Creatinine Reduction Ratio Is a Prognostic Factor for Acute Kidney Injury following Cardiac Surgery with Cardiopulmonary Bypass: A Single-Center Retrospective Cohort Study

Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the predictors of AKI after surgery. The secondary objective was to determine the reliability of the CRR for short- and long-term outcomes. We retrospectively collected information about cardiac surgery patients who underwent cardiopulmonary bypass. Patients were divided into AKI and non-AKI groups based on the AKIN and RIFLE criteria. We analyzed the two groups regarding the preoperative patient data and operative information. The CRR was calculated as follows: (preoperative creatinine-postoperative creatinine)/preoperative creatinine. The prognostic factors of AKI-CS were surgery time, CPB time, aorta clamp time, platelet transfusion, and CRR < 20%. In the multivariate logistical analysis, CRR was an independent predictor of AKI (adjusted odds ratio: 0.90 [0.87-0.93], p < 0.001). However, there were no significant differences in CRR in terms of the rate of new onset chronic kidney disease (CKD). After cardiac surgery with cardiopulmonary bypass, CRR has good diagnostic power for predicting perioperative AKI. However, we cannot use it as a prognostic factor over a long-term period.

Silicon nanocavity with a quality factor of 6.7 million fabricated by a CMOS-compatible process

Here, we report on the increase of the quality-factors of photonic crystal nanocavities fabricated by a CMOS-compatible process. We fabricated nanocavities with the same cavity design but used either a binary photomask or a phase-shift photomask in the photolithography step to assess the impact of the photomask-type on the fabrication accuracy of the air holes. We characterized 62 cavities using time-resolved measurements and the best cavity had a quality-factor of 6.65 × 106. All cavities exhibited a quality-factor larger than 2 million and the overall average was 3.25 × 106. While the estimated magnitude of the scattering loss due to the air hole variations in the 33 cavities fabricated with the phase-shift photomask was slightly lower than that in the 29 cavities fabricated with binary photomask, the phase-shift photomask did not provide a significant improvement in the fabrication accuracy. On average, the scattering loss in these samples is more than 3 times larger than that of nanocavities fabricated using electron-beam lithography, which indicates room for further improvement.

Impact of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome during Intensive Care Admission on Each Post-Intensive Care Syndrome Component in a PICS Clinic

BACKGROUND

Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is known as a prolonged immunodeficiency that occurs after severe infection. Few studies have demonstrated a direct relationship between PIICS and physical dysfunction in post-intensive care syndrome (PICS). We herein investigated how each component of PICS was affected by the diagnosis of PIICS during hospitalization and examined the relationship between PIICS and PICS using PICS assessments performed at the Hitachi General Hospital PICS Clinic.

METHODS

The 273 patients who visited the PICS clinic at one month after discharge from the ICU at Hitachi General Hospital were included in the study. We used the diagnostic criteria for PIICS described in previous studies. At least two of the following blood test values on day 14 of hospitalization had to be met for a diagnosis of PIICS: C-reactive protein (CRP) > 2.0 mg/dL, albumin (Alb) < 3.0 g/dL, and lymphocytes (Lym) < 800/μL. Blood test values closest to day 14 out of 11-17 days of hospitalization were used. The primary outcome was a Barthel Index (BI) < 90, while secondary outcomes were the results of various PICS assessments, including mental and cognitive impairments, performed at the PICS clinic. We supplemented missing data with multiple imputations by chained equations. We performed a nominal logistic regression analysis with age, sex, BMI, SOFA, and the presence of PIICS as variables for BI < 90.

RESULTS

Forty-three out of two hundred seventy-three PICS outpatients met the diagnostic criteria for PIICS during hospitalization. In comparisons with non-PIICS patients, significantly higher severity scores for APACHE II and SOFA and a longer hospital stay were observed in PIICS patients, suggesting a higher clinical severity. The primary outcome, BI, was lower in the PIICS group (97.5 (58.5, 100) vs. 100 (95, 100), p = 0.008), as were the secondary outcomes (FSS-ICU: 35 (31, 35) vs. 35 (35, 35), MRC score: 55 (50.25, 58) vs. 58 (53, 60), grip strength: 16.45 (9.2, 25.47) vs. 20.4 (15.3, 27.7)). No significant differences were noted in mental or cognitive function assessments, such as HADS, IES-R, and SMQ. A multivariable analysis supplemented with missing data revealed that PIICS (odds ratio: 1.23 (1.08-1.40 p = 0.001) and age (odds ratio: 1.007 (1.004-1.01), p < 0.001) correlated with BI < 90, independent of clinical severity such as sequential organ failure assessment (SOFA). Similar results were obtained in the sensitivity analysis excluding missing data.

CONCLUSIONS

The present study revealed a strong relationship between PIICS and post-discharge PICS physical dysfunction in patients requiring intensive care.

Blood coagulation status after transcatheter aortic valve implantation between the patients with vitamin k antagonist and direct oral anticoagulants

Background

Ischemic stroke after transchatheter aortic valve implantation (TAVI) was recognized. Previous study showed that the median time of a stroke was 2.0 days (IQR, 1.0–5.0) after TAVI. One of the main mechanisms for ischemic stroke after TAVI was hyper-coagulation activity associated with TAVI procedure. However, the change of coagulation status in patients with oral anticoagulant (OAC) therapy was not investigated fully.

Purpose

We investigated the difference of blood coagulation parameters between the patients with vitamin K antagonist (VKA) and those with direct oral anticoagulants (DOAC).

Methods

We enrolled 253 patients underwent transfemoral TAVI between February 2017 and March 2019 in our hospital. Of 253 patients, 71 patients (age: 85, male: 20%) took OAC therapy (VKA: 21 patients, DOAC: 50 patients). Patients who took apixaban was 32 patients, rivaroxaban was 7, edoxaban was 11. Prothrombin activation fragment 1+2 (F1+2) as a molecular marker of thrombin generation, thrombin-anti-thrombin complex (TAT) as a marker of thrombin neutralization, soluble fibrin monomer complex (SFMC) as a marker of thrombophilia and fibrin/fibrinogen degradation product (FDP) as a marker of fibrinolysis were measured before and immediately after TAVI, and on 1 and 2 day postoperatively. We also assessed ischemic stroke after TAVI between 2 groups according to BARC-2 criteria.

Results

In patients with VKA, the value of PT-INR the day before TVAI was 1.2 (1.1–1.4). The level of F1+2 in patients with VKA was significantly greater on day 0 postoperatively than those with DOAC [855 pmol/l (595–1135) vs 614 pmol/l (452–774) P=0.003]. The level of SFMC in patients with VKA was significantly greater on day 0 postoperatively than those with DOAC [37.4 μg/ml (17.3–64.5) vs. 15.7 μg/ml (8.8–27.3) P=0.002]. The level of FDP in patients with VKA was significantly greater on day 0 postoperatively than those with DOAC [VKA: 5.8 μg/ml (3.8–7.9), DOAC: 4.0 μg/ml (3.1–5.3) P=0.023]. There were no patients with ischemic stroke among 2 groups.

Conclusion

This study revealed that coagulation activity was increased after TAVI. Furthermore, the coagulation activity in patients with VKA was significantly higher than that with DOAC at especially immediately after TAVI. Careful attention should be paid to hyper-coagulation status after TAVI in patients with VKA.

Funding Acknowledgement

Type of funding source: None

Simple and fully CMOS-compatible low-loss fiber coupling structure for a silicon photonics platform

A simple low-loss fiber coupling structure consisting of a Si inverted-taper waveguide and a 435 nm wide and 290 nm thick SiN waveguide was fabricated with fully complementary metal-oxide semiconductor (CMOS)-compatible processes. The small SiN waveguide can expand to the optical field corresponding to a fiber with a mode-field diameter of 4.1 µm. The fiber-to-chip coupling losses were 0.25 and 0.51 dB/facet for quasi-TE and quasi-TM modes, respectively, at a 1550 nm wavelength. Polarization-dependent losses of the conversion in the Si-to-SiN waveguide transition and the fiber-to-chip coupling were less than 0.3 and 0.5 dB, respectively, in the wavelength range of 1520-1580 nm.

A question is "what are the optimal targets for anticoagulant therapies?"

A high mortality rate is found among septic patients with disseminated intravascular coagulation (DIC). Anticoagulants have been used for treating septic DIC especially in Japanese clinical settings; however, their effectiveness is quite controversial across studies. According to several randomized controlled trials and meta-analyses, antithrombin and recombinant thrombomodulin had no therapeutic benefit in the treatment of sepsis. However, the majority of the previous research did not discuss “septic DIC” but simply “sepsis”, and some reviews showed that anticoagulants were benefit only in septic DIC. Although immunothrombosis plays an important role in early host defense, it can lead to DIC and organ failure if dysregulated. Therefore, we advocate anticoagulant therapies might have beneficial effects, but research on optimal patient selection is currently lacking.

P2621Clinical safety and efficacy of tolvaptan for acute phase therapy in patients with low-flow severe aortic stenosis

Background

Conventional diuretic therapy for low-flow (LF) severe aortic stenosis (SAS) often has an inadequate effect or causes hemodynamic instability. Tolvaptan is used for acute heart failure in addition to conventional diuretics in Japan, and it does not cause intravascular dehydration.

Purpose

This study aimed to retrospectively investigate the safety and efficacy of tolvaptan in the acute phase patients with SAS and compared LF-SAS with normal-flow (NF) SAS.

Methods

56 consecutive SAS patients are analyzed. The primary endpoints were adverse clinical events (death, worsening heart failure, worsening renal failure, fatal arrhythmia, cardiogenic or hypovolemic shock, and use of inotropic agents) and the volume of urine and fluid balance within 48 hours of tolvaptan administration (Figure).

Results

Among 56 patients, 16 had LF-SAS (29%), and 40 had NF-SAS (71%). Severe adverse clinical events were not observed 48 hours after tolvaptan administration. In both groups, the urine volume significantly increased after tolvaptan administration in comparison to 24 hours before tolvaptan administration (both, p<0.01). There were no changes in the urine volume during the initial 24 and 48 hours. In the LF-SAS group, tolvaptan resulted in a significant decrease in fluid balance during the initial 24 and 48 hours compared to 24 hours before tolvaptan administration (p<0.05).

Treatment and data collection protocols

Conclusion

Adding tolvaptan to conventional treatment leads to an increase in urine output and a decreased fluid balance without hemodynamic instability in patients with LF-SAS.

Acknowledgement/Funding

None

Renal Infiltration of Macrophages in Canine and Feline Chronic Kidney Disease

During the progression of chronic kidney disease (CKD), macrophage infiltration is a crucial event leading to tubulointerstitial fibrosis. In the present study, macrophages infiltrating renal tissue in dogs and cats with CKD were analysed immunohistochemically. Iba-1 was used as a pan-macrophage marker, CD204 was used as a marker of M2 macrophages and tumour necrosis factor (TNF)-α was used as a marker of M1 macrophages. Signals for Iba1 and CD204 were observed in the interstitium of all tested kidney samples. In dogs, the signals were diffusely scattered. In cats, both diffuse and focal signals were observed. Cells that were positive for Iba1 and CD204 were also observed in the tubular lumina in cats. Co-expression of Iba1 and CD204 was also observed in the infiltrating cells by immunofluorescence labelling, and these cells were negative for TNF-α. By quantitative analysis, the indices for Iba1- and CD204-positive cells were significantly correlated with the concentrations of plasma creatinine and/or urea and the extent of interstitial fibrosis in both dogs and cats. These results demonstrated that renal infiltration of M2 macrophages plays an important role in the progression of CKD in dogs and cats. The distribution pattern of the kidney-infiltrating macrophages was unique in cats and may be associated with a cat-specific renal fibrotic process.

Association of the PCK2 Gene Polymorphism With New-onset Glucose Intolerance in Japanese Kidney Transplant Recipients

BACKGROUND

New-onset diabetes mellitus after transplantation (NODAT) is a risk factor for both cardiovascular disease and poor graft survival after kidney transplantation (KTx). In this study, we identified single-nucleotide polymorphisms (SNPs) in genes involved in glucose metabolism and examined the correlation between these SNPs and glucose intolerance after KTx.

METHODS

Thirty-eight patients with normal glucose tolerance before KTx were included in this study. Patients with plasma glucose levels of >140 mg/dL at 120 minutes on the 75-g oral glucose tolerance test at 1 year after KTx were classified as having new-onset impaired glucose tolerance (NIGT). We identified 8 SNPs in 7 genes that are involved in glucose metabolism among the patients included in this study, and compared the prevalence rate of NIGT among SNPs in each gene.

RESULTS

Of the 38 patients, 11 (28.9%) were diagnosed with NIGT. For rs4982856 in the PCK2 gene, the distribution of genotypes among the total patient population was as follows: T/T, 12 (31.6%); T/C, 22 (57.9%); and C/C, 4 (10.5%). Seven of 11 patients with NIGT had the T/T genotype of rs4982856, whereas only 5 of 27 patients with normal glucose tolerance had this genotype. The T allele frequency of the rs4982856 was significantly higher in the NIGT group than in the normal group (81.8 vs 52.8%, respectively; P = .015).

CONCLUSION

Our study indicates that the T allele of the rs4982856 SNP in the PCK2 gene may be a risk factor for glucose intolerance after KTx.

Integrated silicon photonic wavelength-selective switch using wavefront control waveguides

A wavelength selective switch (WSS) can route optical signals into any of output ports by wavelength, and is a key component of the reconfigurable optical add/drop multiplexer. We propose a wavefront control type WSS using silicon photonics technology. This consists of several arrayed waveguide gratings sharing a large slab waveguide, wavefront control waveguides and distributed Bragg reflectors. The structure, design method, operating principle, and scalability of the WSS are described and discussed. We designed and fabricated a 1 × 2 wavefront control type WSS using silicon waveguides. This has 16 channels with a channel spacing of 200 GHz. The chip size is 5 mm × 10 mm. The switching operation was achieved by shifting the phase of the light propagating in each wavefront control waveguide, and by controlling the propagation direction in the shared large slab waveguide. Our WSS has no crossing waveguide, so the loss and the variation in loss between channels were small compared to conventional waveguide type WSSs. The heater power required for switching was 183 mW per channel, and the average extinction ratios routed to Output#1 and Output#2 were 9.8 dB and 10.2 dB, respectively.

Transcranial Doppler Ultrasound Examination in Dogs with Suspected Intracranial Hypertension Caused by Neurologic Diseases

Background

Transcranial Doppler ultrasound examination (TCD) is a rapid, noninvasive technique used to evaluate cerebral blood flow and is useful for the detection of intracranial hypertension in humans. However, the clinical usefulness of TCD in diagnosing intracranial hypertension has not been demonstrated for intracranial diseases in dogs.

Objectives

To determine the association between the TCD variables and intracranial hypertension in dogs with intracranial diseases.

Animals

Fifty client‐owned dogs with neurologic signs.

Methods

Cross‐sectional study. All dogs underwent TCD of the basilar artery under isoflurane anesthesia after magnetic resonance imaging (MRI). Dogs were classified into 3 groups based on MRI findings: no structural diseases (group I), structural disease without MRI evidence of intracranial hypertension (group II), and structural disease with MRI evidence of intracranial hypertension (group III). The TCD vascular resistance variables (resistive index [RI], pulsatility index [PI], and the ratio of systolic to diastolic mean velocity [Sm/Dm]) were measured.

Results

Fifteen, 22, and 13 dogs were classified into groups I, II, and III, respectively. Dogs in group III had significantly higher Sm/Dm (median, 1.78; range, 1.44–2.58) than those in group I (median, 1.63; range, 1.43–1.75) and group II (median, 1.62; range, 1.27–2.10). No significant differences in RI and PI were identified among groups.

Conclusions and Clinical Importance

Our findings suggest that increased Sm/Dm is associated with MRI findings of suspected intracranial hypertension in dogs with intracranial diseases and that TCD could be a useful tool to help to diagnose intracranial hypertension.

The Effect of Heat Treatment on the Emission Color of P-Doped Ca₂SiO₄ Phosphor

In a series of (Ca_2–x/2–yEu_y□_x/2)(Si_1–xP_x)O₄ (x = 0.06, 0.02 ≤ y ≤0.5), various color-emitting phosphors were successfully synthesized by a solid-state reaction. These phosphors were characterized by photoluminescence (PL) spectroscopy, X-ray powder diffractometry, transmission electron microscopy, and X-ray absorption fine structure spectroscopy. We evaluated the effect of heat treatment on PL properties with various annealing temperatures at 1373–1773 K for 4 h before/after reduction treatment from Eu³⁺ to Eu²⁺. In the red-emitting (Ca_1.95Eu³⁺_0.02□_0.03)(Si_0.94P_0.06)O_4+δ phosphor, the highest PL intensity exhibited when it was annealed at 1773 K. On the other hand, in the green-emitting (Ca_1.95Eu²⁺_0.02□_0.03)(Si_0.94P_0.06)O₄ phosphor, the highest PL intensity was realized when it was annealed at 1473 K and consequently treated under a reductive atmosphere. With increasing annealing temperature, the emission peak wavelength steadily decreased. Furthermore, with increasing Eu²⁺ content, the emission peak wavelength increased, with the color of emitting light becoming yellowish. Thus, the PL properties of the phosphors were affected by both the structural change from β to α’_L, which occurred by heat treatment, and the amount of doped Eu ions.

Ultrahigh-Q photonic crystal nanocavities fabricated by CMOS process technologies

We fabricated photonic crystal high-quality factor (Q) nanocavities on a 300-mm-wide silicon-on-insulator wafer by using argon fluoride immersion photolithography. The heterostructure nanocavities showed an average experimental Q value of 1.5 million for 12 measured samples. The highest Q value was 2.3 million, which represents a record for a nanocavity fabricated by complementary metal-oxide-semiconductor (CMOS)-compatible machinery. We also demonstrated an eight-channel drop filter with 4 nm spacing consisting of arrayed nanocavities with three missing air holes. The standard deviation in the drop wavelength was less than 1 nm. These results will accelerate ultrahigh-Q nanocavity research in various areas.

Hypoxia-Inducible Factor-1α Expression in Kidney Transplant Biopsy Specimens After Reperfusion Is Associated With Early Recovery of Graft Function After Cadaveric Kidney Transplantation

BACKGROUND

Ischemia/reperfusion injury during kidney transplantation (KTx) delays allograft recovery. Hypoxia-inducible factor-1α (HIF-1α) is the key regulator of the protective response to ischemia/reperfusion injury. We evaluated the impact of the HIF-1α signaling pathway on allograft recovery during cadaveric KTx.

METHODS

Between 1996 and 2015, 46 patients underwent cadaveric KTx. The expression levels of HIF-1α-related proteins, including phosphoinositide 3-kinase, phosphorylated (p)-Akt, p-mammalian target of rapamycin, p-Eukaryotic translation initiation factor 4E, p-S6 ribosomal protein, and HIF-1α, were immunohistochemically evaluated and semi-quantitatively scored in graft biopsy specimens after 1 hour of revascularization. Ten kidney biopsy specimens collected during donor nephrectomy for living KTx were used as controls. Delayed graft function (DGF) was defined as the need for dialysis within 1 week of KTx. We compared the staining scores of each protein and several clinical parameters between patients with and those without DGF.

RESULTS

Expression levels of all six proteins in specimens after revasculization were elevated compared with those in controls. Thirty-five patients had DGF. Expression levels of PI3K, p-AKT, p-mTOR, p-eIF4E, and HIF-1α were significantly higher in patients without DGF than in those with DGF. Univariate analysis identified expression levels of p-Akt, p-S6, and HIF-1α, in addition to donor type (heart beating/non-heart beating), cold ischemic time, and donor age as significant predictors of DGF. Of these, only expression levels of HIF-1α and donor type were independently associated with DGF in multivariate analysis.

CONCLUSIONS

Up-regulation of HIF-1α in allografts after reperfusion may be a predictor of early recovery after cadaveric KTx.

Localization of Toll-like Receptor (TLR) 2 and TLR4 mRNA in the Colorectal Mucosa of Miniature Dachshunds with Inflammatory Colorectal Polyps

Inflammatory colorectal polyps (ICRPs) are characterized by the formation of multiple or solitary polyps with marked neutrophil infiltration in the colorectal area, and are speculated to be a novel form of breed-specific canine idiopathic inflammatory bowel disease (IBD). In human IBD, toll-like receptor (TLR) 2 and TLR4 have been reported to be involved in the pathogenesis of the disease. The aim of this study was to evaluate the expression of TLR2 and TLR4 mRNA in the colorectal mucosa of dogs with ICRPs by in-situ hybridization using an RNAscope assay. Samples of inflamed colorectal mucosa (n = 5) and non-inflamed mucosa (n = 5) from miniature dachshunds (MDs) with ICRPs and colonic mucosa from healthy beagles (n = 5) were examined. TLR2 and TLR4 hybridization signals were localized to the colorectal epithelium, inflammatory cells and fibroblasts in the inflamed colorectal mucosa of affected dogs. The signals were significantly greater in inflamed colorectal epithelium compared with non-inflamed epithelium of MDs with ICRPs and healthy beagles (P <0.05). These results suggest that increased expression of TLR2 and TLR4 mRNA in the inflamed colorectal mucosa results from not only inflammatory cell infiltration, but also the upregulation of TLR2 and TLR4 mRNA in the colonic epithelium.

Vitamin D Status in Different Stages of Disease Severity in Dogs with Chronic Valvular Heart Disease

Background

In humans with heart disease, vitamin D deficiency is associated with disease progression and a poor prognosis. A recent study showed that serum 25‐hydroxyvitamin D [25(OH)D] concentration, the hallmark of vitamin D status, was lower in dogs with heart failure than in normal dogs, and a low concentration was associated with poor outcome in dogs with heart failure.

Objectives

To elucidate the vitamin D status of dogs with chronic valvular heart disease (CVHD) at different stages of disease severity.

Animals

Forty‐three client‐owned dogs with CVHD.

Methods

In this cross‐sectional study, dogs were divided into 3 groups (14 dogs in Stage B1, 17 dogs in Stage B2, and 12 dogs in Stage C/D) according to ACVIM guidelines. Dogs underwent clinical examination including echocardiography. Serum 25(OH)D concentrations were measured in each dog.

Results

Serum 25(OH)D concentration was significantly lower in Stage B2 (median, 33.2 nmol/L; range, 4.9–171.7 nmol/L) and C/D (13.1 nmol/L; 4.9–58.1 nmol/L) than in Stage B1 (52.5 nmol/L; 33.5–178.0 nmol/L) and was not significantly different between Stage B2 and Stage C/D. Among clinical variables, there were significant negative correlations between 25(OH)D concentration and both left atrial‐to‐aortic root ratio and left ventricular end‐diastolic diameter normalized for body weight.

Conclusions and Clinical Importance

These results indicate that vitamin D status is associated with the degree of cardiac remodeling, and the serum 25(OH)D concentration begins to decrease before the onset of heart failure in dogs with CVHD.

Ultra-compact 32 × 32 strictly-non-blocking Si-wire optical switch with fan-out LGA interposer

We demonstrate a 32 × 32 path-independent-insertion-loss optical path switch that integrates 1024 thermooptic Mach-Zehnder switches and 961 intersections on a small, 11 × 25 mm2 die. The switch is fabricated on a 300-mm-diameter silicon-on-insulator wafer by a complementary metal-oxide semiconductor-compatible process with advanced ArF immersion lithography. For reliable electrical packaging, the switch chip is flip-chip bonded to a ceramic interposer that arranges the electrodes in a 0.5-mm pitch land grid array. The on-chip loss is measured to be 15.8 ± 1.0 dB, and successful switching is demonstrated for digital-coherent 43-Gb/s QPSK signals. The total crosstalk of the switch is estimated to be less than -20 dB at the center wavelength of 1545 nm. The bandwidth narrowing caused by dimensional errors that arise during fabrication is discussed.

Quantitative contrast-enhanced ultrasonographic assessment of naturally occurring pancreatitis in dogs

BACKGROUND

Quantitative contrast-enhanced ultrasonography (CEUS) can detect pancreatic perfusion changes in experimentally induced canine pancreatitis. However, its usefulness in detecting perfusion changes in naturally occurring pancreatitis is unclear.

HYPOTHESIS/OBJECTIVES

To determine the feasibility of using CEUS to detect pancreatic and duodenal perfusion changes in naturally occurring canine pancreatitis.

ANIMALS

Twenty-three client-owned dogs with pancreatitis, 12 healthy control dogs.

METHODS

Dogs diagnosed with pancreatitis were prospectively included. CEUS of the pancreas and duodenum were performed. Time-intensity curves were created from regions of interest in the pancreas and duodenum. Five perfusion parameters were obtained for statistical analyses: time to initial up-slope, peak time (Tp), time to wash-out (TTW), peak intensity (PI), and area under the curve (AUC).

RESULTS

For the pancreas, Tp of the pancreatitis group was prolonged when compared to controls (62 ± 11 seconds versus 39 ± 13 seconds; P < .001). TTW also was prolonged but not significantly (268 ± 69 seconds versus 228 ± 47 seconds; P = .47). PI and AUC were increased when compared to controls (95 ± 15 versus 78 ± 13 MPV; P = .009 and 14,900 ± 3,400 versus 11,000 ± 2,800 MPV*s; P = .013, respectively). For the duodenum, PI and AUC were significantly increased in the pancreatitis group when compared to controls.

CONCLUSIONS AND CLINICAL IMPORTANCE

Contrast-enhanced ultrasonography can detect pancreatic perfusion changes in naturally occurring canine pancreatitis characterized by delayed peak with prolonged hyperechoic enhancement of the pancreas on CEUS. Additionally, duodenal perfusion changes secondary to pancreatitis were observed.

Prognostic value of left atrial function in dogs with chronic mitral valvular heart disease

Background

A strong correlation between left atrial (LA) dysfunction and the severity of cardiac disease has been described in human patients with various cardiac diseases. The role of LA dysfunction in dogs with chronic mitral valvular heart disease (CMVHD) has not been addressed.

Objectives

To investigate the correlation between LA function and the prognosis of dogs with CMVHD.

Animals

Thirty‐eight client‐owned dogs with CMVHD.

Methods

Prospective clinical cohort study. Dogs were divided into 2 groups (survivors and nonsurvivors) based on the onset of cardiac‐related death within 1 year. Physical examination and echocardiographic variables were compared between the groups. For the assessment of the comparative accuracy in identifying patients with cardiac‐related death, receiver operating characteristic (ROC) curves and multivariate logistic analysis were used.

Results

The highest accuracy was obtained for the LA active fractional area change (LA‐FAC_act), with an area under the ROC curve (AUC) of 0.95, followed by the left atrial to aortic root ratio (LA/Ao), with an AUC of 0.94; peak early diastolic mitral inflow velocity (E), with an AUC of 0.85; and LA total fractional area change (LA‐FAC_total), with an AUC of 0.85. In the multivariate logistic regression analysis, LA‐FAC_act emerged as the only independent correlate of cardiac‐related death within 1 year (odds ratio = 1.401, P = .002).

Conclusions and Clinical Importance

Regarding both the size and function, the LA has a strong correlation with the prognosis of dogs with CMVHD. The most significant independent predictor of mortality in this study was LA‐FAC_act.

Recurrent peritoneal inclusion cysts successfully treated with oral contraceptives: a report of two cases

OBJECTIVE

To examine whether conservative treatment with oral contraceptives is effective in the shrinkage of a peritoneal inclusion cyst (PIC). This is a case report of two patients with a PIC that developed after gynecological surgery.

CASES

Both cases were suspected of a PIC based on the medical history, laboratory data, and image findings. It was difficult in differentiate a PIC from an ovarian tumor. Surgery was chosen at first. However, PICs in both cases recurred after surgery and were treated with oral contraceptives as a conservative treatment. PICs shrank after the treatment of oral contraceptives in both cases.

CONCLUSION

Due to the high rate of recurrence following surgery, conservative treatment is recommended to treat PICs. Hormone therapy using oral contraceptives seems to have some therapeutic benefit for the PICs.

Low-loss, flat-topped and spectrally uniform silicon-nanowire-based 5th-order CROW fabricated by ArF-immersion lithography process on a 300-mm SOI wafer

We report superior spectral characteristics of silicon-nanowire-based 5th-order coupled resonator optical waveguides (CROW) fabricated by 193-nm ArF-immersion lithography process on a 300-mm silicon-on-insulator wafer. We theoretically analyze spectral characteristics, considering random phase errors caused by micro fabrication process. It will be experimentally demonstrated that the fabricated devices exhibit a low excess loss of 0.4 ± 0.2 dB, a high out-of-band rejection ratio of >40dB, and a wide flatband width of ~2 nm. Furthermore, we evaluate manufacturing tolerances for intra-dies and inter-dies, comparing with the cases for 248-nm KrF-dry lithography process. It will be shown that the 193-nm ArF-immersion lithography process can provide much less excess phase errors of Si-nanowire waveguides, thus enabling to give better filter spectral characteristics. Finally, spectral superiorities will be reconfirmed by measuring 25 Gbps modulated signals launched into the fabricated device. Clear eye diagrams are observed when the wavelengths of modulated signals are stayed within almost passband of the 5th-order CROW.

Immunohistochemical detection of nm23-H1/NDP kinase in childhood thyroid carcinoma

Childhood thyroid cancer is known to be aggressive. High incidence of lymph node and distant metastasis are characteristic features of these cases. In adult, reduced expression of nm23-H1/nucleoside diphosphate (NDP) kinase has been correlated with cancer invasion and metastasis in some tumor types. Therefore, we examined the expression of nm23-H1 gene product in childhood thyroid carcinomas in Japan. 27 primary thyroid carcinomas and 8 metastatic lymph nodes were analyzed by immunohistochemistry using monoclonal antibody H1-229. 21 out of 23 cases (91%) of papillary carcinomas were positively immunostained, whereas none of the 4 follicular carcinomas showed any immunoreactivity. No correlation was found between the nm23-H1/NDP kinase antigen expression and nodal involvement or distant metastasis in primary tumors. However, only 50% (4 out of 8) of metastatic lymph nodes from papillary carcinoma were positively stained, demonstrating a significant decrease comparing to those of primary sites. These data indicate that the expression of nm23-H1/NDP kinase cannot predict tumor metastatic potential in childhood thyroid cancer.

Refractory Silicide Schottky Contacts To Gaas

Refractory suicides form high temperature stable Schottky contacts to GaAs. This finding enabled us to develop self-aligned GaAs MESFETs, thereby enabling the development of today's GaAs ICs. This paper reviews electrical and metallurgical studies on refractory-metal/GaAs and refractory-metal-si licide/GaAs interfaces. We emphasize the fact that W5Si3/GaAs contacts have extremely stable electrical properties even after annealing at temperatures up to 850°C. Crystallographical properties of the W5S3 film on GaAs, investigated by x-ray and TEM measurement techiques, are also covered. We found that the Schottky electrical characteristics are not affected by whether the film is amorphous or crystalline.

Lectin histochemical analysis of the olfactory bulbs in the barfin flounder (Verasper moseri)

Several lines of evidence have shown that the olfactory system of the fish contains the main and accessory olfactory systems. However, morphological data indicate that the accessory olfactory bulb, the primary centre for the accessory olfactory system, will not differentiate in the fish. Therefore, the fish olfactory bulb is supposed to engage in both main and accessory olfactory systems. To examine this possibility, we investigated the olfactory bulb of the barfin flounder (Verasper moseri) by histochemical examination using lectins. The olfactory bulb of the barfin flounder showed a laminar structure with four layers, and diffuse glomerular architecture was observed in the glomerular layer. Based on the expression patterns of sugar residues, the glomerular layer of the barfin olfactory bulb was largely divided into three portions. Heterogeneity in the lectin-binding pattern among olfactory glomeruli was clearly demonstrated by the fluorescent double-lectin staining. The results of this study suggest that the fish olfactory bulb contains both regions equivalent to the main and accessory olfactory bulbs, and they are subdivided into small subsets with different functions.

Inhibitory effects of maternal smoking on the development of severe retinopathy of prematurity

PURPOSE

In this study, the effects of maternal smoking along with other clinical risk factors in developing severe retinopathy of prematurity (ROP) were evaluated.

DESIGN

A case-control study.

METHODS

Records of newborn infants with an estimated postmenstrual age of 32 weeks or less (n=86) were reviewed. ROP grading was evaluated in accordance with the International Classification of Retinopathy of Prematurity. Severe ROP was diagnosed when it progressed to stage 3 with plus disease. The factors were first evaluated using a univariate logistic regression analysis between the groups of severe and non-severe ROP, followed by a multivariate logistic regression analysis using STATA version 10 and R version 2.71.

RESULTS

A low birth weight, a long duration of artificial ventilation and oxygen supplementation, presence of chronic lung disease, and absence of maternal smoking were found to be significantly associated with severe ROP in the univariate logistic regression analysis. In the multivariate logistic regression analysis, maternal smoking was revealed as a significant factor independently associated with the incidence of severe ROP.

CONCLUSIONS

An inhibitory effect of maternal smoking against developing severe ROP is suggested. The mechanism by which smoking may reduce the incidence of severe ROP needs to be further investigated.

C3 contributes to the cross-protective immunity induced by Babesia gibsoni phosphoriboprotein P0 against a lethal B. rodhaini infection

We have studied the impact of complement component 3 (C3) deficiency on the progression of lethal Babesia rodhaini infection in immune mice. A B. gibsoni ribosomal phosphoprotein P0 (BgP0) previously reported to be a cross-protective antigen against Babesia infection was used to immunize C57BL/6 wild-type (WT) and C3-deficient (C3-/-) mice. Test mice were immunized intraperitoneally (i.p.) with recombinant BgP0 (rBgP0), while controls either were immunized with PBS or did not receive any immunization. Following the immunization regime, test WT mice induced a specifically strong humoral response consisting of mixed immunoglobulins IgG1 and IgG2 associated with high production of IFN-gamma in the supernatant of splenocytes. While test C3-/- mice had significantly decreased total IgG, IgG1 and IgG2b responses, the secretions of IL-12 and IFN-gamma tended to be lower than those in WT mice. Furthermore, partial protection was only observed in rBgP0-immunized WT mice but not in C3-/- mice or controls. Indeed, rBgP0-immunized WT mice showed significant reductions in the initiation of parasitaemia correlated with delayed mortalities and considerable survival rates. Taken together, our results indicate that cross-protection was impaired in C3-/- mice in view of the decrease in the antibody responses and cytokine production and the high susceptibility to infection.

Comparison of polymerase chain reaction methods for the detection of Theileria equi infection using whole blood compared with pre-extracted DNA samples as PCR templates

Rapid, efficient, and reproducible procedures for isolating DNA before PCR gene amplification are essential for the diagnosis of piroplasms. In this study, we evaluated the ease and reliability of detecting Theileria equi by PCR using pre-extracted DNA samples (by QIAamp DNA Mini Kit and phenol-chloroform methods) compared with blood spotted on FTA cards as PCR templates. Although minimal variations in limit of detection were observed among the methods compared, overall, the use of pre-extracted DNA samples and blood spotted on FTA cards had comparable detection limits. These results indicate that T. equi infection can be efficiently detected directly from FTA cards by PCR without the need for pre-extraction of DNA from blood samples.

Cyclin-dependent kinase inhibitors block erythrocyte invasion and intraerythrocytic development of Babesia bovis in vitro

Cyclin-dependent kinases (CDKs) are essential for the regulation of the eukaryotic cell cycle. A number of chemicals, which selectively inhibit the CDK activities, have been synthesized for the development of anti-cancer drugs. This report describes the inhibitory effect of purine derivatives known to be CDK inhibitors on the asexual growth of Babesia bovis. The 4 compounds, roscovitine, purvalanol A, CGP74514A, and CDK2 Inhibitor II, showed significantly suppressive effects on the in vitro growth of B. bovis. Three (roscovitine, purvalanol A, and CDK2 Inhibitor II) showed an inhibitory effect on the early stages of intraerythrocytic development of B. bovis. CGP74514A (CDK1-specific inhibitor) blocked the erythrocyte invasion by merozoites. Our data suggest the chemotherapeutic potential of the CDK inhibitors for babesiosis, and the target molecules of the compounds would participate in the process of successful erythrocyte invasion or intraerythrocytic development of B. bovis.