Attenuated Total Reflection Infrared and Far-Infrared, and Raman Spectroscopy Studies of Minerals, Rocks, and Biogenic Minerals

Attenuated total reflection infrared (ATR-IR, 4000-400 cm-1), ATR-far-IR (ATR-FIR, 400-50 cm-1), and Raman spectra (4000-10 cm-1) were measured for calcium carbonate, three kinds of minerals (calcite, aragonite, and quartz), two kinds of rocks (obsidian and pumice), and four kinds of biogenic minerals, i.e., coral (aragonite), Ruditapes philippinarum (aragonite), Meretrix lusoria (aragonite), and Corbicula japonica (aragonite), to investigate the polymorphism of minerals and biogenic minerals, differences in the crystal structure among aragonite and aragonite biogenic minerals, water in the minerals and biogenic minerals, Boson peaks of obsidian and pumice, very small amounts of carotenoids in the three kinds of shells, and so on. In this study, we put some emphasis on the low-frequency region of IR (FIR) and Raman spectra. ATR-FIR spectra were measured down to 50 cm-1 and Raman spectra were obtained down to 10 cm-1. Second derivative spectra were calculated for the FIR spectra. It has been found from the present study that the FIR spectra are the most powerful for exploring polymorphism and differences in the crystal structure among aragonite and aragonite biogenic minerals. A Boson peak, which is a characteristic low-frequency Raman band for amorphous materials, was observed at around 40 cm-1 in the Raman spectra of obsidian and pumice. The Boson peak of pumice is located at a lower frequency by 12 cm-1 than that of obsidian, indicating that the mean atomic volume of pumice is larger than that of obsidian. The present study has revealed that IR spectra are useful to investigate the amounts and structure of fluid and bound water. Moreover, it has also been found that Raman spectra can detect a very tiny amount of carotenoids in the shells due to the resonance Raman effect.

Occupational Fall Risk Assessment Tool for older workers

BACKGROUND

No easy-to-use fall risk assessment tools have been devised to assess occupational fall risk in older workers.

AIMS

To develop an Occupational Fall Risk Assessment Tool (OFRAT) and report its predictive validity and reliability in older workers.

METHODS

The baseline fall risk assessment was completed by 1113 participants aged ≥60 years who worked ≥4 days/month in Saitama, Japan. Participants were followed up for falls during occupational activities for 1 year, and 30 participants were assessed twice for test-retest reliability. The following assessment measures were summed to form the OFRAT risk score: older age, male sex, history of falls, physical work participation, diabetes, use of medications increasing fall risk, reduced vision, poor hearing, executive dysfunction and slow stepping. The scores were then classified into four grades (0-2 points: very low, 3 points: low, 4 points: moderate and ≥5 points: high).

RESULTS

During follow-up, 112 participants fell 214 times during work. The negative binomial regression model showed that participants with higher grades had a higher incidence rate ratio [95% confidence interval] for falls than those with very low grades (low: 1.64 [1.08-2.47], moderate: 4.23 [2.82-6.34] and high: 6.12 [3.83-9.76]). The intraclass correlation coefficient for risk score was 0.86 [0.72-0.93], and the weighted kappa coefficient for grade assessment was 0.74 [0.52-0.95].

CONCLUSIONS

The OFRAT is a valid and reliable tool for estimating the occupational fall risk in older workers. It may assist occupational physicians implement strategies to prevent falls in this group.

[A Case of Gallbladder Cancer with Long Survival Treated with Resection after Downstaging with GC Therapy]

A 68-year-old woman with a chief complaint of obstructive jaundice was referred to our hospital. She was diagnosed with gallbladder cancer with invasion to the liver, extrahepatic bile duct, right hepatic artery and portal vein. After endoscopic retrograde biliary drainage, she received chemotherapy with gemcitabine and cisplatin. After 9 courses, the size of the tumor and the lymph nodes decreased, and we planned surgery. There were no unresectable factors, and the right hepatic artery and portal vein were detached from the tumor. We performed a subtotal stomach-preserving pancreaticoduodenectomy and gallbladder bed resection. We then performed adjuvant chemotherapy with S-1 for 1 year. The patient remains alive without recurrence, 5 years after the surgery. We report the case of advanced gallbladder cancer with downstaging after GC therapy.

Fluorescence cholangiography for detection of a cystic duct drained into an accessory hepatic duct: A case report

INTRODUCTION

Laparoscopic cholecystectomy is a safe and standard procedure, but serious bile duct injury may occur due to anatomical anomalies of the biliary tract, especially the accessory hepatic duct. The use of intraoperative fluorescence cholangiography with indocyanine green during laparoscopic cholecystectomy can reportedly prevent bile duct injury.

PRESENTATION OF CASE

A 55-year-old woman with upper abdominal pain was referred to our hospital. Laboratory investigations revealed elevated leukocytes and biliary enzymes, while computed tomography demonstrated increased fatty tissue density around the gallbladder. Magnetic resonance cholangiopancreatography and drip infusion cholangiographic-computed tomography showed that the cystic duct drained into an accessory hepatic duct. Due to the diagnosis of cholelithiasis with a biliary anomaly, we performed laparoscopic cholecystectomy using fluorescence cholangiography with indocyanine green. We were able to recognize the accessory hepatic duct and cystic duct, then safely dissect the cystic duct without bile duct injury.

DISCUSSION

Laparoscopic cholecystectomy is generally regarded as a safe procedure, but complications and even mortalities can arise in patients with anatomical anomalies of the biliary tract. The aid of intraoperative fluorescence cholangiography with indocyanine green allowed to recognize and identify the accessory hepatic duct and cystic duct, allowing us to operate without injury to the bile duct.

CONCLUSIONS

Our experience supports the ease of use, safety, and effectivity of fluorescence cholangiography with indocyanine green. This may become the optimal standard technique to prevent bile duct injury.

Impact of pathological complete response following neoadjuvant chemotherapy (gemcitabine, nab-paclitaxel, S-1) and radiation for borderline resectable pancreatic cancer: a case report and review of literature

Background

Pancreatic cancer (PC) is a highly lethal malignancy, even if surgical resection is possible (median survival: < 30 months). The prognosis of borderline resectable pancreatic cancer (BR-PC) is even worse. There is no clear consensus on the optimal treatment strategy, including pre/postoperative therapy, for BR-PC. We report a patient with BR-PC who achieved clinical partial response with neoadjuvant chemoradiation therapy (NACRT) and underwent curative resection, resulting in pathological complete response (pCR).

Case presentation

A 71-year-old man with jaundice and liver dysfunction was referred to our department because of a 48-mm hypo-vascular mass in the pancreatic head with obstruction of the pancreatic and bile ducts and infiltration of superior mesenteric vein and portal vein. The lesion was identified as atypical cells which suggested adenocarcinoma by biopsy, and he was administered NACRT: gemcitabine and nab-paclitaxel, following S-1 and intensity modulated radiation therapy. After reduction in the tumor size (clinical partial response), pancreaticoduodenectomy was performed, and pCR achieved. Postoperative adjuvant chemotherapy with S-1 was initially administered and the patient is currently alive with no recurrence as of 2 years after surgery.

Conclusions

NACRT is a potentially useful treatment for BR-PC that may lead to pCR and help improve prognosis.

AB0439 COMPARATIVE EFFECTIVENESS OF RAPID AND CONVENTIONAL GLUCOCORTICOID TAPERING REGIMENS IN TREATING PATIENTS WITH PROLIFERATIVE LUPUS NEPHRITIS IN THE REAL WORLD SETTING

Background

Rapid glucocorticoid (GC) tapering is recommended for lupus nephritis (LN) by 2019 EULAR/ERA-EDTA recommendations [1]. However, slower conventional GC tapering regimen is still common in the real world setting, and it is controversial whether a rapid GC tapering regimen is as effective as the conventional regimen.

Objectives

We aimed to compare the renal outcomes between rapid and slower GC tapering regimens in patients with LN.

Methods

We retrospectively surveyed the medical records of 27 patients with proliferative LN (class Ⅲ or Ⅳ) at Kobe City Medical Center General Hospital. These patients were divided into two groups (rapid GC tapering group and conventional GC tapering group) according to GC dosage at month 6. Logistic regression analyses were performed to examine the association of GC tapering regimens with achievement of primary efficacy renal response (PERR) and complete renal response (CRR) which were defined by Furie et al. [2] at month 24.

Results

Twenty-seven patients (19 women and 8 men) with class Ⅲ or Ⅳ LN were included. The mean age was 43 years. The mean eGFR and urine protein-to-creatinine ratio at baseline were 66.7 mL/min/1.73m2 and 3.125 g/gCr, respectively. Concomitant class Ⅴ LN was present in 26.0%. The rapid GC tapering group (PSL≦10 mg/day at month 6) and the conventional GC tapering group (PSL>10 mg/day at month 6) were 11 and 16 patients, respectively. Baseline characteristics were balanced between the two groups except for use of cyclophosphamide or mycophenolate mofetil. Mean urine protein-to-creatinine ratio at month 24 were 0.46 g/gCr in the rapid GC tapering regimen group and 1.08 g/gCr in the conventional GC tapering regimen group (p=0.790). Achievements of PERR and CRR at month 24 were 54.0% and 43.8% in the rapid GC tapering group and 54.5% and 25.0% in the conventional GC tapering group, respectively. After adjustment of cyclophosphamide or mycophenolate mofetil usage and urine protein-to-creatinine ratio at baseline, adjusted odds ratio was 1.52 (95% confidence interval [0.126 to 18.29], p=0.743) and 2.99 (95% confidence interval [0.34 to 28.52], p=0.341), respectively.

Conclusion

Our results suggest rapid GC tapering regimen is as effective as conventional slower tapering regimen for patients with proliferative LN.

References

[1]Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis. Ann Rheum Dis 2020;79:713–723.

[2]Furie R, Rovin BH, Houssiau F, et al. Two-Year, Randomized, Controlled Trial of Belimumab in Lupus Nephritis. N Engl J Med 2020;383:1117–1128.

Table 1.

Baseline patients characteristics.

Rapid GC tapering group(n=11)Conventional GC tapering group(n=16)P valueAge – years41.7 ± 14.743.9 ± 16.20.863Female – no. (%)9 (81.8)10 (62.5)0.405Class Ⅲ LN – no. (%)6 (54.5)7 (43.8)0.704Class Ⅳ LN – no. (%)6 (45.5)9 (56.3)0.704Concomitant Class Ⅴ LN – no. (%)4 (36.4)3 (18.8)0.391Induction therapy (use of CY or MMF) – no. (%)10 (90.9)8 (50.0)0.042Serum creatinine – mg/dL1.15 ± 0.721.14 ± 0.800.882eGFR – mL/min/1.73m265.2 ± 39.067.8 ± 34.50.835UPCR – g/gCr3.29 ± 2.963.01 ± 3.250.604C3 – mg/dL41.1 ± 20.145.0 ± 21.50.639C4 – mg/dL6.8 ± 4.710.1 ± 8.00.346

GC, glucocorticoid; LN, lupus nephritis; UPCR, urine protein-to-creatinine ratio; CY, cyclophosphamide; MMF, mycophenolate mofetil

Disclosure of Interests

None declared

The cumulative incidence of and risk factors for morphometric severe vertebral fractures in Japanese men and women: the ROAD study third and fourth surveys

This population-based cohort study with a 3-year follow-up revealed that the annual incidence rates of vertebral fracture (VF) and severe VF (sVF) were 5.9%/year and 1.7%/year, respectively. The presence of mild VF at the baseline was a significant risk factor for incident sVF in participants without prevalent sVF.

INTRODUCTION

This study aimed to estimate the incidence of morphometric vertebral fracture (VF) and severe VF (sVF) in men and women and clarify whether the presence of a mild VF (mVF) increases the risk of incident sVF.

METHODS

Data from the population-based cohort study, entitled the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study, were analyzed. In total, 1190 participants aged ≥ 40 years (mean age, 65.0 ± 11.2) years completed whole-spine lateral radiography both at the third (2012-2013, baseline) and fourth surveys performed 3 years later (2015-2016, follow-up). VF was defined using Genant's semi-quantitative (SQ) method: VF as SQ ≥ 1, mVF as SQ = 1, and sVF as SQ ≥ 2. Cumulative incidence of VF and sVF was estimated. Multivariate logistic regression analyses were performed to evaluate risk factors for incident sVF.

RESULTS

The baseline prevalence of mVF and sVF were 16.8% and 6.0%, respectively. The annual incidence rates of VF and sVF were 5.9%/year and 1.7%/year, respectively. The annual incidence rates of sVF in participants without prevalent VF, with prevalent mVF, and with prevalent sVF were 0.6%/year, 3.8%/year, and 11.7%/year (p < 0.001), respectively. Multivariate logistic regression analyses in participants without prevalent sVF showed that the adjusted odds ratios for incident sVF were 4.12 [95% confident interval 1.85-9.16] and 4.53 [1.49-13.77] if the number of prevalent mVF at the baseline was 1 and ≥ 2, respectively.

CONCLUSIONS

The annual incidence rates of VF and sVF were 5.9%/year and 1.7%/year, respectively. The presence of prevalent mVF was an independent risk factor for incident sVF.

HLA Gene in 5 Cases of Liver Injury Related to Baikal Skullcap

HLA association with drug-induced liver injury has recently been pointed out about multiple medicines. The aim of this study was to evaluate relationship between HLA gene and liver injury related to Baikal skullcap-containing Kampo medicines (BSCK). We previously examined HLA genes in 3 cases of BSCK-induced liver injury. Recently we could encounter 2 cases diagnosed as "definitely-related case" of BSCK-induced liver injury. HLA genes of the 2 cases were analyzed by Sequencing Based Typing method with Next Generation Sequencer at HLA Laboratory in Kyoto. HLA-DPA1*02:02:02 and DPB1*05:01:01 were observed in the 2 cases: concordance was not observed in HLA-A, B, C, DRB1, DRB4, DQA1, or DQB1. The previous 3 cases of BSCK-induced liver injury had the same allele type to the 2 cases only in HLA-DPA1. Putting all these together, HLA-DPA1*02:02:02 was observed in common among 5 cases of BSCK-induced liver injury. HLA-DPA1*02:02:02 is possibly associated with BSCK-induced liver injury.

Mesh repair under the anterior lamina of the rectus sheath (MUAR) for abdominal incisional hernia

PURPOSE

Abdominal incisional hernia is a frequent complication of major abdominal operations. Our method of performing mesh repair under the anterior lamina of the rectus sheath (MUAR) involves placing mesh between the dorsal surface of the anterior rectus sheath and the rectus abdominis muscle. We evaluated the short-term and long-term outcomes of our MUAR method.

METHODS

The subjects of this retrospective study were 80 patients with abdominal incisional hernia, who underwent MUAR at our hospital between August, 2009 and September, 2018. We investigated the rate of recurrence and postoperative complications in these patients, who were followed-up postoperatively for at least 18 months. Patients who completed all visits were then followed-up further with questionnaires.

RESULTS

The recurrence rate after MUAR was 0%. Postoperative complications consisted of subcutaneous wound infections in two patients (2.5%), successfully treated with wound cleansing and antibiotics; and subcutaneous hematoma in three patients (3.8%), which was spontaneously absorbed in two patients, and removed in one. There were no other complications, such as seroma, intestinal obstruction, mesh infection and bulging, or prolonged postoperative pain.

CONCLUSION

Mesh repair under the anterior lamina of the rectus sheath is simple and safe with positive short-term and long-term outcomes, suggesting that it is a good option for incisional hernia repair.

A Multicenter, Prospective, Randomized, Placebo-Controlled, Double-Blind Study of a Novel Pain Management Device, AT-02, in Patients with Fibromyalgia

Objectives

Existing treatments for fibromyalgia have limited efficacy, and only a minority of individuals clinically respond to any single intervention. This study was a prospective, multicenter, randomized, double-blind, controlled clinical trial to evaluate the feasibility of alternating magnetic field therapy in fibromyalgia patients by comparing the Angel Touch device (AT-02) with a sham control (S-01).

Methods

Two sites enrolled 44 subjects with diagnosed fibromyalgia. After informed consent, subjects taking prohibited concomitant drugs underwent a washout period of two or more weeks. All subjects then began a one-week run-in period. Numerical rating scale (NRS) pain scores were collected without device intervention for one day, followed by S-01 application to four or more painful sites for 10 minutes at each site, twice daily for six days. Subjects were then randomized to AT-02 or S-01, applied to four or more painful sites for 10 minutes at each site, twice daily for eight weeks. NRS scores were obtained twice daily during the entire treatment period.

Results

The primary end point (change in NRS ± SD at week 8 vs baseline) was –0.94 ± 1.33 in the AT-02 group and –0.22 ± 1.38 in the S-01 group. A trend toward a between-group difference in eight-week NRS scores favored the AT-02 group (–0.73, 95% confidence interval = –1.56 to 0.11, P = 0.086). An adjusted repeated measure analysis detected a significant difference in NRS scores (P = 0.039).

Conclusions

The reduction in NRS scores for AT-02 relative to sham was comparable to reductions observed in meta-analyses of fibromyalgia drug therapy. The unadjusted results and the persistence of the pain score reductions remain encouraging.

Incidence rate and risk factors for radiographic hip osteoarthritis in Japanese men and women: a 10-year follow-up of the ROAD study

OBJECTIVE

To investigate the incidence and progression rate of radiographic hip osteoarthritis (OA) and its risk factors in Japanese men and women using a large-scale population of a nationwide cohort study, Research on Osteoarthritis/osteoporosis Against Disability (ROAD).

METHODS

From the baseline survey of the ROAD study, 2,975 participants (1,043 men and 1,932 women) aged 23-94 years (mean, 70.2 years) living in urban, mountainous, and coastal communities were followed up with hip radiography at 3, 7, and 10 years (mean follow-up, 7.1 years). Radiographs were scored using the Kellgren/Lawrence (K/L) grading system, and radiographic hip OA was defined as K/L ≥ 2. The incidence and progression rate of hip OA were examined. Acetabular dysplasia was defined as a central-edge angle <20°. Cox's proportional hazard model was used to assess risk factors for incident and progressive radiographic hip OA.

RESULTS

The incidence rate of radiographic hip OA was 5.6/1,000 person-years and 8.4/1,000 person-years in men and women, respectively. The progression rate of hip OA was 2.2/1,000 person-years and 6.0/1,000 person-years in men and women, respectively. The significant risk factors for incident hip OA were age, obesity, and acetabular dysplasia at baseline (hazard risk [HR] 1.05, 95% confidence interval [CI] 1.03-1.08; 1.78, 1.10-2.75; 2.06, 1.30-3.17, respectively). The significant risk factors for progressive hip OA were baseline hip pain and acetabular dysplasia (HR 5.68, 95%CI 1.07-22.61; 14.78, 3.66-56.06, respectively).

CONCLUSION

Continued longitudinal surveys of the ROAD study will contribute to knowledge about and potential prevention of incident and progressive hip OA.

A Study of Factors Associated with the Development of Pseudoaldosteronism in Outpatients

Objective: The development of pseudoaldosteronism is shown to be mainly associated with four factors: daily dose of glycyrrhiza (licorice), duration of glycyrrhiza use, body size, and age. Recently, direct bilirubinemia and hypoalbuminemia are newly reported as possible factors that trigger pseudoaldosteronism due to glycyrrhiza ingestion. Pseudoaldosteronism occurs in the presence of combinations of these factors; therefore, the importance of each factor on the tolerance to glycyrrhiza loading is still unclear. Methods: In seven patients (63-78 years old, six women) who developed pseudoaldosteronism due to ingestion of glycyrrhiza-containing Kampo extract in their clinic, serum albumin and direct bilirubin (D-bil) levels were investigated. In six women, the authors evaluated the correlations between daily dose of glycyrrhiza ingested and each factor: age, height, weight, body mass index, body surface area (BSA), and duration of ingestion (Pearson's correlation coefficient). Results: No patients had abnormal levels of serum albumin or D-bil around the time of the onset. In six women, the highest correlation coefficient was observed between BSA and the glycyrrhiza dose in Kampo extract at the onset of pseudoaldosteronism. Conclusions: The findings suggested that in elderly women, BSA should be considered first as a factor for predicting the development of pseudoaldosteronism.

Chlortetracycline, Oxytetracycline, and Tetracycline in Edible Animal Tissues, Liquid Chromatographic Method: Collaborative Study

Thirteen laboratories analyzed samples of edible animal tissues for tetracycline residues. The method included extraction of analytes into buffer, elution from a C18 solid-phase extraction (SPE) cartridge, and reversed-phase liquid chromatographic (LC) analysis, including use of a confirmation column. An additional laboratory, using an alternative LC assay based on a different sample cleanup, also analyzed the samples. Results showed the 2 methods are comparable. The LC method for determination of cholortetracycline, oxytetracycline, and tetracycline in edible animal tissues has been adopted by AOAC INTERNATIONAL. Results from 13 laboratories indicate that the method under study provides generally better results at the higher concentrations tested than at concentrations near the detection limit and that there is less problem with interferences in muscle tissue than in kidney. The method can achieve reliable results for analytes and matrixes studied at concentrations from 0.1 to 0.6 ppm and above, depending on the analyte-matrix combination, with generally better performance to be expected with muscle than with kidney. The poorer performance for fortified samples, particularly kidney, was attributed to additional homogenization steps required to prepare these samples. Recovery of analytes from different

Do sarcopenia and/or osteoporosis increase the risk of frailty? A 4-year observation of the second and third ROAD study surveys

In this 4-year follow-up study including 1083 subjects (≥ 60 years), the prevalence of frailty was estimated to be 5.6%; osteoporosis was found to be significantly associated with frailty. Moreover, the presence of both osteoporosis and sarcopenia increased the risk of frailty compared to the presence of osteoporosis or sarcopenia alone.

INTRODUCTION

This study aims to examine the contribution of sarcopenia and osteoporosis to the occurrence of frailty using 4-year follow-up information of a population-based cohort study.

METHODS

The second survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted between 2008 and 2010; 1083 subjects (aged ≥ 60 years, 372 men, 711 women) completed all examinations on frailty, sarcopenia, and osteoporosis, which were defined using Fried's definition, Asian Working Group for Sarcopenia criteria, and WHO criteria, respectively. The third survey was conducted between 2012 and 2013; 749 of 1083 individuals enrolled from the second survey (69.2%, 248 men, 501 women) completed assessments identical to those in the second survey.

RESULTS

The prevalence of frailty in the second survey was 5.6% (men, 3.8%; women, 6.6%). The cumulative incidence of frailty was 1.2%/year (men, 0.8%/year; women, 1.3%/year). After adjustment for confounding factors, logistic regression analysis indicated that osteoporosis was significantly associated with the occurrence of frailty (odds ratio, 3.07; 95% confidence interval, 1.26-7.36; p = 0.012). Moreover, the occurrence of frailty significantly increased according to the presence of osteoporosis and sarcopenia (odds ratio vs. neither osteoporosis nor sarcopenia: osteoporosis alone, 2.50; osteoporosis and sarcopenia, 5.80).

CONCLUSIONS

Preventing osteoporosis and coexistence of osteoporosis and sarcopenia may help reduce the risk of frailty.

An evidence-based review of pregabalin for the treatment of fibromyalgia

OBJECTIVES

Pregabalin, an α2-δ agonist, is approved for the treatment of fibromyalgia (FM) in the United States, Japan, and 37 other countries. The purpose of this article was to provide an in-depth, evidence-based summary of pregabalin for FM as demonstrated in randomized, placebo-controlled clinical studies, including open-label extensions, meta-analyses, combination studies and post-hoc analyses of clinical study data.

METHODS

PubMed was searched using the term "pregabalin AND fibromyalgia" and the Cochrane Library with the term "pregabalin". Both searches were conducted on 2 March 2017 with no other date limits set.

RESULTS

Eleven randomized, double-blind, placebo-controlled clinical studies were identified including parallel group, two-way crossover and randomized withdrawal designs. One was a neuroimaging study. Five open-label extensions were also identified. Evidence of efficacy was demonstrated across the studies identified with significant and clinically relevant improvements in pain, sleep quality and patient status. The safety and tolerability profile of pregabalin is consistent across all the studies identified, including in adolescents, with dizziness and somnolence the most common adverse events reported. These efficacy and safety data are supported by meta-analyses (13 studies). Pregabalin in combination with other pharmacotherapies (7 studies) is also efficacious. Post-hoc analyses have demonstrated the onset of pregabalin efficacy as early as 1-2 days after starting treatment, examined the effect of pregabalin on other aspects of sleep beyond quality, and shown it is effective irrespective of the presence of a wide variety of patient demographic and clinical characteristics.

CONCLUSIONS

Pregabalin is a treatment option for FM; its clinical utility has been comprehensively demonstrated.

Perceptions of dental students in Japanese national universities about studying abroad

PURPOSE

Dental faculties in Japan have organised many short-term international exchange programs to enable their undergraduates to study abroad. However, not many students apply for those programs. In this present study, we attempted to clarify the factors that discourage undergraduate dental students from studying abroad.

METHODS

We administered a questionnaire survey to 512 undergraduate dental students in three national universities located in different areas in Japan.

RESULTS

Although 61.7% of the participants expressed interest in studying abroad, only 19.1% of them had prior experiences of study abroad or plans to do so. Their main worries were about lack of sufficient language ability in academic fields. Comparing those who were interested in studying abroad with those who were not revealed significant differences regarding their concern about lack of language ability and lack of specialised knowledge in dentistry. Participants who did not want to study abroad indicated that they did not perceive a purpose in doing so and cited not having foreign friends as a problem. Household income was significantly correlated with concerns about overall expenses.

CONCLUSION

Overall, language ability and academic knowledge appeared to be the two strongest factors affecting dental students' consideration of studying abroad. Dental schools in Japan can use the findings of this study to improve their undergraduate exchange programs in such a way as to stimulate greater interest amongst their students.

Radiographic measurements of the hip joint and their associations with hip pain in Japanese men and women: the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study

OBJECTIVE

To investigate radiographic measurements of the hip joint and their associations with hip pain, and the prevalence of acetabular dysplasia defined by radiographic measurements of the hip joint in Japanese men and women using the large-scale population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study.

METHODS

From the baseline survey of the ROAD study (cross-sectional study), 2963 participants (1040 men, 1923 women; mean age, 70.2 years) were analyzed. All participants underwent radiographic examinations of both hips using an anteroposterior view under weight-bearing. Minimum joint space width (mJSW), central-edge (CE) angle, acetabular depth-to-width ratio (ADR), and acetabular head index (AHI) were measured. Associations between these radiographic measurements and hip pain were assessed by calculating odds ratios (ORs) using multivariable logistic-regression analysis. Acetabular dysplasia was defined as a CE angle <20°.

RESULTS

Mean radiographic measurements of the hip joint for men were: mJSW, 3.8 mm; CE angle, 30.6°; ADR, 262.1 per 1000; and AHI, 81.4%. For women, these values were: mJSW, 3.4 mm; CE angle, 29.9°; ADR, 262.7 per 1000; and AHI, 81.2%. Associations were seen between hip pain and each of mJSW, CE angle, ADR, and AHI (OR 4.52, 95% confidence interval 3.45-5.97; 1.14, 1.11-1.18; 1.31, 1.24-1.40; and 1.15, 1.12-1.18, respectively). Acetabular dysplasia showed an overall prevalence of 13.9%, and was significantly more prevalent in women than in men (P = 0.012).

CONCLUSION

The present study of radiographic measurements of the hip joint showed that mJSW, CE angle, ADR, and AHI were associated with hip pain.

A mesenteric solid tumor with unusual features in a young male: A case report

The current study presents a mesenteric mesenchymal tumor case, with unusual features in diagnostic imaging and histology. A 16-year-old male was admitted to the hospital with abdominal pain. Computed tomography (CT) revealed an abdominal mass, 2 cm in diameter. The results of contrast-enhanced CT, magnetic resonance imaging and ¹⁸F-fluorodeoxyglucose positron emission tomography indicated no specific features suggestive of its histology. Two arteries branching from the superior mesenteric artery were observed feeding the hypervascular tumor. After endoscopic and other laboratory findings revealed no additional lesions, the lesion was diagnosed as a primary mesenteric tumor. As the possibility of malignancy and future bleeding from this tumor could not be ruled out, a resection of the tumor was performed. During the surgery, the tumor, which was well circumscribed and hypervascular, was located in the mesentery of the jejunum. The resected tumor did not exhibit typical histological characteristics, and was labeled as 'myxoid smooth muscle neoplasm of uncertain biologic potential'. At 2 years after surgery, the patient remained well without evidence of recurrence. As primary mesenteric tumors are rare, particularly in young patients, it is considered important that this type of unusual tumor be included in the differential diagnosis for mesenteric tumors.

Case of ileal herniation through the foramen of Winslow diagnosed preoperatively by CT and treated with laparoscopic surgery

A previously healthy 35-year-old man visited the emergency room complaining of epigastric pain and vomiting. The pain was sudden in onset. His blood tests were within normal limits except for a mild neutrophilia of 14 300/μL. Enhanced abdominal CT scan showed the small intestine dilated into the space between the portal vein and inferior vena cava from the foramen of Winslow. Under the diagnosis of herniation through the foramen of Winslow (HFW), we performed emergency laparoscopic surgery. Laparoscopy revealed an internal herniation of the dilated small intestine through the foramen of Winslow. Because the herniated small intestine was viable, intestinal resection was unnecessary. We released the incarceration under laparoscopy. HFW is very rare and often overlooked, but abdominal CT examination enabled a precise preoperative diagnosis because of characteristic findings. We should consider the possibility of HFW in patients with internal herniation of unknown origin. Laparoscopic surgery for HFW is effective.

Body weight and dysautonomia in early Parkinson's disease

OBJECTIVES

Patients with Parkinson's disease (PD) begin to lose weight several years before diagnosis, which suggests weight variation is associated with some factor(s) that precede the onset of motor symptoms. This study aimed to investigate the association of autonomic nervous system with body weight in patients with PD.

MATERIALS AND METHODS

The subjects were 90 patients with early de novo PD. We examined the associations of body mass index (BMI) with sympathetic nervous activity reflected in orthostatic intolerance or cardiac uptake of ¹²³ I-metaiodobenzylguanidine and parasympathetic nervous activity reflected in constipation or heart rate variability (HRV).

RESULTS

Twelve patients (13.3%) were overweight (BMI>25 kg/m² ), 62 patients (68.9%) were normal-weight (18.5≦BMI<25 kg/m² ), and 16 patients (17.8%) were underweight (BMI<18.5 kg/m² ). Underweight patients had greater disease severity and decrease in blood pressure on head-up tilt-table testing, higher cardiac washout ratio of ¹²³ I-metaiodobenzylguanidine, and lower HRV and complained of constipation more often than those with normal-weight or overweight patients. On multiple regression analyses, the correlation of these variables with BMI maintained statistical significance after adjustment for age, sex, symptom duration, and motor subtype.

CONCLUSIONS

Dysautonomia and disease severity are closely related to body weight independently of age, sex, symptom duration, and motor subtype. Dysautonomia may play a partial role on weight variation in the early stage of PD.

Is osteoporosis a predictor for future sarcopenia or vice versa? Four-year observations between the second and third ROAD study surveys

In a 4-year follow-up study that enrolled 1099 subjects aged ≥60 years, sarcopenia prevalence was estimated at 8.2%. Moreover, the presence of osteoporosis was significantly associated with short-term sarcopenia occurrence, but the reciprocal relationship was not observed, suggesting that osteoporosis would increase the risk of osteoporotic fracture and sarcopenia occurrence.

INTRODUCTION

The present 4-year follow-up study was performed to clarify the prevalence, incidence, and relationships between sarcopenia (SP) and osteoporosis (OP) in older Japanese men and women.

METHODS

We enrolled 1099 participants (aged, ≥60 years; 377 men) from the second survey of the Research on Osteoarthritis/Osteoporosis against Disability (ROAD) study (2008-2010) and followed them up for 4 years. Handgrip strength, gait speed, skeletal muscle mass, and bone mineral density were assessed. SP was defined according to the Asian Working Group for Sarcopenia. OP was defined based on the World Health Organization criteria.

RESULTS

SP prevalence was 8.2% (men, 8.5%; women, 8.0%) in the second survey. In those with SP, 57.8% (21.9%; 77.6%) had OP at the lumbar spine L2-4 and/or femoral neck. SP cumulative incidence was 2.0%/year (2.2%/year; 1.9%/year). Multivariate regression analysis revealed that OP was significantly associated with SP occurrence within 4 years (odds ratio, 2.99; 95% confidence interval, 1.46-6.12; p < 0.01), but the reciprocal relationship was not significantly observed (2.11; 0.59-7.59; p = 0.25).

CONCLUSIONS

OP might raise the short-term risk of SP incidence. Therefore, OP would not only increase the risk for osteoporotic fracture but may also increase the risk for SP occurrence.

PGE2 Activates Cementoclastogenesis by Cementoblasts via EP4

Destruction of cementum and alveolar bone is the main causative event for the exfoliation of teeth as a consequence of periodontitis. Prostaglandin E2 (PGE2) and PGE receptor subtypes (EPs) play an important role in modulating osteoblast-mediated osteoclastogenesis; however, no information is available on the role of PGE2 and EPs in regulating cementoblast-mediated cementoclastogenesis. We hypothesized that the PGE2-EPs pathway also regulates cementoblasts’ ability to activate cementoclasts. For these studies, OCCM-30 cells (a mouse cementoblast cell line) were exposed to PGE2 and specific EP agonists. PGE2 (100 ng/mL) and EP4 agonist (1 μM) up-regulated RANKL and IL-6 mRNA levels, while they down-regulated OPG mRNA expression. The EP4 antagonist (1 μM) eliminated these effects of PGE2. PGE2 treatment of co-cultures of OCCM-30 cells with bone marrow cells induced TRAP-positive cells via the EP4 pathway. These findings suggest that PGE2 promotes cementoblast-mediated cementoclastogenesis by regulating the expression of RANKL and OPG via the EP4 pathway.

Changes of superoxide dismutase activity and ascorbic acid in focal cerebral ischaemia in rats

Free radical reactions are supposed to cause ischaemic brain damage, and active oxygens can initiate these chains reaction. If active oxygens play important roles in ischaemic brain damage, the activity of superoxide dismutase, scavenger of superoxide anion, is supposed to decrease in ischaemic brain. The reduced form of ascorbic acid also scavenges superoxide anion. In rat middle cerebral artery focal ischaemia, we investigated the changes in superoxide dismutase activity and the concentration of reduced ascorbate up to 48 hours. Middle cerebral artery territory of each cerebral hemisphere was homogenized. The supernatant was divided into two aliquots; one was dialysed to remove ascorbate and the other was not. The enzyme activity of the dialysed specimen from the ischaemic hemisphere did not decrease within 4 h after the arterial occlusion. The activity of the dialysed specimen from the nonischaemic side remained unchanged during the examination. Reduced ascorbate levels in nondialysed samples showed similar changes to the superoxide dismutase activities in the dialysed samples. Our data suggest that ascorbic acid may exert the enzyme activity and that the enzyme activity remains at the normal level in the early phase of ischaemia despite the irreversible ischaemic changes that take place within 4 h after the onset of ischaemia.

Change of xanthine dehydrogenase and xanthine oxidase activities in rat brain following complete ischaemia

We studied the activities of xanthine dehydrogenase and xanthine oxidase in rat forebrain after complete ischaemia. Complete ischaemia was induced by decapitation after transcardiac infusion with saline. The activities of xanthine dehydrogenase and xanthine oxidase immediately after ischaemia were 93.3 +/- 38.7 and 18.8 +/- 7.7 microU/mg protein, respectively, and at 24 h after ischaemia were 183.5 +/- 75.1 and 60.8 +/- 15.2 microU/mg protein, respectively. The ratios of xanthine dehydrogenase/xanthine oxidase immediately and 24 h after ischaemia were 5.04 +/- 1.03 and 3.04 +/- 0.99, respectively. These data indicate that xanthine dehydrogenase and xanthine oxidase activities were maintained even 24 h after complete ischaemia. Conversion of xanthine dehydrogenase to xanthine oxidase proceeds slowly during complete ischaemia.

Inactivation of Airborne Bacteria and Viruses Using Extremely Low Concentrations of Chlorine Dioxide Gas

Infectious airborne microbes, including many pathological microbes that cause respiratory infections, are commonly found in medical facilities and constitute a serious threat to human health. Thus, an effective method for reducing the number of microbes floating in the air will aid in the minimization of the incidence of respiratory infectious diseases. Here, we demonstrate that chlorine dioxide (ClO2) gas at extremely low concentrations, which has no detrimental effects on human health, elicits a strong effect to inactivate bacteria and viruses and significantly reduces the number of viable airborne microbes in a hospital operating room. In one set of experiments, a suspension of Staphylococcus aureus, bacteriophage MS2, and bacteriophage ΦX174 were released into an exposure chamber. When ClO2 gas at 0.01 or 0.02 parts per million (ppm, volume/volume) was present in the chamber, the numbers of surviving microbes in the air were markedly reduced after 120 min. The reductions were markedly greater than the natural reductions of the microbes in the chamber. In another experiment, the numbers of viable airborne bacteria in the operating room of a hospital collected over a 24-hour period in the presence or absence of 0.03 ppm ClO2 gas were found to be 10.9 ± 6.7 and 66.8 ± 31.2 colony-forming units/m3 (n = 9, p < 0.001), respectively. Taken together, we conclude that ClO2 gas at extremely low concentrations (≤0.03 ppm) can reduce the number of viable microbes floating in the air in a room. These results strongly support the potential use of ClO2 gas at a non-toxic level to reduce infections caused by the inhalation of pathogenic microbes in nursing homes and medical facilities.

Selective Growth of Noble Gases at Metal/Oxide Interface

The locations and roles of noble gases at an oxide/metal interface in oxide dispersed metal are theoretically and experimentally investigated. Oxide dispersed metal consisting of FCC Fe and Y2Hf2O7 (Y2Ti2O7) is synthesized by mechanical alloying under a saturated Ar gas environment. Transmission electron microscopy and density functional theory observes the strain field at the interface of FCC Fe {111} and Y2Hf2O7 {111} whose physical origin emerges from surface reconstruction due to charge transfer. Noble gases are experimentally observed at the oxide (Y2Ti2O7) site and calculations reveal that the noble gases segregate the interface and grow toward the oxide site. In general, the interface is defined as the trapping site for noble gases; however, transmission electron microscopy and density functional theory found evidence which shows that noble gases grow toward the oxide, contrary to the generally held idea that the interface is the final trapping site for noble gases. Furthermore, calculations show that the inclusion of He/Ar hardens the oxide, suggesting that material fractures could begin from the noble gas bubble within the oxides. Thus, experimental and theoretical results demonstrate that noble gases grow from the interface toward the oxide and that oxides behave as a trapping site for noble gases.

Prevalence of radiographic hip osteoarthritis and its association with hip pain in Japanese men and women: the ROAD study

OBJECTIVE

Although hip osteoarthritis (OA) is a major cause of hip pain and disability in elderly people, few epidemiologic studies have been performed. We investigated the prevalence of radiographic hip OA and its association with hip pain in Japanese men and women using a large-scale population of a nationwide cohort study, Research on Osteoarthritis/osteoporosis Against Disability (ROAD).

METHODS

From the baseline survey of the ROAD study, 2975 participants (1043 men and 1932 women), aged 23-94 years (mean 70.2 years), living in urban, mountainous, and coastal communities were analyzed. The radiographic severity at both hips was determined by the Kellgren/Lawrence (K/L) grading system. Radiographic hip OA was defined as K/L ≥ 2, and severe radiographic hip OA as K/L ≥ 3.

RESULTS

The crude prevalence of radiographic hip OA was 18.2% and 14.3% in men and women, respectively, that of severe radiographic hip OA was 1.34% and 2.54%, and that of symptomatic K/L ≥ 2 OA was 0.29% and 0.99%, respectively. The crude prevalence of hip OA, including severe OA, was not age-dependent in men or women. Male sex was a risk factor for radiographic hip OA, whereas female sex was a risk factor for severe radiographic hip OA and hip pain. Compared with K/L = 0/1, hip pain was significantly associated with K/L ≥ 3, but not with K/L = 2.

CONCLUSION

The present cross-sectional study revealed the prevalence of radiographic hip OA and severe hip OA in Japanese men and women. Hip pain was strongly associated with K/L ≥ 3.

Factors affecting changes in the serum levels of 25-hydroxyvitamin D: a 3-year follow-up of the ROAD study

In this 3-year population-based cohort study, among 1346 subjects, the mean annual change in the serum 25-hydroxyvitamin D levels was 7.6 %/year, which tended to increase during the 3-year period. Multivariate regression analysis indicated that the L2-4 bone mineral density and total daily energy intake were significant independent associated factors.

INTRODUCTION

The aim of this study was to clarify the change rate of the serum levels of 25-hydroxyvitamin D (25D) and the associated factors in a general Japanese population during a 3-year period.

METHODS

The baseline survey of Research on Osteoarthritis/osteoporosis Against Disability study (ROAD), a large-scale population-based cohort study, was performed between 2005 and 2007, and a follow-up survey was repeated 3 years later. Among 1690 participants at baseline, the change rate of the serum 25D levels were assessed in 1346 individuals (79.6 %; 458 men and 888 women) who completed measurements of 25D at both the baseline and follow-up examinations. The change rate was calculated, and the factors associated with the changes in the 25D levels were determined using multivariate regression analysis after adjustment for age, gender, body mass index, participated month, and regional differences at baseline.

RESULTS

The mean (standard deviation) change rate of the 25D levels in all subjects was 7.6 (13.3) %/year (men, 8.2 [12.4] %/year; women, 7.3 [13.7] %/year). Multivariate regression analysis indicated that higher bone mineral density at lumbar spine L2-4 (p = 0.05) and total daily energy intake (p = 0.04) were significantly associated with the change rate of the 25D levels.

CONCLUSIONS

The serum levels of 25D tended to increase over the 3-year period, and higher lumbar bone mineral density and daily energy intake were found to be associated with increases in the 25D levels over time.