Diagnostic accuracy of direct reverse transcription-polymerase chain reaction using guanidine-based and guanidine-free inactivators for SARS-CoV-2 detection in saliva samples

This study aimed to evaluate diagnostic accuracy of SARS-CoV-2 RNA detection in saliva samples treated with a guanidine-based or guanidine-free inactivator, using nasopharyngeal swab samples (NPS) as referents. Based on the NPS reverse transcription-polymerase chain reaction (RT-PCR) results, participants were classified as with or without COVID-19. Fifty sets of samples comprising NPS, self-collected raw saliva, and saliva with a guanidine-based, and guanidine-free inactivator were collected from each group. In patients with COVID-19, the sensitivity of direct RT-PCR using raw saliva and saliva treated with a guanidine-based and guanidine-free inactivator was 100.0%, 65.9%, and 82.9%, respectively, with corresponding concordance rates of 94.3% (κ=88.5), 82.8% (κ=64.8), and 92.0% (κ=83.7). Among patients with a PCR Ct value of <30 in the NPS sample, the positive predictive value for the three samples was 100.0%, 80.0%, and 96.0%, respectively. The sensitivity of SARS-CoV-2 RNA detection was lower in inactivated saliva than in raw saliva and lower in samples treated with a guanidine-based than with a guanidine-free inactivator. However, in individuals contributing to infection spread, inactivated saliva showed adequate accuracy regardless of the inactivator used. Inactivators can be added to saliva samples collected for RT-PCR to reduce viral transmission risk while maintaining adequate diagnostic accuracy.

Clinical trends among patients with asthma hospitalized for COVID-19 based on data from a nationwide database: an observational study

BACKGROUND

While the prevalence of severe cases and mortality rate of coronavirus disease 2019 (COVID-19) appear to be reducing, the clinical characteristics and severity of hospitalized patients with asthma and COVID-19 remain largely unknown. This study aimed to examine the association of asthma with COVID-19 severity and mortality risk.

METHODS

Data from the Japanese COVID-19 Registry Database were used to investigate the association between COVID-19 and asthma. This study focused on patients hospitalized for COVID-19 in 690 facilities from January 31, 2020, to December 31, 2022. Multivariate analysis using logistic regression was conducted to assess whether asthma, compared with other conditions, represents a risk factor for mortality and invasive mechanical ventilation after COVID-19.

RESULTS

In total, 72,582 patients with COVID-19 were included in the analysis, of whom, 3731 were diagnosed with asthma. From January 2020 to June 2021, asthma showed no significant association with an increase in mortality (OR 0.837, 95% CI 0.639-1.080, p = 0.184) or invasive mechanical ventilation events (OR 1.084, 95% CI 0.878-1.326, p = 0.440). An analysis conducted after July 2021 yielded similar results. For patients with asthma, factors such as age, body-mass index, sex, and chronic kidney disease increased the risk of mechanical ventilation. However, non-vaccination status and high blood pressure increased the risk of mechanical ventilation during the second half of the study.

CONCLUSION

Patients with asthma did not have an increased risk of mortality or mechanical ventilation due to COVID-19. However, patients with asthma had a higher risk of more severe COVID-19 due to factors such as advancing age, elevated body-mass index, chronic kidney disease, and non-vaccination.

A case of idiopathic multicentric Castleman disease with pulmonary hyalinizing granuloma-like multiple pulmonary nodules

A 41-year-old man presented with chronic cough and chest pain. Laboratory tests revealed anemia, inflammation, hypoalbuminemia, polyclonal hypergammaglobulinemia, and elevated interleukin-6 levels. Computed tomography revealed diffuse bilateral pulmonary nodules and multicentric lymphadenopathy. Histopathology of the pulmonary nodule resembled pulmonary hyalinizing granuloma (PHG), whereas lymph node histopathology was consistent with idiopathic multicentric Castleman disease (iMCD). The patient was diagnosed with iMCD involving PHG-like pulmonary nodules. Little is known about the association between these two diseases, and the present case provides insights regarding the relationship between PHG and iMCD.

High-flow nasal cannula for severe COVID-19 patients in a Japanese single-center, retrospective, observational study: 1 year of clinical experience

High-flow nasal cannula (HFNC) can be effective in treating type 1 respiratory failure by reducing the severity of coronavirus disease 2019 (COVID-19). The purpose of this study was to assess the reduction of disease severity and safety of HFNC treatment in patients with severe COVID-19. We retrospectively observed 513 consecutive patients with COVID-19 admitted to our hospital from January 2020 to January 2021. We included patients with severe COVID-19 who received HFNC for their deteriorating respiratory status. HFNC success was defined as improvement in respiratory status after HFNC and transfer to conventional oxygen therapy, while HFNC failure was defined as transfer to non-invasive positive pressure ventilation or ventilator, or death after HFNC. Predictive factors associated with failure to prevent severe disease were identified. Thirty-eight patients received HFNC. Twenty-five (65.8%) patients were classified in the HFNC success group. In the univariate analysis, age, history of chronic kidney disease (CKD), non-respiratory sequential organ failure assessment (SOFA) ≥ 1, oxygen saturation to fraction of inspired oxygen ratio (SpO₂/FiO₂) before HFNC ≤ 169.2, were significant predictors of HFNC failure. Multivariate analysis revealed that SpO₂/FiO₂ value before HFNC ≤ 169.2 was an independent predictor of HFNC failure. No apparent nosocomial infection occurred during the study period. Appropriate use of HFNC for acute respiratory failure caused by COVID-19 can reduce the severity of severe disease without causing nosocomial infection. Age, history of CKD, non-respiratory SOFA before HFNC ≤ 1, and SpO₂/FiO₂ before HFNC ≤ 169.2 were associated with HFNC failure.

T790M mutation positive squamous cell carcinoma transformation from EGFR-mutated lung adenocarcinoma after low dose erlotinib: A case report and literature review

RATIONALE

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are widely used for the treatment of EGFR mutation positive advanced nonsmall cell lung cancer (NSCLC); however, acquired resistance is known to develop during these treatments. Among these mechanisms, histological transformation is seldom encountered. Although platinum based chemotherapy has been reported to be effective in the treatment of patients with small cell lung cancer transformation, there is a lack of information on the treatment of patients with squamous cell carcinoma (SQ) transformation.

PATIENT CONCERNS AND DIAGNOSIS

An 80-year-old nonsmoking woman was referred to our hospital because of an abnormal shadow on her chest radiograph. Diagnostic bronchoscopy was performed and pathological examination revealed adenocarcinoma. Mutation analysis of the EGFR gene revealed deletion of E746-A750 in exon 19. She refused both surgical treatment and radiation therapy, and preferred periodic radiologic follow-up. Unfortunately, approximately a year and a half after the initial diagnosis, the primary lesion enlarged, and many pleural nodules were newly detected (clinically T4N2M1a, stage IVA).

INTERVENTIONS AND OUTCOMES

Based on EGFR mutation analysis, a reduced dose of daily erlotinib was prescribed, which achieved a partial response and 34 months of progression-free survival (PFS). A repeated biopsy with an endobronchial cryoprobe was performed on the enlarged primary lesion. Pathological examination revealed SQ harboring an identical EGFR mutation with a secondary EGFR T790M mutation. Osimertinib 80 mg once a day was started as second line therapy, which resulted in 8 months of PFS and 15 months of survival.

LESSON

The literature review and our report suggest that osimertinib is a promising treatment for NSCLC regardless of histology if T790M is present as an acquired mutation.

Suspected Tuberculous Pleurisy and Coronavirus Disease 2019 Comorbidity

A 33-year-old woman with a fever, cough, and pharyngitis was admitted after left-sided pleural effusion was detected. The fever and upper respiratory symptoms were confirmed, and she was diagnosed with coronavirus disease (COVID-19) after showing a positive polymerase chain reaction (PCR) test. After thoracentesis, pleural fluid revealed elevated adenosine deaminase values and a positive QuantiFeron test; tuberculous pleurisy was thus suspected. Subsequent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR and anti-SARS-CoV-2 Spike IgG tests were negative, suggesting that the initial PCR result had been erroneous. However, we were unable to confirm this. Data concerning COVID-19 diagnostics are insufficient at present. It is important to make comprehensive judgments regarding the diagnosis and treatment of patients as well as public health.

Clinical outcomes of corticosteroids for COVID-19 patients at the National Center for Global Health and Medicine during the first wave of infections

Background

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2, has been a significant concern worldwide since its outbreak in December 2019. Various treatments are being researched and developed, and there are reports that dexamethasone has reduced the mortality rate and improved the clinical course of critically ill patients with COVID-19. In this study, we examined the clinical efficacy of corticosteroid therapy for patients with COVID-19 in our hospital during the first wave of infections.

Methods

We retrospectively reviewed the medical records of patients with COVID-19 who were treated with or without corticosteroid therapy at the National Center for Global Health and Medicine in Japan between February and April 2020. The primary outcome was improvement in the patients’ clinical course using a seven-category ordinal scale. We collected data on patient characteristics, treatment, and clinical course, and compared them between two groups: the steroid-using group and the non-steroid-using group.

Results

Between February and April 2020, 110 patients were diagnosed with COVID-19. Despite poor conditions during admission into the steroid group, there were no statistical differences in clinical course between both groups, as measured using the scale. There were no statistical differences between the two groups in the number of days to fever resolution or negative polymerase chain reaction results.

Conclusions

There was no difference in the clinical course between both groups. Because of the difference in background, corticosteroids may potentially make the clinical course of severely ill patients similar to that of mildly ill patients.

Refractory Hemoptysis Caused by Severe Pulmonary Vein Stenosis after Multiple Catheter Ablations

We herein report a 48-year-old man with a history of chronic atrial fibrillation (AF) and repeated hemoptysis after radiofrequency ablation. Contrast tomography showed soft tissue thickening of the left hilar region and left pulmonary vein stenosis. We performed bronchial artery embolization, but the hemoptysis did not disappear, and AF was not controlled. We performed left lung lobectomy and maze procedures since we considered surgical removal necessary as radical treatment. After the surgery, hemoptysis and atrial fibrillation did not recur. Refractory hemoptysis after catheter ablation is rare, but occasionally occurs in patients with severe pulmonary vein stenosis.

A Kidney Transplant Patient Who Died of COVID-19-associated Severe Acute Respiratory Distress Syndrome

We herein report a 67-year-old kidney transplant patient who died of COVID-19. He was treated with hydroxychloroquine and azithromycin and received mechanical ventilation that temporarily improved his respiratory status. Despite our efforts, however, he later developed respiratory failure and died 43 days after the disease onset. The autopsy revealed prominent organization of alveoli and alveolar ducts, with a massive accumulation of macrophages in the lungs. A few severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen-positive cells were detected in the lung, suggesting delayed virus clearance owing to his long-term immunosuppressed state, leading to constant lung damage and ultimately respiratory failure.

Diagnostic accuracy of nasopharyngeal swab, nasal swab and saliva swab samples for the detection of SARS-CoV-2 using RT-PCR

Background

The current gold standard in coronavirus disease (COVID-19) diagnostics is the real-time reverse transcription–polymerase chain reaction (RT-PCR) assay for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in nasopharyngeal swab (NPS) samples. Alternatively, nasal swab (NS) or saliva swab (SS) specimens are used, although available data on test accuracy are limited. We examined the diagnostic accuracy of NPS/NS/SS samples for this purpose.

Methods

Ten patients were included after being tested positive for SARS-CoV-2 RT-PCR in NPS samples according to the National Institute of Infectious Disease guidelines. In comparison with this conventional diagnostic method, NPS/NS/SS samples were tested using the cobas 6800 systems RT-PCR device. To investigate the usefulness of the cobas method and the difference among sample types, the agreement and sensitivity were calculated. Five to six samples were collected over a total period of 5–6 d from each patient.

Results

Fifty-seven sets of NPS/NS/SS samples were collected, of which 40 tested positive for COVID-19 by the conventional method. Overall, the concordance rates using the conventional method were 86.0%/70.2%/54.4% for NPS/NS/SS samples (cobas); however, for samples collected up to and including on Day 9 after disease onset (22 negative and one positive specimens), the corresponding rates were 95.7%/87.0%/65.2%. The overall sensitivity estimates were 100.0%/67.5%/37.5% for NPS/NS/SS samples (cobas). For samples up to 9 d after onset, the corresponding values were 100.0%/86.4%/63.6%.

Conclusions

NS samples are more reliable than SS samples and can be an alternative to NPS samples. They can be a useful diagnostic method in the future.

Pembrolizumab-induced pancytopenia in a patient with squamous cell lung cancer

Immune checkpoint inhibitors (ICIs) are reportedly effective against many kinds of neoplasm, but may be responsible for several kinds of immune‐related adverse events (irAEs). Among these irAEs, the incidence of myelosuppression due to ICIs is relatively low. Corticosteroids are needed to control most cases of myelosuppression. Here, we report an 88‐year‐old woman with squamous cell lung cancer who was administered pembrolizumab. After five cycles of pembrolizumab, she developed severe pancytopenia. The pancytopenia improved under observation without steroid administration after cessation of pembrolizumab. During recovery from this irAE, the patient also maintained long‐term antitumor efficacy.

Key points

Significant findings of the study

There are several kinds of immune‐related adverse events. We encountered a case of pembrolizumab‐induced pancytopenia with squamous cell lung cancer.

What this study adds

Corticosteroids are needed to control most cases of myelosuppression induced by ICIs, but pancytopenia induced by pembrolizumab in our case improved without steroids.

Characterization and Fuel Cell Testing of Radiation-Grafted Psi Membranes

We have demonstrated earlier the useful performance of our PSI radiation-grafted membranes in terms of the current-voltage characteristics of 30 cm2 active area fuel cells containing these membranes and their long-term testing over 6,000 h at 60 °C. We report here on testing of PSI radiation-grafted membranes in these fuel cells at 80 °C and in short stacks comprised of two or four 100 cm2 active area cells. The in-situ degradation of membranes has been investigated by characterizing membranes both before testing in fuel cells and post-mortem after testing in fuel cells. Characterization was accomplished by means of ion-exchange capacity and infrared and Raman spectroscopic measurements. In addition, a rapid screening method for our ex-situ testing of the oxidative stability of proton-conducting membranes was developed in this work. Comparison of the initial screening test results concerning the oxidative stability of some perfluorinated, partially-fluorinated, and non-fluorinated membranes compare well qualitatively with the relative stability of these same membranes during their long-term testing in fuel cells.

Isolation and characterisation of prolactin-releasing peptide in chicks and its effect on prolactin release and feeding behaviour

Prolactin (PRL)-releasing peptides (PrRP) have been identified in mammals, amphibians and fishes, and these animals have several PrRPs that consist of different numbers of amino acids such as 20, 31 and 37. In the present study, we identified the cDNA encoding chicken prepro-PrRP, which can generate putative PrRPs, and cloned and sequenced it. Sequences for the coding region suggested the occurrence of putative PrRPs of 20, 31 and 32 amino acid residues. The amino acid sequence of chicken PrRP20 showed 100%, 95% and 70% identity with those of PrRP20s from teleosts, Xenopus laevis and mammals, respectively. On the other hand, chicken PrRP31 showed approximately 90% and 52-55% homology to PrRP31s of X. laevis and mammals, respectively. Native chicken PrRPs were purified from an acid extract of chick brain by a Sep-Pak C18 cartridge (Waters Corp., Milford, MA, USA), affinity chromatography using anti-salmon PrRP serum, and reverse phase high-performance liquid chromatography (HPLC) on an ODS-120T column (TOSOH, Tokyo, Japan). The existence of chicken PrRP20 and PrRP31 in the brain was demonstrated by comparing them with the synthetic peptides using HPLC and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. Chicken PrRP31 increased plasma PRL concentration when administered peripherally, whereas central administration decreased the concentration, suggesting that chicken PrRP31 has a distinct effect on PRL secretion between tissues in chicks. On the other hand, plasma growth hormone concentration decreased with both peripheral and central administrations of chicken PrRP31. Furthermore, central administration of chicken PrRP31 increased food intake in chicks compared to those observed in mammals and fishes. Taken together with the results indicating that chicken PrRP20 did not show endocrine and behavioural effects, we showed that chicken PrRP has a similar amino acid sequence to teleosts, Xenopus laevis and mammals, although the actions were variable among vertebrates.

Retreatment of cerebral aneurysms after guglielmi detachable coil embolization

SUMMARY

Of 175 patients with 181 aneurysms initially treated with Guglielmi Detachable Coils (GDC), 25 were retreated. All retreatments except one were performed on previously ruptured aneurysms. Thirteen aneurysms were retreated because of recurrence, and 12 aneurysms were retreated to complete initial insufficient embolization. Sixteen patients underwent re-embolization and 9 patients were operated upon surgically. No complications related to the retreatment were experienced. We consider that repeat embolization should be attempted before considering surgical treatment in case that additional therapy is required. However, it is difficult to retreat aneurysms having wide necks. In regard to surgical clipping, aneurysms without a coil in the neck are easier to treat with primary clipping, whereas aneurysms with a coil mass in the neck are difficult to surgical clip. We have never used temporary clipping and coil extraction if the distance between the coil and the parent artery was wider than 2 mm. Emerging new embolic agents or devices and technical improvement might decrease the need for retreatment and increase long-term efficacy after endovascular treatment.

Phase diagram of the electron-doped La2-xCexCuO4 cuprate superconductor from Andreev bound states at grain boundary junctions

We use quasiparticle tunneling across La2-xCexCuO4 grain boundary junctions to probe the superconducting state and its disappearance with increasing temperature and magnetic field. A zero bias conductance peak due to zero energy surface Andreev bound states is a clear signature of the phase coherence of the superconducting state. Hence, such a peak must disappear at or below the upper critical field Bc2(T). For La2-xCexCuO4 this approach sets a lower bound for Bc2(0) approximately 25 T which is substantially higher than reported previously. The method of probing the superconducting state via Andreev bound states should also be applicable to other cuprate superconductors.

Primary structure and tissue distribution of GPR39 messenger ribonucleic acid in Japanese quail, Coturnix japonica

It has been found that GPR39 is an orphan receptor that belongs to the family of G protein-coupled receptors. In mammals, GPR39 has been shown to be involved in the regulation of gastrointestinal and metabolic function. In this study, we performed cDNA cloning for GPR39 in Japanese quail and characterized the tissue expression profiles of its mRNA. The cDNA encoded 462 amino acids, showing very high sequence homology to chicken GPR39 (95.5%) and moderate homology to mouse (64.7%), rat (63.7%), and human (59.9%) GPR39. Real-time PCR analysis revealed that GPR39 mRNA is expressed at high levels in the digestive tissues such as stomach, duodenum, jejunum, ileum, cecum, and colon and rectum and at moderate levels in the oviduct including infundibulum, magnum, isthmus, and uterus. These findings suggest that GPR39 may be involved in gastrointestinal and oviductal functions in Japanese quail.

Persistent supercurrent atom chip

Rubidium-87 atoms are trapped in an Ioffe-Pritchard potential generated with a persistent supercurrent that flows in a loop circuit patterned on a sapphire surface. The superconducting circuit is a closed loop made of a 100 microm wide molecular-beam epitaxy-grown MgB2 stripe carrying a supercurrent of 2.5 A. To control the supercurrent in the stripe, an on-chip thermal switch operated by a focused argon-ion laser is developed. The switch operates as an on/off switch of the supercurrent or as a device to set the current to a specific value with the aid of an external magnetic field. The current can be set even without an external source if the change is in the decreasing direction.

Fertilization and Blastoderm Development of Quail Oocytes After Intracytoplasmic Injection of Chicken Sperm Bearing the W Chromosome

Our previous study demonstrated that elongated spermatids and sperm carrying the female-specific W-chromosome of the sex-reversed domestic fowl can activate the mouse oocyte, but whether they can fertilize the avian oocyte and lead to a developing zygote remains undetermined. A single sperm isolated from the semen and testis of normal rooster and from a testis of sex-reversed hen was microinjected into a quail oocyte and cultured for 20 to 24 h. Blastoderms were fixed, cleaved, nuclei stained by 4',6'-diamidino-2-phenylin-dole, and developmental stages were assessed. In the normal rooster group, ejaculated and testicular sperm induced blastodermal development in 22.6 and 20% of the quail oocytes, respectively. The developmental stages ranged from IV to VII. In the sex-reversal group, 20% of injected testicular sperm induced blastodermal development. The blastodermal stages varied from stage III to VI. Blastoderms after 4',6'-diamidino-2-phenylindole staining were assayed by PCR to identify the W chromosome of either chicken sperm or quail oocyte. The PCR assay results showed that 2 out of 9 developed blastoderms microinjected with sperm of sex-reversed hen were identified containing the female-specific W chromosome derived from sex-reversed hen. From these results, it is concluded that chicken sperm bearing the W chromosome possess fertilizing ability and can function to stimulate blastoderm development similar to that of normal chicken sperm carrying the Z chromosome.

Fertilizing Ability of Chicken Sperm Bearing the W Chromosome

In the sex-reversed domestic fowl, spermatids and sperm carrying the female-specific W chromosome have been demonstrated, but whether the spermatids can become functional sperm and can fertilize the oocyte remains undetermined. In the present study, sex reversal was induced by injection of a nonsteroidal aromatase inhibitor (Fadrozole) into the air sac of the chicken egg on d 4 of incubation, and the chicks were reared to 18 mo old. A single elongated spermatid or sperm was isolated from the testis from either normal roosters or sex-reversed hens, and each was microinjected into a mouse oocyte and cultured for 24 h. Although injected oocytes were monitored on the stage of microscope, they were classified into groups by the number of pronuclei. Those that showed male and female pronuclei (2PN) were considered to have oocyte-activating potency. In the normal rooster group, most semen and testicular sperm induced 2PN, whereas only half of the elongated spermatids induced 2PN. In the sex-reversal group, most testicular sperm induced 2PN, whereas nearly half of the elongated spermatids induced 2PN in the oocytes. There was no pronucleus in the oocytes after microinjection of medium only. A second experiment confirmed the higher rate of oocyte activation by testicular sperm than testicular elongated spermatids. In this second experiment, individual oocytes injected with spermatids and sperm of sex-reversed hens were assayed by PCR to identify the W chromosome. Most spermatids and sperm carried Z chromosome, whereas a minority carried W chromosome. However, the sperm carrying W chromosome evoked 2PN with the same rate of oocyte activation as those carrying Z chromosome. From these results, it is concluded that the chicken elongated spermatids and sperm carrying W chromosome may possess a fertilizing ability similar to normal chicken sperm carrying the Z chromosome.

Fluorescence X-ray absorption spectroscopy using a Ge pixel array detector: application to high-temperature superconducting thin-film single crystals

A Ge pixel array detector with 100 segments was applied to fluorescence X-ray absorption spectroscopy, probing the local structure of high-temperature superconducting thin-film single crystals (100 nm in thickness). Independent monitoring of pixel signals allows real-time inspection of artifacts owing to substrate diffractions. By optimizing the grazing-incidence angle theta and adjusting the azimuthal angle phi, smooth extended X-ray absorption fine structure (EXAFS) oscillations were obtained for strained (La,Sr)2CuO4 thin-film single crystals grown by molecular beam epitaxy. The results of EXAFS data analysis show that the local structure (CuO6 octahedron) in (La,Sr)2CuO4 thin films grown on LaSrAlO4 and SrTiO3 substrates is uniaxially distorted changing the tetragonality by approximately 5 x 10(-3) in accordance with the crystallographic lattice mismatch. It is demonstrated that the local structure of thin-film single crystals can be probed with high accuracy at low temperature without interference from substrates.

A study for establishment of individualized chemotherapy for colorectal cancer using the area under the concentration curve (AUC) based on the collagen gel droplet embedded culture-drug sensitivity test (CD-DST)

13560

Background: The drug sensitivity of tumor cells is one of the key issues to explore for individualized chemotherapy for cancer patients. We reported the 5-fluorouracil (5-FU) sensitivity of cancer cells from colorectal cancer (CRC) patients using the collagen gel droplet embedded culture-drug sensitivity test (CD-DST) under multiple drug concentrations and contact duration. We also reported that growth inhibition rate (IR) and area under the concentration curve (AUC) approximated to logarithmic curve in ASCO 2003 (#1283). The aim of this study was to evaluate the individual 50% inhibitory AUC (AUCIR50) and research the usefulness of individual AUCIR50 for establishment of individualized chemotherapy. Methods: Surgical specimen was obtained from resectable 53 CRC patients without any preoperative chemotherapy during 2002 to 2005. CD-DST was performed under nine different conditions: concentration of 5-FU tested: 0.2, 1 and 10μg/ml; duration of exposure: 3, 24 and 120 hours. After converting drug concentration and contact time to AUC and plotting against growth IR, individual correlation between AUC and growth IR was evaluated. The histogram of individual AUCIR50 was also evaluated. Results: The curve between AUC and growth IR approximated to logarithmic curve in all of the patients (R2=0.69–0.96). We could calculate the individual AUCIR50 in all of the patients (AUCIR50= 23.7–98796298.1μg*hr/ml). The histogram of the individual AUCIR50 (AUCIR50<2500μg*hr/ml) indicated CURT(X) pattern (SK=0.0076). Conclusions: We could obtain a position for each patient on the histogram of AUCIR50. We could also indicate the potential for 5-FU sensitivity to each patient. Some patients demonstrating low 5-FU sensitivity could not be recommended for 5-FU based chemotherapy, and non-5-FU chemotherapy should be explored for them. This study demonstrated that the individual AUCIR50 is useful to distinguish the individualized chemotherapy of colorectal cancer patients. Utilization of CD-DST will facilitate establishment of individualized chemotherapy for colorectal cancer.

No significant financial relationships to disclose.

cDNA cloning of chicken orexin receptor and tissue distribution: sexually dimorphic expression in chicken gonads

Orexin-A and -B are known to stimulate food intake in mammals. However, the critical roles of orexins in birds are not fully understood, since orexins have no stimulatory effect on food intake in the chicken. To understand the physiological role(s) of orexins in birds, we have cloned chicken orexin receptor (cOXR) cDNA by RT-PCR, and analysed the tIssue distribution of OXR mRNA in the chicken. The cOXR cDNA is 1869 bp long and encodes 501 amino acids. The cloned cDNA for cOXR corresponds to the type 2 OXR in mammals, and shows approximately 80% similarity to those of mammals at the amino acid level. Expression analysis by RNase protection assay revealed OXR mRNA was distributed widely in brain regions, and expression in the cerebrum, hypothalamus and optic tectum were abundant. In peripheral tIssues, OXR mRNA was expressed in the pituitary gland, adrenal gland and testis, but no mRNA expression was observed in other tIssues examined. Furthermore, we found that the amount of cOXR mRNA was different between testis and ovary, while prepro-orexin mRNA is equally expressed in the gonads of both sexes in the chicken. These data indicate that the orexins have neuroendocrine actions in chickens, which are mediated through hypothalamic receptors as has been observed in mammals. In addition, orexin may have specific role(s) in the regulation of gonadal function in which sex-dependent mechanisms could be involved.

Profiles of mRNA expression of genes related to sex differentiation of the gonads in the chicken embryo

Sex is determined genetically in birds. The homogametic sex is male (ZZ), whereas the heterogametic sex is female (ZW). According to the genetic sex, gonads develop into testes or ovary. In this study, we performed experiments to reveal mRNA expression patterns in the gonad between d 5.5 and 8.5 of incubation and examined a possible role of Dss-Ahc critical region on the X chromosome 1 (Dax1), Steroidogenic factor 1 (Sf1), P450aromatase (P450arom), Estrogen receptor alpha (ER alpha), doublesex and mab3 related transcription factor 1 (Dmrt1), Sry-related HMG box gene 9 (Sox9), Gata binding protein 4 (Gata4), and anti-müllerian hormone (Amh) in sex differentiation in chicken embryonic gonads using RNase protection assay. In embryonic chicken gonads, Dax1 mRNA was expressed in both sexes but was higher in females than in males at d 6.5 and 7.5 of incubation. The Sf1 mRNA was expressed in both sexes, but it was expressed more in males at d 5.5 than in females but more in females than in males at d 7.5 and 8.5 of incubation. The P450arom mRNA was expressed only in female gonads from d 5.5 of incubation. The ER alpha mRNA was expressed in both sexes, but it did not show a sex difference. On the other hand, the Dmrt1 mRNA was expressed in both sexes, but it showed a male-specific expression pattern. The male-specific expression pattern was observed in Sox9 mRNA, but it was not expressed in female gonads. The Gata4 mRNA was expressed in both sexes, and sex differences were not revealed throughout the observational period. Amh mRNA was expressed in both sexes, but it had male-specific mRNA expression pattern at d 6.5 to 8.5 of incubation. These results indicate that Dax1, Sf1, and P450arom have possible roles in ovary formation, whereas Dmrt1, Sox9, and Amh are related to testis formation in differentiating chicken gonads at d 5.5 to 8.5 of incubation.

Magnetic penetration depth measurements of Pr2-xCexCuO4-delta films on buffered substrates: evidence for a nodeless gap

We report measurements of the inverse squared magnetic penetration depth, lambda(-2)(T), in Pr(2-x)Ce(x)CuO(4-delta) (0.115< or =x < or =0.152) superconducting films grown on SrTiO3 (001) substrates coated with a buffer layer of insulating Pr2CuO4. lambda(-2)(0), T(c), and normal-state resistivities of these films indicate that they are clean and homogeneous. Over a wide range of Ce doping, 0.124< or =x < or =0.144, lambda(-2)(T) at low T is flat: it changes by less than 0.15% over a factor of 3 change in T, indicating a gap in the superconducting density of states. Fits to the first 5% decrease in lambda(-2)(T) produce values of the minimum superconducting gap in the range of 0.29< or =Delta(min)/k(B)T(c)< or =1.01.

Magnetic-field dependence of the maximum supercurrent of La2-xCexCuO4-y interferometers: evidence for a predominant dx2-y2 superconducting order parameter

We performed a phase-sensitive test of the symmetry of the superconducting order parameter of the electron doped cuprate La(2-x)Ce(x)CuO(4-y) using a superconducting quantum interferometer with spatially distributed Josephson junctions. The studies were made on a thin film grown on a SrTiO3 tetracrystal substrate. The superconducting transition temperature was about 29 K which indicates that the sample is close to optimal doping. The magnetic field dependence of the critical current gives strong evidence for a predominant dx(2)(-y(2)) order parameter symmetry of the sample measured. It also gives upper limits for the s-wave component in a mixed order parameter of the type s+idx(2)(-y(2)).

Indirect arterial blood pressure measurement at the wrist using a pad-type square cuff and volume-oscillometric method

Using theoretical and experimental approaches, we examined whether blood pressure at the wrist can be accurately measured by a volume-oscillometric method using a small pad-type square cuff placed above the radial artery (RA). Nuclear magnetic resonance imaging of the wrist allowed us to determine the geometry of two-dimensional (2-D) finite-element models. Finite-element method (FEM) analysis predicted that the pressure transmission ratio (calculated tissue pressure over externally applied pressure; square cuff to RA) was 98.8% for a cuff with a bladder sidelength 0.25 times the wrist diameter placed on the skin surface between the tendons of the brachioradialis muscle (Ta) and the flexor capri radialis muscle (Tb) and over the site (L) at which RA crosses the most protuberant spot on the volar aspect of the distal end of the radius. In addition, FEM analysis using a 3-D finite-element model (constructed by extending the 2-D finite-element model at site L in the longitudinal direction) showed that for all square cuffs with bladder sidelengths greater than or equal to 0.25 times the wrist diameter, the external pressure was transmitted almost completely to RA beneath the cuff center. Moreover, when the bladder sidelength was 0.44 times the wrist diameter, but not 0.29 times the wrist diameter, the mean blood pressure measured at site L in human subjects was similar to that measured at the upper arm. Taken together, the theoretical and the experimental results suggest that (i) blood pressure at the wrist can be measured accurately using a pad-type square cuff placed on the skin surface between Ta and Tb at site L, and (ii) the minimum bladder sidelength for accurate readings is somewhere between one-third and one-half of the wrist diameter.

Intraosseous meningioma of the posterior fossa--Case report

A 62-year-old male presented with a rare intraosseous meningioma with intradural extension manifesting as frequent vomiting and floating sensation that had persisted for 3 months. Neuroimaging detected a mass lesion that was mainly located extradurally in the right posterior fossa with a daughter lesion inside the dura. He underwent surgical excision of the mass lesion. Craniectomy exposed the main lesion of the tumor just beneath the thinned outer table of the skull, and in the extradural space, with the daughter lesion penetrating the dura. Both portions of the tumor were resected. There was no attachment to the adjacent dura mater. Histological examination showed meningotheliomatous meningioma containing scattered bony tissue. This intraosseous meningioma probably originated from the occipital bone with a small intradural extension caused by mechanical compression.

The evaluation of preoperative embolization of meningioma

SUMMARY

To evaluate the efficacy of preoperative embolization of meningioma, we examined the correlation between the angiographic disappearance of the tumor blush after the embolization and the volume of blood loss and transfusion intraoperatively. Preoperative embolization of meningioma with intravascular neurosurgery was attempted for 42 trials, 41 cases from July 1989 to December 1995. There were no major complications attributed to the embolization procedure. As a subjective assessment in 23 cases the information from the surgeon following the operation was obtained. The angiographic disappearance of the tumor blush and reducing of the bleeding from tumor could be considered to be statiscally significant (p < 0.05). As an objective assessment in 37 cases following operation, the volume of both intraoperative blood loss and blood transfusion was examined. The angiographic disappearance of the tumor blush and reduced intraoperative blood transfusion could be also considered to be statiscally significant (p < 0.05), otherwise reduced intraoperative blood loss failed to reach the significance level. 1n this study the efficacy of preoperative embolization of meningioma has been especially shown to reduce intraoperative blood transfusion significantly, therefore it is very useful to increase the chance of complete tumor removal with more safely and less invasively.

Suitable location and optimum bladder width for the occluding cuff used for indirect arterial blood pressure measurements at the wrist

Using a finite element method (FEM) and a volume oscillometric method with a photo-electric plethysmograph, we tried to determine which location(s) and which bladder width(s) of the occluding cuff would allow the most accurate indirect blood pressure measurements at the human wrist. Nuclear magnetic resonance imaging of the wrist allowed us to determine the geometry of two-dimensional (2D) finite element models. FEM analysis showed that the pressure transmission ratio (calculated tissue pressure: externally applied pressure) from the cuff to the radial artery (RA) was 100% when the cuff was placed over the site (L1) at which the RA crosses the most protuberant spot on the volar aspect of the distal end of the radius. In fact, the mean blood pressure (BPM) measured at this site in human subjects coincided with that measured at the upper arm (BPMA). In addition, a three-dimensional (3D) FEM was constructed by extending the 2D FEM at site L1 in the longitudinal direction to investigate the relation between pressure transmission to the RA and cuff bladder width. FEM analysis using the 3D finite element model showed that for all cuff widths greater than 0.25 times the diameter of the wrist, the external pressure was transmitted almost completely to the RA beneath the cuff center. Moreover, when the cuff width was as large as 0.45 times the diameter of the wrist, the BPM measured at site L1 in human subjects was similar to the BPMA. The theoretical and experimental results in the present study both suggest that for accurate indirect blood pressure measurements at the wrist, the L1 site is a suitable location for the occluding cuff and a cuff whose bladder width is more than one-third but less than one-half the wrist diameter can be used.

Nontraumatic bilateral first rib fractures

The authors report the case of a 21-year old woman who presented bilateral spontaneous fractures of the first ribs, in the posterior portion on the right side, in the anterior portion on the left side. The pathogenesis of spontaneous fractures of the first rib is discussed.

Polyethylene wear from femoral bipolar neck-cup impingement as a cause of femoral prosthetic loosening

A 33-year-old woman underwent an uncemented bipolar hip arthroplasty for osteoarthrosis of the left hip in 1985. Because of painful aseptic loosening, the bipolar implant was revised to a total hip prosthesis in 1994. Membranous tissues around the implant histologically presented foreign-body reaction against polyethylene debris. The retrieved implant showed polyethylene wear of the rim of the bipolar cup. Three-dimensional measurement of the surface configuration of the polyethylene of the cup indicated that wear debris had been generated almost exclusively from femoral bipolar neck-cup impingement. Volumetric wear in the articulating dome portion of the polyethylene was negligible. This report clearly illustrates how impingement of a bipolar cup on the femoral neck can be a major source of polyethylene wear debris which induces femoral osteolysis and subsequent stem loosening.

Cloning and expression of pigeon growth hormone receptor cDNA in COS-7 monkey kidney cells

Pigeon growth hormone receptor (pGHR) cDNA has been cloned, sequenced, characterized and expressed in COS-7 cells. The predicted pGHR preprotein was composed of 611 amino acids and contained a putative signal peptide, a single transmembrane region and the conserved proline-rich box 1 domain in the cytoplasmic region. A canonical polyadenylation signal was found in the extracellular region, as was observed in chicken growth hormone receptor cDNA. Northern blot analysis identified a single species of pGHR mRNA and its expression was widely observed in tissues in the young male pigeon. A pGHR expression vector was constructed and transfected into COS-7 cells. The transfected cells were specifically bound by 125I-labeled chicken GH and the binding was suppressed by the addition of excess amounts of unlabeled chicken GH.

Thyroid hormones are involved in insulin-like growth factor-I (IGF-I) production by stimulating hepatic growth hormone receptor (GHR) gene expression in the chicken

Effect of thyroid status on IGF-I production in growing chickens was studied. Serum concentrations of GH were not affected by propylthiouracil (PTU) or thyroxine (T4) treatments, whereas serum IGF-I levels were significantly decreased in PTU-treated chickens. The lowered serum IGF-I levels in the PTU-treated group were completely restored to the control levels by T4 injections. In the liver, the messenger RNA (mRNA) expressions both for GH receptor (GHR) and IGF-I were significantly repressed by PTU treatment, and were restored again by T4 replacement. In addition, the results of analysis on radiolabelled GH binding to the liver membrane were consistent with the levels of hepatic GHR mRNA expression. Serum concentrations of IGF-I were positively correlated with hepatic IGF-I mRNA and GHR mRNA expressions. The correlation coefficient between serum T3 levels and hepatic IGF-I mRNA expressions was also significant. These results indicate that thyroid hormones regulate IGF-I production in the chicken by affecting hepatic GHR expression.

[Simultaneous rupture of multiple intracranial aneurysms: a case report]

A rare case of simultaneous rupture of multiple aneurysms is reported. A 68-year-old man presented severe headache and vomiting and was transferred to our hospital. CT scan showed subarachnoid hemorrhage (SAH) in the interhemispheric fissure, the right basal cistern, the right sylvian fissure and intracerebral hemorrhage (ICH) in the paraventricle area. Continuation of the hemorrhage could not be detected between SAH and ICH on CT scan. Multiple aneurysms were detected by angiograms on the anterior communicating artery (A-com) and the bifurcation and the distal portion of the left middle cerebral artery (MCA). These findings suggested that SAH was due to a ruptured aneurysm of A-com, and ICH was due to a ruptured aneurysm of the distal portion of MCA. Simultaneous rupture of multiple aneurysms was confirmed by surgical findings. This case indicates that the usual assumption of a single aneurysm rupture in a patient with multiple aneurysms may be erroneous.

Cerebral gumma mimicking glioblastoma on magnetic resonance images--case report

A 39-year-old female presented with a syphilitic cerebral gumma mimicking small glioblastoma multiforme manifesting as visual impairment. Magnetic resonance imaging showed a low signal intensity area on T1-weighted images and marked small ring-like enhancement less than 1 cm in diameter following the administration of gadolinium. The symptoms and radiological abnormalities improved several weeks after penicillin therapy. The small ring-like enhancement was probably caused by inflammation associated with treponemal infection. A mass with a small ring-like enhancement less than 1 cm in diameter is a useful finding indicating an inflammatory lesion rather than a glial tumor.

Intrasyringal hemorrhage of the cervical cord associated with Chiari type I malformation--case report

A 34-year-old male presented with intrasyringal hemorrhage associated with Chiari type I malformation manifesting as a history of repetitive severe pain around his neck and back and progressive sensory disturbance. Magnetic resonance imaging clearly demonstrated syringomyelia at the cervical region associated with Chiari type I malformation and hemorrhage in the syrinx which was strongly suggestive of bleeding into pre-existing syringomyelia or Gowers' syringal hemorrhage. Irrigation of the syrinx and syringosubarachnoid shunting were performed, but rebleeding occurred causing shunt malfunction. Shunt revision was performed, but a new cavity developed above the original syrinx. Foramen magnum decompression resulted in successful reduction of the new syrinx and subsequent neurological improvement. Simultaneous foramen magnum decompression and syrinx irrigation may be a better approach to treat this disease.

Effects of acidic fibroblast growth factor on neuronal activity of the parvocellular part in rat paraventricular nucleus

The effects of acidic fibroblast growth factor (aFGF) and its amino-terminal and carboxyl-terminal fragments (aFGF(1-15) and aFGF(114-140), respectively were examined on the neuronal activity in the parvocellular part of the paraventricular nucleus. As well known, this part contains a lot of corticotropin-releasing factor (CRF)-immunoreactive neurons. Application of 1 pg/ml and 2 pg/ml aFGF produced responses in 29.7% and 46.7% of neurons tested, respectively. Half or more than half of the responding neurons increased their discharge rate. Application of 0.2 ng/ml and 0.4 ng/ml aFGF(1-15) (1-15) also elicited response in 46.2% and 68.8% of neurons tested, respectively. Of these responding neurons, more than two third increased their firing rate. However, most of neurons tested for 0.67 ng/ml and 1.33 ng/ml aFGF(114-140) did not respond. Results suggest that aFGF and aFGF(1-15) promote the release of CRF through the activation of CRF-containing neurons.

Successful reconstruction for combined tracheal and bronchial disruption

After a head-on automobile collision, a 21-year-old man was admitted with respiratory distress and subcutaneous emphysema. Bronchoscopy revealed a disruption of the trachea and a complete transection of the intermediate bronchus. A right posterolateral thoracotomy was performed, and both lesions were reconstructed primarily using absorbable materials.

Portable digital subtraction angiography in the operating room and intensive care unit

A simple, inexpensive method of portable digital subtraction angiography (DSA) using an image processor (Sigma X), still-videorecorder and control panel combined with a surgical x-ray television unit can provide real time subtraction images on the monitor. This portable DSA unit was used in 161 cases (130 in the operating room and 31 in the intensive care unit). In the operating room it is useful: 1) to confirm patency of the parent artery and its branches after aneurysm clipping, 2) to identify feeding arteries of arteriovenous malformation and to confirm total extirpation, 3) to confirm the patency of extracranial-intracranial bypass, 4) to confirm patency of the internal carotid artery and absence of flap formation after carotid endarterectomy. In the intensive care unit, it is particularly useful for visualizing cerebral vasospasm after subarachnoid hemorrhage and recanalization of an occluded major intracranial artery. Absence of intracranial circulation can be demonstrated in patients with suspected brain death.

Radiolucent osteoma of the skull: case report

A rare case of a radiolucent osteoma of the skull is reported. The radiological and pathological findings of this lesion, including magnetic resonance imaging findings, are presented, and the efficacy of magnetic resonance imaging for the diagnosis of this skull tumor is evaluated. The differential diagnosis of radiolucent bone tumors is discussed.

[Intraoperative evaluation of carotid endarterectomy with electromagnetic flowmetry and portable DSA]

In order to perform carotid endarterectomy more safely, we have evaluated, intraoperatively, the result of an operation with electromagnetic flowmeter and portable digital subtraction angiography (DSA). During surgery, flow of the exposed internal and common carotid artery was measured with an electromagnetic flowmeter, before and after endarterectomy. After the closure of the arteriotomy, portable DSA was carried out by injecting contrast medium from the common carotid artery. Our simple portable DSA system consists of a surgical X-ray television set, image processor (Sigma X) and still video-recorder. This system almost gives us a real-time presentation of a subtracted view of angiography. There were twenty patients including one patient with major stroke, 14 with minor stroke, three with transient ischemic attack, and two asymptomatic patients. Increase of the flow through the internal carotid artery was documented with an electromagnetic flow-meter in 13 of 20 patients following endarterectomy. Flow reduction was seen in two patients, one of whom was found to have an intimal flap from residual plaque visualized in the portable DSA. The plaque was removed by reopening the artery. Among twenty patients, intraoperative portable DSA showed an intimal flap in three patients and a step in four patients. Although the incidence of abnormal findings was high, degree of abnormality was not severe enough to reopen the artery except in one case. The purposes of carotid endarterectomy is two-fold. It is used for the removal of the plaques which can be a source of emboli, and also for the augmentation of flow in the narrowed segment of the artery.(ABSTRACT TRUNCATED AT 250 WORDS)