Ergothioneine Prevents Neuronal Cell Death Caused by the Neurotoxin 6-Hydroxydopamine

Neuronal cell death is a key mechanism involved in the development and exacerbation of Parkinson's disease (PD). The excessive production of reactive oxygen species (ROS) is a major cause leading to neuronal death; therefore, compounds that prevent oxidative stress-dependent neuronal death may be promising as a preventive method for PD. Ergothioneine is a natural amino acid with antioxidant properties, and its protective functions in the body are attracting attention. However, there has been no investigation into the protective functions of ergothioneine using in vivo and in vitro PD models. Thus, in this study, we analyzed the efficacy of ergothioneine against 6-hydroxydopamine (6-OHDA)-dependent neuronal cell death using immortalized hypothalamic neurons (GT1-7 cells). First, we found that ergothioneine prevents 6-OHDA-dependent neuronal cell death by suppressing ROS overproduction in GT1-7 cells. The cytoprotective effect of ergothioneine was partially abolished by verapamil, an inhibitor of OCTN1, which is involved in ergothioneine uptake. Furthermore, ergothioneine-rich Rice-koji (Ergo-koji) showed cytoprotective and antioxidant effects similar to those of ergothioneine. Taken together, these results suggest that ergothioneine or foods containing ergothioneine may be an effective method for preventing the development and progression of PD.

Successful Systemic Steroid Administration for the Treatment of Edematous Anastomotic Stenosis After the Laparoscopic Augmented Rectangle Technique for Billroth I Reconstruction for Laparoscopic Distal Gastrectomy

Edematous anastomotic stenosis is a well-known complication following Billroth I anastomosis for distal gastrectomy. Currently, there is no established treatment for this condition. A 54-year-old female patient underwent the augmented rectangle technique for Billroth I reconstruction after total laparoscopic distal gastrectomy for early gastric cancer. On postoperative day (POD) 9, the patient started vomiting. During the conservative waiting period, edematous anastomotic stenosis was diagnosed using imaging on PODs 11 and 13. Systemic steroid administration was initiated on POD 13, and the drainage volume of the nasogastric tube decreased four days after initiation. The edematous anastomosis stenosis improved, and gastrografin flowed into the duodenum on POD 19. Food intake was started on POD 20. Oral steroid administration was continued after hospital discharge and gradually terminated. Systemic steroid treatment may help improve edematous anastomotic stenosis.

Descattering for transmissive inspection in production line using slanted linear image sensors

We propose a descattering method that can be easily applied to food production lines. The system consists of several sets of linear image sensors and linear light sources slanted at different angles. The images captured by these sensors are partially clear along the direction perpendicular to the sensors. We computationally integrate these images on the frequency domain into a single clear image. The effectiveness of the proposed method is assessed by simulation and real-world experiments. The results show that our method recovers clear images. We demonstrate the applicability of the proposed method to a real production line by a prototype system.

Development and Evaluation of Dorsiflexion Support Unit Using Elastomer Embedded Flexible Joint

In our previous study, we developed a walking support shoe with an elastomer-embedded flexible joint (EEFJ) to assist the function of tibialis anterior (TA) in initial stances (IC) and swing phases (SW). However, its usability and supporting effect have not been sufficiently evaluated. Therefore, in this study, we developed a dorsiflexion support unit (DSU) using the EEFJs with consideration on the usability for frail persons. Their needs were investigated in hearings at community centers. With reference to their comments, we proposed a three-phased scenario in which pre- / post-activities were considered as important factors of its product design of the DSU. We designed the DSU for better usability in the pre- / post-activities. Its basic function and mechanical properties were also investigated in experiments. According to the mechanical tests, the supporting torque was around 10% of the activation of TA in IC. In addition, the results of gait tests show reductions of ankle rotations by 17% and 11% in IC and SW, respectively, without significant increases of TA activations.

Eliminating Temporal Illumination Variations in Whisk-broom Hyperspectral Imaging

We propose a method for eliminating the temporal illumination variations in whisk-broom (point-scan) hyperspectral imaging. Whisk-broom scanning is useful for acquiring a spatial measurement using a pixel-based hyperspectral sensor. However, when it is applied to outdoor cultural heritages, temporal illumination variations become an issue due to the lengthy measurement time. As a result, the incoming illumination spectra vary across the measured image locations because different locations are measured at different times. To overcome this problem, in addition to the standard raster scan, we propose an additional perpendicular scan that traverses the raster scan. We show that this additional scan allows us to infer the illumination variations over the raster scan. Furthermore, the sparse structure in the illumination spectrum is exploited to robustly eliminate these variations. We quantitatively show that a hyperspectral image captured under sunlight is indeed affected by temporal illumination variations, that a Naïve mitigation method suffers from severe artifacts, and that the proposed method can robustly eliminate the illumination variations. Finally, we demonstrate the usefulness of the proposed method by capturing historic stained-glass windows of a French cathedral.

Intertumor and intratumor heterogeneity of PIK3CA mutations in extramammary Paget's disease

Although the prognosis of patients with extramammary Paget's disease (EMPD) treated with radical resection is good, the prognosis of EMPD with distant metastasis is very poor. PIK3CA mutations predict a good response to PIK3CA inhibitors. The aim of this study was to investigate the occurrence rate of PIK3CA mutations (including multiple mutations [MM]) related to the intertumor and intratumor heterogeneity in EMPD and to evaluate the correlation between these mutations and clinical parameters of EMPD. We performed droplet digital polymerase chain reaction to detect PIK3CA mutations (E542K, E545K, H1047R, and MM) in 68 patients with EMPD. In addition, we investigated the presence of PIK3CA mutations at multiple sites in 16 patients with PIK3CA mutations to assess the intratumor heterogeneity of PIK3CA mutations in EMPD. The frequency of one or more PIK3CA mutations in patients with EMPD was 30.8% (21/68). The frequency of E542K, E545K, H1047R, and MM were 10.2% (7/68), 13.2% (9/68), 11.7% (8/68), and 4.4% (3/68), respectively. No significant correlation was found between PIK3CA mutation patterns and clinical parameters. Of the 21 patients with PIK3CA mutations, 16 with tissue samples that could be analyzed at multiple sites were examined. The proportion of patients with the same PIK3CA mutations at all sites was 12.5% (2/16). The proportion of patients with the same PIK3CA mutations at least two or more sites, but not at all sites, was 31.2% (5/16). The proportion of patients with no PIK3CA mutations at other sites was 37.5% (6/16). The proportion of patients with other PIK3CA mutations at other sites was 18.7% (3/16). There is intertumor and intratumor heterogeneity of PIK3CA mutations. PIK3CA mutations in EMPD may be progressor mutations in EMPD.

Repeated Cardioembolic Stroke after COVID-19 mRNA Vaccination: A Case Report

Objective

There have been no reports suggesting a relationship between the COVID-19 mRNA vaccines that encodes the spike glycoprotein of SARS-CoV-2 and cerebrovascular disease. A case of repeated cardioembolic stroke after vaccination with the BNT162b2 (Pfizer) COVID-19 mRNA vaccine is presented.

Methods

Imaging and laboratory findings, treatment decisions, and the outcome of this case are presented.

Results

An 83-year-old Japanese woman developed right hemiplegia and motor aphasia three days after receiving her first dose of the BNT162b2 (Pfizer) COVID-19 mRNA vaccine. She had been taking rivaroxaban for persistent atrial fibrillation for 10 years, but had no symptomatic ischemic strokes. On magnetic resonance imaging (MRI) the left middle cerebral artery (MCA) was occluded. Intravenous recombinant tissue-plasminogen activator (rt-PA) therapy and mechanical thrombectomy were performed, and she recovered almost fully. However, three days after the second dose, she developed left hemiplegia and left hemispatial neglect. MRI showed occlusion of the right MCA. Only mechanical thrombectomy was performed again, but it could not be resumed due to the hard thrombus.

Discussion

In this case, it is difficult to exclude a causal relationship between the COVID-19 mRNA vaccine and ischemic stroke. This association needs to be carefully monitored.

Genomic landscape of circulating tumour DNA in metastatic extramammary Paget's disease

Although cancer personalized profiling by deep sequencing (CAPP-Seq) of cell-free DNA (cfDNA) has gained attention, the clinical utility of circulating tumour DNA (ctDNA) in extramammary Paget's disease (EMPD) has not been investigated. In this study, genomic alterations in the cfDNA and tumour tissue DNA were investigated in seven patients with metastatic EMPD. CAPP-Seq revealed mutations in 18 genes, 11 of which have not yet been reported in EMPD. The variant allele frequency of some of the mutated genes reflected the disease course in patients with EMPD. In one patient, the mutation was detected even though imaging findings revealed no metastasis. In another patient with triple EMPD (genital area and both axilla), cfDNA sequencing detected the mutation in a rib metastatic lesion, which was also detected in both axilla lesions but not the genital region. Investigations of the ctDNA may be useful towards the elucidation of clonal evolution in EMPD.

Copper as a Collaborative Partner of Zinc-Induced Neurotoxicity in the Pathogenesis of Vascular Dementia

Copper is an essential trace element and possesses critical roles in various brain functions. A considerable amount of copper accumulates in the synapse and is secreted in neuronal firings in a manner similar to zinc. Synaptic copper and zinc modulate neuronal transmission and contribute to information processing. It has been established that excess zinc secreted during transient global ischemia plays central roles in ischemia-induced neuronal death and the pathogenesis of vascular dementia. We found that a low concentration of copper exacerbates zinc-induced neurotoxicity, and we have demonstrated the involvement of the endoplasmic reticulum (ER) stress pathway, the stress-activated protein kinases/c-Jun amino-terminal kinases (SAPK/JNK) signaling pathway, and copper-induced reactive oxygen species (ROS) production. On the basis of our results and other studies, we discuss the collaborative roles of copper in zinc-induced neurotoxicity in the synapse and the contribution of copper to the pathogenesis of vascular dementia.

Time-Resolved Far Infrared Light Transport Decomposition for Thermal Photometric Stereo

We present a novel time-resolved light transport decomposition method using thermal imaging. Because the speed of heat propagation is much slower than the speed of light propagation, the transient transport of far infrared light can be observed at a video frame rate. A key observation is that the thermal image looks similar to the visible light image in an appropriately controlled environment. This implies that conventional computer vision techniques can be straightforwardly applied to the thermal image. We show that the diffuse component in the thermal image can be separated, and therefore, the surface normals of objects can be estimated by the Lambertian photometric stereo. The effectiveness of our method is evaluated by conducting real-world experiments, and its applicability to black body, transparent, and translucent objects is shown.

Time-of-flight imaging in fog using multiple time-gated exposures

We propose a time-of-flight measurement algorithm for depth and intensity that is robust to fog. The key idea of the algorithm is to compensate for the scattering effects of fog by using multiple time-gating and assigning one time-gated exposure for scattering property estimation. Once the property is estimated, the depth and intensity can be reconstructed from the rest of the exposures via a physics-based model. Several experiments with artificial fog show that our method can measure depth and intensity irrespective of the traits of the fog. We also confirm the effectiveness of our method in real fog through an outdoor experiment.

Neurometals in the Pathogenesis of Prion Diseases

Prion diseases are progressive and transmissive neurodegenerative diseases. The conformational conversion of normal cellular prion protein (PrP^C) into abnormal pathogenic prion protein (PrP^Sc) is critical for its infection and pathogenesis. PrP^C possesses the ability to bind to various neurometals, including copper, zinc, iron, and manganese. Moreover, increasing evidence suggests that PrP^C plays essential roles in the maintenance of homeostasis of these neurometals in the synapse. In addition, trace metals are critical determinants of the conformational change and toxicity of PrP^C. Here, we review our studies and other new findings that inform the current understanding of the links between trace elements and physiological functions of PrP^C and the neurotoxicity of PrP^Sc.

Super-resolution for a dispersive spectrometer using a tilted area sensor and spectrally varying blur kernel interpolation

The grating, lens, and linear sensor determine a spectrometer's wavelength resolution and measurement range. While conventional methods have tried to improve the optical design to obtain a better resolution, they have a limitation caused by the physical property. To improve the resolution, we introduce a super-resolution method from the computer vision field. We propose tilting an area sensor to realize accurate subpixel shifting and recover a high-resolution spectrum using interpolated spectrally varying kernels. We experimentally validate that the proposed method achieved a high spectral resolution of 0.141nm in 400-800nm by just tilting the sensor in the spectrometer.

Development of Ankle Support Shoes with Elastomer-Embedded Flexible Joints

Walking is one of the most important activities in daily living, and difficulty walking presents a severe limitation. In this study, we develop shoes with elastomer-embedded flexible joints (EEFJ) that assist the tibialis anterior in its function during the initial stance and swing phase of the gait cycle. The EEFJ designed is suitable for shoes, with an adjustment mechanism incorporated for easy adjustment. To assess the ease of wearing, we measured the time it took four elderly subjects to wear the shoes for the first time. The donning time was less than one minute for all four participants. Furthermore, no one indicated discomfort when they walked naturally with the shoes. The supporting effect of the EEFJ shoes was assessed for ten healthy male subjects walking with their ankles relaxed. Statistical analysis reveals significant differences in the ankle at initial contact (p=0.02) and maximum plantar flexion (p=0.03). The average angle at initial contact while wearing the EEFJ shoes is 5.3° less than without it, and the average maximum plantar flexion is 5.1° less than without the shoes.

Phase disambiguation using spatio-temporally modulated illumination in depth sensing

Phase ambiguity is a major problem in the depth measurement in either time-of-flight or phase shifting. Resolving the ambiguity using a low frequency pattern sacrifices the depth resolution, and using multiple frequencies requires a number of observations. In this paper, we propose a phase disambiguation method that combines temporal and spatial modulation so that the high depth resolution is preserved while the number of observation is kept. A key observation is that the phase ambiguities of temporal and spatial domains appear differently with respect to the depth. Using this difference, the phase can disambiguate for a wider range of interest. We develop a prototype to show the effectiveness of our method through real-world experiments.

Carnosine as a Possible Drug for Zinc-Induced Neurotoxicity and Vascular Dementia

Increasing evidence suggests that the metal homeostasis is involved in the pathogenesis of various neurodegenerative diseases including senile type of dementia such as Alzheimer’s disease, dementia with Lewy bodies, and vascular dementia. In particular, synaptic Zn²⁺ is known to play critical roles in the pathogenesis of vascular dementia. In this article, we review the molecular pathways of Zn²⁺-induced neurotoxicity based on our and numerous other findings, and demonstrated the implications of the energy production pathway, the disruption of calcium homeostasis, the production of reactive oxygen species (ROS), the endoplasmic reticulum (ER)-stress pathway, and the stress-activated protein kinases/c-Jun amino-terminal kinases (SAPK/JNK) pathway. Furthermore, we have searched for substances that protect neurons from Zn²⁺-induced neurotoxicity among various agricultural products and determined carnosine (β-alanyl histidine) as a possible therapeutic agent for vascular dementia.

Amyloids: Regulators of Metal Homeostasis in the Synapse

Conformational changes in amyloidogenic proteins, such as β-amyloid protein, prion proteins, and α-synuclein, play a critical role in the pathogenesis of numerous neurodegenerative diseases, including Alzheimer’s disease, prion disease, and Lewy body disease. The disease-associated proteins possess several common characteristics, including the ability to form amyloid oligomers with β-pleated sheet structure, as well as cytotoxicity, although they differ in amino acid sequence. Interestingly, these amyloidogenic proteins all possess the ability to bind trace metals, can regulate metal homeostasis, and are co-localized at the synapse, where metals are abundantly present. In this review, we discuss the physiological roles of these amyloidogenic proteins in metal homeostasis, and we propose hypothetical models of their pathogenetic role in the neurodegenerative process as the loss of normal metal regulatory functions of amyloidogenic proteins. Notably, these amyloidogenic proteins have the capacity to form Ca²⁺-permeable pores in membranes, suggestive of a toxic gain of function. Therefore, we focus on their potential role in the disruption of Ca²⁺ homeostasis in amyloid-associated neurodegenerative diseases.

A Single-institution Study on Predictors of Short-term Progression from Mild Cognitive Impairment in Parkinson's Disease to Parkinson's Disease with Dementia

Background

Patients with non-demented Parkinson's disease (PD) sometime have mild cognitive impairment (MCI), and mild cognitive impairment in Parkinson's disease (PD-MCI) may convert to Parkinson's disease with dementia (PDD) within several years. Cognitive impairment also occurs in the early stages of the disease, gradually progressing to lower quality of life and instrumental activities of daily living. It is important to elucidate the predictors of progression from PD-MCI to PDD via longitudinal studies.

Methods

This was a single center, case-control study. We analysed data from 49 patients with PD-MCI diagnosed as level I using the Movement Disorder Society PD-MCI criteria at baseline who had completed 1.5 years of follow-up. We defined patients who progressed to PDD as patients with progressive PD-MCI and patients who did not progress to PDD as patients with non-progressive PD-MCI. Depression, apathy, sleep disorders, constipation, light-headedness, hallucinations, impulse control disorders (ICDs) and impulsive-compulsive behaviors (ICBs) at baseline were statistically analysed as predictors of progression.

Results

Of the 49 PD-MCI patients, 33 did not convert to PDD (non-progressive PD-MCI), and 16 converted to PDD (progressive PD-MCI). The Mini-Mental State Examination (MMSE) score, light-headedness and ICDs were elucidated as predictors of progressive PD-MCI via a multivariate logistic regression model. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each item were MMSE score, OR 0.324, 95% CI 0.119-0.882, P = 0.027; light-headedness, OR 27.665, 95% CI 2.263-338.185, P= 0.009; and ICDs, OR 53.451, 95% CI 2.298-291.085, P = 0.010.

Conclusion

Cognitive function, ICDs and light-headedness may be risk factors for the development of PDD in PD-MCI patients.

Material Classification from Time-of-Flight Distortions

This paper presents a material classification method using an off-the-shelf Time-of-Flight (ToF) camera. The proposed method is built upon a key observation that the depth measurement by a ToF camera is distorted for objects with certain materials, especially with translucent materials. We show that this distortion is due to the variation of time domain impulse responses across materials and also due to the measurement mechanism of the ToF cameras. Specifically, we reveal that the amount of distortion varies according to the modulation frequency of the ToF camera, the object material, and the distance between the camera and object. Our method uses the depth distortion of ToF measurements as a feature for classification and achieves material classification of a scene. Effectiveness of the proposed method is demonstrated by numerical evaluations and real-world experiments, showing its capability of material classification, even for visually indistinguishable objects.

Depth from phasor distortions in fog

This paper presents a time-of-flight (ToF) measurement method for use in foggy weather. The depth measured by a ToF camera is greatly distorted in fog because the light scattered in the fog reaches the camera much faster than the target reflection. We reveal that the multi-frequency measurements contain a cue whether two arbitrary pixels have the same depth. After clustering the same depth pixels using this cue, the original depth can be recovered for each cluster by line fitting in the Cartesian coordinate frame. The effectiveness of this method is evaluated numerically via real-world and road-scale experiments.

The utility of the combined use of 123I-FP-CIT SPECT and neuromelanin MRI in differentiating Parkinson's disease from other parkinsonian syndromes

BACKGROUND

Neuromelanin magnetic resonance imaging (NmMRI) and ¹²³I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguishes Parkinson's disease (PD) from non-degenerative parkinsonian syndrome (NDPS).

PURPOSE

To determine whether a multiparametric scoring system (MSS) could improve accuracy compared to each parameter of DAT-SPECT and NmMRI in differentiating PD from NDPS.

MATERIAL AND METHODS

A total of 49 patients, including 14 with NDPS, 30 with PD, and five with atypical parkinsonian disorder (APD) underwent both NmMRI and DAT-SPECT and were evaluated. The average (Ave) and the asymmetry index (AI) were calculated in the substantia nigra compacta area (SNc-area), SNc midbrain-tegmentum contrast ratio (SNc-CR), and specific binding ratio (SBR). Cut-off values were determined, using receiver operating characteristic (ROC) analysis, for the differentiation of PD from NDPS on the statistically significant parameters. All cases were scored as either 1 (PD) or 0 (NDPS) for each parameter according to its threshold. These individual scores were totaled for each case, yielding a combined score for each case to obtain a cut-off value for the MSS.

RESULTS

The Ave-SNc-area, Ave-SNc-CR, and Ave-SBR in PD were significantly lower than those in NDPS. The AI-SNc-area and AI-SBR in PD were significantly higher than those in NDPS. Of the five parameters, the highest accuracy was 93% for the Ave-SNc-area. For the MSS, a cut-off value of 3 was the accuracy of 96%. Besides, no significant difference was observed between PD and APD on all parameters.

CONCLUSION

An MSS has comparable or better accuracy compared to each parameter of DAT-SPECT and NmMRI in distinguishing PD from NDPS.

A quality assurance for respiratory gated proton irradiation with range modulation wheel

The purpose of this study was to provide periodic quality assurance (QA) methods for respiratory-gated proton beam with a range modulation wheel (RMW) and to clarify the characteristics and long-term stability of the respiratory-gated proton beam. A two-dimensional detector array and a solid water phantom were used to measure absolute dose, spread-out Bragg peak (SOBP) width and proton range for monthly QA. SOBP width and proton range were measured using an oblique incidence beam to the lateral side of a solid water phantom and compared between with and without a gating proton beam. To measure the delay time of beam-on/off for annual QA, we collected the beam-on/off signals and the dose monitor-detected pulse. We analyzed the results of monthly QA over a 15-month period and investigated the delay time by machine signal analysis. The dose deviations at proximal, SOBP center and distal points were -0.083 ± 0.25%, 0.026 ± 0.20%, and -0.083 ± 0.35%, respectively. The maximum dose deviation between with and without respiratory gating was -0.95% at the distal point and other deviations were within ±0.5%. Proximal and SOBP center doses showed the same trend over a 15-month period. Delay times of beam-on/off for 200 MeV/SOBP 16 cm were 140.5 ± 0.8 ms and 22.3 ± 13.0 ms, respectively. Delay times for 160 MeV/SOBP 10 cm were 167.5 ± 15.1 ms and 19.1 ± 9.8 ms. Our beam delivery system with the RMW showed sufficient stability for respiratory-gated proton therapy and the system did not show dependency on the energy and the respiratory wave form. The delay times of beam-on/off were within expectations. The proposed QA methods will be useful for managing the quality of respiratory-gated proton beams and other beam delivery systems.

Low skeletal muscle mass is associated with the risk of all-cause mortality in patients with type 2 diabetes mellitus

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of muscle mass reduction. However, the association between muscle mass and mortality in T2DM remains unknown.

METHODS

This was a historical cohort study with the endpoint of all-cause mortality. This study included 163 Japanese men and 141 postmenopausal women with T2DM whose body compositions were evaluated using dual-energy X-ray absorptiometry. Low muscle mass was defined as a skeletal muscle mass index (SMI) of <7.0 kg/m² for men and <5.4 kg/m² for women.

RESULTS

During the 6-year follow-up period, 32 men and 14 women died. In a Cox regression analysis adjusted for age, T2DM duration, glycated hemoglobin, serum creatinine, fasting C-peptide, body mass index, and lean body mass were associated with the risk of mortality in men [hazard ratio (HR) = 1.81, 95% confidence interval (CI) = 1.00-3.28 per standard deviation (SD) decrease, p = 0.049] and women (HR = 4.53, 95% CI = 1.14-17.96 per SD decrease, p = 0.032). Neither fat mass nor bone mineral content was associated with mortality. Low SMI was associated with increased mortality in women (HR = 5.97, 95% CI = 1.04-34.37, p = 0.045), while the association between low SMI and mortality was marginal in men (HR = 2.38, 95% CI = 0.92-6.14, p = 0.074).

CONCLUSIONS

Low muscle mass was independently associated with all-cause mortality in patients with T2DM. The preservation of skeletal muscle mass is important to protect patients with T2DM from increased mortality risk.

Higher Serum Uric Acid is a Risk Factor of Vertebral Fractures in Postmenopausal Women with Type 2 Diabetes Mellitus

Purpose Serum uric acid (UA) level may affect bone metabolism because it has an anti-oxidative effect. However, whether serum UA level is associated with a fracture risk in type 2 diabetes mellitus (T2DM) is unclear. We thus aimed to clarify the association between serum UA and bone parameters in T2DM.

Methods We conducted a cross-sectional study to investigate the association of serum UA with bone mineral density (BMD) at lumbar spine (LS) and femoral neck (FN), bone turnover markers such as osteocalcin and urine type I collagen cross-linked N-telopeptide (uNTX), and the prevalence of vertebral fractures (VF) in 356 postmenopausal women and 512 men with T2DM.

Results Multiple regression analyses adjusted for age, duration of diabetes, hemoglobin A1c, body mass index and log (serum creatinine) showed that serum UA level was significantly and negatively associated with uNTX in postmenopausal women with T2DM, whereas it was not associated with osteocalcin or BMD at each site. In men, serum UA was not associated with BMD or bone turnover markers. Because postmenopausal women with VF were significantly older and had longer duration of diabetes, higher serum creatinine level and lower BMD than those without it, logistic regression analyses adjusted for these confounding factors were performed. Higher serum UA level was significantly associated with the presence of VF.

Conclusions The present study showed that higher serum UA is a risk factor for VF independently of BMD in postmenopausal women with T2DM.

Reference equation for the incremental shuttle walk test in Japanese adults

BACKGROUND

The incremental shuttle walk test (ISWT) is widely used in clinical and research settings. However, there are no reference equations to predict the walk distance achieved in the ISWT (ISWD) for healthy Japanese adults. We aimed to establish a reference equation for the ISWD prediction in Japanese adults.

METHODS

The sample comprised 590 healthy Japanese subjects (237 male). All subjects performed the ISWT twice, and their anthropometric and demographic data were collected, including gender, age, height, weight, and body mass index (BMI).

RESULTS

Subjects walked 640 [490-793] m in the ISWT. The ISWD correlated (p < 0.001 for all) with age (r = - 0.51), gender (r = 0.56), weight (r = 0.39), and height (r = 0.62), but not with BMI (r = - 0.01, p = 0.74). The stepwise multiple regression model showed that age, gender, and height were independent contributors to the ISWT in healthy subjects, explaining 50% of the variability. The reference equation for the ISWD was: ISWD(m) = - 4.894 - 4.107 × Age (years) + 131.115 × Gender + 4.895 × Height (cm), where male gender = 1.

CONCLUSION

We have established a reference equation for the ISWD prediction in Japanese adults. The prediction accuracy was high (R² = 50%), and a reference equation was established using anthropometric and demographic variables that can be easily assessed in clinical settings. The reference equation developed in this study will be useful for evaluating the magnitude of exercise intolerance in Japanese adults.

Effects of Systematic Intervention for Chronic Obstructive Pulmonary Disease on Follow-up and Smoking Cessation Rates and Changes of the Pulmonary Function: A 7-year Longitudinal Study in a Japanese Rural City

Objective The early detection and treatment of chronic obstructive pulmonary disease (COPD) requires comprehensive follow-up over a long period. The aim of this study was to determine the effects of a comprehensive long-term intervention system developed by the COPD Task Force for a rural city in Japan during a 7-year period. Methods This prospective, community-based longitudinal study encompassed 2006-2013 in Matsuura City, Japan. Primary and secondary screenings were performed for the early diagnosis and treatment of COPD. Individuals diagnosed with COPD were managed by the COPD Task Force's comprehensive early intervention system. The outcomes of interest were the rate of continuous follow-up after the diagnosis of COPD, the smoking cessation rate, and changes in the pulmonary function during a 7-year period. Subjects The study included 8,878 residents of 50-89 years of age who resided in Matsuura in 2006. Results In total, 140 participants received definitive diagnoses of COPD in 2006. After 7 years of intervention, 34 patients withdrew; 78 (74%) patients continued with treatment in our intervention system. The rate of smoking cessation was significantly increased in the intervention group (from 30% to 68%; p<0.01) over the 7-year period. The change in forced expiratory volume in 1 second (FEV₁) was -23.2 mL/year. Conclusion Our systematic longitudinal intervention system during a 7-year period led to high rates of follow-up and smoking cessation. Furthermore, our system may be able to prevent the decline of FEV₁ in COPD patients. This intervention system may be effective in rural cities with few respiratory physicians.

The Utility of the Combined Use of 123I-FP-CIT and 123I-MIBG Myocardial Scintigraphy in Differentiating Parkinson's Disease from Other Parkinsonian Syndromes

BACKGROUND

123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguish Parkinson's disease (PD) from parkinsonian syndromes other than PD (non-PD), including atypical parkinsonian disorder (APD) and non-PD other than APD (nPD-nAPD). The purpose of this study was to determine whether combining DAT-SPECT and MIBG myocardial scintigraphy using multiparametric scoring system (MSS) could improve diagnostic test accuracy in discriminating PD from APD or discriminating PD from nPD-nAPD.

METHODS

A total of 52 patients, including 36 PD, eight APD and eight nPD-nAPD, underwent both MIBG myocardial scintigraphy and DAT-SPECT, were evaluated. The heart-to-mediastinum (H/M) ratios (early and delayed), washout-rate (WR), the average (Ave) and asymmetry index (AI) of specific binding ratio (SBR) were calculated. Cutoff values were determined, using ROC analysis, for discriminating PD from APD and for discriminating PD from nPD-nAPD, on five parameters. All cases were scored as either 1 (PD) or 0 (nPD-nAPD or APD) for each parameter according to its threshold in each discrimination. These individual scores were summed for each case, yielding a combined score to obtain a cutoff value for the MSS in each discrimination.

RESULTS

For discriminating PD from nPD-nAPD, the highest accuracy was 80% at a cutoff value of 19% for the WR and a cut off value of 2 improved diagnostic accuracy to 84% for MSS. For discriminating PD from APD, the highest accuracy was 86% at a cutoff value of 2.8 for the H/M ratio (late) and a cut off value of 2 showed diagnostic accuracy of 86% for MSS.

CONCLUSION

A MSS has comparable or better accuracy compared to each parameter of MIBG myocardial scintigraphy and DAT-SPECT in distinguishing PD from nPD-nAPD or distinguishing PD from APD.

Evaluation of dosimetric advantages of using patient-specific aperture system with intensity-modulated proton therapy for the shallow depth tumor

In this study, we evaluate dosimetric advantages of using patient-specific aperture system with intensity-modulated proton therapy (IMPT) for head and neck tumors at the shallow depth. We used four types of patient-specific aperture system (PSAS) to irradiate shallow regions less than 4 g/cm² with a sharp lateral penumbra. Ten head and neck IMPT plans with or without aperture were optimized separately with the same 95% prescription dose and same dose constraint for organs at risk (OARs). The plans were compared using dose volume histograms (DVHs), dose distributions, and some dose indexes such as volume receiving 50% of the prescribed dose (V₅₀ ), mean or maximum dose (D_mean and D_max ) to the OARs. All examples verified in this study had decreased V₅₀ and OAR doses. Average, maximum, and minimum relative reductions of V₅₀ were 15.4%, 38.9%, and 1.0%, respectively. D_max and D_mean of OARs were decreased by 0.3% to 25.7% and by 1.0% to 46.3%, respectively. The plans with the aperture over more than half of the field showed decreased V₅₀ or OAR dose by more than 10%. The dosimetric advantage of patient-specific apertures with IMPT was clarified in many cases. The PSAS has some dosimetric advantages for clinical use, and in some cases, it enables to fulfill dose constraints.

Recovering temporal PSF using ToF camera with delayed light emission

Recovering temporal point spread functions (PSFs) is important for various applications, especially analyzing light transport. Some methods that use amplitude-modulated continuous wave time-of-flight (ToF) cameras are proposed to recover temporal PSFs, where the resolution is several nanoseconds. Contrarily, we show in this paper that sub-nanosecond resolution can be achieved using pulsed ToF cameras and an additional circuit. A circuit is inserted before the illumination so that the emission delay can be controlled by sub-nanoseconds. From the observations of various delay settings, we recover temporal PSFs of the sub-nanosecond resolution. We confirm the effectiveness of our method via real-world experiments.

Recovering Inner Slices of Layered Translucent Objects by Multi-Frequency Illumination

This paper describes a method for recovering appearance of inner slices of translucent objects. The appearance of a layered translucent object is the summed appearance of all layers, where each layer is blurred by a depth-dependent point spread function (PSF). By exploiting the difference of low-pass characteristics of depth-dependent PSFs, we develop a multi-frequency illumination method for obtaining the appearance of individual inner slices. Specifically, by observing the target object with varying the spatial frequency of checker-pattern illumination, our method recovers the appearance of inner slices via computation. We study the effect of non-uniform transmission due to inhomogeneity of translucent objects and develop a method for recovering clear inner slices based on the pixel-wise PSF estimates under the assumption of spatial smoothness of inner slice appearances. We quantitatively evaluate the accuracy of the proposed method by simulations and qualitatively show faithful recovery using real-world scenes.

Aminophylline suppresses stress-induced visceral hypersensitivity and defecation in irritable bowel syndrome

Pharmacological therapy for irritable bowel syndrome (IBS) has not been established. In order to find candidate drugs for IBS with diarrhea (IBS-D), we screened a compound library of drugs clinically used for their ability to prevent stress-induced defecation and visceral hypersensitivity in rats. We selected the bronchodilator aminophylline from this library. Using a specific inhibitor for each subtype of adenosine receptors (ARs) and phosphodiesterases (PDEs), we found that both A2BARs and PDE4 are probably mediated the inhibitory effect of aminophylline on wrap restraint stress (WRS)-induced defecation. Aminophylline suppressed maternal separation- and acetic acid administration-induced visceral hypersensitivity to colorectal distension (CRD), which was mediated by both A2AARs and A2BARs. We propose that aminophylline is a candidate drug for IBS-D because of its efficacy in both of stress-induced defecation and visceral hypersensitivity, as we observed here, and because it is clinically safe.

Screening tools for clinical characteristics of probable REM sleep behavior disorder in patients with Parkinson's disease

INTRODUCTION

The REM sleep behavior disorder (RBD) screening questionnaire (RBDSQ) has been used as a screening tool for RBD. We investigated the clinical characteristics of probable RBD (pRBD) using the RBDSQ in patients with Parkinson's disease (PD).

METHODS

Seventy patients with PD (age: 69.2 ± 8.9 years old, 31 males and 49 females, length of PD morbidity: 7.4 ± 6.4 years, Hoehn and Yahr: 2.7 ± 0.8) underwent examination including the RBDSQ and Mini-Mental State Examination (MMSE) in both 2011 and 2013. We assessed the changes and characteristics of pRBD associated with PD during the two year interval.

RESULTS

Nineteen patients (27.1%) in 2011 and 27 patients (38.6%) in 2013 were diagnosed as having pRBD because they scored 6 or higher on the RBDSQ. During the 2 year interval, twelve patients showed persistent pRBD, 15 developed pRBD, and 7 showed improved pRBD. In 2013, PD patients with pRBD took higher amounts of levodopa equivalents and scored lower on the MMSE than those without pRBD. Also, more PD patients with pRBD had dementia than those without pRBD. Similarly, more patients with persistent and developed pRBD had dementia than those without.

CONCLUSION

We found that RBD symptoms might fluctuate during the clinical course of PD, and RBD symptoms might temporarily affect cognitive impairment.

Bilateral Axillary Arterial Perfusion in Surgery on Thoracic Aorta

Bilateral axillary arterial cannulation for selective cerebral perfusion might minimize cerebral embolic complications during surgery on the ascending aorta and aortic arch. From March 2002 through February 2004, bilateral axillary arterial perfusion was applied in 12 consecutive patients (mean age, 61.3 years). Operative procedures were total arch replacement in 8 patients, hemiarch replacement in 1, and ascending aorta replacement in 3. Antegrade selective cerebral perfusion was established through vascular grafts anastomosed to the bilateral axillary arteries and a perfusion catheter placed directly into the left carotid artery. Bilateral axillary arterial perfusion through the grafts was successful in all patients. There were no early or late deaths and no incidence of neurologic deficit. There were no complications related to cannulation of the axillary arteries. Bleeding, temporary renal failure, acute respiratory distress syndrome, and graft infection occurred in one patient each; all recovered from these complications. Bilateral axillary arterial perfusion is feasible and effective for brain protection during surgery on the ascending aorta and aortic arch.

A proton therapy system in Nagoya Proton Therapy Center

The purpose of this paper is to describe an outline of a proton therapy system in Nagoya Proton Therapy Center (NPTC). The NPTC has a synchrotron with a linac injector and three treatment rooms: two rooms are equipped with a gantry and the other one is equipped with a fixed horizontal beamline. One gantry treatment room has a pencil beam scanning treatment delivery nozzle. The other two treatment rooms have a passive scattering treatment delivery nozzle. In the scanning treatment delivery nozzle, an energy absorber and an aperture system to treat head and neck cancer have been equipped. In the passive treatment delivery nozzle, a multi-leaf collimator is equipped. We employ respiratory gating to treat lung and liver cancers for passive irradiation. The proton therapy system passed all acceptance tests. The first patient was treated on February 25, 2013, using passive scattering fixed beams. Respiratory gating is commonly used to treat lung and liver cancers in the passive scattering system. The MLCs are our first choice to limit the irradiation field. The use of the aperture for scanning irradiation reduced the lateral fall off by half or less. The energy absorber and aperture system in scanning delivery is beneficial to treat head and neck cancer.

Three cases of neuromyelitis optica spectrum disorder

Neuromyelitis optica (NMO) is characterized by attacks of optic neuritis and longitudinally extensive transverse myelitis. Cases positive for aquaporin 4 antibodies are classified to NMO spectrum disorder (NMOSD) which includes cases with optic neuritis, transverse myelitis, or with brain lesions typical of NMO. Our three cases with NMO/NMOSD revealed five imaging features: (i) extensive transverse cord lesions, extending more than three vertebral segments, partially persisting as cavitation; (ii) periependymal lesions; (iii) lesions of the corticospinal tracts; (iv) extensive and confluent hemispheric white matter lesions reflecting vasogenic edema and partially involving the cerebral cortices and basal ganglia; and (v) two patterns of serial hemispheric white matter lesions: one is cavitation and another is partial regression or disappearance. Cavitations, in the upper spinal cord and hemispheric white matter, are considered to be caused by severe vasogenic edema and are likely to be one of the characteristic findings in NMOSD.

Production and removal of superoxide anion radical by artificial metalloenzymes and redox-active metals

Generation of reactive oxygen species is useful for various medical, engineering and agricultural purposes. These include clinical modulation of immunological mechanism, enhanced degradation of organic compounds released to the environments, removal of microorganisms for the hygienic purpose, and agricultural pest control; both directly acting against pathogenic microorganisms and indirectly via stimulation of plant defense mechanism represented by systemic acquired resistance and hypersensitive response. By aiming to develop a novel classes of artificial redox-active biocatalysts involved in production and/or removal of superoxide anion radicals, recent attempts for understanding and modification of natural catalytic proteins and functional DNA sequences of mammalian and plant origins are covered in this review article.

Acute Motor-dominant Polyneuropathy as Guillain-Barré Syndrome and Multiple Mononeuropathies in a Patient with Sjögren's Syndrome

A patient with xerostomia and xerophthalmia due to Sjögren's syndrome presented with acute motor-dominant polyneuropathy and multiple mononeuropathy with antiganglioside antibodies. Nerve conduction studies and a sural nerve biopsy revealed the neuropathy as a mixture of segmental demyelination and axonal degeneration. Positive results were obtained for several antiganglioside antibodies. Corticosteroid treatment proved effective. The neuropathy was considered to represent a mixture of polyneuropathy as Guillain-Barré syndrome and multiple mononeuropathy via Sjögren's syndrome. We speculate that Guillain-Barré syndrome occurred in the patient and Guillain-Barré syndrome itself activated multiple mononeuropathy via Sjögren's syndrome.

Superoxide dismutase overexpression protects against glucocorticoid-induced depressive-like behavioral phenotypes in mice

In the stress response, activation of the hypothalamic-pituitary-adrenal axis, and particularly the release of glucocorticoids, plays a critical role. However, dysregulation of this system and sustained high plasma levels of glucocorticoids can result in depression. Recent studies have suggested the involvement of reactive oxygen species (ROS), such as superoxide anion, in depression. However, direct evidence for a role of ROS in the pathogenesis of this disorder is lacking. In this study, using transgenic mice expressing human Cu/Zn-superoxide dismutase (SOD1), an enzyme that catalyzes the dismutation of superoxide anions, we examined the effect of SOD1 overexpression on depressive-like behavioral phenotypes in mice. Depressive-like behaviors were induced by daily subcutaneous administration of the glucocorticoid corticosterone for 4 weeks, and was monitored with the social interaction test, the sucrose preference test and the forced swim test. These tests revealed that transgenic mice overexpressing SOD1 are more resistant to glucocorticoid-induced depressive-like behavioral disorders than wild-type animals. Furthermore, compared with wild-type mice, transgenic mice showed a reduction in the number of 8-hydroxy-2'-deoxyguanosine (a marker of oxidative stress)-positive cells in the hippocampal CA3 region following corticosterone administration. These results suggest that overexpression of SOD1 protects mice against glucocorticoid-induced depressive-like behaviors by decreasing cellular ROS levels.

Reduction in Endogenous Insulin Secretion is a Risk Factor of Sarcopenia in Men with Type 2 Diabetes Mellitus

Sarcopenia has recently attracted widespread attention, because it increases risks of fall and bedridden. Although patients with type 2 diabetes mellitus (T2DM) are known to have lower muscle mass of limbs than healthy people, the mechanism is still unclear. We thus examined the association of muscle mass with parameters of endogenous insulin secretion such as fasting immunoreactive insulin, fasting C-peptide immunoreactivity (CPR), and daily urine CPR in 191 men with T2DM. Muscle mass of arms and legs was evaluated by dual-energy X-ray absorptiometry, and we calculated relative skeletal muscle index (RSMI), which is useful for the diagnosis of sarcopenia. Multiple regression analyses adjusted for age, duration of T2DM, serum creatinine, HbA1c, and insulin-like growth factor-I showed that each parameter of endogenous insulin was significantly and positively correlated with muscle mass of arms and legs as well as RSMI (p < 0.05). Moreover, logistic regression analyses adjusted for confounding factors mentioned above showed that each parameter of endogenous insulin was significantly lower in subjects with sarcopenia than those without it (p < 0.05). In conclusion, reduction in endogenous insulin secretion is an independent risk factor of sarcopenia in men with T2DM.

Value of systematic intervention for chronic obstructive pulmonary disease in a regional Japanese city based on case detection rate and medical cost

OBJECTIVE

We established a COPD taskforce for early detection, diagnosis, treatment, and intervention. We implemented a pilot intervention with a prospective and longitudinal design in a regional city. This study evaluates the usefulness of the COPD taskforce and intervention based on COPD case detection rate and per capita medical costs.

METHOD

We distributed a questionnaire to all 8,878 inhabitants aged 50-89 years, resident in Matsuura, Nagasaki Prefecture in 2006. Potentially COPD-positive persons received a pulmonary function test and diagnosis. We implemented ongoing detection, examination, education, and treatment interventions, performed follow-up examinations or respiratory lessons yearly, and supported the health maintenance of each patient. We compared COPD medical costs in Matsuura and in the rest of Nagasaki Prefecture using data from 2004 to 2013 recorded by the association of Nagasaki National Health Insurance Organization, assessing 10-year means and annual change.

RESULTS

As of 2014, 256 people have received a definitive diagnosis of COPD; representing 31% of the estimated total number of COPD patients. Of the cases detected, 87.5% were mild or moderate in severity. COPD medical costs per patient in Matsuura were significantly lower than the rest of Nagasaki Prefecture, as was rate of increase in cost over time.

CONCLUSION

The COPD program in Matsuura enabled early detection and treatment of COPD patients and helped to lower the associated burden of medical costs. The success of this program suggests that a similar program could reduce the economic and human costs of COPD morbidity throughout Japan.

The exacerbating roles of CCAAT/enhancer-binding protein homologous protein (CHOP) in the development of bleomycin-induced pulmonary fibrosis and the preventive effects of tauroursodeoxycholic acid (TUDCA) against pulmonary fibrosis in mice

The purpose of this study was to evaluate the role of CCAAT/enhancer-binding protein homologous protein (CHOP), an important transcription factor that regulates the inflammatory reaction during the endoplasmic reticulum (ER) stress response, in the development of pulmonary fibrosis induced by bleomycin (BLM) in mice. An intratracheal injection of BLM transiently increased the expression of CHOP mRNA and protein in an early phase (days 1 and 3) in mice lungs. BLM-induced pulmonary fibrosis was significantly attenuated in Chop gene deficient (Chop KO) mice, compared with wild-type (WT) mice. Furthermore, the inflammatory reactions evaluated by protein concentration, the total number of leucocytes and neutrophils in the bronchoalveolar lavage fluid (BALF), the mRNA expression of interleukin 1b and caspase 11, and the apoptotic cell death were suppressed in Chop KO mice compared with those in WT mice. In addition, administration of tauroursodeoxycholic acid (TUDCA), a pharmacological agent that can inhibit CHOP expression, inhibited the BLM-induced pulmonary fibrosis and inflammation, and the increase in Chop mRNA expression in WT mice in a dose-dependent manner. These results suggest that the ER stress-induced transcription factor, CHOP, at least in part, plays an important role in the development of BLM-induced pulmonary fibrosis in mice, and that the inhibition of CHOP expression by a pharmacological agent, such as TUDCA, may be a promising strategy for the prevention of pulmonary fibrosis.

Effects of high glucose and advanced glycation end products on the expressions of sclerostin and RANKL as well as apoptosis in osteocyte-like MLO-Y4-A2 cells

In diabetes mellitus (DM), high glucose (HG) and advanced glycation end products (AGEs) are involved in bone quality deterioration. Osteocytes produce sclerostin and receptor activator of nuclear factor-кB ligand (RANKL) and regulate osteoblast and osteoclast function. However, whether HG or AGEs directly affect osteocytes and regulate sclerostin and RANKL production is unknown. Here, we examined the effects of HG, AGE2, and AGE3 on the expression of sclerostin and RANKL and on apoptosis in osteocyte-like MLO-Y4-A2 cells. Treatment of the cells with 22 mM glucose, 100 μg/mL either AGE2 or AGE3 significantly increased the expression of sclerostin protein and mRNA; however, both AGEs, but not glucose, significantly decreased the expression of RANKL protein and mRNA. Moreover, treatment of the cells with HG, AGE2, or AGE3 for 72 h induced significant apoptosis. These detrimental effects of HG, AGE2, and AGE3 on sclerostin and RANKL expressions and on apoptosis were antagonized by pretreatment of the cells with 10(-8) M human parathyroid hormone (PTH)-(1-34). Thus, HG and AGEs likely suppress bone formation by increasing sclerostin expression in osteocytes, whereas AGEs suppress bone resorption by decreasing RANKL expression. Together, these processes may cause low bone turnover in DM. In addition, HG and AGEs may cause cortical bone deterioration by inducing osteocyte apoptosis. PTH may effectively treat these pathological processes and improve osteocyte function.

Increased low-density lipoprotein cholesterol level is associated with non-vertebral fractures in postmenopausal women

Although a high serum low-density lipoprotein cholesterol (LDL-C) level is an established risk factor for atherosclerosis, it is unclear whether it is associated with osteoporosis. In this study, the associations between the serum LDL-C level and bone mineral density (BMD), bone metabolic markers, and the presence of prevalent vertebral or non-vertebral fractures were examined. A total of 211 healthy postmenopausal women (age range, 46-80 years) who visited a community health center were recruited consecutively. Their radiographic and biochemical characteristics were collected. Prevalent vertebral and non-vertebral fractures were found in 49 (23.2%) and 36 (17.1%) subjects, respectively. Simple regression analyses showed that the serum LDL-C level was not significantly correlated with lumbar or femoral BMD or serum levels of total amino-terminal propeptide of type I collagen (PINP) or carboxy-terminal telopeptide of type I collagen (CTX). Logistic regression analyses adjusted for age and BMI showed that the increased serum LDL-C level was selected as an index affecting the presence of prevalent non-vertebral fractures, but not vertebral fractures. This result was still significant after additional adjustments for years since menopause, physical activity, previous cardiovascular events, bone markers, BMD, serum Ca, P, Cr, 25(OH)D, grip strength, tandem gait test, and use of drugs for hyperlipidemia [odds ratio 1.76 (1.13-2.73), p=0.012]. These findings suggest that a high serum LDL-C level may be a risk factor for prevalent non-vertebral fragility fractures independent of bone turnover, bone mass, vitamin D insufficiency, or frail status in postmenopausal women, and that it may be detrimental to bone, as well as blood vessels.