Effects of canagliflozin on hyperkalaemia and serum potassium in people with diabetes and chronic kidney disease: insights from the CREDENCE trial

Background

Hyperkalaemia is a common complication of type 2 diabetes mellitus (T2DM) and limits the optimal use of agents that block the renin-angiotensin aldosterone system (RAAS), particularly in patients with chronic kidney disease (CKD). In patients with CKD, sodium glucose cotransporter 2 (SGLT2) inhibitors provide cardiorenal protection, but whether they affect the risk of hyperkalaemia remains uncertain.

Purpose

We sought to assess the effect of canagliflozin on hyperkalaemia and other potassium-related outcomes in people with T2DM and CKD by conducting a post-hoc analysis of the CREDENCE trial.

Methods

The CREDENCE trial randomized 4401 participants with T2DM and CKD to the SGLT2 inhibitor canagliflozin or matching placebo. In this post-hoc analysis using an intention-to-treat approach, we assessed the effect of canagliflozin on a composite outcome of time to either investigator-reported hyperkalaemia or the initiation of potassium binders. We also analysed effects on central laboratory-determined hyper- and hypokalaemia (serum potassium ≥6.0 and <3.5 mmol/L, respectively) and change in serum potassium.

Results

At baseline the mean serum potassium in canagliflozin and placebo arms was 4.5 mmol/L; 4395 (99.9%) participants were receiving renin angiotensin system blockade. Canagliflozin reduced the risk of investigator-reported hyperkalaemia or initiation of potassium binders (HR 0.78, 95% CI 0.64–0.95, p=0.014; Figure 1). The incidence of laboratory-determined hyperkalaemia was similarly reduced (HR 0.77, 95% CI 0.61–0.98, p=0.031; Figure 2); the risk of hypokalaemia (HR 0.92, 95% CI 0.71–1.20, p=0.53) was not increased. Mean serum potassium over time with canagliflozin was similar to that of placebo.

Conclusion

Among patients treated with RAAS inhibitors, SGLT2 inhibition with canagliflozin may reduce the risk of hyperkalaemia in people with T2DM and CKD without increasing the risk of hypokalaemia.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Comparison of standing stability with different doses in epidural fentanyl among post-cesarean delivery women: a prospective trial

BACKGROUND

The study purpose was to determine the safety and efficacy of different doses of epidural fentanyl plus local anesthetics on ambulation for patients who had elective cesarean delivery.

METHODS

A prospective study at a single community hospital used posturography to compute Sway area for assessment of standing stability [ISRCTN14517337]. Continuous epidural infusion of 0.2% ropivacaine containing either 2.5 mcg.mL^-1 (Group 1, n = 8) or 5 mcg.mL^-1 fentanyl (Group 2, n = 8) was randomly assigned to an individual and started at a rate of 5 mL.h^-1 postoperatively and continued for 48 hours after cesarean delivery in addition to standing acetaminophen and ibuprofen. Posturography measured with SYMPACK™ was used to compute Sway area for investigation of standing stability. The unpaired t-test was used to compare continuous variables between groups. Analysis of variance (ANOVA) was used to assess differences of Sway area measured repeatedly within groups.

RESULTS

Participants' demographics, pain status, and leg motor function one day after cesarean delivery were not different between groups. Sway area in Group 1 was not different across three repeated measurements. Sway area of Group 2 on postoperative day 1, with epidural analgesia, was significantly higher than at the baseline (4.1 ± 2.8 vs. 3.1 ± 1.1 cm², p < 0.05).

CONCLUSIONS

Because both low and high concentrations of epidural fentanyl allowed participants to ambulate with the same pain effect, the lower concentration of continuous epidural fentanyl (2.5 mcg.mL^-1 at 5 mL.h^-1) is warranted to avoid potential adverse events during ambulation after cesarean delivery.

Unusual visual and olfactory perceptions during radiotherapy sessions: an investigation of the organs responsible

During radiotherapy sessions to treat brain tumors or head-and-neck cancers, some patients experience unusual visual and/or olfactory perceptions. This prospective study sought to answer two questions: (i) what proportion of patients experience these unpleasant sensations?, and (ii) which organs are responsible? Eligible patients had brain or near-orbital tumors treated by helical tomotherapy. All were aged 10 years or older, able to communicate, and interviewed by a radiation oncologist at least once weekly during radiation therapy. If they had experienced such sensations, they were encouraged to join the second phase of the study. The patients were asked to indicate, using a button, when a sensation commenced and ended. The recorded data were collated with the treatment log. Thirty-eight consecutive patients were eligible. Twenty-six experienced visual and 13 olfactory sensations. The radiation doses to the organs related to the visual or olfactory sensations did not differ between patients who reported sensations and those who did not. Seventeen patients were enrolled in the second phase of the study. All 14 with visual sensations reported that the sensations occurred when the X-rays passed at eye level. Olfactory sensations were reported by eight out of nine patients when the X-rays passed through the olfactory epithelium and/or ethmoid sinus level. In conclusion, 68% of patients experienced visual sensations caused by X-rays passing through the level of the eyes, and 34% complained of olfactory sensations. With the exception of one patient, olfactory sensations occurred when the X-rays passed through the levels of the olfactory epithelium and/or ethmoid sinus.

Quantification of Oscillatory Shear Stress from Reciprocating CSF Motion on 4D Flow Imaging

BACKGROUND AND PURPOSE

Oscillatory shear stress could not be directly measured in consideration of direction, although cerebrospinal fluid has repetitive movements synchronized with heartbeat. Our aim was to evaluate the important of oscillatory shear stress in the cerebral aqueduct and foramen magnum in idiopathic normal pressure hydrocephalus by comparing it with wall shear stress and the oscillatory shear index in patients with idiopathic normal pressure hydrocephalus.

MATERIALS AND METHODS

By means of the 4D flow application, oscillatory shear stress, wall shear stress, and the oscillatory shear index were measured in 41 patients with idiopathic normal pressure hydrocephalus, 23 with co-occurrence of idiopathic normal pressure hydrocephalus and Alzheimer-type dementia, and 9 age-matched controls. These shear stress parameters at the cerebral aqueduct were compared with apertures and stroke volumes at the foramen of Magendie and cerebral aqueduct.

RESULTS

Two wall shear stress magnitude peaks during a heartbeat were changed to periodic oscillation by converting oscillatory shear stress. The mean oscillatory shear stress amplitude and time-averaged wall shear stress values at the dorsal and ventral regions of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus groups were significantly higher than those in controls. Furthermore, those at the ventral region of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus group were also significantly higher than those in the co-occurrence of idiopathic normal pressure hydrocephalus with Alzheimer-type dementia group. The oscillatory shear stress amplitude at the dorsal region of the cerebral aqueduct was significantly associated with foramen of Magendie diameters, whereas it was strongly associated with the stroke volume at the upper end of the cerebral aqueduct rather than that at the foramen of Magendie.

CONCLUSIONS

Oscillatory shear stress, which reflects wall shear stress vector changes better than the conventional wall shear stress magnitude and the oscillatory shear index, can be directly measured on 4D flow MR imaging. Oscillatory shear stress at the cerebral aqueduct was considerably higher in patients with idiopathic normal pressure hydrocephalus.

Study of charged particle activation analysis (II): Determination of boron concentration in human blood samples

Boron Neutron Capture Therapy (BNCT) is a radiotherapy for the treatment of intractable cancer. In BNCT precise determination of ¹⁰B concentration in whole blood sample before neutron irradiation of the patient, as well as accurate neutron dosimetry, is crucial for control of the neutron irradiation time. For this purpose ICP-AES and neutron induced prompt γ-ray analysis are generally used. In Ibaraki Neutron Medical Research Center (iNMRC), an intense proton beam will be accelerated up to 8 MeV, which can also be used for Charged Particle Activation Analysis (CPAA). Thus, in this study, we apply the CPAA utilizing the proton beam to non-destructive and accurate determination of ¹⁰B concentration in whole blood sample. A CPAA experiment is performed by utilizing an 8 MeV proton beam from the tandem accelerator of Nuclear Science Research Institute in Japan Atomic Energy Agency. The 478 keV γ-ray of ⁷Be produced by the ¹⁰B(p, α)⁷Be reaction is used to quantify the ¹⁰B in human blood. The 478 keV γ-ray intensity is normalized by the intensities of the 847 keV and 1238 keV γ-rays of ⁵⁶Co originating from Fe in blood. The normalization methods were found to be linear in the range of 3.27 μg ¹⁰B/g to 322 μg ¹⁰B/g with correlation coefficients of better than 0.9999.

Identification of a TLR2-regulated gene signature associated with tumor cell growth in gastric cancer

Toll-like receptors (TLRs) are key regulators of innate immune responses, and their dysregulation is observed in numerous inflammation-associated malignancies, including gastric cancer (GC). However, the identity of specific TLRs and their molecular targets which promote the pathogenesis of human GC is ill-defined. Here, we sought to determine the clinical utility of TLR2 in human GC. TLR2 mRNA and protein expression levels were elevated in >50% of GC patient tumors across multiple ethnicities. TLR2 was also widely expressed among human GC cell lines, and DNA microarray-based expression profiling demonstrated that the TLR2-induced growth responsiveness of human GC cells corresponded with the up-regulation of six anti-apoptotic (BCL2A1, BCL2, BIRC3, CFLAR, IER3, TNFAIP3) and down-regulation of two tumor suppressor (PDCD4, TP53INP1) genes. The TLR2-mediated regulation of these anti-apoptotic and tumor suppressor genes was also supported by their increased and reduced expression, respectively, in two independent genetic GC mouse models (gp130^F/F and Gan) characterized by high tumor TLR2 expression. Notably, enrichment of this TLR2-regulated gene signature also positively correlated with augmented TLR2 expression in human GC tumors, and served as an indicator of poor patient survival. Furthermore, treatment of gp130^F/F and cell line-derived xenograft (MKN1) GC mouse models with a humanized anti-TLR2 antibody suppressed gastric tumor growth, which was coincident with alterations to the TLR2-driven gene signature. Collectively, our study demonstrates that in the majority of GC patients, elevated TLR2 expression is associated with a growth-potentiating gene signature which predicts poor patient outcomes, thus supporting TLR2 as a promising therapeutic target in GC.

Frequent somatic mutations in epigenetic regulators in newly diagnosed chronic myeloid leukemia

Although tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis of chronic myeloid leukemia (CML), the ability of TKIs to eradicate CML remains uncertain and patients must continue TKI therapy for indefinite periods. In this study, we performed whole-exome sequencing to identify somatic mutations in 24 patients with newly diagnosed chronic phase CML who were registered in the JALSG CML212 study. We identified 191 somatic mutations other than the BCR-ABL1 fusion gene (median 8, range 1–17). Age, hemoglobin concentration and white blood cell counts were correlated with the number of mutations. Patients with mutations ⩾6 showed higher rate of achieving major molecular response than those<6 (P=0.0381). Mutations in epigenetic regulator, ASXL1, TET2, TET3, KDM1A and MSH6 were found in 25% of patients. TET2 or TET3, AKT1 and RUNX1 were mutated in one patient each. ASXL1 was mutated within exon 12 in three cases. Mutated genes were significantly enriched with cell signaling and cell division pathways. Furthermore, DNA copy number analysis showed that 2 of 24 patients had uniparental disomy of chromosome 1p or 3q, which disappeared major molecular response was achieved. These mutations may play significant roles in CML pathogenesis in addition to the strong driver mutation BCR-ABL1.

Computational fluid dynamics study of the pharyngeal airway space before and after mandibular setback surgery in patients with mandibular prognathism

The purpose of this study was to investigate the relationship between the pressure drop in the pharyngeal airway space (ΔP_PAS) and the minimum cross-sectional area (minCSA) of the pharyngeal airway before and after mandibular setback surgery using computational fluid dynamics, in order to prevent iatrogenic obstructive sleep apnoea. Eleven patients with mandibular prognathism underwent bilateral sagittal split osteotomy for mandibular setback. Three-dimensional models of the upper airway were reconstructed from preoperative and postoperative computed tomography images, and simulations were performed using computational fluid dynamics. ΔP_PAS and the minCSA of the pharyngeal airway were calculated, and the relationship between them was evaluated by non-linear regression analysis. In all cases, the minCSA was found at the level of the velopharynx. After surgery, ΔP_PAS increased significantly and the minCSA decreased significantly. The non-linear regression equation expressing the relationship between these variables was ΔP_PAS=3.73×minCSA^-2.06. When the minCSA was <1cm², ΔP_PAS increased greatly. The results of this study suggest that surgeons should consider bimaxillary orthognathic surgery rather than mandibular setback surgery to prevent the development of iatrogenic obstructive sleep apnoea when correcting a skeletal class III malocclusion.

Mass production of functional human pancreatic β-cells: why and how?

Diabetes (either type 1 or type 2) is due to insufficient functional β-cell mass. Research has, therefore, aimed to discover new ways to maintain or increase either β-cell mass or function. For this purpose, rodents have mainly been used as model systems and a large number of discoveries have been made. Meanwhile, although we have learned that rodent models represent powerful systems to model β-cell development, function and destruction, we realize that there are limitations when attempting to transfer the data to what is occurring in humans. Indeed, while human β-cells share many similarities with rodent β-cells, they also differ on a number of important parameters. In this context, developing ways to study human β-cell development, function and death represents an important challenge. This review will describe recent data on the development and use of convenient sources of human β-cells that should be useful tools to discover new ways to modulate functional β-cell mass in humans.

Identical wave forms of vena cava and pulmonary artery during pulmonary artery catheter insertion due to kinking: a case report of a rare complication

BACKGROUND

We experienced a rare malposition of a pulmonary artery catheter due to kinking in a 63-year-old male who was scheduled for an off-pump coronary artery by-pass graft.

FINDINGS

Given the difficulty to obtain stable pulmonary artery waveform, we discovered that the two waveforms of the distal and proximal ports of the pulmonary artery catheter were completely identical. Subsequent fluoroscopy revealed that because the catheter had formed a kink around the apex of the right ventricle, the distal port faced the proximal port of the catheter.

CONCLUSIONS

We recommend that both ports of the pulmonary artery catheter need to be monitored simultaneously in case neither portable fluoroscopy nor transesophageal echo is available.

Development of a compact label-free small molecule measurement system using a periodically nanostructured sensor substrate

Compact label-free small molecule measurement system with visible light.

[Anesthetic management of a pneumothorax patient with complete situs inversus]

We experienced a case of pneumothorax in a patient with complete situs inversus. A 30-year-old man was scheduled for partial resection of the left lung under video assisted thoracic surgery. He had asymptomatic complete situs inversus. We advanced a bronchial blocker easily into the left (anatomically right) main bronchus under fiberoptic guidance. One lung ventilation during the operation was performed successfully. The chest X-ray after the surgery showed an atelectasis of the left upper lobe. After endotracheal suction, we extubated him and noticed improvement of atelectasis. There are several ways of one lung ventilation in patients with situs inversus. To use a bronchial blocker is one of the effective choices. However, in some cases, it is necessary to consider using a double-lumen tube depending on the case considering the anatomical structure and the characteristics of the procedure.

Core-Level Photoemission From Stoichiometric GaN(0001)-1×1

We report on a high-resolution x-ray photoelectron spectroscopy (HRXPS) study using synchrotron radiation, for the identification of the core level binding energies of Ga 3d and N 1s, from a stoichiometric Ga-polar GaN(0001)-1×1 sample.

Three surface shifted components were found on the stoichiometric surface for the Ga 3d feature. The first surface shifted component has a higher binding energy of 0.85 eV, and is interpreted as surface Ga with one of the N bonds replaced by an empty dangling bond. This structure is belonging to the stoichiometric clean and ordered Ga-polar GaN(0001)-1×1 surface. The second, with a binding energy relative the bulk of −0.76 eV, is interpreted as Ga with one of the bonds to a Ga atom, which indicates a slight excess of Ga on the surface. The third surface shifted component is shifted by 2.01 eV and is related to gallium oxide in different configurations.

The N 1s feature is complex with five surface shifted components relative the bulk were found. Two components with binding energy shifts of −0.54 eV and 0.47 eV are interpreted as surface shifted core levels from the stoichiometric, clean Ga-polar GaN(0001)-1×1 surface.

We also analysed the Ga 3d spectrum after deposition of 1.5 ML of Ga on a stoichiometric surface. The surface shift for the Ga 3d5/2 component from the Ga overlayer is −1.74 eV relative the bulk GaN.

The C 1s and O 1s core levels from remaining surface contamination have also been line shaped analysed and show complex structures.

Electronic excitations of a magnetic impurity state in the diluted magnetic semiconductor (Ga,Mn)As

The electronic structure of doped Mn in (Ga,Mn)As is studied by resonant inelastic x-ray scattering. From configuration-interaction cluster-model calculations, the line shapes of the Mn L3 resonant inelastic x-ray scattering spectra can be explained by d-d excitations from the Mn ground state dominated by charge-transferred states, in which hole carriers are bound to the Mn impurities, rather than a pure acceptor Mn2+ ground state. Unlike archetypical d-d excitation, the peak widths are broader than the experimental energy resolution. We attribute the broadening to a finite lifetime of the d-d excitations, which decay rapidly to electron-hole pairs in the host valence and conduction bands through the hybridization of the Mn 3d orbital with the ligand band.

A novel triple secured technique for pancreatic reconstruction following pancreaticoduodenectomy for a soft pancreas

BACKGROUND/AIMS

Soft pancreases are susceptible to developing pancreatic fistula following pancreaticoduodenectomy. To reduce the incidence of pancreatic fistula after pancreaticoduodenectomy in patients with a soft pancreas, we developed a triple secured technique. In this study, we describe the details of this technique and also report on the postoperative outcomes.

METHODOLOGY

The triple secured technique employed an ultrasonic dissector for pancreatic transection with skeletonizing and ligating of the small pancreatic branch ducts, duct-invagination or duct-to-mucosa anastomosis for main pancreatic duct management, and, finally, four large stitches between the pancreatic stump parenchyma and the jejunal seromuscular layer to prevent minor pancreatic leakage. A total of 28 consecutive patients with a soft pancreas who underwent pancreaticoduodenectomy using our technique were included in this study.

RESULTS

Postopetrative complications occurred in 16 patients. Grade B pancreatic fistula developed in 6 patients. However, no grade C pancreatic fistula occurred in this series. Neither any reoperation nor in-hospital mortality was observed in this series.

CONCLUSIONS

Our triple secured technique after pancreaticoduodenectomy was feasible and safe, with an acceptable rate of grade B pancreatic fistula and no grade C pancreatic fistula for patients with a soft pancreas.

Spin-filter tunnel junction with matched fermi surfaces

Efficient injection of spin-polarized current into a semiconductor is a basic prerequisite for building semiconductor-based spintronic devices. Here, we use inelastic electron tunneling spectroscopy to show that the efficiency of spin-filter-type spin injectors is limited by spin scattering of the tunneling electrons. By matching the Fermi-surface shapes of the current injection source and target electrode material, spin injection efficiency can be significantly increased in epitaxial ferromagnetic insulator tunnel junctions. Our results demonstrate that not only structural but also Fermi-surface matching is important to suppress scattering processes in spintronic devices.

Self-energy on the low- to high-energy electronic structure of correlated metal SrVO3

The correlated electronic structure of SrVO(3) has been investigated by angle-resolved photoemission spectroscopy using in situ prepared thin films. Pronounced features of band renormalization have been observed: a sharp kink ∼60 meV below the Fermi level (E(F)) and a broad so-called "high-energy kink" ∼0.3 eV below E(F) as in the high-T(c) cuprates, although SrVO(3) does not show magnetic fluctuations. We have deduced the self-energy in a wide energy range by applying the Kramers-Kronig relation to the observed spectra. The obtained self-energy clearly shows a large energy scale of ∼0.7 eV, which is attributed to electron-electron interaction and gives rise to the ∼0.3 eV kink in the band dispersion as well as the incoherent peak ∼1.5 eV below E(F). The present analysis enables us to obtain a consistent picture for both the incoherent spectra and the band renormalization.

[The problem of cardiac surgery with neoplasm]

Neoplasm and cardiac diseases are rarely found at the same time. If the standard treatment for both of these diseases is operation, several problems arise;1 stage or 2 stage operation, which operation should be done 1st etc. Especially, if cardiac operation needs cardiopulmonary bypass, neoplasm may grow faster. In such cases, we must decide operative procedure carefully.

Inflammation-induced repression of tumor suppressor miR-7 in gastric tumor cells

Inflammation has an important role in cancer development through various mechanisms. It has been shown that dysregulation of microRNAs (miRNAs) that function as oncogenes or tumor suppressors contributes to tumorigenesis. However, the relationship between inflammation and cancer-related miRNA expression in tumorigenesis has not yet been fully understood. Using K19-C2mE and Gan mouse models that develop gastritis and gastritis-associated tumors, respectively, we found that 21 miRNAs were upregulated, and that 29 miRNAs were downregulated in gastric tumors in an inflammation-dependent manner. Among these miRNAs, the expression of miR-7, a possible tumor suppressor, significantly decreased in both gastritis and gastric tumors. Moreover, the expression of miR-7 in human gastric cancer was inversely correlated with the levels of interleukin-1β and tumor necrosis factor-α, suggesting that miR-7 downregulation is related to the severity of inflammatory responses. In the normal mouse stomach, miR-7 expression was at a basal level in undifferentiated gastric epithelial cells, and was induced during differentiation. Moreover, transfection of a miR-7 precursor into gastric cancer cells suppressed cell proliferation and soft agar colony formation. These results suggest that suppression of miR-7 expression is important for maintaining the undifferentiated status of gastric epithelial cells, and thus contributes to gastric tumorigenesis. Although epigenetic changes were not found in the CpG islands around miR-7-1 of gastritis and gastric tumor cells, we found that activated macrophage-derived small molecule(s) (<3 kDa) are responsible for miR-7 repression in gastric cancer cells. Furthermore, the miR-7 expression level significantly decreased in the inflamed gastric mucosa of Helicobacter-infected mice, whereas it increased in the stomach of germfree K19-C2mE and Gan mice wherein inflammatory responses were suppressed. Taken together, these results indicate that downregulation of tumor suppressor miR-7 is a novel mechanism by which the inflammatory response promotes gastric tumorigenesis.

Scanning photoelectron microscope for nanoscale three-dimensional spatial-resolved electron spectroscopy for chemical analysis

In order to achieve nondestructive observation of the three-dimensional spatially resolved electronic structure of solids, we have developed a scanning photoelectron microscope system with the capability of depth profiling in electron spectroscopy for chemical analysis (ESCA). We call this system 3D nano-ESCA. For focusing the x-ray, a Fresnel zone plate with a diameter of 200 μm and an outermost zone width of 35 nm is used. In order to obtain the angular dependence of the photoelectron spectra for the depth-profile analysis without rotating the sample, we adopted a modified VG Scienta R3000 analyzer with an acceptance angle of 60° as a high-resolution angle-resolved electron spectrometer. The system has been installed at the University-of-Tokyo Materials Science Outstation beamline, BL07LSU, at SPring-8. From the results of the line-scan profiles of the poly-Si/high-k gate patterns, we achieved a total spatial resolution better than 70 nm. The capability of our system for pinpoint depth-profile analysis and high-resolution chemical state analysis is demonstrated.

Dimensional-crossover-driven metal-insulator transition in SrVO3 ultrathin films

We have investigated the changes occurring in the electronic structure of digitally controlled SrVO(3) ultrathin films across the metal-insulator transition (MIT) by the film thickness using in situ photoemission spectroscopy. With decreasing film thickness, a pseudogap is formed at E(F) through spectral weight transfer from the coherent part to the incoherent part. The pseudogap finally evolves into an energy gap that is indicative of the MIT in a SrVO(3) ultrathin film. The observed spectral behavior is reproduced by layer dynamical-mean-field-theory calculations, and it indicates that the observed MIT is caused by the reduction in the bandwidth due to the dimensional crossover.

Effect of turbulence on feeding intensity and survival of Japanese flounder Paralichthys olivaceus pelagic larvae

Three-day rearing experiments were conducted to study the effect of turbulence on the feeding intensity and survival of pelagic larvae of Japanese flounder Paralichthys olivaceus. Four levels of turbulence as control (10(-7.2) m2 s(-3)), low (10(-6.2) m2 s(-3)), mid (10(-5.6) m2 s(-3)) and high (10(-5.0) m2 s(-3)) were set by changing the flow rate of water pumped through pipes set on the bottom of the tanks. In B-stage larvae, defined as having buds of elongated dorsal fin rays, the feeding intensity and growth were higher in the low and mid turbulence levels, while survival was highest in the control level. Most of the larvae surviving in the control level, however, were judged to be in a seriously starved condition leading to subsequent high mortality. Because the three-day span of the rearing experiments was thought to be a little shorter than the periods before starvation-induced, high mortality occurs. In contrast, for D-stage larvae, their feeding and growth were optimal in the control and low levels. Feeding was more adversely affected in the high level for D-stage larvae compared with B-stage larvae. This is probably due to the compressed body shape and elongated dorsal fin rays of D-stage larvae, which may be more strongly affected by turbulence and, as a consequence, the larval feeding behaviour such as pursuit and capture of prey organisms becomes less efficient than in lower turbulence. Considering the vertical distribution of B and D-stage larvae in the oceanic water column, the optimum turbulence level range found in the present study corresponded to a wind speed of 7-10 m s(-1). Therefore, moderate weather conditions of this wind speed range are considered to potentially enhance survival of early larval stages of P. olivaceus.

[Suspected case of peripartum cardiomyopathy developed during elective cesarean section]

A 35-year-old primigravida with twin gestation was admitted for elective cesarean section. She had no preoperative systemic diseases including heart disease. At 37 weeks of gestation, elective cesarean section was performed under combined spinal-epidural anesthesia. Anesthetic course was uneventful until the delivery when the patient started to cough and complained of dyspnea. At the same time, Spo2 started to decline to reach 95% despite the oxygen supplement. Pleural effusion was observed on the chest X-ray on postoperative day 2. An echocardiography showed diffuse hypokinesis of the left ventricle with ejection fraction (EF) of 36%. Peripartum cardiomyopathy was strongly suspected. Symptoms of heart failure were alleviated by water restriction and furosemide by the 9th POD. The EF increased to 50% on the 15th POD.

[Relationship between pleural indentation on computed tomography scans and pleural invasion in small peripheral lung cancer of 2 cm in size or less]

Eighty-six cases of small peripheral lung cancer without contact with the chest wall on computed tomography (CT) scans were studied on the presence of radiological pleural indentation and pathological pleural invasion. Twenty-three tumors in 44 cases with pleural indentation were found to reach the pleura histologically, but only one in 42 cases without pleural indentation. There is a high possibility of pleural invasion or contact with the pleura in small lung cancers with pleural indentation. There was no relationship between the presence of pleural indentation and the tumor/chest wall distance on CT scans. Pleural indentations were more frequently seen in small adenocarcinomas of low ground-glass opacity (GGO) ratio or Noguchi's type C. Small lung nodules with pleural indentation had better be removed as early as possible because of the possibility of pleural invasion and pleural dissemination.

Polyphosphoric acid treatment promotes bone regeneration around titanium implants

This study was conducted to evaluate the effect of polyphosphoric acid (PPA) treatment on bone regeneration around titanium (Ti) implants in vivo. Adsorption of PPA by Ti was achieved by immersing Ti implants (2 mm in diameter, 4 mm in length) in different concentrations of PPA solution (0, 1 and 10 wt%) for 24 h at 37 degrees C after proper Ti surface cleaning. The treated Ti implants were implanted on 8-week-old-male rat (n = 30) tibiae. Two or four weeks after implantation, all animals were deeply anaesthetized and underwent perfusion fixation. Ten specimens in each condition were further immersed in the same fixative for 1 week and eventually embedded in polyester resin. Afterwards, undecalcified sections were ground to a thickness of approximately 70 microm parallel to the long axis of the implant. The sections were stained with basic fuchsine and methylene blue and then examined by light microscopy. For quantitative evaluation of bone regeneration around the implants, the bone-implant contact ratio (BICR) was determined. Polyphosphoric acid treatment of the Ti implant surface significantly enhanced direct bone contact to the Ti surface. Especially, the BICRs of the 1 wt% PPA-treated Ti implants were significantly higher than those of the control untreated Ti implants, both 2 and 4 weeks after implantation. At 4 weeks, 10 wt% PPA-treated implants also significantly increased the BICR as compared to that of the untreated Ti implants. These results suggest that PPA treatment promotes osteoconductivity of Ti in vivo.

Origin of metallic states at the heterointerface between the band insulators LaAlO3 and SrTiO3

We have studied the electronic structure at the heterointerface between the band insulators LaAlO3 and SrTiO3 using in situ photoemission spectroscopy. Our experimental results clearly reveal the formation of a notched structure on the SrTiO3 side due to band bending at the metallic LaAlO3/TiO2-SrTiO3 interface. The structure, however, is absent at the insulating LaAlO3/SrO-SrTiO3 interface. The present results indicate that the metallic states originate not from the charge transfer through the interface on a short-range scale but from the accumulation of carriers on a long-range scale.

Nature of magnetic coupling between Mn ions in As-grown Ga1-xMnxAs studied by X-ray magnetic circular dichroism

The magnetic properties of as-grown Ga1-xMnxAs have been investigated by the systematic measurements of temperature and magnetic field dependent soft x-ray magnetic circular dichroism (XMCD). The intrinsic XMCD intensity at high temperatures obeys the Curie-Weiss law, but a residual spin magnetic moment appears already around 100 K, significantly above the Curie temperature (T_{C}), suggesting that short-range ferromagnetic correlations are developed above T_{C}. The present results also suggest that the antiferromagnetic interaction between the substitutional and interstitial Mn (Mn_{int}) ions exists and that the amount of the Mn_{int} affects T_{C}.