Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Stabilization of Waste-to-Energy (WTE) fly ash for disposal in landfills or use as cement substitute

This study investigated two approaches for managing Waste-to-Energy (WTE) fly ash (FA): (i) phosphoric acid stabilization of FA and disposal in non-hazardous landfills, so that it can pass the U.S. TCLP procedure and meet the U.S. Resource Conservation and Recovery Act (RCRA) standards; (ii) use of FA or phosphoric acid stabilized fly ash (PFA) as cement substitute in construction for avoiding disposal in landfills and reducing the consumption of Portland cement. The effect of stabilization was identified by TCLP tests and XRD quantification (QXRD), which showed that the economically optimal concentration for PFA to pass the RCRA was 1 mol/L H₃PO₄ (equivalent to 0.4 mol of H₃PO₄/kg of FA). Zn/Pb-phosphates were formed in treated ash by using high concentration H₃PO₄ (e.g., 3 mol/L). Thus, the hazardous FA was chemically stabilized to PFA, that were both discussed as cement substitute. QXRD and SEM results showed that both FA and PFA (1 mol/L H₃PO₄) chemically reacted with cement and water. Up to 25 vol% of the cement can be replaced by FA or PFA, with similar mechanical performance of cement mortars than that of reference. Testing by LEAF Method 1313-pH dependence showed that the FA and PFA cement mortars exhibited the same leachability of heavy metals; therefore, this study demonstrated the technical feasibility of utilizing either raw FA or stabilized PFA as supplementary cementitious material. The leachability of heavy metals in optimal FA or PFA 25 vol% cement mortar was under the U.K. WAC non-hazardous limits.

CO2 utilization in built environment via the PCO2 swing carbonation of alkaline solid wastes with different mineralogy

Carbon mineralization to solid carbonates is one of the reaction pathways that can not only utilize captured CO2 but also potentially store it in the long term. In this study, the dissolution and carbonation behaviors of alkaline solid wastes (i.e., waste concrete) was investigated. Concrete is one of the main contributors to a large carbon emission in the built environment. Thus, the upcycling of waste concrete via CO2 utilization has multifaceted environmental benefits including CO2 emission reduction, waste management and reduced mining. Unlike natural silicate minerals such as olivine and serpentine, alkaline solid wastes including waste concrete are highly reactive, and thus, their dissolution and carbonation behaviors vary significantly. Here, both conventional acid (e.g., hydrochloric acid) and less studied carbonic acid (i.e., CO2 saturated water) solvent systems were explored to extract Ca from concrete. Non-stoichiometric dissolution behaviors between Ca and Si were confirmed under far-from-equilibrium conditions (0.1 wt% slurry density), and the re-precipitation of the extracted Si was observed at near-equilibrium conditions (5 wt% slurry density), when the Ca extraction was performed at a controlled pH of 3. These experiments, with a wide range of slurry densities, provided valuable insight into Si re-precipitation phenomena and its effect on the mass transfer limitation during concrete dissolution. Next, the use of the partial pressure of CO2 for the pH swing carbon mineralization process was investigated for concrete, and the results were compared to those of Mg-bearing silicate minerals. In the PCO2 swing process, the extraction of Ca was significantly limited by the precipitation of the carbonate phase (i.e., calcite), since CO2 bubbling could not provide a low enough pH condition for concrete-water-CO2 systems. Thus, this study showed that the two-step carbon mineralization via PCO2 swing, that has been developed for Mg-bearing silicate minerals, may not be viable for highly reactive Ca-bearing silicate materials (e.g., concrete). The precipitated calcium carbonate (PCC) derived from waste concrete via a pH swing process showed very promising results with a high CO2 utilization potential as an upcycled construction material.

Performance of structural concrete using Waste-to-Energy (WTE) combined ash

In the U.S., about 27 million metric tons of municipal solid waste are used as fuel in Waste-to-Energy (WTE) power plants, generating about seven million tons of mixed bottom ash and fly ash (combined ash) annually, which are disposed of in landfills after metal separation. This study assessed the effect of using combined ash as a substitute of mined stone aggregates on the mechanical properties and leachability of cement mortar and concrete. The as-received combined ash was separated into three fractions: fine (<2 mm), medium (2-9.5 mm), and coarse (9.5-25 mm). The substitution of up to 100% of stone aggregate by the coarse and medium fractions of combined ash produced concrete with compressive strength exceeding 28 MPa after 28 days of curing. Similar results were obtained when the fine combined ash was used as a sand substitute, at 10 wt%, in mortar. The concrete specimens were subjected to several days of curing and mechanical testing. The results were comparable to the properties of commercial concrete products. The mechanical test results were supplemented by XRD and SEM analysis, and leachability tests by EPA Method 1313 showed that the optimal concrete products effectively immobilized the heavy metals in the combined ash.

Potential survival of the lichen Caloplaca flavovirescens under high helium-beam doses

Testing the limits of survivability in space is the primary focus in astrobiological research. Although a number of previous studies have examined terrestrial life survival in an extraterrestrial environment, only a few have investigated how life systems respond to high doses of alpha cosmic ray, the main component of cosmic rays. We used respiration and photosynthetic rates as indicators of the vital signs of the lichen Caloplaca flavovirescens, which is a symbiotic life form including fungi and algae. Our experiment demonstrated that the photosynthetic rate decreased with increased helium-beam doses, whereas the respiration rate was relatively unaffected. Specifically, under a helium-beam dose greater than 10 Gy, the respiration rate remained nearly constant regardless of further increases in the radiation rate. Our results indicate that the different metabolic systems of terrestrial life forms might exhibit different survival characteristics when they are in space.

Clinical and Histological Study on Direct Pulp Capping With CO2 Laser Irradiation in Human Teeth

The study aimed to histologically evaluate wound healing of exposed human pulp on direct pulp capping using super-pulsed CO₂ laser preirradiation. In this single-blind clinical trial, 28 third molar teeth of 17 volunteers were randomly capped with either CO₂ laser irradiation (n=14) or Dycal (calcium hydroxide cement; n=14) and restored using resin composite. The laser was operated in super-pulsed mode (pulse duration, 0.2 ms; interval, 5.8 ms; 0.003 J/pulse). The irradiation conditions were a power output of 0.5 W, an irradiation time of 15 seconds, repeat mode (10-ms irradiation and 10-ms intervals, for a total beam exposure time of 7.5 seconds), total applied energy of 3.75 J, and an activated air-cooling system. Each tooth was extracted at six or 12 months posttreatment and prepared for histological evaluation. We evaluated the parameters of pulp tissue disorganization, inflammatory cell infiltration, reparative dentin formation (RDF), and bacterial penetration. There were no significant differences between groups for all parameters at each postoperative period (Mann-Whitney U-test, p>0.05). CO₂ laser irradiation completely controlled bleeding and exudate from the exposed pulp. The CO₂ laser group had a tendency to delay RDF compared with the Dycal group, but 4 of 7 teeth from the CO₂ laser group showed a complete dentin bridge at 12 months posttreatment.

Influence of Carbon Nanotube Clustering on Mechanical and Electrical Properties of Cement Pastes

Given the continued challenge of dispersion, for practical purposes, it is of interest to evaluate the impact of multi-walled carbon nanotubes (MWCNTs) at different states of clustering on the eventual performance properties of cement paste. This study evaluated the clustering of MWCNTs and the resultant effect on the mechanical and electrical properties when incorporated into cement paste. Cement pastes containing different concentrations of MWCNTs (up to 0.5% by mass of cement) with/without surfactant were characterized. MWCNT clustering was assessed qualitatively in an aqueous solution through visual observation, and quantitatively in cement matrices using a scanning electron microscopy technique. Additionally, the corresponding 28-day compressive strength, tensile strength, and electrical conductivity were measured. Results showed that the use of surfactant led to a downward shift in the MWCNT clustering size distribution in the matrices of MWCNT/cement paste, indicating improved dispersion of MWCNTs. The compressive strength, tensile strength, and electrical conductivity of the composites with surfactant increased with MWCNT concentration and were higher than those without surfactant at all concentrations.

Twenty-year trends in neonatal surgery based on a nationwide Japanese surveillance program

AIM

To discuss the chronological changes observed in a national survey of neonatal surgery in Japan performed every 5 years by the Committee in the Japanese Society of Pediatric Surgeons.

METHODS

We analyzed the data obtained for 20 years from 1993 to 2013 and herein report the chronological changes.

RESULTS

The number of summarized cases was least in 1993, with 2806 cases, and subsequently increased to 3753 cases in 2013. The mortality rate among the patients with maternal transport linearly decreased (p = 0.0386). Although the proportion of extremely low birth weight infants linearly increased (p = 0.0014), with an annual rate of +0.39 %, the mortality rate linearly decreased (p = 0.0010), with an annual rate of -1.68 %. Moreover, the overall mortality rate linearly decreased (p = 0.0002), with an annual rate of -0.26 %. Most diseases were observed to exhibit a decline in the mortality rate with the same trend as overall mortality. The decline in the mortality rate was most robust with respect to congenital diaphragmatic hernia (CDH). The mortality rates, except for that of CDH, omphalocele, esophageal atresia, and intestinal perforation, declined to 5 % or lower by 2013.

CONCLUSIONS

The present findings may be the result of remarkable progress in perinatal management.

Haemolytic action of N-alkylpolymethylenediamines

The haemolytic action of various N-alkyl derivatives (lauryl; C12H25-, myristyl; C14H29-, palmityl; C16H33-) of 1,3-diaminopropane, 1,4-diaminobutane, 1,5-diaminopentane, 1,6-diaminohexane, 1,7-diaminoheptane, 1,8-diaminooctane was examined using rabbit red blood cells. The activities of the various derivatives were compared with those of antiplaque agents commonly used as mouthwashes; cetylpyridinium chloride (CP) and chlorhexidine acetate (CH). The haemolytic activities of these agents were dependent on the length of the N-alkyl chain, whereas the number of methylene groups between the nitrogen atoms had little effect. The order of potency was CP, N-palmityl derivatives, N-myristyl derivatives &gt; N-lauryl derivatives &gt; CH which was similar to the order of the antiplaque effect evaluated in-vitro.

Three-dimensional reconstruction of a fibro-osseous lesion using binary images transformed from histopathological images

The aim of this report was to introduce a new method of three-dimensional (3D) reconstruction for fibro-osseous lesions (FOLs) using binary images transformed from histopathological images and to describe its usefulness. A sample of multiconfluent FOL was used (one of the five types of FOL according to a radiographic classification) which was diagnosed histopathologically as ossifying fibroma. Approximately 30 pathological images were assembled into a composite image of the slide using Tiling Boutique software version 3 for Windows (Sanyo Electric, Osaka, Japan). The tiling images were transformed into 8-bit scale images and then into binary images using ImageJ software ver.1.37 (National Institutes of Health, Bethesda, MD). These images were used for 3D reconstruction using ImageJ software. Images were loaded at the same matrix size and were reconstructed into layers of two-dimensional image stacks, adjusted so that contiguous images were aligned based on their centre points, and arranged with long axes horizontal. 3D findings aided the visual understanding of morphological features in the lesion. The 3D reconstruction can be displayed with arbitrary rotation. In this case, the 3D reconstruction, using Real Image software version 4.01 for Windows (KGT, Tokyo, Japan), was created from an arbitrary section. This allowed us to determine the pattern of calcification between groups of connected osteoids and to compare the internal structure of such lesions that are not visible on histopathological findings. Differentiation of features was even more pronounced with a two colour display indicating fibrous connective tissue and osteoid tissue. A 3D reconstruction of a multiconfluent ossifying fibroma was created using binary images transformed from histopathological images. The quality of the images depends above all on the functionality of the image-processing software. Comparison of each pattern of FOL might allow more simple assessment of the morphological features of FOLs.

Disparity between serotonin- and acetylcholine-provoked coronary artery spasm

BACKGROUND AND HYPOTHESIS

Intrinsic vasoactive substances, such as serotonin and acetylcholine, are known to provoke coronary artery spasm in patients with vasospastic angina. It remains unclear, however, whether these different agents, which activate different receptors, produce spasms at the same sites in these patients. The present study was designed to clarify the disparity of receptor agonist-induced coronary artery spasms in the same patients.

METHODS

We conducted sequential provocative tests of coronary artery spasm by acetylcholine, serotonin, and ergonovine in 20 patients with rest angina examined with quantitative coronary angiography.

RESULTS

Coronary artery spasms were provoked in all patients at 27 spastic sites. In 13 patients, ergonovine provoked spasms and in 10 of 13 patients who were diagnosed with variant angina, both acetylcholine and serotonin provoked spasms at the same sites where ergonovine also did. In 4 of 13 patients, spasms were provoked by serotonin but not by acetylcholine. In the remaining seven patients, whose spasms were induced by ergonovine, spasms were produced by acetylcholine but not by serotonin. On coronary angiography, the spastic sites for both acetylcholine and serotonin, and those for serotonin alone, were located in the proximal segments of coronary arteries, whereas the spastic sites for acetylcholine alone were located in the distal segments.

CONCLUSIONS

This study documented the disparity between serotonin- and acetylcholine-induced spasms. Provocative tests using agents that activate different receptors may produce coronary artery spasms at the same and/or different sites, and this disparity may reflect the clinical heterogeneity of vasospastic ischemic syndrome.

Correlation between histopathological image and radiographic image pattern in fibro-osseous lesions in relation to bone complexity and distribution

OBJECTIVES

This study examined correlations between radiographic patterns and the shape of osteoid tissue formations, as determined histopathologically.

METHODS

20 cases of fibro-osseous lesions were investigated, comprising 5 radiographic patterns: focal (n = 3), target (n = 6), lucent (n = 4), calcification (n = 3) and multiconfluent (n = 4). Histopathological images in the central area of a full-section specimen were transformed into binary images and then into 8-bit scale images. Bone complexity and density of bone distribution were calculated and compared between patterns.

RESULTS

Bone complexity score was 7384.64 for lucent, 2029.85 for focal, 2713.40 for multiconfluent, 8388.63 for calcification and 1364.27 for target pattern. The results could be broadly separated into two types: small (target, focal and multiconfluent patterns), and large (lucent and calcification patterns). Density of bone distribution was relatively low in all areas for lucent and calcification patterns, and high for focal, multiconfluent and target patterns. No significant differences in bone complexity or density of bone distribution were seen between individual patterns.

CONCLUSIONS

Correlations appear to exist between image patterns from radiography and the shape of osteoid tissue on histopathology, but reorganization of the five patterns may be warranted.

The views of doctors on registration trials in a Japanese rural area: a survey of medical institutions registered to the Tokushima Network for Clinical Trials

Tokushima University Hospital has established the Tokushima Network for Clinical Trials (TNCT) to promote clinical trials in the area in collaboration with the Tokushima Medical Association. The present study investigated the views of doctors towards registration trials in the TNCT. A questionnaire was provided to 49 clinics/hospitals registered to the TNCT in 2006 and 38 (78%) responded. It revealed that 48% of doctors were aware of registration trials and 87% were favourable towards participating as investigators in them. They considered close contact with developmental drugs, advancement of therapy and the opportunity to learn about state-of-the-art treatment as benefits of participation. The main areas of difficulty included management of adverse reactions and patients' refusal to take part. Many doctors wanted more opportunity to learn about trial-related issues such as regulations. The survey indicates that the TNCT needs to develop the infrastructure and enlighten participants to promote registration trials in this rural regional area.

Breed differentiation among Japanese native chickens by specific skull features determined by direct measurements and computer vision techniques

1. Inter-breed morphological comparisons were made among 11 breeds of Japanese native chickens (Gifujidori, Hinaidori, Shokoku, Totenko, Tomaru, Satsumadori, Shamo, Koshamo, Koeyoshi, Chabo and Nagoya), White Leghorn, broiler chickens (Chunky) and red junglefowl collected in the Philippines, based on results of direct measurements and analysis by computer vision techniques of the skull. 2. Analysis of direct measurements identified two groups of chicken: a small type that included the Chabo, Koshamo, red junglefowl, Gifujidori and Shokoku and a large type that included the remaining breeds studied. These groupings were made based on size determined both in the first (PC1) and second principal component (PC2). The greatest length of the cranium and condylobasal length greatly contributed to the morphological differences between these two groups. 3. Analysis by computer vision techniques, however, identified three groups: the Bantam group (which includes red junglefowl), Shokoku group and Shamo group. White Leghorn clustered within the Shokoku group while the broiler chicken belonged to the Shamo group. The region around the junction of the neural cranium and the visceral cranium contributed greatly to the morphological differences among breeds, both in the PC1 and PC2.

Serotonin induces vasoconstriction of smooth muscle cell-rich neointima through 5-hydroxytryptamine2A receptor in rabbit femoral arteries

BACKGROUND

Smooth muscle cell (SMC)-rich intima is a morphological feature of atherosclerotic lesions that is observed in eroded plaque and spastic arteries. Arteries with SMC-rich intima are susceptible to vasoconstriction or vasospasm against some vasoactive agents.

OBJECTIVE

The present study evaluates the contribution of SMC-rich intima to thrombogenic vasoconstriction.

METHODS

We established SMC-rich neointima by damaging rabbit femoral arteries using balloons and then measured the isometric tension of the femoral strips against 5-hydroxytryptamine (5-HT), adenosine diphosphate, adenosine triphosphate and thrombin.

RESULTS

Among these agents, only 5-HT induced a hypercontractile response of the injured arteries with SMC-rich neointima, compared with non-injured arteries. Smooth muscle cells of both the neointima and media expressed 5-HT(2A) receptor, and sarpogrelate, a selective 5-HT(2A) receptor antagonist significantly inhibited the hypercontraction. Furthermore, 5-HT induced contraction of separated neointima and hypercontraction of separated media compared with non-injured media. Sarpogrelate and fasudil, a specific Rho-kinase inhibitor, significantly suppressed such contraction of both the neointima and media of injured arteries.

CONCLUSIONS

These results suggest that 5-HT plays a crucial role in thrombogenic vasoconstriction, and that SMC-rich intima as well as media directly contributes to the hypercontractile response of atherosclerotic vessels through the 5-HT(2A) receptor and the Rho-kinase pathway.

Comparison of image validity between cone beam computed tomography for dental use and multidetector row helical computed tomography

OBJECTIVES

To evaluate and compare the image validity of a cone beam CT machine for dental use (3DX) and the latest medical CT system, multidetector row helical CT (MDCT).

METHODS

A dried right maxilla of an Asian adult was used as a phantom. It was cut from the zygomatic process towards the midline, parallel to the midline plane, into eight slices of 2 mm thickness. This phantom was imaged with the 3DX and MDCT machines. Images were evaluated by comparing them with one selected bone slice from the phantom. In this comparison, two types of MDCT images were used: one with the window level (WL) and window width (WW) suitable for observing teeth (MDCT tooth image), and the other appropriate for observing bone (MDCT bone image). Three dentists and one radiographer then used our reported subjective five-level scale to evaluate and compare images generated by the two systems in terms of validity. Cancellous bone as well as enamel, dentin, pulp cavity, periodontal ligament space, lamina dura and overall impression were evaluated.

RESULTS

Statistically significant differences (P<0.05) were found for almost all observation items. Our subjective evaluation clarified that 3DX was superior to MDCT in terms of image validity. Few significant intra- or interevaluator errors were found.

CONCLUSIONS

Our subjective evaluation of image validity clarified 3DX as being superior to MDCT. Taken together with the low skin dose we previously reported for 3DX, the results demonstrate 3DX to be beneficial for imaging diagnosis of hard tissues in the maxillofacial region.

Protective effect of endothelial nitric oxide synthase against induction of chemically-induced diabetes in mice

Since activation of endothelial nitric oxide synthase has been shown to exert protective effects against the metabolic syndrome, while endothelial nitric oxide synthase knockout mice develop hyperinsulinemia and glucose intolerance, we hypothesised that endothelial nitric oxide might play a protective role against induction of diabetes. The role of endothelial nitric oxide in the development of chemically-induced diabetes has been determined using mice in which the bioavailability of endothelial nitric oxide was either increased, through upregulation of endothelial nitric oxide synthase, or absent, through deletion of endothelial nitric oxide synthase gene. Diabetes was induced intraperitoneally with either a single dose of alloxan, streptozotocin, or multiple low doses of streptozotocin and blood glucose monitored twice a week. The role of cyclic guanosine monophosphate was investigated in wildtype mice by treatment with the phosphodiesterase inhibitor, tadalafil, during diabetes induction. Results showed that the incidence of diabetes was markedly decreased in mice overexpressing endothelial nitric oxide synthase, compared to wildtype or endothelial nitric oxide synthase knockout mice, regardless of the method of diabetes induction. Under normal physiological conditions, or during diabetes induction with alloxan or multiple low doses of streptozotocin, blood glucose was significantly lower in mice overexpressing endothelial nitric oxide synthase compared to wildtype or knockout mice. Treatment with tadalafil had no effect on the incidence or severity of diabetes in wildtype mice. We conclude that upregulation of endothelial nitric oxide synthase exerts a protective action against diabetes induction through a direct effect of nitric oxide, independently of cyclic guanosine monophosphate.

Analysis of mtDNA sequences shows Japanese native chickens have multiple origins

In this study, we analysed the mitochondrial DNA D-loop region of Japanese native chickens to clarify their phylogenetic relationships, possible maternal origin and routes of introduction into Japan. Seven haplogroups (Types A-G) were identified. Types A-C were observed in Jidori, Shokoku and related breeds. However, Type C was absent in Shokoku, which was introduced from China, while most Indonesian native chickens were included in the Type C haplogroup. Types D-G were observed in Shamo and related breeds. Type E had a close genetic relationship with Chinese native chickens. Our results indicate that some breeds were not introduced into Japan as suggested in conventional literature, based on low nucleotide diversity of certain chicken breeds. Sequences originating from China and Korea could be clearly distinguished from those originating from Southeast Asia. In each group, domestic chickens were divided into the Jidori-Shokoku and Shamo groups. These results indicate that Chinese and Korean chickens were derived from Southeast Asia. Following the domestication of red junglefowl, a non-game type chicken was developed, and it spread to China. A game type chicken was developed in each area. Both non-game and game chickens formed the foundation of Japanese native chickens.

Relationships between nitric oxide-mediated endothelial function, eNOS coupling and blood pressure revealed by eNOS-GTP cyclohydrolase 1 double transgenic mice

Endothelium-dependent relaxation in conduit vessels is mediated largely by nitric oxide (NO), produced by the enzyme endothelial nitric oxide synthase (eNOS) in the presence of the cofactor tetrahydrobiopterin (BH4) and mediated through a cGMP-dependent downstream signalling cascade. Endothelial NOS regulates blood pressure in vivo, and impaired endothelial NO bioactivity in vascular disease states may contribute to systemic hypertension. In the absence of sufficient levels of the cofactor BH4, NO becomes uncoupled from arginine oxidation and eNOS produces superoxide rather than NO. The enzymatic uncoupling of eNOS is an important feature of vascular disease states associated with increased oxidative stress. However, whether eNOS coupling, rather than overall eNOS activity, has specific effects on endothelium-dependent vasorelaxation in vitro, or on blood pressure regulation in vivo, remains unclear. In this study, we evaluate the relationships between blood pressure and endothelial function in models of eNOS uncoupling, using mice with endothelium-targeted transgenic eNOS overexpression (eNOS-Tg), in comparison with littermates in which eNOS coupling was rescued by additional endothelium-targeted overexpression of GTP cyclohydrolase 1 (eNOS/GCH-Tg) to increase endothelial BH4 levels. Despite the previously characterized differences in eNOS-dependent superoxide production between these animals, we find that blood pressure is equally reduced in both genotypes, compared with wild-type animals. Furthermore, both eNOS-Tg and eNOS/GCH-Tg mice exhibit similarly impaired endothelium-dependent vasorelaxation. We show that reduced vasorelaxation responses result from desensitization of cGMP-mediated signalling and are associated with increased NO production rather than changes in superoxide production.

Single air contrast arthrography for temporomandibular joint disorder using limited cone beam computed tomography for dental use

MRI has the problem of artefacts caused by metal or body motion and is also incompatible for patients with claustrophobia. Arthrography is invasive and involves the risk of perforation or allergy to a contrast medium. This report discusses a patient with temporomandibular joint (TMJ) disorder who required soft tissue imaging of the TMJ. As she had claustrophobia and a reaction to iodine, air contrast arthrography and pumping manipulation therapy using limited cone beam computed tomography for dental use (3DX) was performed. We conclude that the 3DX examination method used in the study is practical as a diagnostic procedure and thus recommend this method to be used for patients with TMJ disorder in the presence of iodine contraindication.

Therapeutic efficacy of sustained drug release from chitosan gel on local inflammation

The model anti-inflammatory drug prednisolone (PS) was retained in chitosan (CS) gel beads, which were prepared in a 10% aqueous amino acid solution (pH 9.0). Sustained release of PS from the CS gel beads was observed. Carrageenan solution was injected into air pouches (AP), which were prepared subcutaneously on the dorsal surface of mice, in order to induce local inflammation. CS gel beads retaining PS were then implanted into the AP to investigate the therapeutic efficacy of sustained PS release against local inflammation. In vivo PS release from CS gel beads was governed by both diffusion of the drug and degradation of the gel matrix. Sustained drug release by CS gel beads allowed the supply of the minimum effective dose and facilitated prolonged periods of local drug presence. Inflammation indexes were significantly reduced after implantation of CS gel beads when compared with injection of PS suspension. Thus, extension of the duration of drug activity by CS gel beads resulted in improved therapeutic efficacy. These observations indicate that CS gel beads are a promising biocompatible and biodegradable vehicle for treatment of local inflammation.

Transient expression of juvenile-type neurocan by reactive astrocytes in adult rat brains injured by kainate-induced seizures as well as surgical incision

Neurocan is one of the major chondroitin sulfate proteoglycans expressed in nervous tissues. The expression of neurocan is developmentally regulated, and full-length neurocan is detected in juvenile brains but not in adult brains. In the present study, we demonstrated by western blot analysis that full-length neurocan transiently appeared in adult rat hippocampus when it was lesioned by kainate-induced seizures. Immunohistochemical studies showed that neurocan was detected mainly around the CA1 region although the seizure resulted in neuronal cell degeneration in both the CA1 and CA3 regions of the hippocampus. Double-labeling for neurocan mRNA and glial fibrillary acidic protein demonstrated that many reactive astrocytes expressed neurocan mRNA. The re-expression of full-length neurocan was also observed in the surgically injured adult rat brain. In contrast, the expression of other nervous tissue chondroitin sulfate proteoglycans, such as phosphacan and neuroglycan C, was not intensified but rather was either reduced in the kainate-lesioned hippocampus or in the surgically injured cerebral cortex. These observations indicate that induction of neurocan expression by reactive astrocytes is a common phenomenon in the repair process of adult brain injury, and therefore, it can be postulated that juvenile-type neurocan plays some roles in brain repair.