Faster acquisition of magnetic resonance imaging sequences of the knee via deep learning reconstruction: a volunteer study

AIM

To evaluate whether deep learning reconstruction (DLR) can accelerate the acquisition of magnetic resonance imaging (MRI) sequences of the knee for clinical use.

MATERIALS AND METHODS

Using a 1.5-T MRI scanner, sagittal fat-suppressed T2-weighted imaging (fs-T2WI), coronal proton density-weighted imaging (PDWI), and coronal T1-weighted imaging (T1WI) were performed. DLR was applied to images with a number of signal averages (NSA) of 1 to obtain 1DLR images. Then 1NSA, 1DLR, and 4NSA images were compared subjectively, and by noise (standard deviation of intra-articular water or medial meniscus) and contrast-to-noise ratio between two anatomical structures or between an anatomical structure and intra-articular water.

RESULTS

Twenty-seven healthy volunteers (age: 40.6 ± 11.9 years) were enrolled. Three 1DLR image sequences were obtained within 200 s (approximately 12 minutes for 4NSA image). According to objective evaluations, PDWI 1DLR images showed the smallest noise and significantly higher contrast than 1NSA and 4NSA images. For fs-T2WI, smaller noise and higher contrast were observed in the order of 4NSA, 1DLR, and 1NSA images. According to the subjective analysis, structure visibility, image noise, and overall image quality were significantly better for PDWI 1DLR than 1NSA images; moreover, the visibility of the meniscus and bone, image noise, and overall image quality were significantly better for 1DLR than 4NSA images. Fs-T2WI and T1WI 1DLR images showed no difference between 1DLR and 4NSA images.

CONCLUSION

Compared to PDWI 4NSA images, PDWI 1DLR images were of higher quality, while the quality of fs-T2WI and T1WI 1DLR images was similar to that of 4NSA images.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

Boehringer Ingelheim and Eli Lilly.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

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

POS1196 SARS-CoV-2 VACCINE ACCEPTANCE AND ASSOCIATED PSYCHOLOGICAL FACTORS IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background

The mortality rate of coronavirus disease 2019 (COVID-19) in patients with rheumatic and musculoskeletal disease (RMD) is as high as approximately 10% [1]. Therefore, vaccination promotion is a critical issue. However, there are few reports on the psychological aspects of patient vaccine acceptance.

Objectives

To investigate the intention of patients with RMD to receive the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine and explore the psychological factors related to vaccine acceptance.

Methods

We conducted a questionnaire-based survey of 406 outpatients with RMD at Shiga General Hospital from July to October 2021. The questionnaire included the following sections: (1) vaccination status; (2) expectation of susceptibility to severe COVID-19; (3) expectation of vaccine efficacy; and (4) anxiety about the vaccine, which included concerns on I) the diminishing effect of the vaccine due to current treatment and II) the influence of vaccination on: i) primary disease status, ii) treatment, and iii) adverse reaction.

Results

There were 305 vaccinated and 101 unvaccinated individuals. Unvaccinated individuals were classified into the acceptance group (n=60) and hesitancy group (n=41) according to their vaccination status (Figure 1).

Figure 1.

SARS-CoV-2 vaccination status (n=406)

We compared the backgrounds and awareness of the patients on vaccination between the two groups. Univariate analysis did not show any difference in the backgrounds. The expectation of susceptibility to severe COVID-19 was similar in both groups. There were also no significant differences in the vaccine-related anxiety levels. However, the expectation of vaccine efficacy was higher in the acceptance group and significantly influenced vaccination intention as revealed by multivariate analyses (Table 1).

Table 1.

Awareness towards COVID-19 and SARS-CoV-2 vaccine associated with vaccination intention

Awareness towards COVID-19 and SARS-CoV-2 vaccineAcceptance(N=60)Hesitancy(N=41)UnivariateAnalysis§Multivariate Analysis||Median[IQR]Median[IQR]p-valuep-valueExpectation of susceptibility to severe COVID-19*2.0[1.0-3.0]2.0[1.5-2.5]0.84720.3440Expectation of vaccine efficacy†3.0[3.0-3.0]2.0[1.0-3.0]<0.0001¶<0.0001**Concerns about the diminishing effect of the vaccine due to current treatment‡2.0[1.0-3.0]3.0[2.0-3.0]0.04750.3600Concerns about the effect of vaccination on treatment‡3.0[1.0-3.0]3.0[2.0-4.0]0.01280.6232Concern about the effect of vaccination on primary disease status‡3.0[1.0-3.0]3.0[2.0-3.0]0.05760.7134Concern about the effect of vaccination on adverse reaction‡3.0[3.0-3.0]3.0[3.0-4.0]0.00930.8335

*0: Less likely to become severe~3: Very likely to become severe, †0: Not expected at all~4: Highly expected, ‡0: Not concerned at all ~4:Very concerned

§Pearson’s chi-square test or Wilcoxon test, ||Nominal logistic regression analysis, ¶ p<0.008 (after Bonferroni correction), ** p<0.05.

Conclusion

The perception of vaccine efficacy is strongly correlated with vaccine acceptance. In order to promote vaccination in patients with RMDs, this study suggests that emphasizing the efficacy of the vaccine may be more effective than alleviating anxiety about the adverse effects of the vaccine.

References

[1]Strangfeld, A. et al. Ann. Rheum. Dis. 2021; 80: 930–942.

Disclosure of Interests

Haruka Sugawara: None declared, Hiroshi Doi: None declared, Takeshi Iwasaki: None declared, Yoichi Nakayama: None declared, Yuri Nishida: None declared, Yoshie Gon: None declared, Masaki Kamakura: None declared, Kenshi Ohbori: None declared, Naoko Sakane: None declared, Naomi Nakamura: None declared, Takahiko Utsumi: None declared, Akio Morinobu Speakers bureau: Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma., and Chugai Pharmaceutical Co. Ltd., Grant/research support from: Eli Lilly Japan K.K., Ono Pharmaceutical Co., Pfizer Inc., UCB Japan, AbbVie G.K., Asahi Kasei Pharma., and Chugai Pharmaceutical Co. Ltd.

A first case of meningitis/encephalitis associated with SARS-Coronavirus-2

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Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly.

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This is the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance.

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The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF.

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This case warns the physicians of patients who have CNS symptoms.

Novel coronavirus (SARS-Coronavirus-2:SARS-CoV-2) which emerged in Wuhan, China, has spread to multiple countries rapidly. We report the first case of meningitis associated with SARS-CoV-2 who was brought in by ambulance due to a convulsion accompanied by unconsciousness. He had never been to any foreign countries. He felt generalized fatigue and fever (day 1). He saw doctors nearby twice (day 2 and 5) and was prescribed Laninamivir and antipyretic agents, His family visited his home and found that he was unconsciousness and lying on the floor in his vomit. He was immediately transported to this hospital by ambulance (day 9). Under emergency transport, he had transient generalized seizures that lasted about a minute. He had obvious neck stiffness. The specific SARS-CoV-2 RNA was not detected in the nasopharyngeal swab but was detected in a CSF. Anti- HSV 1 and varicella-zoster IgM antibodies were not detected in serum samples. A brain MRI showed hyperintensity along the wall of right lateral ventricle and hyperintense signal changes in the right mesial temporal lobe and hippocampus, suggesting the possibility of SARS-CoV-2 meningitis. This case warns the physicians of patients who have CNS symptoms.

Superconductivity and magnetic fluctuations developing in the vicinity of strong first-order magnetic transition in CrAs

We report single crystal preparation, resistivity, and nuclear quadrupole resonance (NQR) measurements for new pressure-induced superconductor CrAs. In the first part, we present the difference between crystals made by different thermal sequences and methods, and show the sample dependence of superconductivity in CrAs. In the latter part, we show NQR data focusing the microscopic electronic state at the phase boundary between the helimagnetic and the paramagnetic phases. They suggest strongly that a quantum critical point is absent on the pressure-temperature phase diagram of CrAs, because of the strong first-order character of the magnetic transition; however, the spin fluctuations are observed in the paramagnetic phase. The close relationship between the spin fluctuations and superconductivity can be seen even in the vicinity of the first-order magnetic transition in CrAs.

Quasilinear quantum magnetoresistance in pressure-induced nonsymmorphic superconductor chromium arsenide

In conventional metals, modification of electron trajectories under magnetic field gives rise to a magnetoresistance that varies quadratically at low field, followed by a saturation at high field for closed orbits on the Fermi surface. Deviations from the conventional behaviour, for example, the observation of a linear magnetoresistance, or a non-saturating magnetoresistance, have been attributed to exotic electron scattering mechanisms. Recently, linear magnetoresistance has been observed in many Dirac materials, in which the electron–electron correlation is relatively weak. The strongly correlated helimagnet CrAs undergoes a quantum phase transition to a nonmagnetic superconductor under pressure. Here we observe, near the magnetic instability, a large and non-saturating quasilinear magnetoresistance from the upper critical field to 14 T at low temperatures. We show that the quasilinear magnetoresistance may arise from an intricate interplay between a nontrivial band crossing protected by nonsymmorphic crystal symmetry and strong magnetic fluctuations.

The electronic structure of the helimagnet CrAs is unusual due to its nonsymmorphic crystal symmetry. Here, the authors observe quasilinear magnetoresistance close to a pressure-driven superconducting transition, which may arise from the interaction of the band structure and magnetic fluctuations.

A case of cerebral tuberculoma mimicking neurocysticercosis

Case

A 42-year-old Peruvian woman residing in Japan for 11 years with a family history of neurocysticercosis presented to our intensive care unit with fever and intense headache.Computed tomography indicated multiple micronodular lesions in the brain parenchyma, and cerebral tuberculoma and neurocysticercosis were considered in the differential diagnosis. Neurocysticercosis was initially suspected, and oral praziquantel was initiated. However, because of a high adenosine deaminase level in the cerebrospinal fluid and positive peripheral blood interferon gamma release test result, cerebral tuberculoma was subsequently considered.

Outcome

Antituberculous drugs with steroids were initiated on day 10, after which the symptoms gradually resolved; the patient was discharged on day 29. Gadolinium-contrast magnetic resonance imaging 8 months later showed reduced nodular shadows, confirming cerebral tuberculoma.

Conclusion

Immediate diagnosis and treatment are imperative for cerebral tuberculoma, a lethal infection. Considering the recent increases in immigration worldwide, increased cases of tuberculoma mimicking neurocysticercosis are expected.

Divalent cations enhance fluoride binding to Streptococcus mutans and Streptococcus sanguinis cells and subsequently inhibit bacterial acid production

One preventive effect of topical fluoride application is derived from the fact that fluoride can inhibit bacterial acid production. Furthermore, divalent cations such as Ca(2+) and Mg(2+) increase the binding of fluoride to bacterial cells. These findings suggest that exposure of oral bacteria to fluoride in the presence of divalent cations increases fluoride binding to bacterial cells and subsequently enhances fluoride-induced inhibition of bacterial acid production. This study investigated the effects of fluoride exposure (0-20,000 ppm F) in the presence of Ca(2+) or Mg(2+) prior to glucose challenge on pH fall ability by bacterial sugar fermentation, as well as fluoride binding to bacterial cells by exposure to fluoride, and fluoride release from bacterial cells during bacterial sugar fermentation, using caries-related bacteria, Streptococcus mutans and Streptococcus sanguinis. The pH fall by both streptococci was inhibited by exposure to over 250 ppm F in the presence of Ca(2+) (p < 0.01), whereas in the presence of Mg(2+), the pH fall by S. mutans and S. sanguinis was inhibited after exposure to over 250 and 950 ppm F, respectively (p < 0.05). The amounts of fluoride binding to and released from streptococcal cells increased with the concentration of fluoride the cells were exposed to in the presence of Mg(2+), but were high enough even after 250 ppm F exposure in the presence of Ca(2+). The enhanced inhibition of acid production in the presence of divalent cations is probably due to the improved efficiency of fluoride binding to bacterial cells being improved via these divalent cations.

Comparison of efficacy between continuous hemodiafiltration with a PMMA high-performance membrane dialyzer and a PAN membrane hemofilter in the treatment of septic shock patients with acute renal failure

The aim of this study was to investigate whether continuous hemodiafiltration (CHDF) with a high-performance membrane dialyzer made of polymethylmethacrylate (PMMA-CHDF) in the treatment of septic shock patients with acute renal failure (ARF) is clinically relevant. 30 patients were treated with PMMA-CHDF. 13 patients treated with CHDF used a hemofilter made of polyacrylonitrile membrane (PAN-CHDF). Systolic blood pressure significantly increased in the PMMA-CHDF group following 24 h of treatment (p < 0.01), whereas it did not improve in the PAN-CHDF group. Urine volume significantly increased in the PMMA-CHDF group following 24 h of treatment which was more than in the PAN-CHDF group (p < 0.05). 28-day survival was 83.3% in the PMMA-CHDF group and 30.8% in the PAN-CHDF group, respectively (p < 0.01). We can assume that PMMA-CHDF in the treatment of septic shock patients with ARF is clinically relevant.

Kondo scaling of the pseudogap in CeOs4Sb12 and CeFe4P12

CeOs(4)Sb(12) and CeFe(4)P(12) are classified as Kondo semiconductors, which show coupled changes in electrical transport, thermodynamic and magnetic properties with a low-temperature semiconductor-like electrical resistivity. We have carried out core level and valence band photoemission spectroscopy on single crystal CeOs(4)Sb(12) and CeFe(4)P(12) to study their electronic structure and the evolution of states at the Fermi level as a function of temperature (∼10-300 K). The Ce 3d core level spectra show the presence of f(0), f(1) and f(2) final states with very different relative intensities in the two compounds. Single-impurity Anderson model calculations provide f electron counts of n(f) = 0.97 and 0.86 per Ce atom, suggestive of a low- and high-T(K) (= single ion Kondo temperature) for CeOs(4)Sb(12) and CeFe(4)P(12), respectively. The high-resolution temperature-dependent near-Fermi level spectra show pseudogaps of energy ∼ 50 meV and ∼ 110 meV in the valence band density of states (DOS) of CeOs(4)Sb(12) and CeFe(4)P(12), respectively. The temperature dependence of the DOS at the Fermi level follows the change in effective magnetic moment estimated from magnetic susceptibility for both materials, confirming the Kondo nature of the pseudogap in CeOs(4)Sb(12) and CeFe(4)P(12). A compilation of measured pseudogaps using photoemission and optical spectroscopy identifies the charge gaps Δ(C) for Ce-based Kondo semiconductors and provides a direct relation with T(K) given by Δ(C) ∼ 2k(B)T(K). In conjunction with the known behaviour of the spin gaps Δ(S) ∼ k(B)T(K), the results establish the coupled energy scaling of the spin and charge gaps in Kondo semiconductors.

Excitation spectrum of PrOs(4)Sb(12) under a magnetic field

The evolution of the magnetic excitation spectrum of the heavy fermion superconductor PrOs(4)Sb(12) was studied by inelastic neutron scattering on crossing the critical field H(c2) for superconductivity at low temperature. The peak positions in energy and the peak intensities of the modes of the triplet split by magnetic field confirm the known crystal field parameters for PrOs(4)Sb(12) in T(h) symmetry. A selective broadening of the lineshape occurs on increasing the magnetic field: the linewidth of the upper mode of the triplet increases while the one of the middle mode does not.

Anomalous duality of 4f electrons in filled skutterudite CeOs4Sb12

We study the electronic structure of the filled skutterudite CeOs4Sb12 using photoemission spectroscopy (PES). Soft x-ray excited Ce 3d-4f resonant PES confirms the existence of Ce 4f states at the Fermi level (EF). Temperature dependent high-resolution laser-PES spectra reveal a pseudogap formation around EF, which can be explained in terms of the hybridization gap. Simultaneously, a sharp feature is formed just above EF with decreasing temperature. The heavy-fermion-like specific heat is attributed to the occupation of this feature. The results identify the origin of the anomalous coexistence of heavy-fermion and pseudogap behavior in terms of a symmetry dependent hybridization.

Diagnostics of a He(+) beam extracted from a compact magnetic bucket-type ion source

Performance of a compact He(+) ion source was investigated before installing it to the experiment system developed for studying the efficiency of autodetachment neutralization from He(-) to He(0). Dependence of the extracted ion current upon the plasma parameters and that upon the extraction voltage indicated that the source performance was limited by space charge effect. The beam emittance was measured with a multislit system for various operation conditions. The experimentally determined emittance agreed well with the emittance obtained from ion trajectories calculated with input plasma parameters measured by a Langmuir probe. The beam current density of 60 mA/cm(2) and the emittance of less than 25pi mm mrad are expected to deliver enough current to the downstream of the He(-) neutralizer system to clarify factors affecting the final He(0) intensity.

Energy straggling of low-energy ion beam in a charge exchange cell for negative ion production

Energy straggling in a charge exchange cell, which is frequently used for negative ion production, was studied experimentally and compared with the results of theoretical evaluation. The change of the energy spectrum of a He(+) beam due to charge exchange processes in argon gas was measured in the energy range of 2-6 keV. Energy straggling by multiple collisions is expressed by the energy loss formula due to inelastic and elastic processes. The impact parameter is related to the elastic scattering angle, and the geometry of the charge exchange cell and other components of the beam transportation system determines the maximum acceptable scattering angle. The energy spread was evaluated taking the integral limit over the impact parameter into consideration. The theoretical results showed good agreement with those of actual measurement.

A beam transport system for an intense He(-) beam source

We have been developing a test stand for fast He(0) beam production. One of the major issues is how to transport effectively the He(+) and He(-) beams from which the He(0) beam is produced. The beam should be focused in two transverse focal points, the center of the charge exchange cell and the electrostatic accelerator. We studied the beam transport system and effect of space charge neutralization in the test stand by experiments and calculation.

Regulation of human protein Z gene expression by liver-enriched transcription factor HNF-4alpha and ubiquitous factor Sp1

BACKGROUND AND OBJECTIVES

Protein Z (PZ), which regulates blood coagulation, is mainly synthesized in the liver. Its plasma level varies widely among individuals, and is highly sensitive to Warfarin. The mechanism for the basic transcription of the human PZ gene, however, has not been reported. The aim of this study was to elucidate the mechanism of gene regulation for PZ by characterizing its 5'-flanking region.

METHODS AND RESULTS

A reporter gene assay using the human hepatoma cell line, HepG2, identified a minimal promoter region (site A) and two enhancer regions (sites B and C) in the PZ gene. DNase I footprinting and electromobility shift assays revealed binding of the liver-enriched transcriptional factor hepatocyte nuclear factor (HNF)-4alpha to site A, the ubiquitous transcriptional factor Sp1 to sites A and C, and an unidentified factor to site B. The co-transfection of an HNF-4alpha expression vector with reporter gene constructs to the non-hepatic cell line HeLa resulted in a significant increase of PZ promoter activity.

CONCLUSIONS

HNF-4alpha plays a crucial role in human PZ gene expression in hepatocytic cells, and Sp1 is also important. These findings provide the first step toward understanding the mechanisms of the varying plasma PZ levels in individuals under physiological and pathological conditions.

DDBJ with new system and face

DDBJ (http://www.ddbj.nig.ac.jp) collected and released 1 880 115 entries or 1 134 086 245 bases in the period from July 2006 to June 2007. The released data contains the high-throughput cDNAs of cricket and high-quality draft genome of medaka among others. Our computer system has been upgraded since March 2007. Another new aspect is an efficient data retrieval tool that has recently been equipped and served at DDBJ. It is called All-round Retrieval for Sequence and Annotation, which enables the user to search for keywords also in the Feature/Qualifier of the International Nucleotide Sequence Database Collaboration (http://www.insdc.org/). We will also replace our home page with a more efficient one by the end of 2007.

Mechanism of spatially resolved photochemical control of the resistivity of a molecular crystalline solid

By maintaining α-Ag(DM)(2) (DM = C(10)H(8)N(4)) around room temperature (RT) ([Formula: see text]) during ultraviolet-visible (UV-vis) irradiation, a series of photochemical products named β was obtained. The solid β was comprised of structurally different compounds. All of the solid β phases share the original chemical formula of Ag(DM)(2) and exhibit semiconducting behaviour, yet they differ from each other in their XRD patterns. They are divided into two phases: β1 and β2. Compared with the XRD pattern of the α phase, the β1 phase exhibited XRD peaks at the same 2θ-angles but with different relative intensities, while the β2 phase exhibited totally different XRD patterns from those of the α or β1 phases. The actual composition of a particular solid of 'β' phase is dependent upon irradiation time, and can be controlled continuously. Around RT, the α phase exhibits metallic conductivity, while the β1 and β2 phases are suggested to be semiconductors. As a result, one can continuously and finely control the electrical resistivity of Ag(DM)(2) by UV irradiation to modify it into a mixture of α, β1 and/or β2 phases.

Connection between charge fluctuations and the coherent temperature in the heavy-fermion system SmOs4Sb12: a {121, 123}Sb NQR study

We report {121, 123}Sb nuclear quadrupole resonance measurements under pressure in a novel heavy fermion (HF) system SmOs4Sb12. The nuclear spin-spin relaxation rate 1/T{2} exhibits a distinct peak near the coherent temperature of the Kondo effect. The isotope effect of 121Sb and 123Sb indicates that the peak in 1/T{2} is electrical in origin. The connection between the peak in 1/T{2} and the development of coherency of the Kondo effect is robust even under pressure. It is conjectured that charge fluctuation plays an important role in forming the HF state in SmOs4Sb12.

Coexistence of strongly mixed-valence and heavy-fermion character in SmOs4Sb12 studied by soft- and hard-X-ray spectroscopy

Sm-based heavy-fermion compound SmOs4Sb12 has been investigated by soft x-ray (hnu=1070-1600 eV) and hard x-ray (HX; hnu=7932 eV) spectroscopy. The HX photoemission spectroscopy clearly demonstrates that the strongly mixed-valence state and the heavy-fermion state coexist in the bulk. It is found that the Sm valence decreases below 100 K, indicating that the Kondo coherence develops with approaching the proposed Kondo temperature. Our theoretical analyses suggest that the origin of the coexistence in SmOs4Sb12 is the coincidence of two conditions, namely, (i) the energy difference between Sm divalent and trivalent states is very small and (ii) the hybridization between Sm 4f and conduction electrons is weak.

Involvement of epidermal growth factor receptor and downstream molecules in bone and soft tissue tumors

Correlations among epidermal growth factor receptor (EGFR) gene amplification, mutation, and overexpression/activation of proteins were investigated in 39 cases of bone/soft tissue tumors (BSTTs). By immunohistochemistry, EGFR overexpression was found in 22.6% of sarcomas, but not in benign lesions. By immunoblotting, among sarcoma cases showing upregulation of EGFR, 47.4% showed EGFR activation. In 2 cases of malignant fibrous histiocytoma with high level of EGFR gene copy numbers, EGFR expression and phosphorylation levels were significantly higher; and signal transducer and activator of transcription 3 (Stat-3) was activated. Point mutations were detected in 4 cases, 3 of which were missense mutations. In these 3 cases, activation of EGFR and Stat-3 was found in 2 cases. In the cases without gene aberrations, upregulation of the EGFR was found in both sarcomas and benign lesions; but activation was found only in sarcomas. However, EGFR activation did not specifically correlate with activation of particular downstream molecules. Among the 3 downstream cascades, Akt pathway was more frequently activated than those of Stat-3 or extracellular signal-related protein kinase 1/2, and Stat-3 was activated in tumors exhibiting an epithelial nature, including synovial sarcoma and chordoma. These results suggest that persistent Stat-3 activation may be a critical event downstream of overexpressed EGFR by high level of EGFR gene copy numbers. In contrast, tumors harboring EGFR mutation may not necessarily activate EGFR or specific downstream cascades. Finally, in BSTTs, Akt functions as a predominant molecule. These overall results could provide novel insights into the involvement of EGFR and downstream molecules and suggest that EGFR-mediated cascades are candidates for molecular targeting therapy in defined subsets of BSTTs.

Drastic change in transport of entropy with quadrupolar ordering in

The antiferroquadrupolar ordering of is explored by probing thermal and thermoelectric transport. The lattice thermal conductivity drastically increases with the ordering, as a consequence of a large drop in carrier concentration and a strong electron-phonon coupling. The low level of carrier density in the ordered state is confirmed by the anomalously large values of the Seebeck and Nernst coefficients. The results are reminiscent of and suggest that both belong to the same class of partial metal-insulator transitions. The magnitude of the Nernst coefficient, larger than in any other metal, indicates a new route for Ettingshausen cooling at Kelvin temperatures.

Direct observation of quadrupolar excitons in the heavy-fermion superconductor PrOs4Sb12

We report inelastic neutron scattering experiments performed to investigate the low energy magnetic excitations on single crystals of the heavy-fermion superconductor PrOs(4)Sb(12). The observed excitation clearly softens at a wave vector Q=(1,0,0), which is the same as the modulation vector of the field-induced antiferro-quadrupolar ordering, and its intensity at Q=(1,0,0) is smaller than that around the zone center. This result directly evidences that this excitonic behavior is derived mainly from nonmagnetic quadrupolar interactions. Furthermore, the narrowing of the linewidths of the excitations below the superconducting transition temperature indicates the close connection between the superconductivity and the excitons.

Multiband superconductivity in the heavy fermion compound PrOs4Sb12

The thermal conductivity of the heavy fermion superconductor Pr(Os(4)Sb(12) was measured down to T(c)/40 throughout the vortex state. At lowest temperatures and for magnetic fields H approximately 0.07H(c2), already 40% of the normal state thermal conductivity is restored. This behavior (similar to that observed in MgB2) is a clear signature of multiband superconductivity in this compound.

Relationship between accreditation scores and the public disclosure of accreditation reports: a cross sectional study

OBJECTIVE

To examine the association between accreditation scores and the disclosure of accreditation reports.

DESIGN

A cross sectional study.

SETTING

Hospitals participating in an accreditation programme in Japan.

PARTICIPANTS

547 of the 817 hospitals accredited by the Japan Council for Quality Health Care (JCQHC) by January 2003.

MAIN OUTCOME MEASURES

Data on participation in public disclosure of accreditation reports through the JCQHC website were obtained from the JCQHC database. Comments on the disclosure were obtained using a questionnaire based survey.

RESULTS

A total of 508 (93%) of the participating hospitals disclosed their accreditation reports on the JCQHC website. Public hospitals were significantly more committed to public disclosure than private hospitals, and larger hospitals were significantly more likely to participate in public disclosure than smaller hospitals. Accreditation scores were positively related to the public disclosure of hospital accreditation reports. Scores for patient focused care and efforts to meet community needs were significantly higher in actively disclosing hospitals than in non-disclosing hospitals. Among the large hospitals, scores for safety management were significantly higher in hospitals advocating disclosure than in non-disclosing hospitals.

CONCLUSIONS

There was a positive correlation between accreditation scores and public disclosure. Our results suggest that the public disclosure of accreditation reports should be encouraged to improve public accountability and the quality of care. Future studies should investigate the interaction between public disclosure, processes and outcomes.

Leuprorelin acetate granulomas: case reports and review of the literature

Leuprorelin acetate, an agonist of gonadotropin-releasing hormone (GnRH), is indicated in the treatment of prostate cancer. Recently, depot formulations of leuprorelin acetate have been widely used. We report three patients who showed a granulomatous reaction after treatment using a leuprorelin acetate 3-month depot formulation. These patients presented with 5-6-cm subcutaneous nodules at injection sites, which developed after the depot type was changed from a 1-month to a 3-month formulation. Skin biopsy showed epithelioid cells and foreign body giant cells containing round, translucent microspheres which formed sarcoidal granulomas. Changing to other GnRH agonists resulted in no further problems. We have reviewed the previous reports of leuprorelin acetate-induced granuloma formation. The formation of such granulomas may be related to the polymers that allow slow release after injection, or leuprorelin acetate itself may be responsible. The depot injection methods using leuprorelin also seem to have a causal effect in granuloma formation. Dermatologists need to know that depot leuprorelin acetate may cause a granulomatous reaction which produces a subcutaneous nodule that might be misdiagnosed as a malignant tumour.

DDBJ in collaboration with mass-sequencing teams on annotation

In the past year, we at DDBJ (DNA Data Bank of Japan; http://www.ddbj.nig.ac.jp) collected and released 1 066 084 entries or 718 072 425 bases including the whole chromosome 22 of chimpanzee, the whole-genome shotgun sequences of silkworm and various others. On the other hand, we hosted workshops for human full-length cDNA annotation and participated in jamborees of mouse full-length cDNA annotation. The annotated data are made public at DDBJ. We are also in collaboration with a RIKEN team to accept and release the CAGE (Cap Analysis Gene Expression) data under a new category, MGA (Mass Sequences for Genome Annotation). The data will be useful for studying gene expression control in many aspects.

Flux-line lattice distortion in PrOs4Sb12

We report that the flux-line lattice in the cubic superconductor Pr(Os4Sb12 is strongly distorted from an ideal hexagonal lattice at very low temperatures in a small applied field. We attribute this to the presence of gap nodes in the superconducting state on at least some Fermi-surface sheets.

High magnetic field phase diagram of PrOs4Sb12

The magnetic phase diagram of PrOs4Sb12 has been investigated by specific heat measurements between 8 and 32 T. A new Schottky anomaly, due to excitations between two lowest crystalline-electric-field (CEF) singlets, has been found for both H parallel (100) and H parallel (110) above the field where the field-induced ordered phase (FIOP) is suppressed. The constructed H-T phase diagram shows weak magnetic anisotropy and implies a crossing of the two CEF levels at about 8-9 T for both field directions. These results provide an unambiguous evidence for the Gamma(1) singlet being the CEF ground state and suggest the level crossing (involving lowest CEF levels) as the driving mechanism of FIOP.

DDBJ in the stream of various biological data

In the past year we at DDBJ (http://www.ddbj.nig. ac.jp) have made a steady increase in the number of data submissions with a 50.6% increment in the number of bases or 46.5% increment in the number of entries. Among them the genome data of man, ascidian and rice hold the top three. Our activity has extended to providing a tool that enables sequence retrieval using regular expressions, and to launching our SOAP server and web services to facilitate the acquisition of proper data and tools from a huge number of biological data resources on websites worldwide. We have also opened our public gene expression database, CIBEX.

Probing the superconducting gap symmetry of PrOs4Sb12: a penetration depth study

We report measurements of the magnetic penetration depth lambda in single crystals of PrOs4Sb12 down to 0.1 K, with the ac field applied along the a, b, and c directions. In all three field orientations, lambda approximately T2 and superfluid density rho(s) approximately T2 for T<0.3T(c). Data are best fit by the 3He A-phase-like gap with multidomains, each having two point nodes along a cube axis, and parameter Delta(0)(0)/k(B)T(c)=2.6, suggesting that PrOs4Sb12 is a strong-coupling superconductor with two point nodes on the Fermi surface. We also confirm the double transitions at 1.75 and 1.85 K seen in other measurements.

Time-reversal symmetry-breaking superconductivity in heavy-fermion PrOs4Sb12 detected by muon-spin relaxation

We report on muon-spin relaxation measurements of the 4f(2)-based heavy-fermion superconductor filled-skutterudite Pr(Os4Sb12. The results reveal the spontaneous appearance of static internal magnetic fields below the superconducting transition temperature, providing unambiguous evidence for the breaking of time-reversal symmetry in the superconducting state. A discussion is made on which of the spin or orbital component of Cooper pairs carries a nonzero momentum.