm, p < 0.0001). Conclusions: The wearing of elastic compression stockings on the lower legs is objectively effective for improving leg edema in pregnant women.

Collaborative Research Activities of the Arase and Van Allen Probes

This paper presents the highlights of joint observations of the inner magnetosphere by the Arase spacecraft, the Van Allen Probes spacecraft, and ground-based experiments integrated into spacecraft programs. The concurrent operation of the two missions in 2017-2019 facilitated the separation of the spatial and temporal structures of dynamic phenomena occurring in the inner magnetosphere. Because the orbital inclination angle of Arase is larger than that of Van Allen Probes, Arase collected observations at higher L -shells up to L ∼ 10 . After March 2017, similar variations in plasma and waves were detected by Van Allen Probes and Arase. We describe plasma wave observations at longitudinally separated locations in space and geomagnetically-conjugate locations in space and on the ground. The results of instrument intercalibrations between the two missions are also presented. Arase continued its normal operation after the scientific operation of Van Allen Probes completed in October 2019. The combined Van Allen Probes (2012-2019) and Arase (2017-present) observations will cover a full solar cycle. This will be the first comprehensive long-term observation of the inner magnetosphere and radiation belts.

Novel electron microscopic staining method using traditional dye, hematoxylin

Uranyl acetate (UA) has been routinely used as a staining solution for ultrathin sections used in biological electron microscopy. As a radioactive nuclear material, UA is subject to strict international regulations. To develop an alternative and easy-to-use staining method for ultrathin sections, we examined various commercial light microscopic dyes. We found that Mayer's hematoxylin followed by Reynold's lead citrate solution showed staining results comparable to UA and Reynold's lead citrate solution, and this method is therefore suggested as a reliable and promising alternative to UA staining.

Novel method of diastolic stress echocardiography during bottle-feeding for infants with congenital heart disease

Funding Acknowledgements

Type of funding sources: None.

Background

Recent studies have demonstrated the utility of diastolic stress echocardiography in evaluating diastolic dysfunction during exercise in adults. However, there have been no such reports in infants. This study determined whether measuring cardiac function using echocardiography during bottle feeding is a valid method of stress testing in infants with congenital heart disease.

Methods

The study population comprised 25 infants with congenital heart disease (Table 1). Echocardiographic measurements of the infants were taken during and after bottle feeding (Figure 1A). Active feeding (AF) was defined as the start of feeding during which the heart rate started increasing. End of feeding (EF) was defined as the time of completion of feeding during which the heart rate slowed down. The 25 infants were divided into two groups according to brain natriuretic peptide levels: less than 50 pg/ml (low group) and more than 50 pg/ml (high group). Cardiac function was compared between the groups using 2D speckle tracking analysis, and intraventricular pressure differences (IVPD) via color M-mode Doppler (Figures 1B and 1C) and 2D echocardiography. We compared the fractional change (FC%), defined as (AF and EF measurements)/EF measurements, between the two groups.

Results

Heart rate increased AF comparing with EF, significantly in both groups, the low group from 162 to 139 bpm; the high group from 152 to 140 bpm. The FC_IVPD was higher in the low group than in the high group (Figure.2). There were negative correlations between brain natriuretic peptide levels and the FC_IVPD (Figure 3). There were 4 cases were performed the intra-cardiac repair (ICR). In 2 cases, VSD and right ventricular outflow tract obstruction (RVOTO) velocity were increased during feeding. Indication of ICR, VSD case was aortic regurgitation with aortic cusp prolapse, TOF case was RVOTO. In VSD peak velocity in 2 cases did not increase during feeding (Table2). Indication of

ICR, two VSD cases were moderate left to right shunt, or pulmonary hypertension.

Conclusions

Our findings indicate that stress echocardiography during bottle-feeding might be a substitute for diastolic stress echocardiography in infants. The VSD or RVOT peak velocity, and FC% in IVP D and IVPG are sensitive markers for cardiac function in infants with congenital heart disease. Abstract Table1  Abstract Figure.

Early recovery of basic mobility under femoral nerve block after hip fracture surgery - A propensity score matched pilot study

BACKGROUND

Previous studies have shown better pain reduction utilizing femoral nerve block (FNB) in patients who underwent hip fracture surgery. However, few studies have focused on the recovery of physical function after FNB, and most studies excluded patients with dementia. We investigated the association between FNB performed in the operating room and the recovery of physical function after hip fracture surgery, including patients with dementia.

METHODS

A total of 103 patients with a mean age of 87.4 years who underwent hip fracture surgery under spinal anesthesia between July 2015 and December 2017 (46 patients receiving a single injection of FNB and 57 standard care) were enrolled. Patients with FNB versus standard care were matched by a propensity score to adjust for patient characteristics. An anesthesiologist performed FNB with 20ml of 0.2% ropivacaine, and the standard care group received intravenous 1000 mg acetaminophen or 50mg flurbiprofen once after surgery. After matching, 78 patients were analyzed. Our primary outcome was 3-day cumulated ambulation score (CAS, 0-18 points) and secondary outcomes were 1-day CAS on postoperative day 1-3 and length of hospital stay. We also stratified patient groups based on the presence of dementia and fracture type.

RESULTS

Patients undergoing FNB had significantly better 3-day CAS compared to standard care (mean [SD], 8.72 [3.42] vs 7.33 [2.62]; mean difference, 1.38 [95%CI; 0.03 - 2.74]; p = 0.048) and 1-day CAS on postoperative day two (mean [SD], 3.10 [1.39] vs 2.56 [0.94]; mean difference, 0.54 [0.01 - 1.07]; p = 0.049). Length of hospital stay did not significantly differ among the two groups (p = 0.65). Larger positive effect was likely to be seen for patients with a femoral neck fractures and for those without dementia.

CONCLUSIONS

Patients who underwent surgery with spinal anesthesia plus FNB had better ambulatory status early after hip fracture surgery compared to patients not offered FNB. The beneficial association between FNB and ambulatory status was likely to be observed especially in patients with femoral neck fracture and without dementia.

SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

Validity of ultrasound arterial wall vascularization for assessment of vascular inflammation

Background

Vascular inflammation plays a fundamental role in most vascular diseases including atherosclerosis and vasculitis syndrome, in which arterial wall vascularization (AWV) frequently develops. Visualization of AWV is informative in detecting the vascular inflammation but is challenging. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low-velocity flows. We examined an availability of SMI for assessment of the instability of atherosclerotic plaques and the activity of Takayasu arteritis (TA).

Methods and results

The study consists of two independent and consecutive parts A and B, examined in carotid stenosis (A) and TA (B), respectively. In part A, 12 patients with symptomatic severe carotid stenosis (CS group) scheduled for carotid endarterectomy were enrolled. In six of 12 patients, preoperative ultrasonography with SMI showed intraplaque neovascularization at the plaque shoulder. Postoperatively, histopathology confirmed the neovessels at the corresponding sites of visualized AWV. SMI had a sensitivity of 67%, specificity of 90% for detection of AWV in CS group. In SMI analysis, false positive findings were caused by motion artifact and arterial wall calcification, and a false negative finding is attributed by intraplaque hemorrhage. In part B, 10 patients with TA were enrolled. All patients underwent 18F-FDG-PET/CT, and its vascular uptake were compared with AWV detected by SMI. Bilateral common carotid arteries (CCA), internal carotid arteries and common iliac arteries were examined by SMI. Active vascular 18F-FDG uptake (max SUV &gt;2.1) were found at five sites in three patients, which were not significantly correlated with the prevalence of macaroni sign, increase in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Of note, SMI revealed AWV at five sites corresponding to uptake of 18F-FDG, with a sensitivity/specificity of 100% and 98%, positive predictive value 71%, and a negative predictive value 100%.

Conclusion

SMI enables visualization of AWV at vulnerable plaque in CS patients and at 18F-FDG positive sites in TA patients. SMI has potential as a modality to detect the vascular inflammation.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research, Japan

Utility of superb microvascular imaging for assessment of foot perfusion in patients with critical limb ischemia

Background

Recently, an increasing attention has been paid to foot microcirculation in critical limb ischemia (CLI). Although skin perfusion pressure (SPP) is the most frequently used marker of microcirculation, SPP is often unmeasurable at the most ischemic site in the foot. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low velocity flows and enables the quantitative verification as vascular index (VI). We examined the diagnostic value of SMI-based VI in assessing foot perfusion when planning endovascular treatment (EVT).

Methods

Consecutive 50 patients with CLI were enrolled. All cases underwent EVT for superficial femoral arteries. SMI-based VI of plantar, dorsal, medial heel, lateral heel and toe's area were obtained before and after EVT, and those were compared with SPP (plantar and dorsal) or ankle-brachial index (ABI) representing macrocirculation.

Results

Based on the six angiosomes concept, SMI enabled to visualize microcirculation in all subjects, but SPP was not feasible in 13% of all subjects at the most ischemic site. After EVT, ABIs were significantly increased from 0.64±0.19 to 0.85±0.27 (P=0.0003). Plantar SPP also increased from 39.6±20.4 mmHg to 58.5±27.1 mmHg (p=0.002). SMI-based VI significantly increased in each sites based on the six angiosomes concept. Of note, plantar SMI-based VI significantly increased from 5.1±3.2% to 10.6±6.6% (p&lt;0.0001), suggesting improvement of foot perfusion. Plantar SMI-based VI was well correlated with plantar-SPP both before and after EVT (p=0.002, r=0.663). Plantar VI was also informative in showing a rapid improvement of foot perfusion during EVT.

Conclusion

SMI enabled to visualize the foot microcirculation on the basis of angiosomes concept. SMI has potential as an alternative to SPP.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in -Aid for Scientific Reseach, Japan

[My Story of Recovery from Brain Damage]

The author (hereafter referred to as I) is a speech-language-hearing pathologist and former professor of neuropsychology at Kobe University, who had been engaged in neuropsychological rehabilitation and research of conditions, such as aphasia and unilateral spatial neglect, for 37 years. In July 2009, I experienced right hemispheric infarction in Kobe City, and developed left-sided hemiparesis and various symptoms of cognitive dysfunctions, which was previously my field of expertise. As a neuropsychological rehabilitation expert, I focused my efforts on recovery and I have recovered the majority of my cognitive and neurologic functions. This is my story of recovery from stroke, in which functional magnetic resonance imaging (fMRI) studies of my arithmetic ability are described. I had been an excellent abacus user with brilliant achievements since elementary school. Premorbidly, I could use the right hemisphere of my brain to visualize a clear image of an abacus. However, my ability to visualize the abacus disappeared following the stroke. Two experiments were conducted involving calculation and digit memory tasks using fMRI. This may be the most important aspect of my story. My recovery process for other cognitive deficits is also delineated here.

P199 The predictors of adherence with nasal continuous positive airway pressure treatment in Japanese

Introduction

Continuous positive airway pressure (CPAP) is considered the-first line treatment for obstructive sleep apnea syndrome (OSAS). CPAP adherence, however, is suboptimal. Poor CPAP adherence could not prevent cardiovascular events. An early intervention in patients with poor adherence with CPAP may have a better likelihood of avoiding dropout from CPAP or improving adherence.

Purpose

To determine the predictors of CPAP adherence in patients with OSAS.

Methods

We studied 291（219 male 72 female）patients with OSAS with an apnea hypopnea index (AHI) ≥ 20 events per hour were enrolled in from April 2014 to march 2017 at 4 Clinical Centers. The introduction of CPAP treatment was performed in patient with OSAS in the hospital for education including neurocognitive performance or in outpatient with OSAS in their home, receiving education excluding neurocognitive performance. We assessed the relationship between apnea hypopnea index (AHI), the Epworth Sleepiness Scale score (ESS), B-type natriureic peptide (BNP), the type D personality (depressed state assessed by means of a valid and reliable 14-item questionnaire) and health-related quality of life using the Short Form (36) Health Survey (SF-36) and CPAP adherence (good; ≥4 h every night, 70% days in a month). 

Results

219 male were mean age 60.1 ± 13.7 years, mean BMI 26.8kg/m2, mean AHI 44.8/h, and 72 female were 63.4 ±13.8 years, 28.2 kg/m2, 50.5/h, respectively. CPAP treatment improved ESS from 7.5 ± 4.1 to 5.3 ± 3.2 after 3 months（p = 0.009）, AHI from 44.8 ± 19.4 to 6.1 ± 6.2（ p &lt; 0.001）in the first month. CPAP adherence declined 89.8％ in 1 month、73.6 % in 6 months, 68.2 % in 12 months. There were no difference in CPAP adherence among 4 Clinical Centers (p = 0.47). There were not relationship between CPAP adherence and sex , age(≥ 40 years), AHI (≥30), ESS (≥11), BNP, type D personality. However, BMI(≥25 p = 0.01) and patients with initiating CPAP treatment in the hospital have better adherence than outpatients with initiating CPAP treatment in their home (hazard ratio 0.40 (95 % CI 0.16-0.9 p = 0.043) . Although CPAP treatment improved health-related quality of life (vitality, mental health, before CPAP vs after, 48.4 vs 51.4, 49.4 vs 52.5, p &lt;0.05, respectively), there was no difference in relationship between CPAP adherence and improvement of vitality or mental health.

Conclusions

Patents with OSAS in the hospital, receiving education including neurocognitive performance, were good adherence to CPAP treatment. Severity of OSAS, Depress state, and improvement of health quality did not impact on CPAP adherence. This study showed education is important to keep CPAP good adherence in Japanese as well as Western people.

[The Analgesic Effect of Aspirin on Inflammatory Pain in Rats Is Affected by Pain Intensity and Administration Timing]

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely known as painkillers. The analgesic action of NSAIDs is attributable to the inhibition of prostaglandin synthesis that occurs in response to blocking cyclooxygenase activity. The effective dose of NSAIDs can vary depending on pain intensity and administration timing; however, there are few studies on this. This study aimed to elucidate whether the analgesic effect of NSAIDs changes depending on the situation in which they are taken and we focused on the NSAID, aspirin (ASP). In a rat model of brewer's yeast-induced inflammation, pain caused by 20% (w/v) brewer's yeast-treatment was defined as "strong pain" and that caused by 2.5% (w/v) was defined as "weak pain". The analgesic effect of ASP (low-dose; 44 mg/kg or high-dose; 66 mg/kg) against strong pain was dose-dependent, but that against weak pain was the same. Furthermore, we defined drug administration after 3 h of brewer's yeast-treatment as "late administration" and that after 20 min as "early administration". In the case of strong pain, the analgesic effect of "late ASP administration" was dose-dependent, but that of "early ASP administration" was the same. These results suggest that low-dose NSAIDs have an analgesic effect against weak pain or when taken early.

Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers

Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed diagnostic procedures and treatments for secondary leg lymphedema, and discuss how to better manage leg lymphedema. Among the currently available diagnostic tools, indocyanine green lymphography (ICG-LG) can detect dermal lymph backflow in asymptomatic legs at stage 0. Therefore, ICG-LG is considered the most sensitive and useful tool. At symptomatic stage ≥1, ultrasonography, magnetic resonance imaging-lymphography/computed tomography-lymphography (MRI-LG/CT-LG) and lymphosintiography are also useful. For the treatment of lymphedema, complex decongestive physiotherapy (CDP) including manual lymphatic drainage (MLD), compression therapy, exercise and skin care, is generally performed. In recent years, CDP has often required effective multi-layer lymph edema bandaging (MLLB) or advanced pneumatic compression devices (APCDs). If CDP is not effective, microsurgical procedures can be performed. At stage 1–2, when lymphaticovenous anastomosis (LVA) is performed, lymphaticovenous side-to-side anastomosis (LVSEA) is principally recommended. At stage 2–3, vascularized lymph node transfer (VLNT) is useful. These ingenious procedures can help maintain the patient’s quality of life (QOL) but unfortunately cannot cure lymphedema. The most important concern is the prevention of secondary lymphedema, which is achieved through approaches such as skin care, weight control, gentle limb exercises, avoiding sun and heat, and elevation of the affected leg.

The Space Physics Environment Data Analysis System (SPEDAS)

With the advent of the Heliophysics/Geospace System Observatory (H/GSO), a complement of multi-spacecraft missions and ground-based observatories to study the space environment, data retrieval, analysis, and visualization of space physics data can be daunting. The Space Physics Environment Data Analysis System (SPEDAS), a grass-roots software development platform (www.spedas.org), is now officially supported by NASA Heliophysics as part of its data environment infrastructure. It serves more than a dozen space missions and ground observatories and can integrate the full complement of past and upcoming space physics missions with minimal resources, following clear, simple, and well-proven guidelines. Free, modular and configurable to the needs of individual missions, it works in both command-line (ideal for experienced users) and Graphical User Interface (GUI) mode (reducing the learning curve for first-time users). Both options have "crib-sheets," user-command sequences in ASCII format that can facilitate record-and-repeat actions, especially for complex operations and plotting. Crib-sheets enhance scientific interactions, as users can move rapidly and accurately from exchanges of technical information on data processing to efficient discussions regarding data interpretation and science. SPEDAS can readily query and ingest all International Solar Terrestrial Physics (ISTP)-compatible products from the Space Physics Data Facility (SPDF), enabling access to a vast collection of historic and current mission data. The planned incorporation of Heliophysics Application Programmer's Interface (HAPI) standards will facilitate data ingestion from distributed datasets that adhere to these standards. Although SPEDAS is currently Interactive Data Language (IDL)-based (and interfaces to Java-based tools such as Autoplot), efforts are under-way to expand it further to work with python (first as an interface tool and potentially even receiving an under-the-hood replacement). We review the SPEDAS development history, goals, and current implementation. We explain its "modes of use" with examples geared for users and outline its technical implementation and requirements with software developers in mind. We also describe SPEDAS personnel and software management, interfaces with other organizations, resources and support structure available to the community, and future development plans.

ELECTRONIC SUPPLEMENTARY MATERIAL

The online version of this article (10.1007/s11214-018-0576-4) contains supplementary material, which is available to authorized users.

Development of a cognitive function test using virtual reality technology: examination in healthy participants

We developed a virtual reality test to assess the cognitive function of Japanese people in near-daily-life environment, namely, a virtual shopping test (VST). In this test, participants were asked to execute shopping tasks using touch panel operations in a "virtual shopping mall." We examined differences in VST performances among healthy participants of different ages and correlations between VST and screening tests, such as the Mini-Mental State Examination (MMSE) and Everyday Memory Checklist (EMC). We included 285 healthy participants between 20 and 86 years of age in seven age groups. Therefore, each VST index tended to decrease with advancing age; differences among age groups were significant. Most VST indices had a significantly negative correlation with MMSE and significantly positive correlation with EMC. VST may be useful for assessing general cognitive decline; effects of age must be considered for proper interpretation of the VST scores.

Pulsating aurora from electron scattering by chorus waves

Auroral substorms, dynamic phenomena that occur in the upper atmosphere at night, are caused by global reconfiguration of the magnetosphere, which releases stored solar wind energy. These storms are characterized by auroral brightening from dusk to midnight, followed by violent motions of distinct auroral arcs that suddenly break up, and the subsequent emergence of diffuse, pulsating auroral patches at dawn. Pulsating aurorae, which are quasiperiodic, blinking patches of light tens to hundreds of kilometres across, appear at altitudes of about 100 kilometres in the high-latitude regions of both hemispheres, and multiple patches often cover the entire sky. This auroral pulsation, with periods of several to tens of seconds, is generated by the intermittent precipitation of energetic electrons (several to tens of kiloelectronvolts) arriving from the magnetosphere and colliding with the atoms and molecules of the upper atmosphere. A possible cause of this precipitation is the interaction between magnetospheric electrons and electromagnetic waves called whistler-mode chorus waves. However, no direct observational evidence of this interaction has been obtained so far. Here we report that energetic electrons are scattered by chorus waves, resulting in their precipitation. Our observations were made in March 2017 with a magnetospheric spacecraft equipped with a high-angular-resolution electron sensor and electromagnetic field instruments. The measured quasiperiodic precipitating electron flux was sufficiently intense to generate a pulsating aurora, which was indeed simultaneously observed by a ground auroral imager.

Short umbilical cord length: reflective of adverse pregnancy outcomes

A short umbilical cord is associated with adverse pregnancy outcomes. However, there is no universally accepted definition of a short cord.

OBJECTIVE

This study aimed to determine the umbilical cord length showing the highest correlation with adverse pregnancy outcomes.

MATERIALS AND METHODS

The authors retrospectively analyzed the clinical data of women who attempted vaginal birth in the present institution. Umbilical cord lengths were categorized into three groups: less than the first percentile, from the first percentile to less than the tenth percentile, and others. Maternal and neonatal characteristics previously suggested to affect cord length were evaluated. The main outcome was the rate of cesarean delivery. The authors also evaluated the frequency of operative vaginal delivery, small-for-gestational-age (SGA) births, neonatal intensive care unit (NICU) admission, umbilical artery pH < 7.1, and abnormal bleeding during delivery.

RESULTS

Cord lengths of 35 and 45 cm corresponded to the first and tenth percentiles, respectively. A short cord was an indi- cator of unplanned cesarean delivery and small-for-gestational-age births.

CONCLUSION

An umbilical cord length of ≤ 45 cm is a clinically useful indicator of adverse pregnancy outcomes.

Effect of Antihypertensive Therapy on Blood Rheology in Patients with Essential Hypertension

Hypertension is an important risk factor for cardiovascular disease, and antihypertensive drugs can decrease the occurrence of such events in hypertensive patients. This study compared the rheological properties of blood in 22 untreated hypertensive patients, 42 patients taking antihypertensive drugs and 74 normotensive subjects. Using a microchannel method, the whole blood passage time was measured and blood movement was observed with a microscope connected to an image display unit. The blood passage time in untreated hypertensive patients was significantly higher than in treated hypertensive patients or normotensive subjects, but was similar in the latter two groups. Microscopic observations showed that platelet aggregation and leucocyte adhesion were increased in untreated hypertensive patients, resulting in poor flow, while blood samples from treated hypertensive patients and normotensive subjects passed smoothly through the microchannels. These rheological differences could contribute to the decrease in cardiovascular disease seen when hypertensive patients are treated effectively.

MAVEN observations of the response of Mars to an interplanetary coronal mass ejection

Coupling between the lower and upper atmosphere, combined with loss of gas from the upper atmosphere to space, likely contributed to the thin, cold, dry atmosphere of modern Mars. To help understand ongoing ion loss to space, the Mars Atmosphere and Volatile Evolution (MAVEN) spacecraft made comprehensive measurements of the Mars upper atmosphere, ionosphere, and interactions with the Sun and solar wind during an interplanetary coronal mass ejection impact in March 2015. Responses include changes in the bow shock and magnetosheath, formation of widespread diffuse aurora, and enhancement of pick-up ions. Observations and models both show an enhancement in escape rate of ions to space during the event. Ion loss during solar events early in Mars history may have been a major contributor to the long-term evolution of the Mars atmosphere.

Early MAVEN Deep Dip campaign reveals thermosphere and ionosphere variability

The Mars Atmosphere and Volatile Evolution (MAVEN) mission, during the second of its Deep Dip campaigns, made comprehensive measurements of martian thermosphere and ionosphere composition, structure, and variability at altitudes down to ~130 kilometers in the subsolar region. This altitude range contains the diffusively separated upper atmosphere just above the well-mixed atmosphere, the layer of peak extreme ultraviolet heating and primary reservoir for atmospheric escape. In situ measurements of the upper atmosphere reveal previously unmeasured populations of neutral and charged particles, the homopause altitude at approximately 130 kilometers, and an unexpected level of variability both on an orbit-to-orbit basis and within individual orbits. These observations help constrain volatile escape processes controlled by thermosphere and ionosphere structure and variability.

Gastric adenocarcinoma of fundic gland type (chief cell predominant type) with unique endoscopic appearance curatively treated by endoscopic submucosal resection

Gastric adenocarcinoma of fundic gland type [chief cell predominant type; (GA-FD-CCP)] is a rare gastric cancer variant arising from non-atrophic mucosa without Helicobacter pylori infection in the upper third portion of the stomach. GA-FD-CCP originates deep in the mucosal layer; hence, endoscopic lesion detection is often difficult at an early stage because of a minimal change in the mucosal surface. Here we present a 66-year-old man with an early stage of GA-FD-CCP showing characteristic endoscopic features. Esophagogastroduodenoscopy demonstrated a flat, slightly reddish area with black pigment dispersion and irregular micro-surface structure at the gastric fornix. The tumor was resected by endoscopic submucosal dissection and was pathologically diagnosed as GA-FD-CCP. Prussian blue staining revealed that the black pigment was a hemosiderin deposition. We reported a rare case of successfully treated GA-FD-CCP with black pigmentation that aided in early lesion detection.

Influence of p53 status on the effects of boron neutron capture therapy in glioblastoma

BACKGROUND/AIM

The tumor suppressor gene p53 is mutated in glioblastoma. We studied the relationship between the p53 gene and the biological effects of boron neutron capture therapy (BNCT).

MATERIALS AND METHODS

The human glioblastoma cells; A172, expressing wild-type p53, and T98G, with mutant p53, were irradiated by the Kyoto University Research Reactor (KUR). The biological effects after neutron irradiation were evaluated by the cell killing effect, 53BP1 foci assay and apoptosis induction.

RESULTS

The survival-fraction data revealed that A172 was more radiosensitive than T98G, but the difference was reduced when boronophenylalanine (BPA) was present. Both cell lines exhibited similar numbers of foci, suggesting that the initial levels of DNA damage did not depend on p53 function. Detection of apoptosis revealed a lower rate of apoptosis in the T98G.

CONCLUSION

BNCT causes cell death in glioblastoma cells, regardless of p53 mutation status. In T98G cells, cell killing and apoptosis occurred effectively following BNCT.

Hepatic arterial infusion chemotherapy with cisplatin before radical local treatment of early hepatocellular carcinoma (JIS score 0/1) improves survival

BACKGROUND

It has not yet been determined whether hepatic arterial infusion (HAI) chemotherapy improves survival in patients with early hepatocellular carcinoma (HCC). We evaluated the effectiveness of HAI with high-concentration cisplatin (DDP-H) for the treatment of HCC by comparing outcomes between patients who received HAI with DDP-H before radical local treatment of early-stage HCC [Japan Integrated Staging (JIS) score 0/1] and patients who did not receive HAI chemotherapy.

PATIENTS AND METHODS

Survival was analyzed in 114 patients with early-stage HCC who underwent radical local treatment. The patients were divided into two groups: a HAI group (n = 79) who received DDP-H infusion into the whole liver via the proper hepatic artery, and a non-HAI group (n = 35) who did not receive HAI chemotherapy.

RESULTS

The cumulative survival rates at 1, 3, and 5 years were 77.4%, 69.2%, and 55.3% in the non-HAI group and 97.4%, 87.0%, and 84.4% in the HAI group, respectively. Survival time prolonged significantly in the HAI group compared with the non-HAI group (log-rank test: P = 0.023; generalized Wilcoxon test: P = 0.012) Multivariate analysis using the Cox proportional hazards model identified HAI with DDP-H as the most important factor affecting survival.

CONCLUSIONS

Whole-liver HAI with DDP-H before radical local treatment can improve the prognosis of patients with early-stage HCC.

Expression and Distribution of Very Late Antigen-5 in Mouse Peritoneal Macrophages upon Ingestion of Fibronectin-BoundStaphylococcus aureus

Many pathogens colonize host tissues by binding to the extracellular matrix via their cell surface adhesion molecules, which are called MSCRAMMs (microbial surface components recognizing adhesive matrix molecules). Staphylococcus aureus expresses several of these adhesion molecules, some of which bind to fibronectin. Of these adhesion molecules, fibronectin-binding proteins play a role in the pathogenicity of S. aureus, although it is not yet clear whether they enhance its virulence. We have previously shown that fibronectin-bound S. aureus is efficiently phagocytosed by thioglycolate-induced mouse peritoneal macrophages. Bacterial ingestion is mediated by Very Late Antigen-5 (VLA-5; alpha5beta1 integrin) and is accompanied by the formation of adhesion complexes. Here we show that the expression of VLA-5 is restricted to thioglycolate-induced inflammatory macrophages and is not found in the resident macrophages. When cells were in suspension, alpha5 integrin was not expressed on the surface of either resident or inflammatory macrophages, whereas in adherent cells, this integrin was distributed on the surface of inflammatory but not resident macrophages. A high level of this integrin was present in the cytoplasmic region only in inflammatory macrophages. In agreement with this, fibronectin-mediated phagocytosis of S. aureus was observed only in the inflammatory macrophages. In inflammatory macrophages ingesting fibronectin-bound S. aureus, alpha5 integrin was concentrated close to the phagocytosed bacteria. This change in distribution was not found in macrophages ingesting untreated bacteria. Together with our previous work, these results indicate that, upon ingestion of fibronectin-bound S. aureus, VLA-5 accumulates in the area of phagocytosis in inflammatory macrophages, where it forms adhesion complexes.

A virtual shopping test for realistic assessment of cognitive function

Background

Cognitive dysfunction caused by brain injury often prevents a patient from achieving a healthy and high quality of life. By now, each cognitive function is assessed precisely by neuropsychological tests. However, it is also important to provide an overall assessment of the patients’ ability in their everyday life. We have developed a Virtual Shopping Test (VST) using virtual reality technology. The objective of this study was to clarify 1) the significance of VST by comparing VST with other conventional tests, 2) the applicability of VST to brain-damaged patients, and 3) the performance of VST in relation to age differences.

Methods

The participants included 10 patients with brain damage, 10 age-matched healthy subjects for controls, 10 old healthy subjects, and 10 young healthy subjects. VST and neuropsychological tests/questionnaires about attention, memory and executive function were conducted on the patients, while VST and the Mini-Mental State Examination (MMSE) were conducted on the controls and healthy subjects. Within the VST, the participants were asked to buy four items in the virtual shopping mall quickly in a rational way. The score for evaluation included the number of items bought correctly, the number of times to refer to hints, the number of movements between shops, and the total time spent to complete the shopping.

Results

Some variables on VST correlated with the scores of conventional assessment about attention and everyday memory. The mean number of times referring to hints and the mean number of movements were significantly larger for the patients with brain damage, and the mean total time was significantly longer for the patients than for the controls. In addition, the mean total time was significantly longer for the old than for the young.

Conclusions

The results suggest that VST is able to evaluate the ability of attention and everyday memory in patients with brain damage. The time of VST is increased by age.

The effect on the bones of condensed phosphate when used as food additives: Its Importance in Relation to Preventive Medicine

Based on the fact that chemical products such as binding agents are produced by mixing three kinds of phosphates with different ratios, we mixed metaphosphate, polyphosphate and pyrophosphate. Each was made to Na-phosphate, K-phosphate, and Ca-phosphate and each was mixed with commercial feeds so that the content of P would be approximately 0.1, 0.15, 0.3, 0.4, 0.6 and 1.0%. The prepared pellets were given to ICR, CF # 1 and AKR strains of mice at 29 days of age for 680 days and observations were made through this experimental period at different stages. The observations were also carried out on the mice administered with the experimental feeds for 1.5 months from 9 to 10.5 months of age. The observations were compared with those of the control group at all times. As a result, plasma 1 α, 25 (OH)(2) D(3) and P levels were always significantly higher in the phosphate administered groups relative to the control. Urine P and Fe increased while urine Ca decreased in the phosphate-treated groups.The effect of phosphates on the bones was studied taking soft X-ray pictures of hind legs and applying microdensitometry to them. Through these observations we recognized thinning of the cortex of bones, reduction of marrow trabecules and development of osteophyte. Histological observations disclosed that changes in knee joint tissues were apparent; that is, a decrease in or an irregular loss of the number of cells in superficial, intermediate, and radial strata of the joint cartilage, proliferation of subchondral bone, and the development of osteophytes were noted. As for muscles, diameters of musclar fibers became smaller; in particular, type II fibers showed greater shrinkage. Regarding kidneys, swelling and atrophy of glomerular capillaries, proliferation of mesangial cells, nephroselerosis, swelling, thinning, and loss of tubular epithelium, interstitial tissue inflammation, development of cylindruria, and deposition of calcium were observed. All these changes seem to be a particularly advanced aspect of the changes which are more pronounced with increasing dose and age.These changes were found even in the group administered with the feed containing 0.1% phosphorus, and, these changes were dependent on the concentration level of P. It was observed that administration to older subjects for a short term (1.5 months) produced effects stronger than those to younger subjects administered for a long term (10.5 months).The effects of condensed Ca-phosphate on bones were similar to those of condensed Na- and K-phosphates, and, hence, it was supposed that these effects were caused by phosphate radicals.

Inhibition of liver metastasis formation by anti-CD44 variant exon 9 monoclonal antibody

The overexpression of variants of the glycoprotein CD44 is thought to be associated with the tumorigenesis and progression of human cancers. We examined the role of the variant CD44v8-10 in the metastasis of the human colon cancer cell line HT29 using a monoclonal antibody (mAb 44-1V) reactive with the v9 product. After immunization with mAb 44-1V, the growth of HT29m cells in vitro was not retarded. Six-to 8-week-old mice were divided into 4 groups for liver metastasis assay. All animals in control groups injected with intrasplenic HT29m developed metastases. In contrast, only one of the animals injected with HT29m that reacted with mAb 44-1V developed a metastatic tumor in the liver. The intravenous administration of mAb 44-1V after intrasplenic HT29m injection did not inhibit the formation of liver metastasis. In addition, the adhesiveness of the HT29m cells to the basement membrane matrix was decreased by treatment with the anti-CD44v9 mAb. These findings indicated that a CD44 variant containing the products of variants of exons v8-10 may play an important role in adhesion of tumor cells to the capillaries of distant organs in the metastatic process.

Abacus in the brain: a longitudinal functional MRI study of a skilled abacus user with a right hemispheric lesion

The abacus, a traditional physical calculation device, is still widely used in Asian countries. Previous behavioral work has shown that skilled abacus users perform rapid and precise mental arithmetic by manipulating a mental representation of an abacus, which is based on visual imagery. However, its neurophysiological basis remains unclear. Here, we report the case of a patient who was a good abacus user, but transiently lost her "mental abacus" and superior arithmetic performance after a stroke owing to a right hemispheric lesion including the dorsal premotor cortex (PMd) and inferior parietal lobule (IPL). Functional magnetic resonance imaging experiments were conducted 6 and 13 months after her stroke. In the mental calculation task, her brain activity was shifted from the language-related areas, including Broca's area and the left dorsolateral prefrontal and IPLs, to the visuospatial-related brain areas including the left superior parietal lobule (SPL), according to the recovery of her arithmetic abilities. In the digit memory task, activities in the bilateral SPL, and right visual association cortex were also observed after recovery. The shift of brain activities was consistent with her subjective report that she was able to shift the calculation strategy from linguistic to visuospatial as her mental abacus became stable again. In a behavioral experiment using an interference paradigm, a visual presentation of an abacus picture, but not a human face picture, interfered with the performance of her digit memory, confirming her use of the mental abacus after recovery. This is the first case report on the impairment of the mental abacus by a brain lesion and on recovery-related brain activity. We named this rare case "abacus-based acalculia." Together with previous neuroimaging studies, the present result suggests an important role for the PMd and parietal cortex in the superior arithmetic ability of abacus users.

Cultural adaptation and validating a Japanese version of the readiness for interprofessional learning scale (RIPLS)

Readiness for interprofessional education (IPE) can be an important factor to evaluate because of the influences of attitudes toward the outcomes of interprofessional learning activities. However, a dearth of Japanese evaluation tools hinders its evaluation. The readiness for interprofessional learning scale (RIPLS) was selected, because it has been validated in different countries and its items reflected our local situation best. This research aimed to develop and validate a Japanese version of the original 19-item RIPLS. We developed a Japanese RIPLS employing forward/backward translation. Reliability of the Japanese version was studied using classical test theory and structural equation modeling to construct a model to inform curriculum development. We obtained a 0.74 Cronbach's α, which indicates adequacy. Subscales of "interprofessional education opportunities" (α = 0.90) and "uniqueness of profession" (α = 0.60) have relatively little weight compared to "teamwork and collaboration" (α = 0.92). A one-way structure suggests that readiness for interprofessional learning starts with "teamwork & collaboration" followed by changes in "learning opportunities" and subsequently "uniqueness of profession" (root mean square error of approximation = 0.06, comparative fit index = 0.93). This Japanese RIPLS can be used in undergraduate health sciences students with appropriate caution. Further development of the subscales and a client-centered subscale would be beneficial to fully achieve its potential. The need for further research into its reliability and validity is identified. Recommendations are provided for cross-cultural adaptation and for establishing validity across different contexts.