Treatment experience with continuous local antibiotic perfusion for periprosthetic joint infection

BACKGROUND

Antibiotic concentrations 100-1000 times higher than the minimum inhibitory concentration are necessary for eradicating biofilms in periprosthetic joint infections (PJI). Achieving this with intravenous antibiotics is challenging, but continuous local antibiotic perfusion (CLAP) can increase the local concentration of antibiotics. Although there are several reports on CLAP therapy in the fracture-related infection, there are only few reports on its application in PJI. Here, we report our experience with CLAP therapy for PJI.

METHODS

Eight patients with PJI (two males and six females, with mean age of 73.5 years [±11.6]) were treated at our department, and their clinical characteristics were analyzed. The parameters considered were the classification of PJI, surgical procedure, duration of CLAP, duration of transvenous antibiotic administration, time of CRP-negative status, whether the infection resolved or recurred, and whether there were complications due to CLAP.

RESULTS

Initial surgery included total knee arthroplasty in five cases, unicompartmental knee arthroplasty in one case, and total hip arthroplasty in two cases. There were four cases of early postoperative infection, two of acute delayed infection, and two of chronic delayed infection. The surgical procedures performed were two-stage revision for two patients, and debridement, antibiotics, and implant retention (DAIR) for the other six. The mean durations of CLAP and transvenous antibiotic administration were 8.5 (±2.4) and 22.4 days (±13.7), respectively, and the mean time to CRP-negative status was 23.3 days (±10.7). All eight patients successfully resolved without additional irrigation or debridement, and no recurrence was observed at the last follow-up after discontinuation of oral antibiotics. No systemic side effects of gentamicin or other complications associated with CLAP were observed.

CONCLUSION

All patients achieved infection resolution with the combined use of CLAP. This suggests that CLAP is a useful treatment option for PJI.

Survey of Osteoarthritis of the Shoulder in Patients who Underwent Knee Arthroplasty for Knee Osteoarthritis

The relationship between osteoarthritis (OA) of the lower extremity and shoulder OA has not been established. This study evaluated the prevalence of shoulder OA in patients with knee OA. We collected contrast-enhanced computed tomography (CECT) images of the shoulder joints of 105 patients with knee OA that were taken 1 week after they underwent primary knee arthroplasty to check for venous thromboembolism (VTE). The images were compared with CECT images of 110 control-group patients that were taken for the purpose of differentiating VTE. Shoulder OA was present in a significantly higher percentage of patients with knee arthroplasty than controls (29% versus 15%), and the difference was particularly pronounced in patients in their 70s (33%) compared to age-matched controls (11%). Patients with knee OA often use arm support to stand up or walk due to knee joint pain and muscle weakness, which places the weight-bearing shoulder at risk of developing OA.

Long-term effectiveness and safety of high dose chemotherapy followed by autologous stem cell transplantation in daily practice in patients with diffuse large B-cell lymphoma

We retrospectively evaluated long-term outcomes of high dose chemotherapy followed by autologous stem cell transplant (HDC/ASCT) in patients with diffuse large B-cell lymphoma (DLBCL). Between 2004 and 2020, 46 DLBCL patients received HDC/ASCT in our institution, including 12 patients (26.1%), who received as an upfront setting (UFS). At a median follow-up time of 69 months (range, 2-169 months), the 5-year progression-free survival (PFS) rates were 82.5% (95%CI, 46.1-95.3%) in the UFS, and 57.8% (95%CI, 38.1-73.2%) in the relapsed or refractory (R/R) patients (n=34), respectively. The 5-year PFS rates were 62.3% (95%CI, 34.0-81.3%) in primary resistant (n=13) or early relapsing (within 1 year from the initial diagnosis) patients (n=4), and 53.3% (95%CI, 25.9-74.6%) in those relapsing >1 year after the initial diagnosis (n=17), with no statistically significant difference (p=0.498). In R/R patients, multivariate analysis showed that the remission status before HDC/ASCT was an independent poor prognostic factor for progression-free survival (hazard ratio [HR], 17.0; 95%CI, 3.35-86.6; p=0.000630) and high-risk category in the international prognostic index for OS (HR, 9.39; 95%CI, 1.71-51.6; p=0.0100). The incidence of non-relapse mortality by 5 years, and 10 years were 12.2%, and 15.2%, respectively. Eleven patients (23.9%) developed second malignancies, which was the most frequent late complication after HDC/ASCT, with 5-year, and 10-year cumulative incidence of 16.9%, 22.5%, respectively. In conclusion, HDC/ASCT is effective for chemo-sensitive R/R DLBCL regardless of the timing and lines of therapy. However, careful observation is required, considering the long-term complications such as secondary malignancies.

Subchondral fatigue fracture of the femoral head with acetabular dysplasia treated by transposition osteotomy of the acetabulum: a case report

Introduction

Subchondral insufficiency fracture of the femoral head commonly occurs in older women with osteoporosis. However, subchondral fatigue fracture of the subchondral femoral head is rare. We present a rare case of fatigue fracture of the subchondral femoral head with acetabular dysplasia.

Case Report

The patient was a 16-year-old male, height 180 cm, weight 112 kg, and body mass index 34.6 kg/m2. Continuous right hip pain appeared after club activity of table tennis a month before admission to our department. Pain was observed on deep flexion of the right hip joint. The FADIR test was positive. X-ray images showed a depressed deformity of the right femoral head loading portion. In addition, the center-edge angle was 10° on the right and 21° on the left, tear drop distance was 12 mm on the right and 8 mm on the left, and bilateral acetabular dysplasia was noted. In magnetic resonance imaging, the T1-weighted image shows low-intensity signal and the T2-weighted image shows high-intensity signal, indicating a fatigue fracture of the femoral head with subchondral depression. Thus, transposition osteotomy of the acetabulum was performed in this case. Postoperatively, the depression portion showed gradual remodeling, and the patient returned to sports after 6 months. Because this patient was highly obese with acetabular dysplasia, a large shear force was applied to the loading portion of the femoral head relative to the acetabular rim. The femoral head was repeatedly forced, resulting in a fatigue fracture. We believe that the stress applied to the depressed portion was dispersed by the transposition osteotomy of the acetabulum, resulting in remodeling.

Conclusion

This is the first report of the transposition osteotomy of the acetabulum for a subchondral fatigue fracture of the femoral head with acetabular dysplasia. Thus, this may serve as a reference in the management of such rare occurrences and pave the way for further understanding of this condition.

Proof-of-Principle Experiment for Testing Strong-Field Quantum Electrodynamics with Exotic Atoms: High Precision X-Ray Spectroscopy of Muonic Neon

To test bound-state quantum electrodynamics (BSQED) in the strong-field regime, we have performed high precision x-ray spectroscopy of the 5g-4f and 5f- 4d transitions (BSQED contribution of 2.4 and 5.2 eV, respectively) of muonic neon atoms in the low-pressure gas phase without bound electrons. Muonic atoms have been recently proposed as an alternative to few-electron high-Z ions for BSQED tests by focusing on circular Rydberg states where nuclear contributions are negligibly small. We determined the 5g_{9/2}- 4f_{7/2} transition energy to be 6297.08±0.04(stat)±0.13(syst)  eV using superconducting transition-edge sensor microcalorimeters (5.2-5.5 eV FWHM resolution), which agrees well with the most advanced BSQED theoretical prediction of 6297.26 eV.

Formation and evolution of carbonaceous asteroid Ryugu: Direct evidence from returned samples

Samples of the carbonaceous asteroid Ryugu were brought to Earth by the Hayabusa2 spacecraft. We analyzed 17 Ryugu samples measuring 1 to 8 millimeters. Carbon dioxide-bearing water inclusions are present within a pyrrhotite crystal, indicating that Ryugu's parent asteroid formed in the outer Solar System. The samples contain low abundances of materials that formed at high temperatures, such as chondrules and calcium- and aluminum-rich inclusions. The samples are rich in phyllosilicates and carbonates, which formed through aqueous alteration reactions at low temperature, high pH, and water/rock ratios of <1 (by mass). Less altered fragments contain olivine, pyroxene, amorphous silicates, calcite, and phosphide. Numerical simulations, based on the mineralogical and physical properties of the samples, indicate that Ryugu's parent body formed ~2 million years after the beginning of Solar System formation.

Comparison of tibial implant positioning between symmetrical and anatomical design implants in unicompartmental knee arthroplasty for Japanese patients

PURPOSE

In unicompartmental knee arthroplasty (UKA) procedures, maximizing the bone coverage of the tibial implant and eliminating the medial and posterior overhang would be optimal. We commonly used Physica ZUK^® (ZUK), which is a symmetrical design. Alternatively, since Persona Partial Knee^® (PPK) was developed in 2017 with an anatomical design to improve bone coverage, we started PPK. We hypothesized that the PPK facilitated better bone coverage than the ZUK without obvious overhangs. This study evaluated the bone coverage and the medial and posterior overhang of these differently designed tibial implants.

METHODS

Seventy-nine knees from 68 patients who underwent UKA were evaluated. Cases were categorized into the ZUK (41 knees) and PPK (38 knees) groups. CT images were acquired before surgery and 1 week after surgery. We measured the tibial bone coverage, and the medial and posterior overhang by 3D software.

RESULTS

The bone coverages were 103.8 ± 4.8% and 102.0 ± 3.0%, the medial overhangs were 2.2 ± 1.2 mm and 1.4 ± 1.1 mm, and the posterior overhangs were 0.6 ± 1.3 mm and 0.4 ± 1.2 mm for the ZUK and PPK groups, respectively. The bone coverage and medial overhang were significantly different between the groups, with ZUK being larger.

CONCLUSION

Patients who received PPK had significantly smaller medial overhangs and better bone coverage. PPK is more likely to give better results than ZUK.

Goishi tea leaf powder affects lower body weight and visceral fat accumulation during energy restriction in obese rats

Goishi tea is a unique Japanese post-fermented tea produced in Kochi prefecture. The aim of this study was to investigate whether the supplementation of energy-restricted diet with Goishi tea leaves affects body weight, visceral fat accumulation, and fecal lipids in diet-induced obese rats. 18 male Wistar rats were fed a high-fat diet for 12 weeks. Subsequently, the diet-induced obese rats were fed a low-energy diet containing 1% (G1 group) or 3% (G3 group) of Goishi tea leaf powder, or without any tea extracts (C group) for 4 weeks. After 4 weeks, body weight and body fat ratio were significantly lower in the G3 group than in the C group. Plasma insulin levels were significantly higher in the C group than in the G1 and G3 groups, whereas plasma leptin levels were significantly lower in the G3 group than in the C group. In addition, the lipid absorption rate was significantly lower in the G3 group than in the C and G1 groups. In conclusion, the administration of Goishi tea leaves under dietary restrictions might contribute to body weight reduction and inhibition of lipid absorption, as a diet therapy to help prevent obesity and metabolic syndrome. J. Med. Invest. 70 : 60-65, February, 2023.

Association between parental occupations, educational levels, and household income and children's psychological adjustment in Japan

OBJECTIVES

Most research on the association between parental or family socio-economic status and psychological adjustment in children has been performed mainly in Western countries, while there is limited evidence of such research in Asian countries. We examined the association of parental occupation and educational levels and household income with children's psychological adjustment in Japan.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Study subjects were 6329 children aged 3 years. Children's psychological adjustment was assessed using the Strengths and Difficulties Questionnaire.

RESULTS

Compared with having an unemployed father, having a father who worked in an administrative and managerial or clerical job was associated with a lower prevalence of peer problems. Compared with having an unemployed mother, having a mother who worked in the professional and engineering, sales, service, or manufacturing process area was associated with a lower prevalence of low prosocial behaviors, whereas having a mother who worked in the clerical, service, or manufacturing process area was associated with an increased prevalence of emotional problems. Having a mother who worked in a clerical area was associated with a higher prevalence of conduct problems. Higher paternal and maternal educational levels were inversely associated with the prevalence of conduct problems and hyperactivity but were positively associated with low prosocial behaviors. A higher household income was inversely associated with the prevalence of emotional problems, conduct problems, and hyperactivity.

CONCLUSION

Parental occupation, educational levels, and household income may affect children's psychological adjustment in Japan.

An Avulsion Fracture of the Lesser Trochanter of the Femur with Prodromal Symptoms in an adult: A Case Report and Review of Literature

Introduction

An avulsion fracture of the lesser trochanter of the femur in adults is rare and should be differentiated from neoplastic lesions. We present a rare case of avulsion fracture of the lesser trochanter of the femur with prodromal symptoms in an adult.

Case Report

A right-handed 40-year-old man with gradual-onset left hip joint pain resulting from baseball pitching consulted a neighborhood doctor. X-ray images did not show any obvious anomalies; however, the pain persisted. Two months after the onset of pain, he stumbled when getting into a car, and the pain worsened. He was then brought into our hospital's emergency unit, and an avulsion fracture of the lesser trochanter of the left femur was detected. Due to mild displacement (<20 mm) and no neoplastic lesions by gadolinium-enhanced magnetic resonance imaging and the technetium scintigraphy, he was managed conservatively. During the final follow-up, 1 year after the onset of symptoms, non-union of the lesser trochanteric fracture was noticed. However, there were no pain and no limited range of motion at the hip joint; therefore, he had no problems with daily activities and sports.

Conclusion

The avulsion fracture of the lesser trochanter of the femur in our patient may have been caused by repeated flexion, adduction, and internal rotation of the hip joint during baseball pitching. Although bone union was not achieved, his condition was managed successfully using conservative treatment. Our experience offers a few key learning points to manage such rare fracture occurrences in adults and suggests that conservative treatment is often sufficient for mild displacement (<20 mm) of the fracture.

Analysis on the Structure of Phlorethols Isolated From the Warm-Temperate Brown Seaweed Sargassum carpophyllum and Their Antioxidant Properties

The brown seaweed Sargassum carpophyllum J. Agardh is an unused warm-temperate species in the family Sargassaceae that has been expanding its distribution along the coastal areas of Japan in recent years. In this study, 3 types of phlorotannins were identified from the EtOAc fraction of the 80% MeOH extract of S. carpophyllum. From the spectroscopic (1H NMR, 13C NMR, and HMBC) and ESI/MS data and comparison with those of prior literature, it was demonstrated that the compounds are oligomers of phlorethol, which is one of the subclasses of phlorotannins, that is triphlorethol B (phloroglucinol trimer), tetraphlorethol C (phloroglucinol tetramer), and pentaphlorethol A (phloroglucinol pentamer). Among the phlorethols, tetraphlorethol C and pentaphlorethol A were isolated and identified for the first time from a brown seaweed collected from the East China Sea, including the coastal areas of Japan. The identified phlorethols were tested for their antioxidant properties. In the antioxidant assay using liposomes, the phlorethols showed comparable inhibitory effects to epigallocatechin gallate (tea polyphenol) and α-tocopherol (liposoluble vitamin) on lipid peroxidation by 4 mM 2,2′-azobis(2-methylpropionamidine) dihydrochloride. In addition, it was revealed that pentaphlorethol A has a superoxide anion scavenging activity (50% effective concentration: 21 μM) higher than that (50% effective concentration: 46 μM) of ascorbic acid (hydrosoluble vitamin).

Factors Associated with Surgical Field Bacterial Detection during Total Hip Arthroplasty

Total hip arthroplasty (THA) provides relief from hip pain and improves hip function. However, periprosthetic joint infection (PJI) remains an area of concern. We examined the detection rate of bacteria from surgical fields in wound closure, along with the relationship between bacterial detection rate and type of antiseptic, surgery time, and surgeon experience for 500 patients who underwent THA at our department. The mean age at surgery was 64.3 (± 27.3) years. The bacterial detection rate was 4.6%. None of the cases revealed PJI. No significant association between the detection rate and type of antiseptic used or surgery time was observed. However, for patients treated by surgeons with < 10 years of orthopedic experience, a detection rate of 7.3% was found, while a rate of 1.3% was observed for those treated by surgeons with ≥ 10 years of orthopedic experience. This finding indicated that orthopedic experience of less than 10 years was significantly associated with an increased bacterial detection rate (chi-square test, p=0.002). The detection rate was associated with surgeon experience but not with antiseptic type or surgery time. It is possible that intraoperative handling may increase the number of bacteria in surgical fields in wound closure.

CXCL10 is a novel anti-angiogenic factor downstream of p53 in cardiomyocytes

Tumor suppressor protein p53 plays crucial roles in the onset of heart failure. p53 activation results in cardiac dysfunction, at least partially by suppressing angiogenesis. Though p53 has been reported to reduce VEGF production by inhibiting hypoxia-inducible factor, the anti-angiogenic property of p53 remains to be fully elucidated in cardiomyocytes. To explore the molecular signals downstream of p53 that regulate vascular function, especially under normoxic conditions, DNA microarray was performed using p53-overexpressing rat neonatal cardiomyocytes. Among genes induced by more than 2-fold, we focused on CXCL10, an anti-angiogenic chemokine. Real-time PCR revealed that p53 upregulated the CXCL10 expression as well as p21, a well-known downstream target of p53. Since p53 is known to be activated by doxorubicin (Doxo), we examined the effects of Doxo on the expression of CXCL10 and found that Doxo enhanced the CXCL10 expression, accompanied by p53 induction. Importantly, Doxo-induced CXCL10 was abrogated by siRNA knockdown of p53, indicating that p53 activation is necessary for Doxo-induced CXCL10. Next, we examined the effect of hypoxic condition on p53-mediated induction of CXCL10. Interestingly, CXCL10 was induced by hypoxia and its induction was potentiated by the overexpression of p53. Finally, the conditioned media from cultured cardiomyocytes expressing p53 decreased the tube formation of endothelial cells compared with control, analyzed by angiogenesis assay. However, the inhibition of CXCR3, the receptor of CXCL10, restored the tube formation. These data indicate that CXCL10 is a novel anti-angiogenic factor downstream of p53 in cardiomyocytes and could contribute to the suppression of vascular function by p53.

Survey of Shoulder Osteoarthritis in Patients who Underwent Total Hip Arthroplasty for Hip Osteoarthritis

To the best of our knowledge, no previous studies have reported a relationship between osteoarthritis (OA) of the lower limbs and OA of the shoulder joints. We evaluated the correlation between shoulder OA and hip OA. We collected contrast-enhanced computed tomography (CECT) images of the shoulder joints of 159 patients with hip OA who underwent primary total hip arthroplasty (THA). The images, taken 1 week after THA to monitor venous thromboembolism (VTE), were used to examine the prevalence of shoulder OA. They were compared with those of 103 controls who underwent CECT during the same period to monitor VTE. Shoulder OA was observed in 15% of the controls and 24% of the THA patients. Although the rate was somewhat higher in the THA group, the difference was not significant. However, in the THA group, significantly more patients with bilateral hip OA (33%) had shoulder OA than those with unilateral hip OA (17%). In summary, the prevalence of shoulder OA was significantly higher in patients with bilateral hip OA. In these patients, pain and instability in the hip joints require them to use arm support to stand up or walk, putting the weight-bearing shoulder at risk of developing OA.

Deexcitation Dynamics of Muonic Atoms Revealed by High-Precision Spectroscopy of Electronic K X Rays

We observed electronic K x rays emitted from muonic iron atoms using superconducting transition-edge sensor microcalorimeters. The energy resolution of 5.2 eV in FWHM allowed us to observe the asymmetric broad profile of the electronic characteristic Kα and Kβ x rays together with the hypersatellite K^{h}α x rays around 6 keV. This signature reflects the time-dependent screening of the nuclear charge by the negative muon and the L-shell electrons, accompanied by electron side feeding. Assisted by a simulation, these data clearly reveal the electronic K- and L-shell hole production and their temporal evolution on the 10-20 fs scale during the muon cascade process.

PKNOX2 regulates myofibroblast functions and tubular cell survival during kidney fibrosis

The number of patients with chronic kidney disease (CKD) is increasing worldwide. When kidneys are exposed to severe injury, tubular cell death occurs and kidney fibrosis progresses by activating fibroblasts and myofibroblasts (referred to as (myo)fibroblasts), leading to CKD; however, the pathological and molecular mechanisms underlying CKD, including kidney fibrosis, remain obscure. In the present study, we focused on a transcription factor PBX/Knotted Homeobox 2 (PKNOX2) in kidney fibrosis. The transcript and protein expression of PKNOX2 was upregulated in fibrotic kidneys after unilateral ureteral obstruction (UUO). Importantly, immunofluorescence microscopic analysis revealed that the number of PKNOX2-expressing myofibroblasts was increased, whereas the expression of PKNOX2 was decreased in proximal tubular epithelial cells after UUO. In (myo)fibroblasts, PKNOX2 was induced by TGF-β1. Knockdown of PKNOX2 using shRNA lentiviral system reduced the viability of (myo)fibroblasts either in the presence or absence of TGF-β1, accompanied by increased apoptosis. Moreover, PKNOX2 knockdown decreased TGF-β1-induced migration of myofibroblasts and differentiation of fibroblasts into myofibroblasts. Significantly, knockdown of PKNOX2 also decreased the viability and increased apoptosis of tubular epithelial cells. Collectively, PKNOX2 regulates the function of (myo)fibroblasts and the viability of proximal tubular epithelial cells in progression of kidney fibrosis.

Maresin-1 induces cardiomyocyte hypertrophy through IGF-1 paracrine pathway

The resolution of inflammation is closely linked with tissue repair. Recent studies have revealed that macrophages suppress inflammatory reactions by producing lipid mediators, called specialized proresolving mediators (SPMs); however, the biological significance of SPMs in tissue repair remains to be fully elucidated in the heart. In this study, we focused on maresin-1 (MaR1) and examined the reparative effects of MaR1 in cardiomyocytes. The treatment with MaR1 increased cell size in cultured neonatal rat cardiomyocytes. Since the expression of fetal cardiac genes was unchanged by MaR1, physiological hypertrophy was induced by MaR1. SR3335, an inhibitor of retinoic acid-related orphan receptor α (RORα), mitigated MaR1-induced cardiomyocyte hypertrophy, consistent with the recent report that RORα is one of MaR1 receptors. Importantly, in response to MaR1, cardiomyocytes produced IGF-1 via RORα. Moreover, MaR1 activated phosphoinositide 3-kinase (PI3K)/Akt signaling pathway and wortmannin, a PI3K inhibitor, or triciribine, an Akt inhibitor, abrogated MaR1-induced cardiomyocyte hypertrophy. Finally, the blockade of IGF-1 receptor by NVP-AEW541 inhibited MaR-1-induced cardiomyocyte hypertrophy as well as the activation of PI3K/Akt pathway. These data indicate that MaR1 induces cardiomyocyte hypertrophy through RORα/IGF-1/PI3K/Akt pathway. Considering that MaR1 is a potent resolving factor, MaR1 could be a key mediator that orchestrates the resolution of inflammation with myocardial repair.

Transient Hyperintensity of the Infant Thyroid Gland on T1-Weighted MR Imaging: Correlation with Postnatal Age, Gestational Age, and Signal Intensity of the Pituitary Gland

BACKGROUND AND PURPOSE

The signal intensity of the thyroid in neonates is high on T1WI. It is affected by gestational and postnatal ages. However, the extent of the influence of these ages is unknown. This study investigated the relationship of signal intensities of the infant thyroid with postnatal and gestational ages and anterior pituitary using 3D gradient-echo T1WI.

MATERIALS AND METHODS

This retrospective study included 183 T1-weighted images from 181 infants. Using a multiple linear regression analysis, we evaluated the effects of postnatal and gestational ages on the thyroid-muscle signal intensity ratio. The relationship between the thyroid and anterior pituitary signal intensities on T1WI and the age of the infants was evaluated.

RESULTS

Multiple linear regression analysis showed that the thyroid signal intensity was affected negatively by postnatal age at examination and positively by gestational age at birth (P < .01 and P = .04, respectively). According to the standardized partial regression coefficients, the influence of postnatal age at examination was stronger than that of gestational age at birth (-0.72 and 0.13, respectively). The thyroid and anterior pituitary signal intensities reached constant values at 12 weeks' postnatal age, and the mean thyroid-anterior pituitary signal intensity ratios were almost 1 throughout the entire period.

CONCLUSIONS

The signal intensity of the infant thyroid on T1WI was more strongly influenced by the postnatal age at examination than the gestational age at birth, and it was almost equal to that of the anterior pituitary.

Transcription factor old astrocyte specifically induced substance is a novel regulator of kidney fibrosis

Prevention of kidney fibrosis is an essential requisite for effective therapy in preventing chronic kidney disease (CKD). Here, we identify Old astrocyte specifically induced substance (OASIS)/cAMP responsive element‐binding protein 3‐like 1 (CREB3l1), a CREB/ATF family transcription factor, as a candidate profibrotic gene that drives the final common pathological step along the fibrotic pathway in CKD. Although microarray data from diseased patient kidneys and fibrotic mouse model kidneys both exhibit OASIS/Creb3l1 upregulation, the pathophysiological roles of OASIS in CKD remains unknown. Immunohistochemistry revealed that OASIS protein was overexpressed in human fibrotic kidney compared with normal kidney. Moreover, OASIS was upregulated in murine fibrotic kidneys, following unilateral ureteral obstruction (UUO), resulting in an increase in the number of OASIS‐expressing pathological myofibroblasts. In vitro assays revealed exogenous TGF‐β1 increased OASIS expression coincident with fibroblast‐to‐myofibroblast transition and OASIS contributed to TGF‐β1–mediated myofibroblast migration and increased proliferation. Significantly, in vivo kidney fibrosis induced via UUO or ischemia/reperfusion injury was ameliorated by systemic genetic knockout of OASIS, accompanied by reduced myofibroblast proliferation. Microarrays revealed that the transmembrane glycoprotein Bone marrow stromal antigen 2 (Bst2) expression was reduced in OASIS knockout myofibroblasts. Interestingly, a systemic anti‐Bst2 blocking antibody approach attenuated kidney fibrosis in normal mice but not in OASIS knockout mice after UUO, signifying Bst2 functions downstream of OASIS. Finally, myofibroblast‐restricted OASIS conditional knockouts resulted in resistance to kidney fibrosis. Taken together, OASIS in myofibroblasts promotes kidney fibrosis, at least in part, via increased Bst2 expression. Thus, we have identified and demonstrated that OASIS signaling is a novel regulator of kidney fibrosis.

Evaluating the anti-inflammatory and analgesic properties of maropitant: A systematic review and meta-analysis

The neurotransmitter Substance P, and its neurokinin-1 receptor (NK-1R) are involved in the regulation of many pathophysiological processes including emesis, inflammation and nociceptive processing. This review provides a brief summary of the anti-inflammatory and analgesic properties of experimental NK-1R antagonists followed by a systematic review and meta-analysis on maropitant, the only NK-1R antagonist with a label indication for emesis in veterinary patients. There is very limited evidence based information on the putative clinical utilisation of maropitant for pain and inflammation. The aim of this systematic review and meta-analysis was to evaluate published reports on anti-inflammatory, analgesic and anaesthesia-sparing effects of maropitant. Medline, Pubmed, Science direct and Web of Science were searched to identify all published studies on maropitant, followed by a meta-analysis. Fourteen studies with 128 animals receiving maropitant and 127 controls met the inclusion criteria. Overall, maropitant had a significant inhalation anaesthetic-sparing effect (SMD -0.92, 95% CI -1.30, -0.54; P < 0.00001). However, treatment with maropitant had no effect on pain (SMD 0.06, 95% CI -0.37, 0.48; P = 0.80), or leukocyte cell infiltration in different inflammatory conditions (SMD -0.60, 95% CI -1.31, 0.11; P = 0.10). Based on all eligible studies for this review, it can be deduced that maropitant significantly reduced the minimum alveolar concentrations for isoflurane and sevoflurane for many different surgical procedures but it had no clearly proven effect on inflammation and pain.

Characteristics of plasma window with various channel diameters for accelerator applications

Plasma window is a feasible device as an atmosphere-vacuum interface, which can withstand energetic particle beams. It is, however, essential to enlarge the diameter to several tens of millimeters for actual beam passing in the accelerator applications. The pressure separation performance and discharge voltage V current I characteristics should be investigated in detail to design the plasma window for each purpose. Therefore, a cascade arc discharge device with a diameter of up to 20 mm was developed, and its characteristics as a function of diameter were examined. As a result, with an increase in the channel diameter, the discharge pressure that was achieved decreased, whose values were smaller compared with the values by the prediction formula, assuming the viscous gas flow with a constant plasma temperature. It showed that the bulk plasma temperature for the larger discharge channel was low because of the low-current density over the channel. Furthermore, the transition of the V-I slope was observed with an increase in the diameter.

Preliminary study: Measurement of ion beam energy spreads produced by a Penning ionization gauge-type ion source using electromagnets for a mega-electron volt compact ion microbeam system

The energy spreads of ion beams generated from a penning ionization gauge-type ion source with electromagnets were measured using a parallel electrostatic analyzer. The ion source was developed to be installed in a mega-electron volt (MeV) compact ion microbeam system. A gaseous ion beam of expectedly high brightness and narrow energy spread was generated from the ion source to form a microbeam. To produce such an ion beam, a high-density plasma with a small volume was generated using a strong magnetic field in the ion source. The beam energy spread width was of particular importance because it forms an ion microbeam by reducing the chromatic aberration at a focusing lens. In this report, the energy spread was investigated by changing the parameters of the ion source, e.g., extraction voltage, excitation current of electromagnets, vacuum, and anode voltage. The investigation showed that spread widths are influenced by the extraction voltage, vacuum, and anode voltage. The minimum width of ∼5.0 ± 0.1 eV was obtained at a beam energy of 200 eV. This value is acceptable for the MeV compact ion microbeam system.

Determination of Docosahexaenoic Acid and n-3 Fatty Acids in Refined Fish Oils by H-NMR Spectroscopy: IUPAC Interlaboratory Study

A high-resolution proton nuclear magnetic resonance (NMR) method for determining the concentration (mg/g) of docosahexaenoic acid (DHA), the molar proportion (mol%) of DHA, and the molar proportion of total n-3 fatty acids in fish oils was validated by an IUPAC interlaboratory study (the Commission VI-6 on Oils, Fats, and Derivatives WG 3/98). Thirteen laboratories from 5 countries tested 6 pairs of blind duplicate fish oils: a refined tuna oil, 2 extracted tuna oils, an extracted bonito oil, an extracted salmon oil, and an extracted sardine oil ranging from 9 to 30 mol% DHA and from 20 to 35 mol% n-3 fatty acids. Before 1D-proton NMR measurements with 300–500 MHz instruments, oil samples were weighed and diluted with deuterochloroform solution containing ethylene glycol dimethyl ether as internal standard. To achieve precise performance, a detailed procedure for signal area measurement was described in the protocol, and all participants were instructed about the critical importance of following the protocol. Statistical performances with invalid and outlier data removed were as follows: repeatability relative standard deviations (RSDr) ranged from 0.91 to 2.62% and reproducibility relative standard deviation (RSDR) ranged from 1.73 to 4.27% for DHA concentration (mg/g); RSDr ranged from 0.39 to 2.06%, and RSDR ranged from 0.59 to 3.46% for mol% DHA; RSDr ranged from 0.23 to 0.90% and RSDR ranged from 0.85 to 2.01% for mol% total n-3 fatty acids. The method is expected to be recommended by IUPAC.

P6578Development of the novel program to diagnose atrial fibrillation using automated blood pressure monitor

Background

Atrial fibrillation (AF) is often asymptomatic and contributes to an increased risk of strokes. The development of proper screening device of AF is unmet medical needs worldwide. Recently, we had reported that multiple measurements using Omron automated blood pressure (BP) monitor with irregular heartbeat detection showed high sensitivity and specificity for AF detection in general cardiac patients, however, this method had limitations in discriminating between AF and other arrhythmias.

Purpose

The aim of this study is to develop a novel program that can accurately diagnose AF by discriminating it from other arrhythmias using the pressure pulse waveform data outputted from Omron automated BP monitor.

Methods

In our previous clinical research, BP measurements were performed 3 times each for 303 general cardiac patients (mean age: 72.2 years, 69.8% male) with recording the real-time single lead ECG, and a total of 909 pressure pulse waveforms were obtained. Among them, 840 pressure pulse waveforms from 280 patients (include 40 AF patients) used for further analysis. We developed a program to analyze and visualize uniquely the characteristics of AF waveform through the autocorrelation-based waveform processing system produced by Melody International Ltd, Kagawa, Japan. All visualized results were judged and classified into Sinus, Non-AF and AF by two individuals blinded to the results. For each patient who obtained 3 results, a two by two contingency table was created and sensitivity, specificity, and accuracy for diagnosing AF were calculated.

Results

Among 840 pressure pulse waveforms, only 21 (2 Sinus and 19 Non-AF) out of 720 Sinus and Non-AF waveforms were judged as AF, and 7 out of 120 AF waveforms were judged as Non-AF. None of AF waveforms was absolutely misjudged as Sinus. In analysis for each patient, when one or more AF judgements were found in 3 waveforms, the diagnosis of AF has sensitivity and specificity of 100% and 95.8%, respectively. When two or more AF judgements were found in 3 waveforms, the diagnosis of AF has sensitivity and specificity of 100% and 97.9%, respectively. In this rule, the diagnostic accuracy of AF reached up to 98.8%, and no sinus patients were misjudged as AF.

Conclusion

The novel program, which applied autocorrelation methods uniquely to analysis of the pressure pulse waveforms recorded by automated BP monitor, showed high sensitivity and high specificity for AF diagnosis in general cardiac patients. This program is expected to be useful for early diagnosis for asymptomatic AF patients.

Acknowledgement/Funding

The present research is supported by a grant through the SCOPE from the Ministry of Internal Affairs and Communications, Japan.

P13.01 TERTpromoter methylation is significantly associated withTERTupregulation and tumor progression in pituitary adenomas

BACKGROUND

Activation of telomerase plays a critical role in tumor development. Somatic alterations in the promoter of the telomerase reverse transcriptase (TERT) gene are a major mechanism of upregulating telomerase. Several mechanisms have been associated with TERT abnormalities, including TERT promoter mutations or methylation. Mutations in the TERT promoter have been observed in a subset of brain tumors, especially in adult gliomas. In pituitary adenomas (PAs), however, TERT abnormalities are not fully understood. The present study aimed to investigate not only mutational but also methylation status changes in the TERT promoter in PAs and to analyze their correlations with clinical variables.

MATERIAL AND METHODS

We retrospectively studied 70 PAs consisting of 53 primary and 17 recurrent samples. Clinical data, including age at surgery, sex, tumor size, tumor subtype, resection rate, presence or absence of postoperative irradiation, and progression-free survival (PFS), were obtained from medical records. First, we investigated TERT promoter hotspot mutations via Sanger sequencing. Next, we quantified the methylation status of the TERT promoter using methylation-sensitive high-resolution melting analysis (MS-HRM). Finally, we investigated TERT mRNA expression levels using real-time quantitative PCR. Fisher’s exact test was applied to evaluate the statistical significance between TERT promoter methylation status and tumor recurrence. PFS was calculated using Kaplan-Meier estimates and compared between methylated with ummethylated PAs with the log-rank test. The correlation between TERT promoter methylation status and mRNA levels was analyzed with the Mann-Whitney U-test. PFS was analyzed using multivariate analysis with the Cox proportional hazards model and included the following variables: age, sex, tumor size, tumor subtype, resection rate, radiation therapy, and methylation status.

RESULTS

TERT promoter hotspot mutations were not observed in any PA sample. Nineteen percent of PAs exhibitedTERT promoter methylation, which was significantly predominant in recurrent PA samples. PFS was significantly shorter in the methylated cases than in the unmethylated cases. Higher TERT expression levels were correlated with methylation status.

CONCLUSION

We found that TERT promoter methylation upregulated TERT expression and was associated with shorter PFS in PAs. Our results suggest thatTERT promoter methylation may be a potential biomarker for predicting tumor recurrence in PAs.

Preterm birth is associated with higher prevalence of wheeze and asthma in a selected population of Japanese children aged three years

BACKGROUND

The present cross-sectional study investigated the associations between low birthweight (LBW), high birthweight, preterm birth (PTB), postterm birth, small for gestational age (SGA), and large for gestational age (LGA) and the prevalence of wheeze and asthma in Japanese children aged three years (age range, 33-54 months; mean age, 38.7 months).

METHODS

Study subjects were 6364 children. A questionnaire was used to collect all data. Wheeze and asthma were defined according to the criteria of the International Study of Asthma and Allergies in Childhood.

RESULTS

The prevalence values of wheeze and asthma were 19.5% and 7.7%, respectively. Of the 6364 subjects, 8.8% were classified as LBW (<2500g), 90.4% as normal birthweight, 0.8% as high birthweight (≥4000g), 4.8% as PTB (<37 weeks), 94.8% as term birth, 0.4% as postterm birth (≥42 weeks), 7.8% as SGA (<10th percentile), 82.5% as appropriate for gestational age, and 9.7% as LGA (>90th percentile). Compared with term birth, PTB was independently positively associated with wheeze and asthma: the adjusted ORs (95% CI) were 1.47 (1.11-1.92) and 1.52 (1.02-2.20), respectively. An independent positive association was shown between PTB and wheeze only in boys; the interaction between PTB and sex was significant. Such an interaction between PTB and sex was not seen for asthma. No evident associations were observed between LBW, high birthweight, postterm birth, SGA, or LGA and wheeze or asthma.

CONCLUSIONS

This is the first study in Japan to show that PTB, but not LBW or SGA, was significantly positively associated with childhood wheeze and asthma.

New precise measurements of muonium hyperfine structure at J-PARC MUSE

High precision measurements of the ground state hyperfine structure (HFS) of muonium is a stringent tool for testing bound-state quantum electrodynamics (QED) theory, determining fundamental constants of the muon magnetic moment and mass, and searches for new physics. Muonium is the most suitable system to test QED because both theoretical and experimental values can be precisely determined. Previous measurements were performed decades ago at LAMPF with uncertainties mostly dominated by statistical errors. At the J-PARC Muon Science Facility (MUSE), the MuSEUM collaboration is planning complementary measurements of muonium HFS both at zero and high magnetic field. The new high-intensity muon beam that will soon be available at H-Line will provide an opportunity to improve the precision of these measurements by one order of magnitude. An overview of the different aspects of these new muonium HFS measurements, the current status of the preparation for high-field measurements, and the latest results at zero field are presented.

Relationship between the length of the forefoot bones and performance in male sprinters

Although recent studies have reported that the forefoot bones are longer in sprinters than in non-sprinters, these reports included a relatively small number of subjects. Moreover, while computer simulation suggested that longer forefoot bones may contribute to higher sprint performance by enhancing plantar flexor moment during sprinting, the correlation between forefoot bone length and sprint performance in humans has not been confirmed in observational studies. Thus, using a relatively large sample, we compared the length of the forefoot bones between sprinters and non-sprinters. We also examined the relationship between forefoot bone length and performance in sprinters. The length of forefoot bones of the big and second toes in 36 well-trained male sprinters and 36 male non-sprinters was measured using magnetic resonance imaging. The length of forefoot bones in the big and second toes was significantly longer in sprinters than in non-sprinters. After dividing the sprinters into faster and slower groups according to their personal best time in the 100-m sprint, it was found that the forefoot bone length of the second toe, but not that of the big toe, was significantly longer in faster group than in slower group. Furthermore, the forefoot bone length of the second toe correlated significantly with the personal best time in the 100-m sprint. This study supported evidence that the forefoot bones are longer in sprinters than in non-sprinters. In addition, this is the first study to show that longer forefoot bones may be advantageous for achieving superior sprint performance in humans.

Evaluation of the effectiveness of the potent bis-quaternary ammonium compound, 4,4'-(α,ω-hexametylenedithio) bis (1-octylpyridinium bromide) (4DTBP-6,8) on Pseudomonas aeruginosa

AIMS

Quaternary ammonium compounds (QACs), including benzalkonium chloride (BAC) and cetylpyridinium chloride (CPC) are cationic surfactants and have been used widely as general disinfectants in the medical field due to their strong antibacterial effects and low cytotoxicity to human cells. 4,4'-(α,ω-hexametylenedithio) bis (1-octylpyridinium bromide) (4DTBP-6,8) is one of the potent bis-QACs synthesized to improve the antimicrobial activities of mono-QACs such as BAC. This study aimed to assess the effectiveness of 4DTBP-6,8 against Pseudomonas aeruginosa, a prevalent hospital pathogen.

METHODS AND RESULTS

The minimum inhibitory concentrations of 4DTBP-6,8, CPC and BAC against P. aeruginosa were measured. 4DTBP-6,8 exhibited strong antibacterial activity. We assessed the bactericidal effects of QACs against P. aeruginosa under certain conditions and their cytotoxicities in human epithelial cells using lactate dehydrogenase (LDH) release. 4DTBP-6,8 exerted excellent bactericidal effects against high concentrations of bacteria, biofilm cells and even in the presence of contaminated proteins. Cellular LDH was not released by the treatment with 4DTBP-6,8.

CONCLUSIONS

4DTBP-6,8 exhibited the strongest bactericidal activity against P. aeruginosa among the three QACs tested without any cytotoxicity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The potent bis-QAC, 4DTBP-6,8 has the potential to be an effective disinfectant in preventing hospital infections caused by P. aeruginosa.