Stage III Chorioamnionitis Is Associated with Reduced Risk of Severe Retinopathy of Prematurity

OBJECTIVE

To identify whether histologically confirmed chorioamnionitis (hCAM) is associated with development of retinopathy of prematurity (ROP).

STUDY DESIGN

We retrospectively analyzed two different cohorts. Cohort 1 was the national database of newborns in Japan born at ≤1500g or <32 weeks' gestation (January 2003 through April 2021, n=38,013). Cohort 2 was babies born at <1500g from a single institution in Tsuchiura, Japan, (April 2015 through March 2018, n=118).

RESULTS

For Cohort1, after adjusting for potential confounders, stage III CAM (n=5,554) was associated with lower odds of severe ROP (stage ≥3 or required peripheral retinal ablation) by 14% (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.78-0.94]. CAM of stage I (n=3,277) and II (N=4,319) was not associated with the risk of ROP. For Cohort 2, the odds of severe ROP were significantly reduced in moderate to severe hCAM groups (stage II, OR: 0.06, 95% CI: 0.05-0.82; stage III, OR: 0.10, 95% CI: 0.01-0.84). Neonates with funisitis, comorbidity of hCAM, and a finding of fetal inflammatory response had lower odds of severe ROP (OR: 0.11; 95% CI: 0.01-0.93).

CONCLUSIONS

After adjusting for confounders, severe hCAM with fetal inflammatory response was associated with reduced risk of ROP.

Transcriptome analysis of umbilical cord mesenchymal stem cells revealed fetal programming due to chorioamnionitis

Although chorioamnionitis (CAM) has been demonstrated to be associated with numerous short- and long-term morbidities, the precise mechanisms remain unclear. One of the reasons for this is the lack of appropriate models for analyzing the relationship between the fetal environment and chorioamnionitis and fetal programming in humans. In this study, we aimed to clarify the fetal programming caused by CAM using the gene expression profiles of UCMSCs. From nine preterm neonates with CAM (n = 4) or without CAM (n = 5), we established UCMSCs. The gene expression profiles obtained by RNA-seq analysis revealed distinctive changes in the CAM group USMSCs. The UCMSCs in the CAM group had a myofibroblast-like phenotype with significantly increased expression levels of myofibroblast-related genes, including α-smooth muscle actin (p < 0.05). In the pathway analysis, the genes involved in DNA replication and G1 to S cell cycle control were remarkably decreased, suggesting that cellular proliferation was impaired, as confirmed by the cellular proliferation assay (p < 0.01–0.05). Pathway analysis revealed that genes related to white fat cell differentiation were significantly increased. Our results could explain the long-term outcomes of patients who were exposed to CAM and revealed that UCMSCs could be an in vitro model of fetal programming affected by CAM.

Effects of polypharmacy on the prevalence of adverse drug events resulting in outpatient visits and hospitalization

A high proportion of hospitalizations is attributable to the prevalence of adverse drug events. This retrospective study included outpatients and inpatients to determine the prevalence of adverse drug events and if polypharmacy increases it. The prevalence, classification, and causality of adverse drug events were assessed based on medical records, laboratory values, and other data. Multivariate analysis (multiple logistic regression analysis) was performed with the presence or absence of adverse drug events at the time of the visit as the dependent variable and items for which the P-value was <0.25 in the univariate analysis as independent variables. The prevalence of adverse drug events was 13.0%, 10.9%, and 16.0% among all patients, the outpatient group, and the inpatient group, respectively. Multivariate analysis showed that polypharmacy (≥5 drugs) significantly increased the risk of adverse drug events in all patients. The prevalence of adverse drug events significantly increased with each additional drug used. We expect that minimizing the number of medications through moderation of the number of prescription drugs and elimination of polypharmacy will reduce the number of outpatient visits and hospitalizations due to adverse drug events.

Spectroscopic analysis in molecular simulations with discretized Wiener-Khinchin theorem for Fourier-Laplace transformation

The Wiener-Khinchin theorem for the Fourier-Laplace transformation (WKT-FLT) provides a robust method to obtain the single-side Fourier transforms of arbitrary time-domain relaxation functions (or autocorrelation functions). Moreover, by combining an on-the-fly algorithm with the WKT-FLT, the numerical calculations of various complex spectroscopic data in a wide frequency range become significantly more efficient. However, the discretized WKT-FLT equation, obtained simply by replacing the integrations with the discrete summations, always produces two artifacts in the frequency-domain relaxation function. In addition, the artifacts become more apparent in the frequency-domain response function converted from the relaxation function. We find the sources of these artifacts that are associated with the discretization of the WKT-FLT equation. Taking these sources into account, we derive discretized WKT-FLT equations designated for both the frequency-domain relaxation and response functions with the artifacts removed. The use of the discretized WKT-FLT equations with the on-the-fly algorithm is illustrated by a flow chart. We also give application examples for the wave-vector-dependent dynamic susceptibility in an isotropic amorphous polyethylene and the frequency-domain response functions of the orientation vectors in an n-alkane crystal.

Secondary prevention of diabetes through workplace health screening

Background

Workplace health screening offers a unique opportunity to assess individuals for type 2 diabetes mellitus.

Aims

To evaluate the association between workplace diabetes screening, subsequent diagnosis and changes in fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and body mass index (BMI) among individuals who screened positive for diabetes.

Methods

Employees without a prior diagnosis of diabetes participated in workplace health screening by 45 employers throughout the USA. Individuals screened positive for diabetes based on standard criteria (≥126 mg/dL FPG or ≥6.5% [48 mmol/mol] HbA1c). Diabetes diagnoses were identified after screening using claims-based ICD9-CM diagnosis codes. Discrete-time survival analysis estimated the monthly rate of new diabetes cases after screening, relative to the time period before screening. Paired t-tests evaluated 1-year changes in blood glucose measures and BMI among individuals with positive screenings.

Results

Of 22790 participating individuals, 900 (4%) screened positive for diabetes. A significantly greater rate of new diabetes diagnoses was observed during the first month after screening, compared to the 3-month period before screening (odds ratio [OR] 2.65, 95% confidence intervals [CIs] 2.02-3.47). Among 538 individuals with diabetes who returned for workplace screening 1 year later, significant improvements were observed in BMI (mean ± SD = -0.63 ± 2.56 kg/m2, P < 0.001) and FPG levels (mean ± SD = -9.3 ± 66.5 mg/dL, P < 0.01).

Conclusions

Workplace screening was associated with a reduction in the number of undiagnosed employees with diabetes and significant improvement in FPG and BMI at 1-year follow-up.

High dispersion and oxygen reduction reaction activity of Co3O4 nanoparticles on platelet-type carbon nanofibers

In this study, platelet-type carbon nanofibers prepared by the liquid phase carbonization of polymers in the pores of a porous anodic alumina template were used to prepare the Co₃O₄/carbon electrocatalysts.

In situ semi-quantitative analysis of zinc dissolution within nanoporous silicon by X-ray absorption fine-structure spectroscopy employing an X-ray compatible cell

The in situ study of the discharge process in a zinc-based half-cell employing a porous electrode as a structural scaffold is reported. The in situ characterization has been performed by synchrotron X-ray absorption fine-structure spectroscopy and, for this purpose, an inexpensive, simple and versatile electrochemical cell compatible with X-ray experiments has been designed and described. The experimental results reported here have been employed to semi-quantify the dissolved and undissolved zinc species during the discharge, allowing the cell feasibility to be tested and to better understand the functioning of the zinc half-cell based on porous electrodes.

Dynamic manipulation of the local pH within a nanopore triggered by surface-induced phase transition

Manipulating the local pH within nanopores is essential in nanofluidics technology and its applications.

Anamorelin (ONO-7643) in Japanese patients with non-small cell lung cancer and cachexia: results of a randomized phase 2 trial

Purpose

Cancer cachexia is characterized by decreased body weight (mainly lean body mass [LBM]) and negatively impacts quality of life (QOL) and prognosis. Anamorelin (ONO-7643) is a novel selective ghrelin receptor agonist under development for treating cancer cachexia.

Methods

In this double-blind, exploratory phase 2 trial, we examined the efficacy and safety of anamorelin in Japanese patients (n = 181) with non-small cell lung cancer (NSCLC) and cancer cachexia (≥5 % weight loss within the previous 6 months). The participants were randomized into three groups and were administered 50 or 100 mg anamorelin, or placebo, orally every day for 12 weeks. The co-primary endpoints were the changes from baseline over 12 weeks in LBM and handgrip strength (HGS). Secondary endpoints included body weight, QOL, Karnofsky Performance Scale (KPS), and serum biomarkers.

Results

The change in LBM over 12 weeks was 0.55 and 1.15 kg in the placebo and 100-mg anamorelin groups, respectively, but the efficacy of anamorelin in HGS was not detected. The changes in body weight were −0.93, 0.54, and 1.77 kg in the placebo, 50-mg anamorelin, and 100-mg anamorelin groups, respectively. Anamorelin (100 mg) significantly improved KPS and QOL-ACD compared with placebo. Administration of anamorelin for 12 weeks was well tolerated.

Conclusions

This phase 2 study showed that 100 mg anamorelin has promising results in improving lean body mass, performance status, and especially, QOL in patients with cancer cachexia.

Electronic supplementary material

The online version of this article (doi:10.1007/s00520-016-3144-z) contains supplementary material, which is available to authorized users.

Dipyridamole therapy in the nephrotic syndrome

Dipyridamole was used in 30 cases of nephrotic syndrome, mostly of intractable type. The results indicate that the drug therapy proved to be effective in decreasing urinary protein and controlling nephrotic condition in 40% of the cases after an initial period of treatment. Long-term results of the drug on urinary protein and on nephrotic condition were rated as good in 36.7 and 53.3%, respectively, of the cases treated. The exact mechanism of action of dipyridamole in the nephrotic syndrome is still obscure in many respects. However, the fact that the drug shares its anti-platelet action with the non-steroid anti-inflammatory drugs, e.g. aspirin and indomethacin, and the rapidity with which it produces its urinary protein-decreasing effect, strongly suggests that it inhibits the release of vasoactive amines and other chemical mediators from blood platelets. As far as the present study is concerned, adverse side effects of dipyridamole were few or minimal, even when the drug used in large doses over a prolonged period of time. From these results it is considered that dipyridamole provides a new remedy which is worthy of trying in nephrotic syndrome as a means of reducing the requirement of steroids and immunosuppressive drugs.

Antibody avidity for native DNA in lupus nephritis

To study the participation of the antibody avidity in the pathogenesis of lupus nephritis, we measured the antibody avidity to native DNA by the method of Minden and Farr (14) in patients with SLE. The avidity to native DNA was almost less than 40%. The avidity and the histological activity of lupus nephritis were well correlated; the antibody avidity of the active-group sera was higher than that of the inactive-group sera and the group without nephritis. In the group with antibodies of relatively high avidity, the complexes were deposited mainly in the subendothelial side of GBM and in the mesangium. On the other hand, in the group with low-avidity antibodies, the complexes were localized in the subepithelial side of GBM. On investigating the quality of the complexes, we noted that the complexes composed of high-avidity antibodies prepared in vitro were larger than those of low avidity and the former were larger than 19S. If the native-DNA-anti-native DNA system is the mechanism basic to lupus nephritis, the differences in immune response of the host, namely the degree of antibody avidity may greatly affect complex formation and influence the histological activity and nephritogenicity of lupus nephritis.

The structural classification of the highly disordered crystal phases of [Nn][BF4], [Nn][PF6], [Pn][BF4], and [Pn][PF6] salts (Nn(+) = tetraalkylammonium and Pn(+) = tetraalkylphosphonium)

The structures of 16 symmetric tetraalkylammonium (Nn(+)) and tetraalkylphosphonium (Pn(+)) salts ([Nn][BF4], [Nn][PF6], [Pn][BF4], and [Pn][PF6], where n = 1 to 4, and denotes the number of carbon atoms in each alkyl chain) have been investigated by X-ray diffraction in order to elucidate the effect of ion size on the disordered structure of organic salts. All the salts exhibit one or more solid-solid phase transitions in differential scanning calorimetric curves. Powder X-ray diffraction revealed that the highest temperature solid phase of these salts belongs to a crystal system with a high cubic or hexagonal symmetry. The structures are classified into 5 different types: CsCl', NaCl, NaCl', inverse NiAs, and TBPPF6. The CsCl'-type whose octant corresponds to the original CsCl unit cell is observed for [N1][PF6] owing to the orientational difference for the cation or the anion. The NaCl-type structure is observed for the N2(+) and P2(+) salts while the NaCl'-type structure is observed for [N3][PF6], where the configuration of ions is based on the NaCl-type but the four equivalent positions in the original NaCl lattice split into two sets of equivalent positions (three and one). The inverse NiAs structure is observed for [P3][PF6]. Single-crystal X-ray diffraction reveals that the disordering of ions in [P4][PF6] becomes more significant with increasing temperature. The new structure of a cubic phase, the TBPPF6-type structure, is found for the salts with long alkyl chains. The structure is roughly determined at 333 K and the ions therein are highly disordered but not rotating. The validity of the radius ratio rule is confirmed through appropriate assessment of the ion size.

Real-time release monitoring for water content and mean particle size of granules in lab-sized fluid-bed granulator by near-infrared spectroscopy

Simultaneous real-time monitoring of water content and mean particle size in the powder bed of a fluidized-bed granulator was performed by near-infrared (NIR) spectroscopy through a window, and the findings were used to evaluate the granular properties.

Effect of gaiters on muscle pump activity in healthy volunteers

OBJECTIVES

Exercise of the leg with external limb compression has been reported to be useful for preventing and reducing leg oedema. The aim of this study was to investigate the effects of leg gaiters on calf muscle pump activity.

METHODS

Continuous measurements of the interface pressure at the leg during exercise and determination of the femoral venous velocity at the groin during exercise were carried out in healthy volunteers with elastic stockings alone, leg gaiters alone and gaiters over the elastic stockings.

RESULTS

The greatest pressure difference between muscle contraction and relaxation during exercise was observed when gaiters were applied over the elastic stockings at the calf. Gaiters alone without elastic stockings led to a significantly greater pressure difference between muscle contraction and relaxation during exercise than elastic stockings alone (P < 0.01). A significantly higher value of the peak flow velocity of the femoral vein was observed with the combined use of gaiters and elastic stockings than the single use of elastic stockings.

CONCLUSIONS

Leg gaiters have a beneficial effect of augmenting venous femoral blood flow during calf muscle pump activity in volunteers with a normal valve function of leg veins.

Interface pressure is affected by slippage of bandages at thigh

AIM

Very little is known about how compression bandages lose interface pressure. We hypothesized that the loss of interface pressure is correlated with the slippage of the bandages, and studied the interface pressure and slippage of three bandages over 8 hours.

METHODS

Twenty-Seven legs from 27 healthy volunteers were bandaged with short stretch bandages (SS), cohesive short stretch bandages (CS), and long stretch bandages (LS). Pressure sensors were placed above the ankle (B1), below the knee (D), and mid thigh (F). Interface pressures in a sitting position were recorded at the beginning, and 4 and 8 hours later. In 17 legs, the pressure sensor sites were marked, and their heights were measured on standing upright.

RESULTS

SS and CS lost interface pressure quickly, but LS maintained pressure better than SS and CS at all sites. There was no pressure difference between SS and CS at the lower leg. However, CS maintained pressure better than SS at the mid thigh (44.6% vs. 54.4% pressure loss at 8 hours, respectively. P=0.037). There was a tendency toward less slippage with CS than SS at the mid thigh. In CS and LS, there was a linear correlation between the slippage of bandages and the interface pressure at the mid thigh (P <.01, in both).

CONCLUSION

The interface pressure may be affected by the slippage of bandages at the thigh, but not at the lower leg. Cohesive short stretch bandages may exert their beneficial impact at the thigh.

[Assessment of contracted bladder following intravesical instillation of BCG (Japan)]

We assessed a situation concerning contracted bladder following intravesical instillation of BCG(Japan), to investigate how the disease could be prevented. Between March 1997 and June 2010, we selected 20 patients with clinically or pathologically confirmed contracted bladder to participate in the study. The incidence of contracted bladder tended to be higher for patients who had received more than 5 doses of BCG. Repeated severe bladder irritation caused by intravesical BCG instillation was suggested to be the major factor leading to contracted bladder. To prevent the onset of contracted bladder and its progression resulting in total cystectomy, BCG instillation should be discontinued in patients who have received the instillation many times and have developed persistent severe bladder irritation with significantly reduced bladder capacity. It is necessary to consider the administration of antituberculotic and steroid therapy for these patients quickly.

Development of separated elastic stockings

Objectives

To investigate the acceptability of newly developed separated elastic stockings, which are divided into two portions at the ankle.

Methods

The difficulty in putting on and taking off stockings was compared between the original or modified separated stockings with various techniques in order to reduce the shift of the stockings and current non-separated stockings in healthy volunteers and patients with lymphoedema by applying both stockings alternately. In the modified model, the shift during daily activities was measured in healthy volunteers and patients with lymphoedema.

Results

The two items, ‘easier compared with non-separated stockings’ and ‘much easier’, were chosen at rates of 75% and 81% for putting on and taking off stockings for the original separated stockings and 75% and 75% for the modified separated stockings, respectively. Complaints during daily activities with the modified type to the stockings decreased as compared with the original type. The shift of stockings after an average 11-hour application was 1.6 ± 3.0 SD mm (range: 0–10 mm).

Conclusions

Modified separated elastic stockings are easier to put on and take off compared with current non-separated stockings, and they can be used safely because of their low-level shift during daily activities.

Interface pressure and stiffness in different combinations of compression material

Objectives

To compare the interface pressure and stiffness between various combinations of compression material.

Methods

Using a stiffness-determining device, the interface pressure and stiffness were determined in several combinations of five elastic stockings and two elastic bandages.

Results

In the double stockings system, the interface pressure increased significantly and the highest stiffness was observed in double short-stretch stockings. When short-stretch bandages were applied over either short- or long-stretch stockings, a significant increase in stiffness was observed at any initial pressure compared with the single use of short-stretch stockings. In double bandage systems, when short-stretch bandages were applied over either short- or long-stretch bandages, the stiffness increased significantly. When long-stretch bandages were used over short-stretch bandages, the stiffness decreased significantly.

Conclusions

The stiffness is changeable according to the combinations of material, such as double stockings, double bandages and the wearing of bandages over stockings. The use of short-stretch bandages as the outside layer produces the highest stiffness at a high initial pressure.

Improvement of a three-dimensional measurement system for the evaluation of foot edema

BACKGROUND/AIMS

This study investigated the accuracy and usefulness of a newly improved three-dimensional measurement system for measuring the volume and circumference at the foot as well as at the calf and ankle.

METHODS

Regarding the newly improved device, halogen light was projected from four directions instead of the conventional two directions. The circumference and volume were measured in the morning and evening with and without elastic stockings in 23 healthy subjects.

RESULTS

The average circumference at the foot calculated using the 'average method', in which the circumference of the foot was measured in 10 places every 1 mm and the values were averaged, significantly increased in the evening compared with in the morning. When stockings were applied, the significant differences in the circumference or volume between the morning and evening disappeared at all sites of the leg.

CONCLUSION

The newly improved three-dimensional measurement system incorporating the halogen light from four directions, in which the foot circumference was calculated using an 'average method', was reliable and useful for evaluating edema at the foot as well as at the calf and ankle. The beneficial effect of elastic stockings on edema prevention was observed at all sites of the leg.

Regional rates of neocortical atrophy from normal aging to early Alzheimer disease

OBJECTIVE

To evaluate the spatial pattern and regional rates of neocortical atrophy from normal aging to early Alzheimer disease (AD).

METHODS

Longitudinal MRI data were analyzed using high-throughput image analysis procedures for 472 individuals diagnosed as normal, mild cognitive impairment (MCI), or AD. Participants were divided into 4 groups based on Clinical Dementia Rating Sum of Boxes score (CDR-SB). Annual atrophy rates were derived by calculating percent cortical volume loss between baseline and 12-month scans. Repeated-measures analyses of covariance were used to evaluate group differences in atrophy rates across regions as a function of impairment. Planned comparisons were used to evaluate the change in atrophy rates across levels of disease severity.

RESULTS

In patients with MCI-CDR-SB 0.5-1, annual atrophy rates were greatest in medial temporal, middle and inferior lateral temporal, inferior parietal, and posterior cingulate. With increased impairment (MCI-CDR-SB 1.5-2.5), atrophy spread to parietal, frontal, and lateral occipital cortex, followed by anterior cingulate cortex. Analysis of regional trajectories revealed increasing rates of atrophy across all neocortical regions with clinical impairment. However, increases in atrophy rates were greater in early disease within medial temporal cortex, whereas increases in atrophy rates were greater at later stages in prefrontal, parietal, posterior temporal, parietal, and cingulate cortex.

CONCLUSIONS

Atrophy is not uniform across regions, nor does it follow a linear trajectory. Knowledge of the spatial pattern and rate of decline across the spectrum from normal aging to Alzheimer disease can provide valuable information for detecting early disease and monitoring treatment effects at different stages of disease progression.

[Osteitis as a complication of BCG vaccination]

OBJECTIVES

To investigate the incidence and increasing tendency of osteitis after BCG vaccination and, in addition, its clinical features, diagnostic methods and results of treatment.

SUBJECTS

22 cases of Japanese children who received BCG vaccination between 1998 and 2007 and developed osteitis, and were reported in medical journals or meetings.

RESULTS AND DISCUSSION

Incidence was very low, 0.2 per 100,000 vaccinations, and an increasing tendency was not seen after 2005, when the vaccination in Japan was limited to below 6 months after birth. However, it might be necessary to follow for much longer period. About 73% of cases of osteitis were seen from 9 to 18 months after receiving the vaccination. The bones of the extremities were commonly affected. Radiography usually showed the defect and cavity formation of the affected bone and often abscess around the lesion. Definitive diagnosis was made by the detection of BCG from the pus or biopsied materials. Recently, multiplex PCR method have been utilized and proved to be a rapid and reliable diagnostic method. Tuberculin reaction was positive, but QFT was negative in all tested cases; QFT will be available for the differential diagnosis of BCG and tuberculous infection. Only 2 patients had multiple lesions, and they had partial interferon-gamma receptor 1 deficiency. Immunodeficiency might have some relationship to the development of osteitis after BCG vaccination. The treatment using INH and RFP was very effective and the outcome was favorable; most of the patients were cured after 6 to 12 months chemotherapy without any complications. However, there is the possibility of defects occurring in the bone and restriction of the articular movement when the diagnosis and treatment are delayed.

CONCLUSION

BCG osteitis, although rare, should be considered as a possible complication of the BCG vaccination, and early diagnosis and treatment of this complication is necessary.

Whole genome sequence analysis of Mycobacterium bovis bacillus Calmette-Guérin (BCG) Tokyo 172: a comparative study of BCG vaccine substrains

To investigate the molecular characteristics of bacillus Calmette-Guérin (BCG) vaccines, the complete genomic sequence of Mycobacterium bovis BCG Tokyo 172 was determined, and the results were compared with those for BCG Pasteur and other M. tuberculosis complex. The genome of BCG Tokyo had a length of 4,371,711bp and contained 4033 genes, including 3950 genes coding for proteins (CDS). There were 18 regions of difference (showing differences of more than 20bp), 20 insertion or deletion (ins/del) mutations of less than 20bp, and 68 SNPs between the two BCG substrains. These findings are useful for better understanding of the genetic differences in BCG substrains due to in vitro evolution of BCG.

Pseudo-subarachnoid hemorrhage found in patients with postresuscitation encephalopathy: characteristics of CT findings and clinical importance

BACKGROUND AND PURPOSE

High-attenuation areas (HDAs) called pseudo-subarachnoid hemorrhages (SAHs) may develop in some patients resuscitated from cardiopulmonary arrest (CPA), though no hemorrhage has occurred. We investigated the imaging characteristics and clinical significance of this phenomenon.

MATERIALS AND METHODS

CT images of consecutive patients resuscitated from nontraumatic CPA were reviewed and classified into cases with pseudo-SAH (pseudo-SAH[+] group, n = 9), those without pseudo-SAH (pseudo-SAH[-] group, n = 28), and those with true SAH (SAH-CPA group, n = 8). Typical patients with SAH (SAH group, n = 13) and 20 healthy individuals were also extracted as control groups. The degree of brain edema was scored visually as none, mild, or severe, and the CT values of the HDAs and brain parenchyma were measured. These parameters were compared among the groups. We also compared the prognosis between the pseudo-SAH(+) and pseudo-SAH(-) groups.

RESULTS

On CT, pseudo-SAH was associated with severe brain edema, whereas there was mild or no edema without pseudo-SAH. The CT values of the HDAs in the pseudo-SAH(+) group were significantly lower than those of the CPA-SAH and SAH groups (P < .0001). The brain parenchyma of the pseudo-SAH(+) group had the lowest CT values among all of the groups (P < .0001). The prognosis of the pseudo-SAH(+) group was significantly poorer than that of the pseudo-SAH(-) group in terms of both clinical outcome (P = .02) and survival (P = .046).

CONCLUSION

The findings of pseudo-SAH have several imaging characteristics differing from SAH and predict a poor prognosis. This provides important information that can be used for deciding treatment strategies.

Event-related potentials reflect spectral differences in speech and non-speech stimuli in children and adults

OBJECTIVE

Event-related brain potentials (ERP) may provide tools for examining normal and abnormal language development. To clarify functional significance of auditory ERPs, we examined ERP indices of spectral differences in speech and non-speech sounds.

METHODS

Three Spectral Items (BA, DA, GA) were presented as three Stimulus Types: syllables, non-phonetics, and consonant-vowel transitions (CVT). Fourteen 7- to 10-year-old children and 14 adults were presented with equiprobable Spectral Item sequences blocked by Stimulus Type.

RESULTS

Spectral Item effect appeared as P1, P2, N2, and N4 amplitude variations. The P2 was sensitive to all Stimulus Types in both groups. In adults, the P1 was also sensitive to transitions while the N4 was sensitive to syllables. In children, only the 50-ms CVT stimuli elicited N2 and N4 spectral effects. In both groups, non-phonetic stimuli elicited larger N1-P2 amplitudes while speech stimuli elicited larger N2-N4 amplitudes.

CONCLUSIONS

Auditory feature processing is reflected by P1-P2 and N2-N4 peaks and matures earlier than supra-sensory integrative mechanisms, reflected by N1-P2 peaks. Auditory P2 appears to pertain to both processing types.

SIGNIFICANCE

These results delineate an orderly processing organization whereby direct feature mapping occurs earlier in processing and, in part, serves sound detection whereas relational mapping occurs later in processing and serves sound identification.

Pelvic body composition measurements by quantitative computed tomography: association with recent hip fracture

INTRODUCTION

Loss of subcutaneous fat, decreased muscle cross-sectional area (CSA) and increased muscle adiposity are related to declining physical function and disability in the elderly, but there is little information about the relationship of these tissue changes to hip fracture. Thus we have compared body composition measures in women with hip fractures to age-matched controls, using quantitative computed tomography (QCT) imaging of the hip to characterize total adiposity, muscle CSA and muscle attenuation coefficient, a measure of adiposity.

MATERIALS AND METHODS

45 Chinese women (mean age 74.71+/-5.94) with hip fractures were compared to 66 healthy control subjects (mean age 70.70+/-4.66). Hip QCT scans were analyzed to compute total adipose CSA as well as CSA and attenuation values of muscle groups in the CT scan field of view, including hip extensors, abductors, adductors and flexors. The total femur areal BMD (aBMD) was estimated from the QCT images. Logistic regression was employed to compare body composition measures between fracture subjects and controls after adjustment for age, height, BMI and aBMD. Receiver-operator curve (ROC) analyses determined whether combinations of aBMD and body composition had higher area under curve (AUC) than aBMD alone.

RESULTS AND CONCLUSIONS

Fracture subjects had lower fat CSA (p<0.0001) than controls but had higher muscle adiposity as indicated by lower attenuation in the adductor, abductor and flexor groups (0.00001<p<0.02). Fracture subjects also had lower extensor and adductor CSA values (p<0.0001). After age and BMI adjustment, the total fat CSA, the extensor and adductor CSA values, and the adductor attenuation values remained significantly lower in the fracture subjects (0.001<p<0.05). In ROC analyses, models combining aBMD with soft tissue measures had higher AUC than models containing only BMD (0.001<p<0.05). Combining body composition with skeletal measures may improve fracture prediction compared to bone measures alone.

The EEG measurement technique under exercising

Our purpose of the research is a development of the detecting method of EEG under exercising. Usually, measuring EEG is done in the quiet state. In case of the measuring EEG under exercising, a movement of the body causes vibration of electrodes and artifact for the EEG. Therefore, generally detection of the EEG under exercising is said to be difficult. So, we developed the measuring method of EEG under exercising by using algorithm that we designed. Five normal subjects were tested with our method, and EEG without artifact was able to be measured in all cases.

Anti-tuberculosis drug susceptibility testing of Mycobacterium bovis BCG Tokyo strain

SETTING

The Mycobacterium bovis bacille Calmette-Guérin (BCG) vaccine is the only vaccine against tuberculosis (TB), owing to its valuable protective effects and low virulence. However, it can occasionally cause systemic infection in immunocompromised hosts. Isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol (EMB) are known to be effective anti-tuberculosis drugs and are used for the treatment of BCG infections. Unfortunately, there are few studies of the susceptibility of BCG vaccine strains to these drugs.

OBJECTIVE

To measure the minimum inhibitory concentrations (MICs) of BCG Tokyo vaccine products for anti-tuberculosis drugs and assess vaccine safety in terms of drug susceptibility.

DESIGN

We measured the MIC for one seed and five product lots of BCG Tokyo strain for INH, RMP, SM and EMB using Middlebrook 7H11 agar plates.

RESULTS

The MIC results for INH were 0.06 and 0.125 mg/ml for the product and seed lots, respectively. The MIC results for RMP, SM and EMB were 0.25-0.5, 0.25 and 2-4 microg/ml, respectively.

CONCLUSION

Our results indicate that the BCG Tokyo strain was susceptible to the major anti-tuberculosis drugs and treatable even in cases of severe adverse events, including systemic infection.

Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study

The purpose of this study was to explore risk factors affecting the incidence of chronic kidney disease (CKD) in general population. We conducted a 10-year follow-up study with 123 764 (male: 41 012, female: 82 752) adults aged 40 years and over who received community-based annual examinations. The primary outcome for the analysis was the development of CKD during the follow-up period. Predictors for the development of CKD were obtained by the significant hazard ratios (HR) in Cox regression model by sex. During the follow-up period, 4307 subjects (male: 2048, female: 2259) developed CKD stage I or II, and 19 411 subjects (male: 4257, female: 15 154) developed CKD stage III or higher. The baseline-adjusted predictor of developing CKD included age, glomerular filtration rate, hematuria, hypertension, diabetes, serum lipids, obesity, smoking status, and consumption of alcohol. Treated diabetes in male subjects, and treated hypertension, systolic blood pressure >160 mm Hg and/or diastolic blood pressure >100 mm Hg, diabetes, and treated diabetes in female subjects were associated with more than a doubling of the HR. For the development of CKD stage III or higher, proteinuria of >or= + +, and proteinuria and hematuria were associated with more than a doubling of the HR in male subjects. The prevalence of newly developed CKD over 10 years was 23 718 subjects (19.2%) in adults. This study suggested that not only hypertension and diabetes but also several metabolic abnormalities were independent risk factors for developing CKD.

Mitochondrial dysfunction in focal segmental glomerulosclerosis of puromycin aminonucleoside nephrosis

Focal segmental glomerular sclerosis (FSGS) is a major renal complication of mitochondrial (mt) cytopathies. The present study was designed to investigate the possibility of mtDNA lesion accumulation in podocytes, which are a primary pathogenic site of FSGS, during the development of glomerulopathy in puromycin aminonucleoside nephrosis (PAN). Two renal pathological phases of PAN, nephrosis phase and FSGS phase were studied. We investigated the expression of mt proteins, the copy number of a 4834 base-pair deletion (del-mtDNA), and total mtDNA content by real-time polymerase chain reaction, as well as the mRNA expression levels of the mt transcription factor A (mtTFA) and the nuclear respiratory factor-1 (NRF-1) in glomeruli. The mtDNA encoded cytochrome c oxidase subunit I (COX I) protein level was identical to control in nephrosis phase, however, a 45% reduction was seen in FSGS phase. Intraglomerular del-mtDNA was 16-21 times higher than controls in both phases, but the proportion of this mutation was <1% of total mtDNA. The copy number of total mtDNA at nephrosis phase increased up to 241%, whereas, it decreased to 34% at FSGS phase in glomeruli. The mRNA expression of both mtTFA and NRF-1 was upregulated at nephrosis phase, but mtTFA was downregulated at FSGS phase. A reduction in mtDNA copy number resulted in reduced levels of COX I in glomeruli at FSGS phase, suggesting that mt dysfunction by mtDNA depletion potentially plays a key role in the pathogenesis of FSGS in PAN.

Identification of two subpopulations of Bacillus Calmette-Guérin (BCG) Tokyo172 substrain with different RD16 regions

Two types of colonies with different morphologies (smooth: S and rough: R) formed when Bacillus Calmette-Guérin (BCG) Tokyo172 substrain was cultured on Middlebrook 7H10 agar medium, and their genotypes were analyzed by multiplex PCR on five RD regions and SenX3-RegX3. In most cases these two colony types had different genotypes, i.e., S colonies showed a characteristic 22 bp deletion in Rv3405c of the RD16 region (type I), and R colonies did not have this deletion (type II) similar to many other BCG substrains. Thus, there was a strong relationship between colony morphology and genotype. Both genotypes were found in every Tokyo172 preparation tested, including the seed lot for production, the origin of seed lot from the 1960s and ATCC BCG Japan. Type I was always in the majority. It was suggested that types I and II constituted independent subpopulations within the Tokyo172 substrain. Type I was shown to have a growth advantage over type II both on culture media and in mice organs.

Crescentic glomerulonephritis associated with renal cell carcinoma after cancer immunotherapy

A 59 year-old woman showed rapidly progressive glomerulonephritis during immunotherapy for metastatic renal cell carcinoma. She received unilateral nephrectomy and cytotoxic T lymphocyte (CTL) therapy for the treatment of retroperitoneal lymph node metastasis of renal cell carcinoma. With CTL therapy, her retroperitoneal lymph node mass decreased in size. One year after the third round of CTL therapy, her serum creatinine was increased and massive proteinuria occurred. Her renal biopsy specimen revealed necrotizing and crescentic glomerulonephritis with immune complex deposition. Her retroperitoneal lymph node mass continued to decrease in size. Consequently, for the purpose of avoiding interfering with the CTL therapy, we performed double filtration plasmapheresis (DFPP) monotherapy for removal of immune complexes without using immunosuppressive drugs or prednisolone. After 24 sessions of DFPP, her serum IgG was reduced from 3,942 mg/dL to 2,400 mg/dL, and proteinuria (from 9.0 g/day to 0.9 g/day) and renal function (serum creatinine; from 5.6 mg/dL to 2.2 mg/dL) also improved. However, 3 months after the final DFPP, she expired due to perforation of the colon. The autopsy sample of the kidney showed that most of the glomeruli were obsolescent, but immunoglobulin depositions were reduced and necrotizing lesions were diminished. In the patients with RPGN associated with renal cell carcinoma, renal functional recovery has not been observed upon immunosuppressive treatment. Consequently, plasmapheresis is considered to be one of the effective and safe methods for patients with this association. We also discuss previous reports of RPGN associated with renal cell carcinoma, or RPGN after cancer immunotherapy.