An Aqueous Redox Flow Battery Using CO2 as an Active Material with a Homogeneous Ir Catalyst

For the application of CO2 as an energy storage material, a H2 storage system has been proposed based on the interconversion of CO2 and formic acid (or formate). However, energy losses are inevitable in the conversion of electrical energy to H2 as chemical energy (≈70 % electrical efficiency) and H2 to electrical energy (≈40 % electrical efficiency). To overcome these significant energy losses, we developed a system based on the interconversion of CO2 and formate for the direct storage and generation of electricity. In this paper, we report an aqueous redox flow battery system using homogeneous Ir catalysts with CO2 -formate redox pair. The system exhibited a maximum discharge capacity of 10.5 mAh (1.5 Ah L-1 ), capacity decay of 0.2 % per cycle, and total turnover number of 2550 after 50 cycles. During charging-discharging, in situ fluorescence X-ray absorption fine structure spectroscopy based on an online setup indicated that the active species was in a high valence state of IrIV .

A case of necrotizing fasciitis caused by Bifidobacterium breve

Background

Bifidobacterium breve is an obligate anaerobic gram-positive bacillus mainly found in the gastrointestinal tract of human infants. Few cases of necrotizing fasciitis caused by B. breve have been reported.

Case presentation

A 42-year-old Japanese man with type 2 diabetes mellitus, obesity, cellulitis of the back, and subcutaneous abscess of the right inguinal region presented with rapidly developing erythema, swelling and severe pain in the right inguinal region. Computed tomography showed widespread gas in the right leg region. Cultures of blood and a swab of the wound abscess grew gram-positive bacilli. Mass spectrography and 16 S rDNA analysis confirmed the gram-positive bacilli as B. breve. The patient recovered following extensive debridement and antibacterial therapy.

Conclusion

Unidentified necrotizing fasciitis can be caused by B. breve, especially in compromised hosts.

Recent Progress in Homogeneous Catalytic Dehydrogenation of Formic Acid

Recently, there has been a strong demand for technologies that use hydrogen as an energy carrier, instead of fossil fuels. Hence, new and effective hydrogen storage technologies are attracting increasing attention. Formic acid (FA) is considered an effective liquid chemical for hydrogen storage because it is easier to handle than solid or gaseous materials. This review presents recent advances in research into the development of homogeneous catalysts, primarily focusing on hydrogen generation by FA dehydrogenation. Notably, this review will aid in the development of useful catalysts, thereby accelerating the transition to a hydrogen-based society.

Altered consciousness with transient abnormal signals in the hippocampus: A case report

Hippocampal infarction is relatively rare. Many different diseases can mimic hippocampal infarction including transient global amnesia, Alzheimer’s disease, epilepsy, encephalitis, and encephalopathies. An 89-year-old man was transported to our hospital for altered consciousness. Diffusion-weighted magnetic resonance imaging revealed slightly intense signals in the hippocampus with a mildly decreased apparent diffusion coefficient. Serial magnetic resonance imaging revealed features of hippocampal infarction. Symptoms and cognitive function gradually improved with rehabilitation, and he was transferred to a rehabilitation facility on Hospital Day 38. Hippocampal infarction is rare in patients with altered mental status, but should be considered when magnetic resonance imaging shows findings suggestive of this condition. Other differential diseases should be ruled out by serial magnetic resonance imaging and observation of the clinical course.

Examination of the acute efficacy and safety about aggressive use of tolvaptan for early rising after admission in super-elder patients with congestive heart failure

Background

From August 2015, for shortening of hospitalization period through efficient medical care in acute phase, we had introduced a unique clinical pathway (PATH) for congestive heart failure (CHF) cases. In PATH, since immediate taking of Tolvaptan, which is an strong oral diuretic and approver for use in the treatment of CHF cases since 2010 in Japan, after admission is specified, early diuresis makes it possible to achieve early rising from bed and streamline each medical care such as oxygen inhalation, continuous infusion, and urethral catheterization. Early rising from bed is particularly important for super-elder CHF patients who merge often frail. On the other hand, for super-elder CHF patients, it is feared that aggressive use of Tolvaptan may frequently cause dehydration, renal damage caused by it, or hypernatremia, which is a peculiar side effect about the drug.

Purpose

In this study, we examined the usefulness and safety of active use of Tolvaptan by introducing PATH in patients with super-elder CHF patients.

Methods

We set up three groups, NE group consist of 37 CHF cases (90 years old or over) who admitted in our hospital before (without) introduction of PATH between April 2014 and July 2015, PE group consist of 130 CHF cases (90 years old or over) and PY group consist of 466 CHF cases (under 90 years old) who ware admitted with introduction of PATH between August 2015 and July 2020. And in each group, we investigated various medical conditions in their acute phase after admission and the incidence of adverse events related to oral administration of tolvaptan, and examined the differences between three groups.

Results

Between NE group and PE group, there were no significant differences in mean age, pre-hospital living status, or clinical status at admission (Figure 1). But due to lean and efficient CHF care, the average length of hospitalization period was significantly shorter in PE group. And, in PE group, each medical care was performed as efficiently as in PY group, but the progression of renal damage or hypernatremia that required unscheduled discontinuation of tolvaptan use occurred more frequently in PE group (Figure 2).

Conclusions

Aggressive Tolvaptan use through our unique clinical pathway for congestive heart failure cases seemed to be useful even in super-elder patients. Although we thought that the safety of active use of tolvaptan for super-elder patients was well tolerated considering the results of this study, the incidence of adverse events such as hypernatremia was clearly higher in super-elder patients than in non-super-elder patients. It seemed that we should pay close attention to the clinical data of super-elder patients after introduction of tolvaptan.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Examination about more realistic prognosis evaluation method, how long the patients with congestive heart failure can spend at home

Background

From August 2015, for efficient medical care in congestive heart failure (CHF) cases, we had introduced a unique clinical pathway (PATH) provided the immediate use of Tolvaptan and comprehensive education by multi-disciplinary staff after admission. And by introduction of PATH, we confirmed the shortening effect of hospitalization period with CHF and the suppressive effect of readmission with CHF after discharge. But since almost CHF patients repeat hospitalization and discharge due to change of their medical condition, the investigation for only first readmission rate after discharge is not enough to assess the entire long clinical course of CHF. Recently we found one report about evaluation method for CHF clinical prognosis, how long CHF patients can stay healthy at their own home after discharge within a certain period. This evaluation method is considered to take into account the long clinical course of CHF.

Purpose

We investigated whether the CHF patients introduced PATH on admission could stay longer at their home than CHF patients without PATH.

Methods

Between April 2014 and July 2019, 471 CHF cases, who ware admitted in our hospital at first and could be followed up for at least 1 month after discharge, ware enrolled. We divided them to two groups, PATH- group before introducing PATH (until July 2015, 142 cases), and PATH+ group applied PATH (after August 2015, 329 cases). Between both groups, we investigated the readmission rate (RR) with CHF and the total period (TP) that patients could spend at home within1, 3, 6 and 12month after discharge.

Results

There were no significant differences in mean age, pre-hospital living status, or clinical status at admission between the two groups. On the other hand, due to efficient CHF care, the average length of hospital stay was significantly shorter (figure1). RR within 1, 3, 6 and 12 months after discharge ware all lower in PATH+ group. And TP within 1, 3, 6 and 12 months after discharge ware all longer in PATH+ group (figure2).

Conclusion

By introducing our unique clinical pathway for congestive heart failure cases requiring hospitalization, we could confirm not only the improvement of their conventional clinical prognosis index but also the improvement of their new and more realistic clinical prognosis index after discharge.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Catalytic Hydrogenation of CO2 to Methanol Using Multinuclear Iridium Complexes in a Gas-Solid Phase Reaction

We report a novel approach toward the catalytic hydrogenation of CO₂ to methanol performed in the gas-solid phase using multinuclear iridium complexes at low temperature (30-80 °C). Although homogeneous CO₂ hydrogenation in water catalyzed by amide-based iridium catalysts provided only a negligible amount of methanol, the combination of a multinuclear catalyst and gas-solid phase reaction conditions led to the effective production of methanol from CO₂. The catalytic activities of the multinuclear catalyst were dependent on the relative configuration of each active species. Conveniently, methanol obtained from the gas phase could be easily isolated from the catalyst without contamination with CO, CH₄, or formic acid (FA). The catalyst can be recycled in a batchwise manner via gas release and filling. A final turnover number of 113 was obtained upon reusing the catalyst at 60 °C and 4 MPa of H₂/CO₂ (3:1). The high reactivity of this system has been attributed to hydride complex formation upon exposure to H₂ gas, suppression of the liberation of FA under gas-solid phase reaction conditions, and intramolecular multiple hydride transfer to CO₂ by the multinuclear catalyst.

Our unique clinical pathway for congestive heart failure cases required admission achieved a dramatic reduction of their hospitalization period and a significant reduction of readmission with heart fa

Background

In recent years, the number of elderly congestive heart failure (CHF) cases has been increasing in Japan with the aging of the population. This tendency is particularly remarkable in rural areas where our facilities are located. After admission with CHF, the hospitalization period (PE) was prolonged due to various complications unique to the elderly, and re-exacerbation of CHF occurred shortly after discharge. Approximately 30% of them were readmitted within one year. From August 2015, for shortening of PE and reduction of CHF readmission through the efficiency of CHF treatment and comprehensive patient education, we had introduced a unique clinical pathway (PATH) that provided the immediate use of Tolvaptan and comprehensive education by multi-disciplinary staff after admission.

Purpose

In this study, we verified whether the improvement of clinical prognosis were achieved by introduction of PATH.

Methods

Between April 2014 and July 2019, 635 CHF cases (764 admissions) ware enrolled. We divided them to two groups, N-group before introducing PATH (198 cases, 262 admissions) and P-group applied PATH (437 cases, 502 admission). Between both groups, we compared the various acute care situation, PE and readmission rate with CHF within 1 year after discharge.

Results

There were no differences between P and N-group in mean age, distribution of underlying illness or daily activity level before admission. There ware not also differences about left ventricle function by echocardiography and various blood test data at admission. The enforcement rate of continuous infusion and the rate of urinary catheter placement were significantly lower in the P-group (71 vs 88%; p<0.0001, 52 vs 63%; p<0.01, respectively). And their enforcement duration was significantly shorter in P-group (4.6±5.3 vs 10.5±9.6 days; p<0.0001, 6.3±7.9 vs 12.8±13.1 days; p<0.0001 respectively). The enforcement rate of cardiac rehabilitation was significantly higher in group P (94 vs 84%; p<0.0001), and the starting time of rehabilitation was significantly earlier (2.9±1.5 vs 6.3±4.8th illness day; p<0.0001). As a result, the average HP was significantly shorter in group P (16.5±13.4 vs 28.6±24.1 days, p<0.0001). The readmission rate with CHF within one year after discharge was significantly lower in group P (23 vs 36%; p<0.001).

Conclusion

By the introduction of our original clinical pathway for congestive heart failure, the efficiency of medical care was achieved and the mean hospitalization period was widely shortened. In addition, by the through comprehensive patient education by multi-disciplinary staff involved in the pathway, the self-restraint life style after discharge seemed to be maintained and the readmission with worsening of heart failure was significantly suppressed.

Funding Acknowledgement

Type of funding source: None

Tachyarrhythmia improved by management of low back pain in a patient with delayed diagnosis of infective spondylodiscitis: A case report

A 77-year-old man presented to the emergency room with a 1-month history of persistent low back pain with the absence of vital sign abnormalities. On several previous orthopedic surgery clinic visits, pathological back pain had not been considered and pain killers had been prescribed because he had low back pain due to lumbar spinal canal stenosis. He was admitted to the intensive care unit for infectious spondylodiscitis and infective endocarditis with disseminated abscess caused by methicillin-resistant Staphylococcus aureus. Shock refractory tachyarrhythmia could not be managed with antiarrhythmic agent in the intensive care unit. Intractable low back pain and persistent tachyarrhythmia were adequately managed by pain control with fentanyl in the intensive care unit. Infectious spondylodiscitis and infective endocarditis were effectively managed with anti-methicillin-resistant Staphylococcus aureus drugs, initially in rotational usage, but the patient died of extended-spectrum beta-lactamase-producing Escherichia coli pneumonia on day 50 of hospitalization. Infectious spondylodiscitis should have been considered for persistent low back pain with hemodialysis, fever, and a history of device implantation. Pain management may be necessary for persistent tachycardia that proves unresponsive to usual antiarrhythmic medications.

P97 Effect of rhythm control therapy for asymptomatic atrial fibrillation

Background/Introduction

Cather ablation (CA) for atrial fibrillation (AF) as rhythm control therapy has widely spread. However, the indication of CA for the patients with asymptomatic AF is controversial (2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS). 

Purpose

This study was aimed to examine the effect of CA for asymptomatic AF patients.

Methods

In a total of 522 consecutive patients who were hospitalized for the initial CA for AF, 123 patients (23.6%) who were asymptomatic were retrospectively analyzed. "Asymptomatic AF" was defined when the patients had no complaints during the medical interviews. Quality of life (QOL) was evaluated with the AF QOL Questionnaire score (AFQLQ, invented by the Japanese Society of Electrocardiology) before CA and at 1 year after a single CA.

Results

A total of 79 patients were persistent AF (64.2%). Sinus rhythm maintenance rate at 3 yeas after CA was 57.0% in a single session and 84.8% in multiple sessions. In cardiac echo data at baseline, 3 months, 6 months, and 1 year after CA, left ventricular ejection fraction (LVEF) and left atrium diameter (LAD) were improved in the initial three months after a single CA (LVEF; 62.8 ± 8.0%→64.4 ± 6.5%, p = 0.045, LAD; 39.7 ± 6.1mm→35.3 ± 7.0mm, p = 0.0002). In LA volume measured with CT before and after CA, LA reverse remodeling was observed (102.7 ± 32.3ml→72.4 ± 24.1ml, p<.0001). In AFQLQ2 (severity of symptoms), there was no significant difference (16.3 ± 2.2→15.9 ± 1.7 out of 18, p = 0.69). However, in AFQLQ1 (frequency of symptoms) and AFQLQ3 (limitations of activities and mental anxiety), the score was improved (20.2 ± 4.5→23.4 ± 1.1 out of 24, p<.0001 and 47.6 ± 7.8→51.3 ± 6.1 out of 56, p = 0.0001).  Moreover, in low LVEF patients (LVEF < 50%, n = 8), LVEF was remarkably improved (44.1 ± 4.0%→56.3 ± 10.8%, p = 0.034).

Conclusions

The improvement of LVEF and LA reverse remodeling can be expected at the early stage after CA, because of the reduction of AF burden. Moreover, the further improvement of QOL can be expected after CA, even in the patients with "asymptomatic" AF.

Efficient Hydrogen Storage and Production Using a Catalyst with an Imidazoline-Based, Proton-Responsive Ligand

A series of new imidazoline-based iridium complexes has been developed for hydrogenation of CO₂ and dehydrogenation of formic acid. One of the proton-responsive complexes bearing two -OH groups at ortho and para positions on a coordinating pyridine ring (3 b) can catalyze efficiently the chemical fixation of CO₂ and release H₂ under mild conditions in aqueous media without using organic additives/solvents. Notably, hydrogenation of CO₂ can be efficiently carried out under CO₂ and H₂ at atmospheric pressure in basic water by 3 b, achieving a turnover frequency of 106 h^-1 and a turnover number of 7280 at 25 °C, which are higher than ever reported. Moreover, highly efficient CO-free hydrogen production from formic acid in aqueous solution employing the same catalyst under mild conditions has been achieved, thus providing a promising potential H₂ -storage system in water.

Direction to practical production of hydrogen by formic acid dehydrogenation with Cp*Ir complexes bearing imidazoline ligands

A Cp*Ir complex with pyridyl-imidazoline achieved the quantity production of 1 m³ of H₂/CO₂ gases from only HCO₂H in water without any additives.

Abstract P2-04-01: Development of mouse breast cancer models based on induced cancer stem cells (iCSC)

Breast cancer is one of the leading causes of death in women worldwide. To develop novel therapeutic approaches for the refractory cases, the mouse models which recapitulate the tumor tissues biologically and pathologically similar to human breast cancer are required. Although xenograft models of established cell lines in immune-deficient mice are frequently used for preclinical experiments, such xenograft models are not sufficient because the heterogenous structure based on the microenvironment and the intrinsic characteristics of cancer cells is not correctly formed.

In this study, we have established induced cancer stem cells (iCSC) from normal mouse mammary stem/progenitor cells through minimal required genetic manipulations and generated mouse breast cancer models by inoculating the iCSCs in the mammary fat pads. Initially, we established iCSC by introducing the H-RasV12 into Ink4a/Arf-knockout mammary stem/progenitor cells and this iCSC formed tumor similar to human triple negative breast cancer in mouse. This finding suggested that two genetic events, an activation of oncogenic signal and a tumor suppressor inactivation, are required for generating the breast cancer iCSC.

Anaplastic Lymphoma Kinase (ALK) gene, which encodes a receptor tyrosine kinase, was reported to be amplified and/or overexpressed up to 86% of patients in inflammatory breast cancer, and pleiotrophin (PTN), which is a physiological ligand for ALK, was also shown to be highly expressed in about 60% of human breast cancers. Therefore, we hypothesized that ALK pathway is involved in tumorigenesis of breast cancers and, then, attempted to generate iCSC by using ALK gene. Interestingly, we found that one of the naturally occurring mutations of ALK is sufficient for generating iCSC and tumor formation in vivo without any prior tumor suppressor inactivation. The ALK-induced iCSCs developed highly aggressive breast cancers in mice. Furthermore, the tumor formation was significantly suppressed when the ALK-induced iCSCs were generated by using mammary stem/progenitor cells derived from mouse deficient in CD44 which is a CSC marker. We have recently revealed a role of CD44, in particular that of a variant isoform (CD44v), in the protection of CSCs from high levels of oxidative stress derived from both tumor cells and their microenvironment (Cancer Cell 19: 387–400, 2011; Cancer Res 72: 1438–1448, 2012; Nat Commun 3: 883, 2012). We will discuss the underlying mechanism of ALK-induced tumorigenesis and a role of CD44 in the CSC functions.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-04-01.

[Pulmonary embolectomy for acute massive pulmonary thromboembolism after failure of thrombolytic therapy]

Acute massive pulmonary thromboembolism (PTE) is associated with an exceptionally high mortality rate and results in death if not diagnosed early and treated properly. We observed 3 cases of acute massive PTE. One of the patients had undergone a surgery for femoral neck fracture. Ten days postoperatively, she developed severe dyspnea with hypoxia, and computed tomography (CT) pulmonary angiography confirmed the PTE diagnosis. She then had cardiac arrest when catheter examination. Although emergency surgical thrombectomy was successful with good postoperative hemodynamic stability and oxygenation, the patient did not recover from the unconsciousness caused by preoperative ischemic brain damage. Subsequently, she died 6 months after surgery. Of the 3 patients, 2 suffered from right ventricular dysfunction without hemodynamic instability. They underwent open thrombectomy after the failure of conservative treatment with a systemic injection of urokinase. Both patients demonstrated a good clinical course and were discharged from hospital in a good general condition 22 and 28 days postoperatively. Herein, we review the current literature on PTE treatment. We concluded that an aggressive surgical intervention might be preferred to thrombolytic therapy for PTE patients with massive thrombosis and progressive right ventricular dysfunction.

Oral administration of pulverized Konjac glucomannan prevents the increase of plasma immunoglobulin E and immunoglobulin G levels induced by the injection of syngeneic keratinocyte extracts in BALB/c mice

BACKGROUND

Immunoglobulin (Ig) E plays a key role in the pathogenesis of atopic diseases, such as asthma, atopic dermatitis and allergic rhinitis. Oral administration of pulverized Konjac glucomannan (PKGM) has recently been demonstrated to prevent both plasma IgE elevation and developing dermatitis in NC/Nga mice, a model of atopic dermatitis.

OBJECTIVE

To clarify the direct effect of PKGM on the increase of plasma IgE, we employed the system of BALB/c mouse that increases IgE level without developing dermatitis in response to continuous injection of the extract of syngeneic keratinocytes, PAM 212 cells (PAM extract).

METHODS

Three weeks after the start of feeding with either control or PKGM diet, mice were injected subcutaneously with PAM extract bi-weekly for 10 weeks. The levels of plasma Igs were measured by enzyme-linked immunosorbent assay every 2 weeks after the injection. The levels of epsilon germline transcription and the amounts of mRNA for IL-4, IFN-gamma, GATA-3 and T bet gene in the spleen were evaluated by real-time RT-PCR at the end of the experiment.

RESULTS

On the one hand, PKGM prevented the increase of plasma IgE and IgG (IgG1, IgG2b) induced by PAM extract, and on the other hand, it enhanced the levels of plasma IgG3. However, it did not affect the level of plasma IgM. PKGM also reduced the levels of plasma ovalbumin (OVA)-specific IgE in OVA-sensitized mice. Moreover, PKGM attenuated the induction of epsilon germline transcription and expression levels of mRNA for IL-4, IFN-gamma and GATA-3 in the spleen of PAM extract-injected mice. PKGM also attenuated the induction of epsilon germline transcription and mRNA for IFN-gamma and T bet in the spleen of phosphate-buffered saline-injected control mice.

CONCLUSIONS

These results suggested that oral administration of PKGM prevents the elevation of plasma IgE by suppressing IgE class switching in B cells and/or the commitment development of naive lymphocytes to both T-helper type 1 (Th1) and Th2.

Regulation of the antioncogenic Chk2 kinase by the oncogenic Wip1 phosphatase

The antioncogenic Chk2 kinase plays a crucial role in DNA damage-induced cell-cycle checkpoint regulation. Here we show that Chk2 associates with the oncogenic protein Wip1 (wild-type p53-inducible phosphatase 1) (PPM1D), a p53-inducible protein phosphatase. Phosphorylation of Chk2 at threonine68 (Thr68), a critical event for Chk2 activation, which is normally induced by DNA damage or overexpression of Chk2, is inhibited by expression of wild-type (WT), but not a phosphatase-deficient mutant (D314A) of Wip1 in cultured cells. Furthermore, an in vitro phosphatase assay revealed that Wip1 (WT), but not Wip1 (D314A), dephosphorylates Thr68 on phosphorylated Chk2 in vitro, resulting in the inhibition of Chk2 kinase activity toward glutathione S-transferase-Cdc25C. Moreover, inhibition of Wip1 expression by RNA interference results in abnormally sustained Thr68 phosphorylation of Chk2 and increased susceptibility of cells in response to DNA damage, indicating that Wip1 acts as a negative regulator of Chk2 in response to DNA damage.