Communication between physicians, patients, their companions and other healthcare professionals in home medical care in Japan

OBJECTIVE

To examine communication in home medical care.

METHODS

Conversations that happened during home medical care involving physicians at nine clinics were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Additional categories were developed to code aspects of home medical care.

RESULTS

Overall, 55 conversations were analyzed. The mean age of the patients was 82.9 ± 10.1 years old. The most common triad was physician, patient, and patient's companion. Information about home medical care professionals who were not present during the conversation was provided by the physician in 21 cases (38.2%), the patient in nine cases (16.4%), and companions in 21 (39.6%) cases.

CONCLUSION

In home medical care, the participants mentioned home medical care professions who were not present at the time, suggesting that these conversations may have facilitated interprofessional collaboration.

PRACTICE IMPLICATIONS

Physicians should be aware that during home medical care, the presence of multiple attendants and other medical professionals contributing to communicate with the patient.

Key determinants for signaling in the sensory rhodopsin II/transducer complex are different between Halobacterium salinarum and Natronomonas pharaonis

The cell membrane of Halobacterium salinarum contains a retinal-binding photoreceptor, sensory rhodopsin II (HsSRII), coupled with its cognate transducer (HsHtrII), allowing repellent phototaxis behavior for shorter wavelength light. Previous studies on SRII from Natronomonas pharaonis (NpSRII) pointed out the importance of the hydrogen bonding interaction between Thr204NpSRII and Tyr174NpSRII in signal transfer from SRII to HtrII. Here, we investigated the effect on phototactic function by replacing residues in HsSRII corresponding to Thr204NpSRII and Tyr174NpSRII . Whereas replacement of either residue altered the photocycle kinetics, introduction of any mutations at Ser201HsSRII and Tyr171HsSRII did not eliminate negative phototaxis function. These observations imply the possibility of the presence of an unidentified molecular mechanism for photophobic signal transduction differing from NpSRII-NpHtrII.

Prediction of hub genes and key pathways associated with the radiation response of human hematopoietic stem/progenitor cells using integrated bioinformatics methods

Hematopoietic stem cells (HSCs) are indispensable for the maintenance of the entire blood program through cytokine response. However, HSCs have high radiosensitivity, which is often a problem during radiation therapy and nuclear accidents. Although our previous study has reported that the combination cytokine treatment (interleukin-3, stem cell factor, and thrombopoietin) improves the survival of human hematopoietic stem/progenitor cells (HSPCs) after radiation, the mechanism by which cytokines contribute to the survival of HSPCs is largely unclear. To address this issue, the present study characterized the effect of cytokines on the radiation-induced gene expression profile of human CD34⁺ HSPCs and explored the hub genes that play key pathways associated with the radiation response using a cDNA microarray, a protein-protein interaction-MCODE module analysis and Cytohubba plugin tool in Cytoscape. This study identified 2,733 differentially expressed genes (DEGs) and five hub genes (TOP2A, EZH2, HSPA8, GART, HDAC1) in response to radiation in only the presence of cytokines. Furthermore, functional enrichment analysis found that hub genes and top DEGs based on fold change were enriched in the chromosome organization and organelle organization. The present findings may help predict the radiation response and improve our understanding of this response of human HSPCs.

Chemotherapy-induced leukopenic septic shock treated with veno-arterial extracorporeal membrane oxygenation: A case report

We present a case of chemotherapy-induced leukopenic septic shock treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Although the indication for VA-ECMO for septic shock in immunosuppressed states remains controversial, her relatively young age and a slightly increasing leukocyte count led to VA-ECMO induction and resulted in recovery.

[Exploration of Indole Compounds as Candidate for Radiation Mitigators]

PURPOSE

In this study, to develop radiomitigators capable of the emergency medical care of patients involved in radiation accidents, we investigated the radiomitigative effects and their underlying mechanisms of indole compounds such as DIM, GRM, and INM.

METHODS

The human normal fibroblast cell line, MRC-5 cells were administered 0.1% DMSO or each indole compound at 10 µM within 50-60 minutes after X-irradiated with 0-4 Gy. Next, we evaluated the alteration in the number of alive cells, clonogenic potential, DNA double-strand breaks, DNA damage repair activities, and protein expression related to regulate the oxidative stress response.

RESULTS

Our results showed that DIM treatment suppressed radiation-induced decrease in the number of alive cells and clonogenic potential. Then, DIM treatment significantly decreased DNA double-strand breaks and highly increased Nrf2 via increased phospho-GSK-3β (Ser9) expression. These findings suggest that, in part, increased expression of p-GSK-3β (Ser9) by DIM treatment reduced DNA double-strand breaks via activation of Nrf2, resulting mitigated radiation-induced a decrease in the number of alive cells and clonogenic potential.

CONCLUSION

Therefore, DIM, not GRM and INM, is a potential candidate for radiomitigators that can be applied to the radiation emergency medicine.

Difference between "Physical Fitness Age" Based on Physical Function and Chronological Age Is Associated with Obesity, Hyperglycemia, Depressive Symptoms, and Low Serum Albumin

OBJECTIVES

This study aimed to (1) develop the physical fitness age, which is the biological age based on physical function, (2) evaluate the validity of the physical fitness age for the assessment of sarcopenia, and (3) examine the factors associated with the difference between physical fitness age and chronological age.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Community-dwelling older adults and outpatients.

MEASUREMENTS

A formula for calculating the physical fitness age was created based on the usual walking speed, handgrip strength, one-leg standing time, and chronological age of 4,076 older adults from the pooled data of community-dwelling and outpatients using the principal component analysis. For the validation of the physical fitness age, we also used pooled data from community-dwelling older adults (n = 1929) and outpatients (n = 473). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 consensus. The association of D-age (the difference between physical and chronological ages) with cardiovascular risk factors, renal function, and cardiac function was examined.

RESULTS

The receiver operating characteristic analysis, with sarcopenia as the outcome, showed that the area under the curve (AUC) of physical fitness age was greater than that of chronological age (AUC 0.87 and 0.77, respectively, p < 0.001). Binomial logistic regression analysis revealed that the D-age was significantly associated with sarcopenia after adjustment for covariates (odds ratio 1.22, 95% confidence interval 1.19-1.26; p <0.001). In multivariate linear regression analysis with D-age as the dependent variable, D-age was independently associated with a history of diabetes mellitus (or hemoglobin A1c as a continuous variable), obesity, depression, and low serum albumin level. D-age was also correlated with estimated glomerular filtration rate derived from serum cystatin C, brain natriuretic peptide, and ankle-brachial index, reflecting some organ function and arteriosclerosis.

CONCLUSIONS

Compared to chronological age, physical fitness age calculated from handgrip strength, one-leg standing time, and usual walking speed was a better scale for sarcopenia. D-age, which could be a simple indicator of physical function, was associated with modifiable factors, such as poor glycemic control, obesity, depressive symptoms, and malnutrition.

Catheter-related thrombosis after cardiac surgery in patients with both central venous and pulmonary artery catheters inserted into the right internal jugular vein: a single-center, prospective, observational study

Central venous catheters (CVCs) and pulmonary artery catheters (PACs) are widely used in intensive care and perioperative management. The detection and prevention of catheter-related thrombosis (CRT) are important because CRT is a complication of catheter use and can cause pulmonary embolism and bloodstream infection. Currently, there is no evidence for CRT in patients using both CVC and PAC. We conducted a single-center, prospective, observational study to identify the incidence, timing, and risk factors for CRT in patients undergoing cardiovascular surgery and using a combination of CVC and PAC through the right internal jugular vein (RIJV). Out of 50 patients, CRT was observed using ultrasonography in 39 patients (78%), and the median time of CRT formation was 1 day (interquartile range: 1-1.5) after catheter insertion. The mean duration of PAC placement was 3 days (interquartile range: 2-5), and the maximum diameter of CRT was 12 mm (interquartile range: 10-15). In short-axis images, CRT occupied more than half of the cross-sectional area of the RIJV in five patients (10%), and CRT completely occluded the RIJV in one patient (2%). Platelet count, duration of PAC placement, and intraoperative bleeding amount were found to be high-risk indicators of CRT. In conclusion, patients who underwent cardiovascular surgery and using both CVC and PAC had a high incidence of CRT. Avoiding unnecessary PAC placement and early removal of catheters in patients at high risk of developing CRT may prevent the development of CRT.

The efficacy of synthetic pseudo-ceramide for dry and rough lips

OBJECTIVE

Lips can easily become dry and rough, one reason being the characteristics of their ceramide (CER) profile. Lips have lower levels of total ceramides, higher percentages of CER[NS] and CER[AS], and lower percentages of CER[NP] and CER[NH] than skin in other regions of the body. The purpose of this study was to clarify the effects of synthetic pseudo‐ceramide (pCer; Cetyl‐PG hydroxyethyl palmitamide) to improve the dryness and roughness of the lips of healthy subjects in a formulation that exclude an occlusive effect.

METHODS

Thirty‐one Japanese female subjects with normal skin (age range 21–37 years; mean 28.6) were enrolled in this study. A four‐week continuous use test was conducted using samples with or without 0.5% or 2.0% pCer. The degree of lip roughness was scored, and values of capacitance, transepidermal water loss (TEWL) and lip surface elasticity were measured. Endogenous CER profiles and absorption levels of pCer in the stratum corneum (SC) were analysed in tape‐stripped skin specimens.

RESULTS

Treatment with the pCer‐2.0% sample significantly improved the visual roughness score after 2 and 4 weeks compared to 0 weeks and compared to the Blank. Moreover, an improvement in TEWL was observed after 4 weeks of treatment with the pCer‐2.0% sample. CER[NP] showed a significant increase in pCer‐2.0% treated lips after 4 weeks compared to the Blank. Both pCer‐0.5% and pCer‐2.0% were significantly absorbed after 2 weeks compared with the Blank.

CONCLUSION

The effect of the synthetic pseudo‐ceramide pCer to improve the roughness of lips was shown excluding the effect of occlusiveness derived from the formulation for the first time. Since the improvement of TEWL and absorption of pCer was observed, we concluded that pCer was first absorbed in rough lip areas, improved the ceramide profile and consequently restored the barrier function.

P1570Cardiac strain detects subclinical decline of cardiac function after hematopoietic stem cell transplantation in patients with hematologic malignancies

Background

Hematopoietic stem cell transplantation (HSCT) has been established as a treatment of various hematologic malignancies and improved their prognoses. HSCT includes intensive chemotherapy and systemic radiation, which occasionally induces cardiac dysfunction. However, early predictor of cardiac dysfunction associated with HSCT is still elusive. Recently, left ventricular (LV) global longitudinal strain (GLS) has been recognized as an early detector of cardiotoxicity. In this study, we retrospectively analyzed GLS and cardiac parameters in patients with hematologic malignancies before and after HSCT to explore HSCT-induced cardiac dysfunction.

Methods

Thirty-one consecutive patients undergone HSCT were enrolled and reviewed their cardiac comorbidities, medications, chemotherapy, and radiotherapy before HSCT. Transthoracic echocardiographic variables including GLS, cardiac troponin-I, and B-type natriuretic peptide were analyzed prior to and 1 month after HSCT.

Results

The patients were 49.7±13.5 years of age, 61% were male, and 52% had cardiovascular risk factors. Cardiac troponin-I was significantly increased following HSCT from 0.010±0.002 ng/ml to 0.016±0.014 ng/ml (P=0.02), indicating that HSCT should have certain impact on cardiac myocytes. Echocardiographic analyses revealed that LV GLS was significantly decreased after HSCT from −19.4±0.8% to −18.8±0.8% (P<0.001), whereas there was no significant difference in LV ejection fraction between these time points of HSCT (63.6±5.5% vs. 64.7±4.6%; P=0.13). Although there was no correlation between the decline of GLS and the increase of troponin-I in this cohort, these results clearly indicated that GLS, but not LVEF, predicted HSCT-induced early and subclinical cardiac dysfunction at 1 month after the HSCT.

Conclusion

GLS detected early decline of cardiac function after HSCT in the patients with hematologic malignancies. Further follow-up investigations will reveal relationship between GLS, troponin-I and prognosis of cardiac function after HSCT in patients with hematologic malignancies.

Contribution of 2-Propenesulfenic Acid to the Antioxidant Activity of Allicin

We re-examined the antioxidative mechanism of allicin as a radical scavenger on the basis of the reactivity toward 2, 2-diphenyl-1-picrylhydrazyl (DPPH) and peroxyl radicals. Initially, it was found that allicin decomposed more rapidly in n-hexane and chlorobenzene than in acetonitrile, ethanol, and ethanol/water solutions and decomposed into ajoene and vinyldithiins in these solvents. Furthermore, the decomposition of allicin and the following formations of ajoene and vinyldithiins from allicin were accelerated by the reaction of allicin with DPPH and peroxyl radicals. These results show that 2-propenesulfenic acid, which arises by Cope elimination from allicin, is proposed to contribute to scavenge these radicals because ajoene and vinyldithiins were produced from allicin through the use of 2-propenesulfenic acid. Next, allicin was more effective at inhibiting the linoleic acid oxidation at 50 °C than at 30 °C and in cyclohexane than in acetonitrile. These results indicate that allicin decomposed rapidly at high temperatures in a hydrogen-bond-acceptor solution to 2-propenesulfenic acid. In addition, 2-propene-1-sulfinothionic acid S-methyl ester, which does not produce sulfenic acid through Cope elimination, has no activity against the radicals. On the other hand, methanesulfinothionic acid S-2-propenyl ester, which produces methanesulfenic acid through Cope elimination, has the same or increased activity as its allicin against the radicals. Based on these results, the Cope elimination product, sulfenic acid, from thiosulfinates with an α-sulfenyl proton was found to make a larger contribution to the radical scavenger than that of allicin itself.

PRACTICAL APPLICATION

We examined the antioxidant activity of allicin on the oxidation of cumene and linoleic acid in homogeneous solutions. It is obvious from these results that 2-propenesulfenic acid was found to make a larger contribution to the radical scavenger than that of allicin itself.

Age-related differences in the functional properties of lips compared with skin

BACKGROUND/AIMS

Lips can easily become dry and rough and their biggest problems are drying and chapping. The cause of those problems is considered to be that the stratum corneum (SC) moisture is small and its barrier function is low. However, those problems decrease in subjects as they approach 40 years of age, after which problems due to their shape and color increase. The purpose of this study was to investigate relationships between SC properties of the lips during aging and to clarify the cause(s) of lip problems.

METHODS

One hundred and 38 Japanese female subjects with normal skin ranging in age from 16 to 78 years were enrolled in the study. The capacitance and transepidermal water loss (TEWL) values, viscoelasticity, and color of their lips were measured and compared with their cheeks.

RESULTS

The capacitance values for the lip and the cheek increased and TEWL values for both areas decreased with age. TEWL values for the lip decreased until ~30 years of age and this is considered to be related to the problem of drying. Although the maximum amplitude U_f of the lip increased with age, the U_r /U_f had no correlation with age. As for color, the L* and a* values decreased with age.

CONCLUSION

Age-related changes with regard to SC functions, viscoelasticity and color of the lips have been clarified for the first time, and it is clear that these changes are related to problems of the lips. Compared with the cheeks, differences with the lips are more apparent.

Surgical Efficacy of Carpal Tunnel Release for Carpal Tunnel Syndrome in Acromegaly: Report of Four Patients

Although carpal tunnel syndrome is frequent in acromegaly, few acromegalics will be encountered by most hand surgeons. This paper considers the treatment of four cases of acromegaly in whom carpal tunnel syndrome arose, to discuss aspects of management of carpal tunnel syndrome in this patient group.

Preparation and Properties of Optically Clear Poly[(Arylenedioxy)(Diphenylsilylene)]s and Poly[(Alkylenedioxy)(Diphenylsilylene)]

Several types of poly[(arylenedioxy)(diphenylsilylene)]s and poly[(alkylenedioxy)(diphenylsilylene)] were synthesized from various diols and dichlorodiphenylsilane by the step polymerization method. The thermal properties, solubility in organic solvents and optical properties of the obtained polymers were investigated by focusing on the chemical structures of their repeating structural units. The weight-average molecular weight ( Mw) of the obtained polymers based on polystyrene ranged from 43000 to 194000. High molecular weight, ductile materials with a high degree of optical clarity were obtained. These polymers display glass transition temperatures ( Tg) between 96 and 130°C. The obtained poly[(arylenedioxy) (diphenylsilylene)]s and poly[(alkylenedioxy)(diphenylsilylene)] were soluble in chloroform and toluene. The refractive index ( nd) was 1.64 for a biphenol-based poly[(arylenedioxy)(diphenylsilylene)] and 1.61 for a bisphenol-A based poly[(arylenedioxy)(diphenylsilylene)]. The poly[(arylenedioxy)(diphenylsilylene)]s and poly[(alkylenedioxy)(diphenylsilylene)] display very low birefringence (Δ n) between 0.0005 and 0.0022. The 70 μm thick film transmission of bicyclohexanol-based poly[(alkylenedioxy)(diphenylsilylene)] was 91% at a 350 nm wavelength.

Ceramide synthase 4 is highly expressed in involved skin of patients with atopic dermatitis

BACKGROUND

Ceramide is a crucial lipid in the stratum corneum (SC) which maintains the barrier function and hydration of the skin. In atopic dermatitis (AD) patients who have defective skin barrier function, ceramide levels are altered. We previously reported that although the amount of total ceramide was lower in involved skin compared with uninvolved skin of AD patients and with healthy control skin, the amounts of smaller ceramide species of Cer[NS] (<40 total carbons, which are total carbons of both sphingoid base and amide-linked fatty acid), especially Cer[NS] with 34 total carbons (C34-Cer[NS]), were higher. However, the enzyme(s) that produces the higher levels of smaller ceramide species in involved skin of AD patients was unclear.

OBJECTIVE

To identify the enzyme(s) that produces higher levels of smaller ceramide species of Cer[NS] in the involved skin of AD patients.

METHODS

Eight female Caucasian subjects who were diagnosed with AD on their arms (age range: 21-45 years) were enroled in this study. We compared ceramide levels in the SC and the expression levels of enzymes involved in ceramide metabolism using real-time PCR and immunohistochemistry between involved and uninvolved skin of AD patients.

RESULTS

Level of mRNA encoding ceramide synthase 4 (CERS4), which is one of the enzymes that synthesize ceramide from a sphingoid base and an amide-linked fatty acid, was significantly higher in involved skin than in uninvolved skin (P < 0.01). Additionally, the protein expression level of CERS4 in the epidermis was also higher in involved skin compared with uninvolved skin. The expression level of CERS4 correlated with the amount of C34-Cer[NS] (P < 0.01) and the skin hydration value (P < 0.05).

CONCLUSIONS

The elevated expression level of CERS4 contributes to the increase of C34-Cer[NS] and the impaired SC barrier function in involved skin of AD patients.

The roughness of lip skin is related to the ceramide profile in the stratum corneum

OBJECTIVE

The structure of skin on the lips is different from skin at other areas of the body; the water content of the stratum corneum (SC) and the barrier function there is low. Therefore, the lips can easily become dry and rough. The SC plays an important role in the barrier and water-holding functions of the skin. Above all, ceramides (CERs) are important SC lipids which maintain SC functions. The purpose of this study was to clarify the relationship between the degree of lip roughness and the CER profile.

METHODS

Forty-one Japanese female subjects with normal skin (age range 22-52 years; mean 34.1) were enrolled in this study. The degree of lip roughness was scored, the values of capacitance and transepidermal water loss (TEWL) were measured and CER profiles of the SC were analysed using tape-stripping.

RESULTS

The degree of lip roughness was related to the capacitance values but not the TEWL values. The roughness level correlated with the levels of CER[NH], CER[NP], CER[AH], CER[EOS] and CER[EOH] and the average carbon numbers of CER[NDS], CER[NH] and CER[NP] but not with the level of total CERs. The capacitance values of the lips were related not only with the levels of total CERs but also with the levels of CER[NH], CER[NP], CER[AH], CER[AP], CER[EOS], CER[EOH] and CER[EOP] and with the average carbon numbers of CER[NDS], CER[NS], CER[NH] and CER[NP]. The TEWL values of the lips were related not only with the levels of total CERs but also with the levels of CER[NH], CER[AH], CER[AP], CER[EOS] and CER[EOH].

CONCLUSION

The relationship between lip roughness and the CER profile was clarified for the first time. The results suggest that not only the level of total CERs but also the specific CER species and their carbon numbers affect the maintenance of SC function.

Mitigative Effects of a Combination of Multiple Pharmaceutical Drugs on the Survival of Mice Exposed to Lethal Ionizing Radiation

It is important to establish an easy-to-use therapeutic protocol for the emergency medical care of patients involved in radiation accidents to reduce the radiation-related casualties. The present study aimed to establish an optimum therapeutic protocol using currently approved pharmaceutical drugs to increase the survival of victims exposed to lethal radiation. Different combinations of four drugs-recombinant human erythropoietin (EPO), granulocyte-colony stimulating factor (G-CSF), c-mpl receptor agonist romiplostim (RP) and nandrolone decanoate (ND)-were administered to mice within 2 h after exposure to a lethal 7 Gy dose of γ-irradiation. On day 30 after irradiation, the condition of the mice was analyzed using various hematological parameters, such as the number of peripheral blood cells, bone marrow cells, hematopoietic progenitor cells and the expression of cell surface antigens. Approximately 10% of the untreated irradiated control mice survived for 21 days, but all of the control mice died by day 30. The combined administration of G-CSF, EPO and RP for five days immediately after irradiation led to a complete survival of the irradiated mice until day 30. However, the treatment with G-CSF, EPO and RP with ND led to only 75% survival at day 30. The hematological analyses showed that the numbers of almost all of hematopoietic cells in the surviving mice treated with effective medications recovered to the levels of non-irradiated mice. The present findings show that the combination of G-CSF, EPO and RP may be a useful countermeasure for victims exposed to accidental lethal irradiation.

Effects of ionizing radiation on differentiation of murine bone marrow cells into mast cells

Mast cells, immune effector cells produced from bone marrow cells, play a major role in immunoglobulin E-mediated allergic responses. Ionizing radiation affects the functions of mast cells, which are involved in radiation-induced tissue damage. However, whether ionizing radiation affects the differential induction of mast cells is unknown. Here we investigated whether bone marrow cells of X-irradiated mice differentiated into mast cells. To induce mast cells, bone marrow cells from X-irradiated and unirradiated mice were cultured in the presence of cytokines required for mast cell induction. Although irradiation at 0.5 Gy and 2 Gy decreased the number of bone marrow cells 1 day post-irradiation, the cultured bone marrow cells of X-irradiated and unirradiated mice both expressed mast cell-related cell-surface antigens. However, the percentage of mast cells in the irradiated group was lower than in the unirradiated group. Similar decreases in the percentage of mast cells induced in the presence of X-irradiation were observed 10 days post irradiation, although the number of bone marrow cells in irradiated mice had recovered by this time. Analysis of mast cell function showed that degranulation of mast cells after immunoglobulin E-mediated allergen recognition was significantly higher in the X-irradiated group compared with in the unirradiated group. In conclusion, bone marrow cells of X-irradiated mice differentiated into mast cells, but ionizing radiation affected the differentiation efficiency and function of mast cells.

Characteristics of human CD34+ cells exposed to ionizing radiation under cytokine-free conditions

To clarify the mechanisms underlying radiation-induced hematopoietic stem cell death, we investigated the effects of excessive ionizing radiation on the clonogenic potential of CD34(+) cells obtained from human umbilical cord blood under cytokine-free conditions. The CD34(+) cells were X-ray-irradiated (up to 2 Gy) and were cultured for 0-48 h under cytokine-free conditions. At various time-points, the CD34(+) cells were investigated for survival, clonogenic potential and the generation of mitochondrial superoxide. At 12 h after X-ray irradiation, the number of viable cells had decreased to ∼70-80% compared with the 0-h non-irradiated control, whereas the clonogenic potential in the X-ray-irradiated cells had decreased to ∼50%-60% compared with the 0-h non-irradiated control. Furthermore, significant generation of mitochondrial superoxide was observed at 6 h, and reached a maximum value between 12 and 24 h after X-ray irradiation. However, no significant differences were observed between non-irradiated and X-ray-irradiated cells in terms of the generation of reactive oxygen species or in the intracellular mitochondrial contents. In addition, a cDNA microarray analysis showed that the majority of the altered genes in the CD34(+) cells at 6 h after X-ray irradiation were apoptosis-related genes. These results suggest the possibility that the elimination of the clonogenic potentials of CD34(+) cells involves the generation of mitochondrial superoxide induced by ionizing radiation.

Synthesis and anticancer properties of phenyl benzoate derivatives possessing a terminal hydroxyl group

To assess the cytotoxic effects on A549 human lung cancer cells, we investigated a liquid-crystalline compound possessing a terminal hydroxyl group at concentrations of 0.1-20 μM. The compound, 4-butylphenyl 4-(6-hydroxyhexyloxy)benzoate (2), showed marked cell-growth inhibition at concentrations higher than 5 μM. Cell accumulation in the Sub-G1 phase indicating apoptosis was observed only at the highest concentration. Dynamic light scattering measurements show that the molecules form a spherical nanoparticle with a diameter of 130-170 nm at concentrations of 5-20 μM. We prepared the corresponding dimeric compounds and investigated their anticancer activity. The 1,2-benzene derivative, 1,2-bis[4-(6-hydroxyhexyloxy)benzoyloxy]benzene (4), exhibited cell-growth inhibition without affecting the cell cycle. However, the 1,3-benzene derivative, 1,3-bis[4-(6-hydroxyhexyloxy)benzoyloxy]benzene (5), was found to induce marked cell accumulation in the Sub-G1 phase. Furthermore, we assessed the cytotoxic effects of compounds 2, 4 and 5 on SW480 colon cancer cells and THP1 leukemic cells, as well as on WI-38 normal fibroblast cells. Both compounds 2 and 5 suppressed the growth of the solid cancer cells (A549 and SW480) more strongly compared with that of the hematological cancer cells (THP1). Unexpectedly, they also exhibited a strong cytotoxicity against the normal cells. We discuss the structure-property relationship in the anticancer activity of the mesogenic compounds.

Evaluating the fundamental critical care support course in critical care education in Japan: a survey of Japanese fundamental critical care support course experience

Background

The Fundamental Critical Care Support (FCCS) course has been introduced after minimal adaptation according to Japanese clinical settings. The original course in the USA is often used to prepare residents for rotations in the intensive care unit (ICU). Therefore, the FCCS program can be appropriate for the basic training of critical care in Japan to standardize critical care management. The purpose of this study is to evaluate whether Japanese FCCS course is useful and has a possibility to deserve a basis of critical care management in Japan.

Methods

The course program was provided with the form of lecture and skills stations. Pre- and post-training knowledge was assessed. After completion of the 2-day course, a questionnaire survey was administered to all course participants. Participants were asked to fill out the questions regarding socio-demographic characteristics. Participants were also asked to identify which lectures or skill stations they thought to be useful for clinical practice. Then, they were asked to rate their performance of each field: ‘Assessment,’ ‘Diagnosis,’ ‘Recognition,’ ‘Response,’ and ‘Transfer’.

Results

The number of participants increased year after year and reached 1,804 during the past 4 years. Nearly 70% of the participants were physicians. Most of the others were nurses. In the established year, the percentage of physicians who had clinical experience more than 5 years exceeded 50%, however, this percentage gradually decreased. On the contrary, the percentages of residents and nurses increased. Regarding useful sessions, nearly half of the participants thought that mechanical ventilation was the most useful. With regard to the results of pre- and post-tests, the participants had already shown a high average mark (78.8 ± 14.1) at the pre-test. Furthermore, the score at the post-test was significantly improved (82.0 ± 6.6, p < 0.01). The participants' confidence in any field regarding critical care management was almost 4 points (5-point scale).

Conclusions

It is considered that Japanese FCCS course is useful and has a promising basis of critical care management in Japan. Therefore, it is reasonable to think that Japanese FCCS mission has been successfully achieved.

RNA tectonics (tectoRNA) for RNA nanostructure design and its application in synthetic biology

RNA molecules are versatile biomaterials that act not only as DNA-like genetic materials but also have diverse functions in regulation of cellular biosystems. RNA is capable of regulating gene expression by sequence-specific hybridization. This feature allows the design of RNA-based artificial gene regulators (riboregulators). RNA can also build complex two-dimensional (2D) and 3D nanostructures, which afford protein-like functions and make RNA an attractive material for nanobiotechnology. RNA tectonics is a methodology in RNA nanobiotechnology for the design and construction of RNA nanostructures/nanoobjects through controlled self-assembly of modular RNA units (tectoRNAs). RNA nanostructures designed according to the concept of RNA tectonics are also attractive as tools in synthetic biology, but in vivo RNA tectonics is still in the early stages. This review presents a summary of the achievements of RNA tectonics and its related researches in vitro, and also introduces recent developments that facilitated the use of RNA nanostructures in bacterial cells.

An in vitro-selected RNA receptor for the GAAC loop: modular receptor for non-GNRA-type tetraloop

Although artificial RNA motifs that can functionally replace the GNRA/receptor interaction, a class of RNA-RNA interacting motifs, were isolated from RNA libraries and used to generate designer RNA structures, receptors for non-GNRA tetraloops have not been found in nature or selected from RNA libraries. In this study, we report successful isolation of a receptor motif interacting with GAAC, a non-GNRA tetraloop, from randomized sequences embedded in a catalytic RNA. Biochemical characterization of the GAAC/receptor interacting motif within three structural contexts showed its binding affinity, selectivity and structural autonomy. The motif has binding affinity comparable with that of a GNRA/receptor, selectivity orthogonal to GNRA/receptors and structural autonomy even in a large RNA context. These features would be advantageous for usage of the motif as a building block for designer RNAs. The isolated motif can also be used as a query sequence to search for unidentified naturally occurring GANC receptor motifs.

Suppressive effects of liquid crystal compounds on the growth of U937 human leukemic monocyte lymphoma cells

BACKGROUND

The aim of this study was to evaluate the biological and pharmaceutical activities of 14 amphiphilic liquid-crystalline compounds (LCs), i.e, phenylpyrimidine derivatives possessing D-glucamine and cyanobiphenyl derivatives with a terminal hydroxyl unit.

RESULTS

The cytotoxic properties of the LCs on the cell growth, cell cycle distribution, and cell signaling pathway of U937 human leukemic monocyte lymphoma cells were assessed by flow cytometry and western blot analysis. Some LCs showed cytostatic effects, suppressing cell growth via S-phase arrest and without apoptosis in U937 cells. To investigate the mechanisms of the LC-induced S-phase arrest, proteins relevant to cell cycle regulation were investigated by western blot analysis. The rate of LC-induced S-phase arrest was congruent with the decreased expression of MCM2, cyclin A, cyclin B, CDK2, phospho-CDK1 and Cdc25C. Observed changes in cell cycle distribution by LC treated might be caused by insufficient preparation for G2/M transition. Considering the structure of the LCs, the rod-like molecules displaying cytotoxicity against U937 cells possessed flexible spacers with no bulky polar group attached via the flexible spacer.

CONCLUSIONS

Our results revealed that some LCs showed cytotoxic properties against non-solid type tumor human leukemic cells via LC-induced S-phase arrest and decreasing expression of several cell cycle related proteins.

Site-specific isotope labeling of long RNA for structural and mechanistic studies

A site-specific isotope labeling technique of long RNA molecules was established. This technique is comprised of two simple enzymatic reactions, namely a guanosine transfer reaction of group I self-splicing introns and a ligation with T4 DNA ligase. The trans-acting group I self-splicing intron with its external cofactor, ‘isotopically labeled guanosine 5′-monophosphate’ (5′-GMP), steadily gave a 5′-residue-labeled RNA fragment. This key reaction, in combination with a ligation of 5′-remainder non-labeled sequence, allowed us to prepare a site-specifically labeled RNA molecule in a high yield, and its production was confirmed with ¹⁵N NMR spectroscopy. Such a site-specifically labeled RNA molecule can be used to detect a molecular interaction and to probe chemical features of catalytically/structurally important residues with NMR spectroscopy and possibly Raman spectroscopy and mass spectrometry.

Generation and development of RNA ligase ribozymes with modular architecture through "design and selection"

In vitro selection with long random RNA libraries has been used as a powerful method to generate novel functional RNAs, although it often requires laborious structural analysis of isolated RNA molecules. Rational RNA design is an attractive alternative to avoid this laborious step, but rational design of catalytic modules is still a challenging task. A hybrid strategy of in vitro selection and rational design has been proposed. With this strategy termed “design and selection,” new ribozymes can be generated through installation of catalytic modules onto RNA scaffolds with defined 3D structures. This approach, the concept of which was inspired by the modular architecture of naturally occurring ribozymes, allows prediction of the overall architectures of the resulting ribozymes, and the structural modularity of the resulting ribozymes allows modification of their structures and functions. In this review, we summarize the design, generation, properties, and engineering of four classes of ligase ribozyme generated by design and selection.

Controlling evening BP as well as morning BP is important in hypertensive patients with prediabetes/diabetes: the JMS-1 study

BACKGROUND

The significance of home blood pressure (BP) measurement in type 2 diabetes (T2DM) has not been well investigated. We aimed to test the hypotheses that home BP is more closely associated with target-organ damage than clinic BP, and that the presence of prediabetes/T2DM enhances the impact of home BP measurement.

METHODS

We studied 551 hypertensives (99 diabetics and 452 nondiabetics) whose self-measured systolic BP (SBP) was >135 mm Hg while on medication. The subjects were followed for 6 months after allocation to either a control group or an active treatment group. The changes in clinic BP and home BP were analyzed in relation to the changes in the spot urine albumin-creatinine ratio (UAR).

RESULTS

The extent of clinic and home BP reduction was similar between the diabetic and nondiabetic groups. The change in UAR in nondiabetics was significantly associated with the extent of SBP reduction in the clinic (r = 0.19), morning (r = 0.33), and evening (r = 0.22, all P < 0.01). In contrast, in the diabetic group, the change in UAR was significantly associated with the changes in morning SBP (r = 0.23, P = 0.02) and evening SBP (r = 0.39, P < 0.001), but not with clinic BP. The correlation with evening SBP in the diabetic group tended to be stronger than the nondiabetic group.

CONCLUSIONS

In hypertensives with prediabetes/T2DM, changes in home BP were better than changes in clinic BP to predict changes in UAR. In particular, this suggests the hypothesis that aggressive control of evening home BP might be equally or more important to morning BP in hypertensives with prediabetes/T2DM.

Rational optimization of the DSL ligase ribozyme with GNRA/receptor interacting modules

The DSL ribozyme is a class of artificial ligase ribozymes with a highly modular architecture, which catalyzes template-directed RNA ligation on a helical substrate module that can be either covalently connected (cis-DSL) or physically separated (trans-DSL) from the catalytic module. Substrate recognition by the catalytic module is promoted by one or two sets of GNRA/receptor interactions acting as clamps in the cis or trans configurations, respectively. In this study, we have rationally designed and analyzed the catalytic and self-assembly properties of several trans-DSL ribozymes with different sets of natural and artificial GNRA-receptor clamps. Two variants newly designed in this study showed significantly enhanced catalytic properties with respect of the original trans-DSL construct. While this work allows dissection of the turnover and catalytic properties of the trans-DSL ribozyme, it also emphasizes the remarkable modularity of RNA tertiary structure for nano-construction of complex functions.

Association of body mass index with cognitive function in elderly hypertensive Japanese

BACKGROUND

As hypertension, obesity, and leanness are reported to be associated with poor cognitive function, it is possible that obesity or leanness in hypertensive patients may also be associated strongly with poor cognitive function.

METHODS

We recruited 184 elderly hypertensive patients comprising 93 very elderly (aged >or=80 years) and 91 younger elderly (aged 61-79 years) subjects. A mini-mental state examination (MMSE) and 24-h ambulatory blood pressure monitoring (ABPM) were performed in all participants. Patients were classified as either lean, normal physique, or obese according to the body mass index (BMI) quartile. The prevalence of poor cognitive function, total MMSE score, and MMSE subscores were compared between the groups.

RESULTS

The prevalence of poor cognitive function, total MMSE score, and MMSE subscore attention/calculation were significantly different between the groups both in the total study population and in the very elderly patients. The multiple logistic regression model showed that leanness was a significant determinant of poor cognitive function in both the total study population (odds ratio (OR) 2.54, 95% confidence interval (CI) 1.13-5.73, P = 0.02) and the very elderly patients (OR 3.94, 95% CI 1.31-11.82, P = 0.01). Obesity was not a significant determinant in either the total study population, very elderly, or younger elderly groups.

CONCLUSION

While obesity in hypertensive elderly patients was not associated with poor cognitive function, leanness in hypertensive elderly patients was, especially in the very elderly.

Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes

BACKGROUND

The prognostic significance of ambulatory blood pressure (ABP) has not been established in patients with type 2 diabetes (T2DM).

METHODS

In order to clarify the impact of ABP on cardiovascular prognosis in patients with or without T2DM, we performed ABP monitoring (ABPM) in 1,268 subjects recruited from nine sites in Japan, who were being evaluated for hypertension. The mean age of the patients was 70.4 +/- 9.9 years, and 301 of them had diabetes. The patients were followed up for 50 +/- 23 months. We investigated the relation between incidence of cardiovascular diseases (CVDs) and different measures of ABP, including three categories of awake systolic blood pressure (SBP <135, 135-150, and >150 mm Hg), sleep SBP (<120, 120-135, and >135 mm Hg), and dipping trends in nocturnal blood pressure (BP) (dippers, nondippers, and risers). Cox regression models were used in order to control for classic risk factors.

RESULTS

Higher awake and sleep SBPs predicted higher incidence of CVD in patients with and without diabetes. In multivariable analyses, elevated SBPs while awake and asleep predicted increased risk of CVD more accurately than clinic BP did, in both groups of patients. The relationships between ABP level and CVD were similar in both groups. In Kaplan-Meier analyses, the incidence of CVD in nondippers was similar to that in dippers, but risers experienced the highest risk of CVD in both groups (P < 0.01). The riser pattern was associated with a approximately 150% increase in risk of CVD, in both groups.

CONCLUSIONS

These findings suggest that ABPM is a better predictor of cardiovascular risk than clinic BP, and that this holds true for patients with or without T2DM.

Negative-ion source applications

In this paper heavy negative-ion sources which we developed and their applications for materials science are reviewed. Heavy negative ions can be effectively produced by the ejection of a sputtered atom through the optimally cesiated surface of target with a low work function. Then, enough continuous negative-ion currents for materials-science applications can be obtained. We developed several kinds of sputter-type heavy negative-ion sources such as neutral- and ionized-alkaline metal bombardment-type heavy negative-ion source and rf-plasma sputter type. In the case where a negative ion is irradiated on a material surface, surface charging seldom takes place because incoming negative charge of the negative ion is well balanced with outgoing negative charge of the released secondary electron. In the negative-ion implantation into an insulator or insulated conductive material, high precision implantation processing with charge-up free properties can be achieved. Negative-ion implantation technique, therefore, can be applied to the following novel material processing systems: the surface modification of micrometer-sized powders, the nanoparticle formation in an insulator for the quantum devices, and the nerve cell growth manipulation by precise control of the biocompatibility of polymer surface. When a negative ion with low kinetic energy approaches the solid surface, the kinetic energy causes the interatomic bonding (kinetic bonding), and formation of a metastable material is promoted. Carbon films with high constituent of sp(3) bonding, therefore, can be formed by carbon negative-ion beam deposition.