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

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

Multivariate Analysis of Risk Factors for Complications in Pediatric Tissue Expansion

BACKGROUND

Tissue expanders represent one of the main surgical options for skin reconstruction in cases of tumors, traumalike burn injury, scar contracture, and alopecia. However, the tissue expander device is also associated with complications such as infection and extrusion. The aim of this study was to analyze risk factors for major complications of use of tissue expanders in pediatric patients using multivariate analysis.

METHODS

A retrospective, single-center observational study was performed over 10 years in pediatric patients who were treated with tissue expanders for tumors, nevus, scars, burn reconstruction, and alopecia from April 2012 to March 2022. The primary outcome was overall complications per operation and expander, including infection and extrusion. Ten predictor variables were included as risk factors based on previous studies and as new factors considered important from clinical experience. Univariate and multivariate logistic regression analyses were performed to identify risk factors for major complications such as expander infection or extrusion.

RESULTS

The study included 44 patients who underwent 92 operations using 238 tissue expanders. The overall complication rate per expander was 14.3%. Univariate logistic regression analysis identified associations of younger age, number of expanders used per operation, history of infection, and tissue expander locations with a higher complication rate. In multivariate logistic regression analysis, younger age (odds ratio, 1.14; P = 0.043) was associated with a high likelihood of expander complications.

CONCLUSIONS

Younger age is an independent risk factor for tissue expander complications in pediatric patients. This factor should be considered in preoperative planning and discussions with the patient's family.

Photocatalytic CO2 Reduction Using an Osmium Complex as a Panchromatic Self-Photosensitized Catalyst: Utilization of Blue, Green, and Red Light

The photocatalytic reduction of carbon dioxide (CO2) represents an attractive approach for solar-energy storage and leads to the production of renewable fuels and valuable chemicals. Although some osmium (Os) photosensitizers absorb long wavelengths in the visible-light region, a self-photosensitized, mononuclear Os catalyst for red-light-driven CO2 reduction has not yet been exploited. Here, we discovered that the introduction of an Os metal to a PNNP-type tetradentate ligand resulted in the absorption of light with longer-wavelength (350-700 nm) and that can be applied to a panchromatic self-photosensitized catalyst for CO2 reduction to give mainly carbon monoxide (CO) with a total turnover number (TON) of 625 under photoirradiation (λ≥400 nm). CO2 photoreduction also proceeded under irradiation with blue (λ0=405 nm), green (λ0=525 nm), or red (λ0=630 nm) light to give CO with >90 % selectivity. The quantum efficiency using red light was determined to be 12 % for the generation of CO. A catalytic mechanism is proposed based on the detection of intermediates using various spectroscopic techniques, including transient absorption, electron paramagnetic resonance, and UV/Vis spectroscopy.

Re-Evaluation of Vascular Histogenesis in the Root Tips of Selected Species in the Poaceae Using New Methods: Analysis of the Plerome, Vascular Initials, Pericycle and Late-Maturing Metaxylem Vessels

Serial sectioning and 3D image reconstruction methods were applied to elucidate the structures of the apices of root vascular cylinders (VCs) in taxa of the Poaceae: Zea mays "Honey Bantam", Z. mays ssp. mexicana, Hordeum vulgare and Oryza sativa. The primary and nodal roots were investigated. Observations were performed using high-quality sectioning and 3D image-processing techniques improved and developed by the authors. We found that a quiescent uniseriate plerome was located at the most distal part of each VC. Vascular initials were located immediately basipetally to the plerome as a specific uniseriate layer that could be classified into central and peripheral initials that produced all the cells in the VC. No supplying of cells from the plerome to the vascular initials was observed. Numerical analysis revealed a "boundary point" along the root axis where the rate of increase of the vascular cell number markedly declined, and the VC diameter, number of vascular cells, and number of late-maturing metaxylem vessels (LMXs) at that point showed a similar relationship among the taxa and the types of roots examined (primary vs. nodal). The plerome and vascular initials layer can be considered independent after seed germination in these taxa. A boundary point at which procambial cell proliferation sharply declined was identified. The diameters of the VCs, number of LMXs, and number of vascular cells at the boundary point were found to be strongly related to each other.

Evaluation of adipogenesis over time using a novel bioabsorbable implant without the addition of exogenous cells or growth factors

Background

Breast reconstruction is crucial for patients who have undergone mastectomy for breast cancer. Our bioabsorbable implants comprising an outer poly-l-lactic acid mesh and an inner component filled with collagen sponge promote and retain adipogenesis in vivo without the addition of exogenous cells or growth factors. In this study, we evaluated adipogenesis over time histologically and at the gene expression level using this implant in a rodent model.

Methods

The implants were inserted in the inguinal and dorsal regions of the animals. At 1, 3, 6, and 12 months post-operation, the weight, volume, and histological assessment of all newly formed tissue were performed. We analyzed the formation of new adipose tissue using multiphoton microscopy and RNA sequencing.

Results

Both in the inguinal and dorsal regions, adipose tissue began to form 1 month post-operation in the peripheral area. Angiogenesis into implants was observed until 3 months. At 6 months, microvessels matured and the amount of newly generated adipose tissue peaked and was uniformly distributed inside implants. The amount of newly generated adipose tissue decreased from 6 to 12 months but at 12 months, adipose tissue was equivalent to the native tissue histologically and in terms of gene expression.

Conclusions

Our bioabsorbable implants could induce normal adipogenesis into the implants after subcutaneous implantation. Our implants can serve as a novel and safe material for breast reconstruction without requiring exogenous cells or growth factors.

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.

PreFlap: From Photoacoustic Tomography Images to Vascular Mapping Sheets for Improved Preoperative Flap Evaluation

OBJECTIVE

Advancements in technology have improved image acquisition and processing in the field of medical imaging, giving medical doctors the tools to implement effective medical care. In plastic surgery, despite advances in anatomical knowledge and technology, problems in preoperative planning for flap surgery remain.

METHODS

In this study, we propose a new protocol to analyze three-dimensional (3D) Photoacoustic tomography images and generate two-dimensional (2D) mapping sheets that can help surgeons identify perforators and the perfusion territory during preoperative planning. The core of this protocol is PreFlap, a new algorithm that converts 3D photoacoustic tomography images into 2D vascular mapping images.

CONCLUSION

Experimental results demonstrate that PreFlap can improve preoperative flap evaluation, thus can greatly saving surgeons' time and improving surgical outcomes.

Morphologic Changes in Postaxial Polydactyly of the Foot: A Standardized Quantitative Analysis Using the Watanabe-Fujita Classification

BACKGROUND

Postaxial polydactyly of the foot is one of the most common congenital abnormalities. A wide forefoot, short toe, and lateral joint deviation are associated with aesthetic and functional outcomes. This study used the Watanabe-Fujita classification to characterize the preoperative and postoperative skeletal morphology of postaxial polydactyly of the foot.

METHODS

This retrospective study included 42 patients (51 feet) with postaxial polydactyly treated at age 1 year. Radiographs taken at ages 0 and 3 to 4 years were used for morphologic analysis. The length of the reconstructed toe, the distance between the fourth and fifth metatarsals, and joint deviation angles were measured. The length measures were standardized using the length of the third metatarsal. Morphologic characteristics were compared based on the Watanabe-Fujita classification at ages 0 and 3 to 4 years. Long-term outcomes were also evaluated in patients followed up for longer than 6 years.

RESULTS

The fifth-ray proximal phalangeal subtype had the shortest toe length both at ages 0 and 3 to 4 years. Proximal phalangeal joint lateral deviation improved postoperatively in 78% of patients with the fifth-ray middle phalangeal subtype, regardless of reconstruction type. There was no significant change in proximal phalangeal joint deviation between ages 3 to 4 years and 7 years or older. A residual metatarsal was associated with lateral metatarsophalangeal joint deviation and a wide intermetatarsal distance, and required revision surgery.

CONCLUSIONS

Morphologic changes of postaxial polydactyly of the foot were successfully characterized using the Watanabe-Fujita classification. This classification could be useful for planning surgical strategies and anticipating morphologic outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

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.

Sensitivity of Mucor piriformis to Natamycin and Efficacy of Natamycin Alone and with Salt and Heat Treatments Against Mucor Rot of Stored Mandarin Fruit

Mucor rot caused by Mucor piriformis is an emerging postharvest disease of mandarin fruit in California. Natamycin is a newly registered biofungicide for postharvest use on citrus and some other fruits. In the study, baseline sensitivity to natamycin in 50 isolates of M. piriformis was determined in vitro. The mean EC50 (effective concentration to inhibit sporangiospore germination by 50%) and MIC (minimum inhibitory concentration to inhibit mycelial growth by 100%) values were 0.59 μg/ml and less than 1.0 μg/ml, respectively. Natamycin at the label rate of 920 μg/ml alone or in combination with 3% potassium sorbate (PS) or 3% sodium carbonate (SC) applied at 20 or 50°C was evaluated for control of Mucor rot on inoculated 'Tango' mandarin fruit. Natamycin alone reduced Mucor rot incidence on stored mandarin fruit from 100% among nontreated control fruit to approximately 30%, a reduction of more than 70% compared to the nontreated control, while 3% PS and 3% SC had no to little control. When applied at 50°C, natamycin and 3% PS reduced Mucor rot incidence by 65.0 and 31.2%, respectively; while natamycin in combination with 3% PS reduced disease incidence by 92.5% compared to the nontreated control after 2 weeks of storage at 5°C. This combined treatment remained effective even when the application of the treatment was delayed for 6 and 12 h after inoculation. However, the effectiveness of the treatments declined when storage was extended to 3 or 4 weeks. Natamycin can be an effective tool to control Mucor rot on mandarin fruit, and minimizing the period of extended storage could help maintain the control efficacy of natamycin.

Improved image processing for 3D virtual object construction from serial sections reveals tissue patterns in root tips of Zea mays

Premise

Previously we described methods for generating three-dimensional (3D) virtual reconstructions of plant tissues from transverse thin sections. Here, we report the applicability of longitudinal sections and improved image-processing steps that are simpler to perform and utilize free applications.

Methods

In order to obtain improved digital images and a virtual 3D object (cuboid), GIMP 2.10 and ImageJ 2.3.0 running on a laptop computer were used. Sectional views of the cuboid and 3D visualization were realized with use of the plug-ins "Volume Viewer" and "3D Viewer" in ImageJ.

Results

A 3D object was constructed and sectional views along several cutting planes were generated. The 3D object consisted of selected tissues inside the cuboid that were extracted and visualized from the original section data, and an animated video of the 3D construct was also produced.

Discussion

Virtual cuboids can be constructed by stacking longitudinal images along the transverse depth direction or stacking transverse images vertically along the organ axis, with both generating similar 3D objects. Which to use depends on the purpose of the investigation: if the vertical cell structures need close examination, the former method may be better, but for more general spatial evaluations or for evaluation of organs over longer tissue distances than can be accommodated with longitudinal sectioning, the latter method should be chosen.

Development of a Self-Assembled Dermal Substitute from Human Fibroblasts Using Long-term Three-Dimensional Culture

Skin substitutes have emerged as an alternative to autografts for the treatment of skin defects. Among them, scaffold-based dermal substitutes have been extensively studied; however, they have certain limitations, such as delayed vascularization, limited elasticity, and the inability to achieve permanent engraftment. Self-assembled, cell-based dermal substitutes are a promising alternative that may overcome these shortcomings but have not yet been developed. In this study, we successfully developed a cell-based dermal substitute (cultured dermis) through the long-term culture of human dermal fibroblasts using the net-mold method, which enables three-dimensional cell culture without the use of a scaffold. Spheroids prepared from human dermal fibroblasts were poured into a net-shaped mold and cultured for 2, 4, or 6 months. The dry weight, tensile strength, collagen and glycosaminoglycan levels, and cell proliferation capacity were assessed and compared among the 2-, 4-, and 6-month culture periods. We found that collagen and glycosaminoglycan levels decreased over time, while the dry weight remained unchanged. Tensile strength increased at 4 months, suggesting that remodeling had progressed. In addition, the cell proliferation capacity was maintained, even after a 6-month culture period. Unexpectedly, the internal part of the cultured dermis became fragile, resulting in the division of the cultured dermis into two collagen-rich tissues, each of which had a thickness of 400 μm and sufficient strength to be sutured during in vivo analysis. The divided 4-month cultured dermis was transplanted to skin defects of immunocompromised mice and its wound healing effects were compared to those of a clinically available collagen-based artificial dermis. The cultured dermis promoted epithelialization and angiogenesis more effectively than the collagen-based artificial dermis. Although further improvements are needed, such as the shortening of the culture period and increasing the size of the cultured dermis, we believe that the cultured dermis presented in this study has the potential to be an innovative material for permanent skin coverage.

Health-Related Quality of Life at Five Years for a Randomized Trial of Tri-Modality Therapy with I-125 Brachytherapy, External Beam Radiation Therapy, and Short- vs. Long-Term Androgen Deprivation Therapy for High-Risk Localized Prostate Cancer (TRIP)

PURPOSE/OBJECTIVE(S)

To describe the patient-reported health-related quality of life (HR-QoL) outcomes at five years for a multicenter randomized trial of tri-modality therapy with iodine-125 brachytherapy, external beam radiation therapy (EBRT), and short- versus long-term androgen deprivation therapy (ADT) for high-risk localized prostate cancer (TRIP/TRIGU0907).

MATERIALS/METHODS

A total of 332 men with high-risk prostate cancer were randomized to either 6 months of ADT (n = 165) or 30 months of ADT (n = 167) in conjunction with combined modality radiation therapy. For the HR-QoL assessment, general HR-QoL and disease-specific HR-QoL were measured using the Japanese version of the Medical Outcomes Study 8-items Short-Form Health Survey (SF-8) and the Expanded Prostate Cancer Index Composite (EPIC). Patient-reported outcome questionnaires were filled out before ADT initiation, and five years after. Scores were reported as mean with the standard deviation. QoL end points were assessed as the change between pre and post treatment using paired student t-test. Changes in the International Prostate Symptom Scores (IPSS) score, including total score and subscores, were also evaluated. The study was powered according to the primary endpoint of biochemical progression free survival with HR-QoL as a secondary endpoint. In addition, recovery of testosterone level (300ng/dL or higher) was calculated as the cumulative incidence curve and compared between arms by log-rank test.

RESULTS

The cumulative incidence of biochemical progression, and salvage ADT treatment were not different between the arms. Mean domain scores at baseline were well balanced between the two arms in all HR-QoL. There were no differences in the SF-8 assessment and the total and subscore EPIC assessments between the arms. The average sexual function score was lower in short arm versus long arm; 16.24 versus 20.24 at baseline, but not different at five years, 9.96 versus 7.78 (p = 0.164). There were no significant differences between the arms for the total and subscore IPSS. Significantly higher percentage of patients, 71.7% in the short arm recovered to a normal testosterone level at 6 years after the initiation of ADT compared to 43.2% in long arm (p<0.0001).

CONCLUSION

At five years after ADT initiation, there were no significant differences in all score changes between the two arms with general HR-QoL and disease-specific HR-QoL. Most of HR-QoL returned to baseline level, and sexual function scores were low from baseline in this population. Two-years' adjuvant ADT did not affect HR-QoL at five years, although it significantly retarded testosterone recovery compared to 6 months of hormone therapy.

Preoperative visualization of midline-crossing subcutaneous arteries in transverse abdominal flaps using photoacoustic tomography

BACKGROUND

Photoacoustic tomography is a noninvasive vascular imaging modality that uses near-infrared pulsed laser light and ultrasound to visualize vessels. We previously demonstrated the utility of photoacoustic tomography for anterolateral thigh flap surgery involving body-attachable vascular mapping sheets. However, it was not possible to obtain clear separate images of arteries and veins. In this study, we tried to visualize subcutaneous arteries that cross the midline of the abdomen, since these arteries are known to be important for obtaining large perfusion areas in transverse abdominal flaps.

METHODS

Four patients scheduled to undergo breast reconstruction with abdominal flaps were examined. Photoacoustic tomography was performed preoperatively. The tentative arteries and veins were traced according to the S-factor, an approximate hemoglobin oxygen saturation parameter calculated using 2 laser excitation wavelengths (756 and 797 nm). Intraoperatively, arterial-phase indocyanine green (ICG) angiography was performed after abdominal flap elevation. Images of vessels speculated to be arteries by preoperative photoacoustic tomography were merged with those of intraoperative ICG angiography and analyzed in an 8 × 4-cm2 area below the umbilical region.

RESULTS

The S-factor was used to visualize the midline-crossing subcutaneous arteries in all 4 patients. A matching analysis compared preoperative tentative arteries according to photoacoustic tomography with ICG angiography results in the 8 × 4-cm2 area below the umbilical region and indicated a 71.3-82.1% match (average: 76.9% match).

CONCLUSIONS

This study demonstrates that the S-factor, a noninvasive, label-free imaging modality, can be used to successfully visualize subcutaneous arteries. This information can aid in selecting perforators for abdominal flap surgery.

Hydrogenation of CO2 to MeOH Catalyzed by Highly Robust (PNNP)Ir Complexes Activated by Alkali Bases in Alcohol

Despite receiving significant attention, well-defined homogeneous complexes for hydrogenation of carbon dioxide (CO2) to methanol (MeOH) are scarce and suffer issues of low catalyst turnover numbers (TONs) at high catalyst concentrations and deactivation in the presence of CO and at elevated temperatures. Herein, we disclose a system deploying sterically demanded (PNNP)Ir complexes for a sustained activity for hydrogenation of CO2 to MeOH at temperatures ∼200 °C in an alcohol solvent. Through reaction optimization, we achieved a TON of ∼9000 for MeOH formation, which exceeds most active homogeneous systems reported to date, and robustness on par with or exceeding most reactive systems utilizing amine additives was demonstrated. The key to achieving sustained catalyst turnover for the system was utilizing a catalytic amount of an alkali base additive, which serves the dual purpose of facilitating more efficient outer-sphere reduction of CO2 and HCO2Et and enhancing the selectivity of MeOH over in situ formed CO.

A novel approach for wound treatment using dried cultured epidermal allograft: A phase I/II, single-center, open-label clinical trial

BACKGROUND

Autologous cultured epidermis (CE) is successfully used in burn care, but it requires a manufacturing time of three weeks and is very expensive owing to its custom-made nature of treatment. To compensate this disadvantage, dried allogeneic CE promises a novel therapeutic approach; and previous reports have demonstrated its efficacy in promoting wound healing using a murine skin defect model. Herein, a prospective clinical study was conducted to confirm the safety and efficacy of dried allogeneic CE for wound treatment.

METHODS

Dried CE was manufactured using donor keratinocytes obtained from excess surgical skin and applied to skin defects that were at least 3 cm in length and less than 10 % of the body surface area of the patients. The patients were observed for 14 days after CE application. The primary endpoint was the incidence of adverse events and the secondary endpoint was the percentage of wound healed since baseline, on days 7 and 14. Furthermore, as a stratified analysis, the percentage of wound healed, specified as deep dermal burns, was calculated.

RESULTS

Six patients (five burns and one skin ulcer after necrotizing fasciitis) enrolled in the study. As a serious adverse event, a local infection was observed in one patient, which resolved by debridement and conventional skin grafting. Other adverse events that were potentially related to this treatment included two cases of skin erosion, and one case of systemic fever. No unresolved adverse events remained at the end of the study period. The percentage of wound healed was 73.4 ± 19.2 % on Day 7, and 92.2 ± 11.8 % on Day 14. When the targeted disease was restricted to deep dermal burns, the percentage of wound healed was 69.9 ± 28.9 % on Day 7 and 90.5 ± 13.2 % on Day 14.

CONCLUSION

Treatment with dried CE was safely performed without any unresolved severe adverse effects. Dried CE is a new and promising modality for skin defect treatment, such as burns and ulcers, and is expected to compensate for the disadvantages of autologous CE. However, large-scale clinical trials are required to confirm their efficacy.

Recombination of vibrationally cold N2+ ions with electrons

Recombination of vibrationally cold N2+ ions with electrons was studied in the temperature range of 140-250 K. A cryogenic stationary afterglow apparatus equipped with cavity ring-down spectrometer and microwave diagnostics was utilized to probe in situ the time evolutions of number densities of particular rotational and vibrational states of N2+ ions and of electrons. The obtained value of the recombination rate coefficient for the recombination of the vibrational ground state of N2+ with electrons is αv=0 = (2.95 ± 0.50) × 10-7(300/T)(0.28±0.07) cm3 s-1, while that for the first vibrationally excited state was inferred as αv=1 = (4 ± 4) × 10-8 cm3 s-1 at 250 K.

Influence of fetal hiccups on Doppler blood flow waveform of fetal arteries: Difference among arteries

BACKGROUND

A few studies have been reported on the influence of fetal hiccups on umbilical artery. The aim of this study is to clarify the influence of fetal hiccups on Doppler blood flow waveform (DBFW) of some fetal arteries, and to show the difference in these influences among fetal arteries.

OBJECTIVE

DBFW of umbilical artery, descending aorta, and middle cerebral artery were recorded at hiccups in normal fetuses between 34th and 40th gestational weeks. The changes on DBFW were classified into three shapes by the direction and the size of the changes. Shape 1: sharp decrease but not to the baseline, Shape 2: sharp decrease to the baseline (absence), and Shape 3: reverse flow.

RESULTS

At all hiccups, the changes on DBFW of these arteries were observed. These changes were classified into three shapes. Changes of umbilical artery were widely distributed in three shapes depending on when hiccup occurred during cardiac cycle. On the other hand, most changes of the descending aorta and middle cerebral artery were Shape 3 whenever the hiccup occurred during cardiac cycle.

CONCLUSION

The changes on DBFW of fetal arteries were observed at all hiccups. Changes of umbilical artery were widely distributed in three shapes depending on when hiccup occurred during cardiac cycle. On the other hand, most changes of descending aorta and middle cerebral artery were Shape 3. This is the first study clarified the influence of fetal hiccups on DBFW of some fetal arteries, and showed the difference in these influences among fetal arteries.

Direct Imaging of Band Structure for Powdered Rhombohedral Boron Monosulfide by Microfocused ARPES

Boron-based two-dimensional (2D) materials are an excellent platform for nanoelectronics applications. Rhombohedral boron monosulfide (r-BS) is attracting particular attention because of its unique layered crystal structure suitable for exploring various functional properties originating in the 2D nature. However, studies to elucidate its fundamental electronic states have been largely limited because only tiny powdered crystals were available, hindering a precise investigation by spectroscopy such as angle-resolved photoemission spectroscopy (ARPES). Here we report the direct mapping of the band structure with a tiny (∼20 × 20 μm2) r-BS powder crystal by utilizing microfocused ARPES. We found that r-BS is a p-type semiconductor with a band gap of >0.5 eV characterized by the anisotropic in-plane effective mass. The present results demonstrate the high applicability of micro-ARPES to tiny powder crystals and widen an opportunity to access the yet-unexplored electronic states of various novel materials.

Machine-Learning Classification for the Prediction of Catalytic Activity of Organic Photosensitizers in the Nickel(II)-Salt-Induced Synthesis of Phenols

Catalytic systems using a small amount of organic photosensitizer for the activation of an inorganic (on-demand ligand-free) nickel(II) salt represent a cost-effective method for cross-coupling reactions, while C(sp² )-O bond formation remains less developed. Herein, we report a strategy for the synthesis of phenols with a nickel(II) salt and an organic photosensitizer, which was identified via an investigation into the catalytic activity of 60 organic photosensitizers consisting of various electron donor and acceptor moieties. To examine the effect of multiple intractable parameters on the catalytic activity of photosensitizers, machine-learning (ML) models were developed, wherein we embedded descriptors representing their physical and structural properties, which were obtained from DFT calculations and RDKit, respectively. The study clarified that integrating both DFT- and RDKit-derived descriptors in ML models balances higher "precision" and "recall" across a wide range of search space relative to using only one of the two descriptor sets.

Dried human-cultured epidermis accelerates wound healing in a porcine partial-thickness skin defect model

Introduction

Autologous cultured epidermis (CE) is an effective approach for overcoming the deficiency of donor sites to treat extensive burns. However, the production of autologous CE takes 3-4 weeks, which prevents its use during the life-threatening period of severe burns. In contrast, allogeneic CE can be prepared in advance and used as a wound dressing, releasing several growth factors stimulating the activity of recipient cells at the application site. Dried CE is prepared by drying CEs under controlled temperature and humidity conditions until all the water is completely removed and no viable cells are present. Dried CE accelerates wound healing in a murine skin defect model and is potentially a new therapeutic strategy. However, the dried CE safety and efficacy have not yet been studied in large animal models. Therefore, we studied the safety and efficacy of human-dried CE in wound healing using a miniature swine model.

Methods

Human CE was manufactured using Green's method from donor keratinocytes. Three types of CEs (Fresh, Cryopreserved, and Dried) were prepared, and the ability of each CE to promote keratinocyte proliferation was confirmed in vitro. Extracts of the three CEs were added to keratinocytes seeded in 12-well plates, and cell proliferation was evaluated using the WST-8 assay for 7 days. Next, we prepared a partial-thickness skin defect on the back of a miniature swine and applied three types of human CE to evaluate wound healing promotion. On days 4 and 7, the specimens were harvested for hematoxylin-eosin, AZAN, and anti-CD31 staining to assess epithelialization, granulation tissue, and capillary formation.

Results

The conditioned medium containing dried CE extract significantly enhanced keratinocyte proliferation compared to the control group (P < 0.05). In vivo experiments revealed that human-dried CE significantly accelerated epithelialization at day 7 to the same extent as fresh CE, compared to the control group (P < 0.05). The three CE groups similarly affected granulation formation and neovascularization.

Conclusions

Dried CE accelerated epithelialization in a porcine partial-thickness skin defect model, suggesting that it may be an effective burn treatment alternative. A clinical study with a long-term follow-up is needed to assess the applicability of CEs in clinics.

Establishment of a keratinocyte and fibroblast bank for clinical applications in Japan

Regenerative medicine products using allogeneic cells, such as allogeneic cultured epidermis (allo-CE), have become a more critical therapeutic method for the treatment of burns. However, there are no clinically available allo-CE products in Japan. Therefore, establishing a quality-controlled cell bank is mandatory to create regenerative medical products using allogeneic cells. In this study, we selected ten patients from the Department of Plastic Surgery of Kyoto University Hospital to become cell donors. We performed medical interviews and blood sampling for the donor to ensure virus safety. We examined the tissues and isolated cells by performing a nucleic acid test (NAT). To establish a master cell bank, quality evaluation was performed according to the International Conference of Harmonization (ICH) Q5A. Serological tests of the blood samples from the ten donors showed that two of them were ineligible. The cells registered in the cell bank were found to be compatible after virus testing was performed, and a master cell bank was constructed. Hence, we established a keratinocyte and fibroblast bank of clinically usable human cultured cells in Japan for the first time.

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

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

Rhombohedral Boron Monosulfide as a p-Type Semiconductor

Two-dimensional materials have wide ranging applications in electronic devices and catalysts owing to their unique properties. Boron-based compounds, which exhibit a polymorphic nature, are an attractive choice for developing boron-based two-dimensional materials. Among them, rhombohedral boron monosulfide (r-BS) has recently attracted considerable attention owing to its unique layered structure similar to that of transition metal dichalcogenides and a layer-dependent bandgap. However, experimental evidence that clarifies the charge carrier type in the r-BS semiconductor is lacking. In this study, we synthesized r-BS and evaluated its performance as a semiconductor by measuring the Seebeck coefficient and photo-electrochemical responses. The properties unique to p-type semiconductors were observed in both measurements, indicating that the synthesized r-BS is a p-type semiconductor. Moreover, a distinct Fano resonance was observed in Fourier transform infrared absorption spectroscopy, which was ascribed to the Fano resonance between the E(2) (TO) phonon mode and electrons in the band structures of r-BS, indicating that the p-type carrier was intrinsically doped in the synthesized r-BS. These results demonstrate the potential future application prospects of r-BS.

Three-dimensional analysis of load-dependent changes in the orientation of dermal collagen fibers in human skin: A pilot study

The availability of quantitative structural data on the orientation of collagen fibers is of crucial importance for understanding the behavior of connective tissues. These fibers can be visualized using a variety of imaging techniques, including second harmonic generation (SHG) microscopy. However, characterization of the collagen network requires the accurate extraction of parameters from imaging data. To this end, several automated processes have been developed to identify the preferred orientation of collagen fibers. Common methods include fast Fourier transforms and curvelet transforms, but these tools are mostly used to infer a single preferred orientation. The purpose of this pilot study was to develop an easy procedure for comprehensively comparing multiple human skin samples with the goal of analyzing load-dependent changes via SHG microscopy. We created a 3D model based upon 2D image stacks that provide fiber orientation data perpendicular and parallel to the plane of the epidermis. The SHG images were analyzed by CurveAlign to obtain angle histogram plots containing information about the multiple fiber orientations in each single image. Subsequently, contour plots of the angle histogram intensities were created to provide a useful visual plotting method to clearly show the anomalies in the angle histograms in all samples. Our results provided additional details on how the collagen network carries a load. In fact, analysis of SHG images indicated that increased stretch was accompanied by an increase in the alignment of fibers in the loading direction. Moreover, these images demonstrated that more than one type of preferred orientation is present. In particular, the 3D network of fibers appears to have two preferred orientations in the planes both perpendicular and parallel to the plane of the epidermis.

Multicenter registry of the Watchman left atrial appendage closure device for patients with atrial fibrillation in Japan: The TERMINATOR registry

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific Japan

Background

Transcatheter left atrial appendage closure (LAAC) provides an alternative to oral anticoagulation for thromboembolic risk reduction in patients with nonvalvular atrial fibrillation (AF). A meta-analysis of previous two randomized trials reported improved rates of hemorrhagic stroke, cardiovascular/unexplained death, and nonprocedural bleeding compared to warfarin (1). Recently, the next-generation LAAC device, the Watchman FLX system, became available, and showed a low incidence of adverse events and a high incidence of anatomic closure (2). This transcatheter stroke prevention has already been approved in Asian countries. However, there is little data of LAAC in Asian population.

Purpose

This study sought to assess efficacy and safety of LAAC for patients with nonvalvular AF in Asia.

Methods

The TERMINATOR (Transcatheter Modification of Left Atrial Appendage by Obliteration with Device) registry is a multicenter nonrandomized study in Japan. This enrolled patients who underwent LAAC in 23 Japanese institutions. The LAAC was indicated for patients with nonvalvular atrial fibrillation in whom oral anticoagulation is required, but who have a risk of bleeding (history of BARC type 3 bleeding or HAS-BLED score ≥3 points). Baseline patient and procedural characteristics and clinical outcomes were evaluated.

Results

A total of 729 patients were enrolled between September 2019 and November 2021. The mean age was 74.9±8.8 years and the mean CHA2DS2-VASc score was 4.7±1.5. The Watchman generation 2.5 and FLX system were used in 469 (64.3%) and 260 patients (35.7%), respectively. Procedural success was achieved in 722 patients (99.0%). In-hospital adverse events were as follows; 6 tamponades (0.8%), 3 pericardial effusion (0.4%), 2 device embolization (0.3%), no stroke (0%), and no death (0%). During follow-up, device-related thrombus and all-cause death were reported in 16 (2.2%) and 23 patients (3.2%), respectively.

Conclusions

LAAC with the Watchman system provides compatible efficacy and safety outcomes in Asian population.

Minoxidil-induced lung disease, masquerading as hypersensitivity pneumonitis

We report the case of a 71-year-old male with essential thrombosis who presented with ground-glass lung opacity with a mosaic pattern on computed tomography, which resolved spontaneously with hospitalization. This was confused with a case of hypersensitivity pneumonitis (HP), which later turned out to be a drug-induced lung disease caused by surreptitiously administered minoxidil. This case emphasizes the importance of obtaining a correct medication history to make an accurate diagnosis, and this is the first report of minoxidil causing HP-like pulmonary illness.

Use of the duplication range concept for understanding morphology and predicting prognosis in thumb polydactyly

This study systematically and comprehensively analysed 129 thumb polydactylies in 122 patients using a duplicating range concept based on the level of skin and skeletal bifurcation. Numerical levels were defined along the longitudinal axis of the ulnar thumb duplicate from distal to proximal: level 0 (thumb tip) to level 6 (carpometacarpal joint). The relationships between duplication range and morphological parameters were evaluated. Nail asymmetry was associated with skin bifurcation levels 0 to 2. Proximal phalangeal asymmetry and interphalangeal joint deviation, associated with skin bifurcation levels were assigned scores of 1 to 2.5 and 1 to 2, respectively. Metacarpophalangeal joint deviation had a bimodal distribution, at levels 1.5 and 4 of the longitudinal axes. Morphological similarity was found in patients with the same duplication range. The duplication range concept could potentially improve our understanding of morphology variation and predicting prognoses in thumb polydactyly.Level of evidence: III.

Bandgap widening through doping for improving the photocatalytic oxidation ability of narrow-bandgap semiconductors

The trade-off relationship between narrowing the bandgap and achieving sufficient redox potentials accounts for the hindrance to the development of an efficient photocatalyst. Most of the previous researchers attempt to narrow the bandgap of semiconductors by impurity doping to achieve visible-light sensitivity, but this approach causes the losses of their oxidation and/or reduction ability. Conversely, this study presents a bandgap widening strategy by doping to improve the redox potential of photogenerated carriers. Employing first-principles simulations, we propose the lanthanum-doped bismuth vanadate (La-BiVO₄) photocatalyst as a wider-bandgap semiconductor exhibiting stronger oxidation ability compared to pristine BiVO₄, and the results revealed that the bismuth orbital in the valence band (VB) was diluted by lanthanum-ion doping, while the VB shifted to a higher potential (positively shifted). Thereafter, a La-BiVO₄ powder was synthesized via a solid-state reaction, after which its activity was evaluated in the photocatalytic oxidation of 2-propanol (IPA). La-BiVO₄ exhibited bandgap widening; thus, the number of absorbed photons under visible-light irradiation was lower than that of pristine BiVO₄. However, the quantum efficiency (QE) of La-BiVO₄ for the oxidation of IPA was higher than that of the pristine BiVO₄. Consequently, the photocatalytic reaction rate of La-BiVO₄ was superior to that of pristine BiVO₄ under the same visible-light irradiation conditions. Although the bandgap of La-BiVO₄ is widened, it is still sensitive to the cyan-light region, which is the strongest in the sunlight spectrum. These results demonstrate that the orbital dilution strategy by impurity elemental doping is effective for bandgap widening and contributes to improving the oxidation and/or reduction ability of the photogenerated charge carriers. This study elucidates the possibility of boosting photocatalytic performances via bandgap widening.

Group A Streptococcal Rapid Antigen Detection Test: A Clinical Study to Evaluate the Reproducibility Using Human Wound Samples

BACKGROUND

The early diagnosis of necrotizing soft tissue infection (NSTI) caused by group A streptococcus (GAS) for performing debridement surgery is key to the patient survival. In 1996, the diversional use of a GAS-rapid antigen detection test (RADT) for pharyngitis was reported, quickly spreading as a clinically useful method. However, no clinical study has evaluated the reliability of RADT by using wound samples. This is the first study using clinical wound samples to examine the reproducibility between GAS-RADT and wound culture.

METHODS

Patients in whom wound culture samples were clinically necessary were included in this study. Two samples were obtained simultaneously: one for isolation of bacteria as wound culture and the other for GAS-RADT, with written informed consent. The reproducibility between GAS-RADT and wound culture was statistically evaluated by Cohen's kappa coefficient.

RESULTS

One hundred samples from 94 patients were collected from 2020 to 2021. Two samples were GAS-positive on wound culture, and both were RADT-positive (positive reproducibility: 100%). Ninety-eight samples were GAS-negative on wound culture; of these, 97 were RADT-negative (negative reproducibility: 99%). Cohen's kappa coefficient was 0.80, indicating excellent agreement beyond chance. None of the bacteria showed cross-reactional influences. The only discrepant case (RADT-positive and wound culture-negative) was attributed to the administration of antibiotics for 2 days before the sampling.

CONCLUSIONS

The reproducibility between GAS-RADT and wound culture was statistically excellent, underscoring the reliability of GAS-RADT for wounds.

Functional analysis of thermo-sensitive TRPV1 in an aquatic vertebrate, masu salmon (Oncorhynchus masou ishikawae)

Transient receptor potential vanilloid 1 (TRPV1) is mainly expressed in nociceptive primary sensory neurons and acts as a sensor for heat and capsaicin. The functional properties of TRPV1 have been reported to vary among species and, in some cases, the species difference in its thermal sensitivity is likely to be associated with thermal habitat conditions. To clarify the functional properties and physiological roles of TRPV1 in aquatic vertebrates, we examined the temperature and chemical sensitivities of TRPV1 in masu salmon (Oncorhynchus masou ishikawae, Om) belonging to a family of salmonids that generally prefer cool environments. First, behavioral experiments were conducted using a video tracking system. Application of capsaicin, a TRPV1 agonist, induced locomotor activities in juvenile Om. Increasing the ambient temperature also elicited locomotor activity potentiated by capsaicin. RT-PCR revealed TRPV1 expression in gills as well as spinal cord. Next, electrophysiological analyses of OmTRPV1 were performed using a two-electrode voltage-clamp technique with a Xenopus oocyte expression system. Heat stimulation evoked an inward current in heterologously expressed OmTRPV1. In addition, capsaicin produced current responses in OmTRPV1-expressing oocytes, but higher concentrations were needed for its activation compared to the mammalian orthologues. These results indicate that Om senses environmental stimuli (heat and capsaicin) through the activation of TRPV1, and this channel may play important roles in avoiding environments disadvantageous for survival in aquatic vertebrates.

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Capsaicin evoked behavioral responses of Oncorhynchus masou ishikawae (Om).

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The behavioral response to heat was potentiated by capsaicin.

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Heterologously expressed OmTRPV1 was activated by heat and capsaicin.

Adjustable biodegradability of low-swelling hydrogels prepared from recombinant peptides based on human collagen type 1

An ideal hydrogel for tissue engineering and regenerative therapy is cytocompatible, biocompatible, and has low-swelling characteristics. Recently, a novel low-swelling hydrogel with a homogenous structure was developed by crosslinking a recombinant peptide, modeled on human collagen type 1 (RCPhC1), with a four-arm polyethylene glycol (tetra-PEG). Here, we hypothesized that the biodegradability of the RCPhC1 hydrogel was adjustable by altering its initial polymer concentration. Three types of RCPhC1 hydrogels were prepared using the initial polymer at different concentrations, and their morphology, swelling ratio, collagenase degradability, cytocompatibility, biocompatibility, and biodegradability were compared. The results revealed a low swelling ratio. The higher the concentration of the initial polymer, the longer it took for it to be degraded by collagenase. The average cell viability ratio was over 92% when using the direct contact method, which suggests that the hydrogels have excellent cytocompatibility. No death, tumorigenesis, exposure of the implants, or skin necrosis associated with the subcutaneous implantation of the hydrogels was found in mice in vivo. Moreover, histological evaluation revealed the formation of a thin fibrous capsule, which suggests an acceptable biocompatibility. Furthermore, as hypothesized, it was confirmed that the biodegradability can be adjusted by changing the initial polymer concentration. Collectively, the ability to fine-tune the biodegradability of RCPhC1 hydrogels demonstrates their potential for use in various clinical applications.

Post COVID-19 condition of the Omicron variant of SARS-CoV-2

Objectives

To investigate the prevalence of post coronavirus disease (COVID-19) condition of the Omicron variant in comparison to other strains.

Study design

A single-center cross-sectional study.

Methods

Patients who recovered from Omicron COVID-19 infection (Omicron group) were interviewed via telephone, and patients infected with other strains (control group) were surveyed via a self-reporting questionnaire. Data on patients’ characteristics, information regarding the acute-phase COVID-19, as well as presence and duration of COVID-19-related symptoms were obtained. Post COVID-19 condition in this study was defined as a symptom that lasted for at least 2 months, within 3 months of COVID-19 onset. We investigated and compared the prevalence of post COVID-19 condition in both groups after performing propensity score matching.

Results

We conducted interviews for 53 out of 128 patients with Omicron and obtained 502 responses in the control group. After matching cases with controls, 18 patients from both groups had improved covariate balance of the factors: older adult, female sex, obesity, and vaccination status. There were no significant differences in the prevalence of each post COVID-19 condition between the two groups. The number of patients with at least one post COVID-19 condition in the Omicron and control groups were 1 (5.6%) and 10 (55.6%) (p = 0.003), respectively.

Conclusions

The prevalence of post Omicron COVID-19 conditions was less than that of the other strains. Further research with a larger sample size is needed to investigate the precise epidemiology of post COVID-19 condition of Omicron, and its impact on health-related quality of life and social productivity.

Importance of steric bulkiness of iridium photocatalysts with PNNP tetradentate ligands for CO2 reduction

A series of Ir complexes has been developed as multifunctional photocatalysts for CO₂ reduction to give HCO₂H selectively. The catalytic activities and photophysical properties vary widely across the series, and the bulky group insertion resulted in the formation of HCO₂H and CO with the catalyst turnover number of >10 400.

Clinical features of organizing pneumonia in anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders

BACKGROUND

Anti-aquaporin-4 (AQP4) antibody is an autoantibody marker often observed in patients with neuromyelitis optica spectrum disorder (NMOSD). The pathological relevance of complicated pulmonary disorders in anti-AQP4 antibody-positive NMOSD remains unclear. We aimed to assess the clinical and histological relevance of complicated pulmonary disorders in anti-AQP4 antibody-positive NMOSD.

METHODS

We retrospectively reviewed the medical records of 52 patients with anti-AQP4 antibody-positive NMOSD and conducted immunohistochemical evaluations of the lung biopsy specimens.

RESULTS

Among 52 patients with anti-AQP4 antibody-positive NMOSD, 4 patients showed pulmonary involvement with a diagnosis of organizing pneumonia (OP). The proportion of males was larger (75% vs. 12.5%; p = 0.013) and creatine kinase levels were higher (458.3 U/L vs. 83.9 U/L; p = 0.003) in patients with OP than in those without OP. OP development preceded or coincided with the NMOSD symptoms. Chest computed tomography findings were consistent with OP in all four patients. Bronchoalveolar lavage fluid predominantly contained lymphocytes. Transbronchial lung biopsy revealed intraluminal plugs of inflammatory debris within the alveoli. Alveolar epithelial cells covering the OP lesions exhibited AQP4 loss, immunoglobulin G deposition, and complement activation. Corticosteroid treatment resulted in clinical improvement of OP.

CONCLUSION

OP may be considered a pulmonary manifestation of anti-AQP4 antibody-positive NMOSD beyond the central nervous system. Complement-dependent cytotoxicity of the lung epithelial cells caused by anti-AQP4 antibody is at least partly involved in OP development. When diagnosing NMOSD, the possibility of OP should be carefully evaluated based on the detailed history and chest imaging findings.

POS0760 HIGH LEVELS OF PROTEINS, CELL COUNTS, AND IL-6 IN CEREBROSPINAL FLUID IN PATIENTS WITH NEUROPSYCHIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS ARE ASSOCIATED WITH DAMAGE ACCRUAL OF NON-NEUROPSYCHIATRIC DOMAINS AS WELL AS THAT OF NEUROPSYCHIATRIC DOMAINS

Background

Neuropsychiatric systemic lupus erythematosus (NPSLE) is one of severe organ manifestations and directly associated with neuropsychiatric damages, such as cerebral vascular accident, cognitive impairment, or seizures. However, factors associated with damage accrual of neuropsychiatric and non-neuropsychiatric domains in NPSLE patients remain unknown.

Objectives

The aim of this study was to identify factors associated with damage accrual in patients with NPSLE.

Methods

We reviewed all patients with SLE who had attended our hospital between January 2010 to December 2020 retrospectively and identified those with NPSLE. We analyzed clinical characteristics and laboratory data including cerebrospinal fluid (CSF) in association with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) progression after the onset of NPSLE.

Results

461 patients with SLE were reviewed. Among them, 37 (8.0%) were diagnosed with NPSLE. Thirty-six patients were included in the analysis after excluding one patient with insufficient information. Seventeen (47.2%) patients were diagnosed with NPSLE at the same time with SLE diagnosis and 19 patients were diagnosed at relapse. At NPSLE onset, the mean age was 33.7 years, 35 were female, and the mean SLEDAI-2K was 21.8. Eighteen (50.0%) patients had active lupus nephritis simultaneously at the onset of NPSLE. The most frequent NPSLE types according to the 1999 ACR classification were lupus headache in 10 patients, followed by cerebrovascular disease in 7, seizure disorders in 6, acute confusional state, psychosis and mononeuropathy in 3, and aseptic meningitis in 2. All patients were treated with glucocorticoids, and the mean initial dose of prednisolone was 52.3 mg/day with steroid pulse therapy in 19 patients. Thirty (83.3%) patients were treated with concomitant immunosuppressive treatments. During the observation period with the mean of 10.0 years, 17 (47.2%) patients developed at least one point of SDI. Among them, 9 patients (25.0%) had neuropsychiatric damage progression including cerebrovascular accident in 6, seizures requiring drug treatment for more than 6 months in 2, and cognitive impairment in 1. Non-neuropsychiatric damage was also increased such musculoskeletal in 5, ocular in 3, cardiovascular in 2, renal, gastrointestinal, premature gonadal failure, diabetes, and malignancy in each one case. Neither neuropsychiatric nor overall damage progression were associated with SLEDAI-2K, anti-cardiolipin antibodies positivity, abnormal electroencephalogram, abnormal single photon-emission computed tomography at NPSLE onset or kinds of immunosuppressive treatments. In 21 patients who underwent CSF examination, the high level of CSF IL-6 was associated with neuropsychiatric damage progression (p=0.032). Also, high levels of CSF protein (p=0.030), cell counts (p=0.007), and IL-6 (p=0.032) were associated with overall SDI progression.

Conclusion

CSF IL-6 concentrations are associated with neuropsychiatric damage progression, and high CSF protein, cell counts and IL-6 at onset in patients with NPSLE can predict overall damage accrual.

References

[1]Liang MH, Corzillius M, Bae SC, et al. The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42: 599–608.

[2]Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for systemic lupus erythematosus. Arthritis Rheum 1996; 39: 363–369.

Disclosure of Interests

None declared

POS0459 APTAMER-BASED PROTEOMIC SCREENING IN IDENTIFICATION OF PATHOGENIC SIGNAL PATHWAY AND URINARY BIOMARKERS ASSOCIATED WITH HISTOLOGICAL FINDINGS IN LUPUS NEPHRITIS

Background

The current gold standard for the diagnosis and classification, assessment of the severity of lupus nephritis (LN) is a renal biopsy. On the other hand, since the procedure is highly invasive, there is a pressing need to identify biomarkers for predicting the presence and its histological severity of LN. In addition, the background pathogenesis of each histological findings is not clearly understood.

Objectives

The purpose of this study was to elucidate the urine biomarkers for predicting the presence and the severity of histological findings of LN, and to search the pathogenic signal pathway.

Methods

Urine samples from 24 biopsy-proven active LN patients were initially screened for the levels of 1305 distinct human proteins using an aptamer-based-targeted proteomic assay. We developed histological scoring system based on ISN/RPS lesion definitions and classification, NIH activity and chronicity score. Two experienced evaluators assessed the histological scores. Cluster analysis and pathway analysis were performed.

Results

A total of 24 LN patients were included: 20 (83%) had a proliferative histological class (III or IV +/-V), 4 (17%) pure membranous (V). Through cluster analysis, several histological subgroups were extracted according to correlation with each histological finding, and proteins which corelated with each histological scores were analyzed. We focused on two subgroups: one in which including active glomerular histological findings (endocapillary hypercellularity, karyorrhexis, neutrophil infiltration, subendothelial deposits) and the other in which including interstitial histological findings (interstitial inflammation, interstitial fibrosis, tubular atrophy). Histological scores in the former group showed strong positive correlation with protein group which contained 59 proteins (Group A), including CCL21, CXCL10, VCAM1. Histological scores in the latter group corelated with another protein group which contained 85 proteins (Group B), including MCP-1, CCL11. Ingenuity Pathway Analysis showed 16 pathways (PDGF Signaling, Granulocyte Adhesion and Diapedesis, etc) were upregulated in Group A and 11 pathways (IL-17 signaling, Fibrosis signaling pathway, etc) upregulated in Group B. Among group A and group B urine proteins, those showed strong correlation between respective histological findings were validated with ELISA assays.

Conclusion

An aptamer-based-targeted proteomic assay screening by combining with renal histological scoring system suggested several urine proteins can predict the severity and the presence of major renal histological findings, and suggested to be related with the pathogenesis in patients with LN.

Disclosure of Interests

Kazuoto Hiramoto: None declared, Shuntaro Saito: None declared, Hironari Hanaoka: None declared, Katsuya Suzuki: None declared, Jun Kikuchi: None declared, Hiroyuki Fukui: None declared, Ryo Takano Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Fumihiko Miyoshi Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Noriyasu Seki Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Kunio Sugahara Employee of: Mitsubishi Tanabe Pharma Corporation Sohyaku, Yuko Kaneko: None declared, Tsutomu Takeuchi: None declared.

POS1183 RISK FACTORS FOR CYTOMEGALOVIRUS INFECTION IN PATIENTS WITH RHEUMATIC DISEASE; SINGLE-CENTER PROSPECTIVE COHORT STUDY

Background

Cytomegalovirus (CMV) infection is one of serious opportunistic infections for immunosuppressed patients, therefore, identifying patients at risk for CMV infection is of importance. However, no prospective study about CMV infection in systemic rheumatic disease has been reported.

Objectives

To identify risk factors relevant with CMV infection in patients with systemic rheumatic disease during intensive remission induction therapy.

Methods

Consecutive systemic rheumatic disease cases who started intensive immunosuppressive therapy from February 2017 until February 2019 were enrolled. Serum CMV-IgG was measured before the induction therapy, and subsequently, CMV pp65 antigen was monitored weekly. Patients were divided into 2 groups according to the presence or absence of CMV infection, and risk factors for CMV infection were analyzed.

Results

157 patients consisting of 136 CMV-IgG positive and 21 CMV-IgG negative patients were enrolled in the study. Mean age was 60.8 ± 17.4 y/o, and female was 70.7%. The underlying diseases were following; vasculitides 54, systemic lupus erythematosus 27, polymyositis/dermatomyositis 25, rheumatoid arthritis 14, IgG4-related disease 13, mixed connected tissue disease 6, Behçet disease 5, adult-onset Still’s disease 4, and others 9. The initial dose of glucocorticoid (GC) was 48.4 ± 11.5 mg/day (0.91 ± 0.16 mg/kg/day) as prednisolone (PSL) with additional methylprednisolone (mPSL) pulse therapy being conducted in 44 (28.0%). Concomitant immunosuppressive therapies were intravenous cyclophosphamide (IVCY) in 55, calcineurin inhibitor 27, mycophenolate mofetil 16, hydroxychloroquine 5, and methotrexate 4. Concomitant biological agents were rituximab 12, tocilizumab 6, infliximab 2, golimumab 1, and abatacept 1. CMV infection occurred in 52 patients (33.1%), and all of them were CMV-IgG positive before induction therapy (38.2% in the CMV-IgG positive patients). Univariable analysis revealed initial PSL dose >0.91 mg/kg/day (odds ratio [OR] 5.2, p<0.01), IVCY (OR 3.4, p<0.01), diabetes mellitus (OR 5.2, p<0.01), and a history of malignancy (OR 2.9, p=0.02) were independent risk factors for CMV infection. CMV antiviral drugs were administered in 22 patients (42.3%). At the first detection of CMV pp65 antigen, PSL dose ≥37.5 mg/day (OR 5294.8, p<0.01), CMV pp65 antigen-positive cells ≥2 cells/2 slides (OR 16.0, p = 0.04), and serum albumin levels <3.0 g/dL (OR 26.3, p=0.01) were associated with subsequent CMV antiviral drug administration.

Conclusion

CMV infection occurred only in CMV-IgG positive patients with systemic rheumatic diseases who were undergoing intensive remission induction therapy. CMV infection was related with treatment regimen and comorbidities, and the necessity of CMV antiviral treatment was predicted with prednisolone dose, the number of CMV pp65 antigen positive cells, and albumin levels at the first detection of CMV pp65 antigen.

Disclosure of Interests

None declared

POS0257 COMPARISON OF SARS-CoV-2 VACCINE RESPONSE IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASE; mRNA-1273 VACCINE INDUCES HIGHER HUMORAL IMMUNOGENICITY THAN BNT162b2

Background

The SARS-CoV-2 messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) have benefitted all countries amid the coronavirus disease 2019 (COVID-19) crisis. Whereas both of them have shown efficacy in preventing COVID-19 illness in healthy participants, there is paucity of data about immunogenicity and safety of mRNA COVID-19 vaccines in patients with autoimmune, inflammatory rheumatic disease. Recent observational studies evaluated mainly BNT162b2, suggesting that glucocorticoids, immunosuppressive agents impair SARS-CoV-2 vaccine responses. However, difference in immune reactions and safety between BNT162b2 and mRNA-1273 have not been clarified in patients with inflammatory rheumatic diseases.

Objectives

To assess humoral and T cell immune responses and safety profiles after two doses of different mRNA vaccine against SARS-CoV-2; BNT162b2 and mRNA-1273.

Methods

We enrolled consecutive, previously uninfected patients with inflammatory rheumatic diseases receiving mRNA vaccine including BNT162b2 and mRNA-1273. Healthy participants receiving BNT162b2 were also recruited as control. Blood samples were obtained 3weeks, 2 months, 3 months, 4 months, and 6 months after second dose of vaccines. We measured titres of neutralizing antibodies against SARS-CoV-2 and calculated seroconversion rates to evaluate humoral responses. We also assessed T-cell immunity responses by using interferon releasing assay against SARS-CoV-2 in a part of the patients. Answers to questionnaires about adverse reactions were obtained from participants.

Results

A total of 974 patients with inflammatory rheumatic diseases and healthy 630 control participants were enrolled. Among them, 796 patients received BNT162b2, 178 patients received mRNA-1273, and all control participants received BNT162b2. Seroconversion rates and neutralizing antibody titres 3 weeks after vaccination were significantly higher in patients with mRNA-1273 and healthy participants with BNT162b2 compared with patients with BNT162b2; seroconversion rates, 97.2% vs 99.5% vs 83.3%, p<0.001; titers of neutralizing antibodies, 29.4±33.9 IU/mL vs 23.9±14.2 IU/mL vs 10.8±16.5 IU/mL, p<0.001, respectively. On another front, T cell reaction against SARS-CoV-2 was similar in both patients with mRNA-1273 and BNT162b2; interferon gamma levels for antigen 1, 1.2±2.1 IU/mL vs 0.8±2.5 IU/mL, p=0.23; and for antigen 2, 1.4±1.9 IU/mL vs 1.0±2.1 IU/mL, p=0.11, respectively. Regarding adverse reaction of each mRNA vaccine, the frequency of systemic adverse reactions including fever and general fatigue are also significantly higher in patients with mRNA-1273 and healthy controls than patients with BNT162b2; fever, 48.0% vs 44.9% vs 10.2%, p<0.001; general fatigue, 70.4% vs 61.8% vs 31.2%, p<0.001, respectively). In longitudinal measurement, neutralizing antibody titres in patients with BNT162b2 were decreased more rapidly than those in healthy controls; 3.3±3.2 IU/mL in patients with BNT162b2 at 4 months and 3.2±4.7 IU/mL in healthy controls with BNT162b2 at 6 months. We identified age, glucocorticoid dose (prednisolone > 7.5mg), use of immunosuppressants including methotrexate, mycophenolate, cyclophosphamide, and tacrolimus are associated with rapid attenuation of humoral responses in patients with BNT162b2.

Conclusion

Our results demonstrated a significant higher humoral immunogenicity and frequency of systemic adverse reaction of the SARS-CoV-2 mRNA-1273 (Moderna) compared with the BNT162b2 (Pfizer-BioNTech) in inflammatory rheumatic disease patients. Glucocorticoid and immunosuppressive agents impaired induction and sustention of neutralizing antibody, and earlier third booster vaccination may be required within 4 months, especially for those receiving BNT162b2.

References

[1]Steensels D, Pierlet N, Penders J et al. JAMA. 2021;326(15):1533–1535.

[2]Friedman MA, Curtis JR and Winthrop KL. Ann Rheum Dis 2021;80:1255–1265.

Disclosure of Interests

None declared

No evidence of bovine leukemia virus proviral DNA and antibodies in human specimens from Japan

Background

The potential risk and association of bovine leukemia virus (BLV) with human remains controversial as it has been reported to be both positive and negative in human breast cancer and blood samples. Therefore, establishing the presence of BLV in comprehensive human clinical samples in different geographical locations is essential.

Result

In this study, we examined the presence of BLV proviral DNA in human blood and breast cancer tissue specimens from Japan. PCR analysis of BLV provirus in 97 Japanese human blood samples and 23 breast cancer tissues showed negative result for all samples tested using long-fragment PCR and highly-sensitive short-fragment PCR amplification. No IgG and IgM antibodies were detected in any of the 97 human serum samples using BLV gp51 and p24 indirect ELISA test. Western blot analysis also showed negative result for IgG and IgM antibodies in all tested human serum samples.

Conclusion

Our results indicate that Japanese human specimens including 97 human blood, 23 breast cancer tissues, and 97 serum samples were negative for BLV.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12977-022-00592-6.