Low-tube-voltage whole-body CT angiography with extremely low iodine dose: a comparison between hybrid-iterative reconstruction and deep-learning image-reconstruction algorithms

AIM

To evaluate arterial enhancement, its depiction, and image quality in low-tube potential whole-body computed tomography (CT) angiography (CTA) with extremely low iodine dose and compare the results with those obtained by hybrid-iterative reconstruction (IR) and deep-learning image-reconstruction (DLIR) methods.

MATERIALS AND METHODS

This prospective study included 34 consecutive participants (27 men; mean age, 74.2 years) who underwent whole-body CTA at 80 kVp for evaluating aortic diseases between January and July 2020. Contrast material (240 mg iodine/ml) with simultaneous administration of its quarter volume of saline, which corresponded to 192 mg iodine/ml, was administered. CT raw data were reconstructed using adaptive statistical IR-Veo of 40% (hybrid-IR), DLIR with medium- (DLIR-M), and high-strength level (DLIR-H). A radiologist measured CT attenuation of the arteries and background noise, and the signal-to-noise ratio (SNR) was then calculated. Two reviewers qualitatively evaluated the arterial depictions and diagnostic acceptability on axial, multiplanar-reformatted (MPR), and volume-rendered (VR) images.

RESULTS

Mean contrast material volume and iodine weight administered were 64.1 ml and 15.4 g, respectively. The SNRs of the arteries were significantly higher in the following order of the DLIR-H, DLIR-M, and hybrid-IR (p<0.001). Depictions of six arteries on axial, three arteries on MPR, and four arteries on VR images were significantly superior in the DLIR-M or hybrid-IR than in the DLIR-H (p≤0.009 for each). Diagnostic acceptability was significantly better in the DLIR-M and DLIR-H than in the hybrid-IR (p<0.001-0.005).

CONCLUSION

DLIR-M showed well-balanced arterial depictions and image quality compared with the hybrid-IR and DLIR-H.

Galectin-3 Plays a Role in Neuroinflammation in the Visual Pathway in Experimental Optic Neuritis

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) featuring numerous neuropathologies, including optic neuritis (ON) in some patients. However, the molecular mechanisms of ON remain unknown. Galectins, β-galactoside-binding lectins, are involved in various pathophysiological processes. We previously showed that galectin-3 (gal-3) is associated with the pathogenesis of experimental autoimmune encephalomyelitis (EAE), an animal model of MS. In the current study, we investigated the expression of gal-3 in the visual pathway in EAE mice to clarify its role in the pathogenesis of ON. Immunohistochemical analysis revealed upregulation of gal-3 in the visual pathway of the EAE mice during the peak stage of the disease, compared with naïve and EAE mice during the chronic stage. Gal-3 was detected mainly in microglia/macrophages and astrocytes in the visual pathway in EAE mice. In addition, gal-3+/Iba-1+ cells, identified as phagocytic by immunostaining for cathepsin D, accumulated in demyelinating lesions in the visual pathway during the peak disease stage of EAE. Moreover, NLRP3 expression was detected in most gal-3+/Iba-1+ cells. These results strongly suggest that gal-3 regulates NLRP3 signaling in microglia/macrophages and neuroinflammatory demyelination in ON. In astrocytes, gal-3 was expressed from the peak to the chronic disease stages. Taken together, our findings suggest a critical role of gal-3 in the pathogenesis of ON. Thus, gal-3 in glial cells may serve as a potential therapeutic target for ON.

Improved Medication Adherence of an Elderly Diabetic Patient at a Dwelling Home Using a Pill Dispenser and Personal Health Records

Fookkun® is a pill dispenser in which single doses of several medications intended to be taken simultaneously are sealed in single film bags rolled onto a medication rotating drum. The system makes musical alert sounds when it is time for the patient to take the medications. If the patient misses a dose, a designated contact, such as the patient's child, is alerted. We conducted an experiment monitoring the use of a pill dispenser (Fookkun®) by an older patient. The participant was a 71-year-old woman with diabetes living in a dwelling home. The experiment lasted approximately 6 months. Fookkun® and the prototype data transmitter were installed at the patient's home. Fookkun®'s medication history data are displayed on the electronic medication record book (E-MRB) and the patient's pharmacist checks the patient's medication history on the E-MRB. The Fookkun® was effective in facilitating medication adherence. The pharmacist and the patient's daughter did not need to check the E-MRB because Fookkun® alerted them when the patient missed her medication. We believe that if the medication history data linked between a pill dispenser and an E-MRB can be shared among medical staff, this will contribute to a medical digital transformation in Japan in the future.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

Boehringer Ingelheim and Eli Lilly.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

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

A Risk Prediction Model for Severe Radiation Induced Lymphopenia in Patients with Pancreatic Cancer Treated with Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

In pancreatic cancer, radiation induced lymphopenia (RIL) is associated with a poor prognosis. However, normal tissue complication probability (NTCP) models predicting RIL in pancreatic cancer treated with concurrent chemoradiotherapy (CCRT) have yet to be developed. This study aims to develop a least absolute shrinkage and selection operator (LASSO)-based multivariate NTCP model to predict severe RIL in patients with pancreatic cancer during CCRT and to validate the model internally.

MATERIALS/METHODS

We retrospectively reviewed patients with localized pancreatic cancer who underwent CCRT using three-dimensional conformal radiation therapy from 2013 to 2021. The exclusion criteria were patients with distant metastasis; patients who did not complete RT due to tumor progression; patients who did not have absolute lymphocyte count (ALC) data available before or during RT. An ALC of < 0.5 K/μL during CCRT was defined as severe RIL. A NTCP model of severe RIL was developed by LASSO-based multivariate analysis. We used age, sex, Karnofsky performance status, maximum tumor size, carbohydrate antigen 19-9 level before RT, ALC before RT, volume of planning target volume (PTV), and dosimetric parameters for surrounding organs (including spleen, vertebrae, liver, bilateral kidneys, gastrointestinal tracts) as variables for LASSO. In addition, internal validation was performed by the bootstrap method. The predictive performance of the model was evaluated by the area under the curve (AUC) of the receiver operating characteristic curve and scaled Brier score.

RESULTS

Of the 131 patients included in the study, the median age was 68 years (range, 42-84), and 55% were male. The median ALC before RT was 1.37 K/µL (0.52-3.50). The median PTV volume was 315.4 ml (86.3-1079.3). The median dose of radiotherapy was 50.4 Gy (16.2-50.4), with 1.8 Gy per fraction. Combination chemotherapy was S-1 in 99 cases (75.6%) and gemcitabine in 32 cases (24.4%). Induction chemotherapy before CCRT was performed in 39 patients (29.8%). Severe RIL was observed in 84 (63.6%) patients. The LASSO showed that low baseline ALC (p = 0.0002), large PTV volume (p < 0.0001), and a large kidney V5 defined as the percentage of bilateral kidneys receiving 5 Gy or more (p = 0.0338) were selected as parameters of the prediction model for severe RIL (AUC = 0.917) and scaled Brier score was 0.511. As a result of internal validation by the bootstrap method, the average AUC was 0.918 (95% confidence interval, 0.849-0.954).

CONCLUSION

Severe RIL occurred frequently during CCRT for pancreatic cancer, and a NTCP model for severe RIL developed and validated internally in this study showed good predictive performance. External validation is needed before this NTCP model can be used as a benchmark for treatment planning to reduce the risk of severe RIL and for considering future treatment approaches.

Bifurcated distal biceps brachii tendon coexisting with separated bicipital aponeurosis: a complex variational case report

Variations appearing in biceps brachii muscle are common with accessory head, different origins, variant insertion, and different pattern of nerve innervation. However, variations appearing in both origin and insertion, and with other anomalous morphology at the same time are seldom. Here we report a complex variational case on the right arm of a 91-year-old Japanese female cadaver. The complex variations included (1) the biceps brachii muscle bifurcated at its distal ending; (2) the long head had its own tendon, which divided into two parts, i.e., a lateral part fused into the fascia between the brachioradialis and extensor carpi brevis, and a medial part attached to the radius about one centimeter ahead of the radial tuberosity; (3) the short head had an accessory origin from the shoulder capsule; (4) the bicipital aponeurosis was of two parts with an anterior superior layer formed by the long head and a posterior deep one formed by the short head; (5) the musculocutaneous nerve was especially underdeveloped that only innervated the coracobrachialis; (6) the existence of communicating branch between the musculocutaneous and median nerves, and the median nerve issued muscular branches to the biceps brachii and brachialis muscles, and (7) the brachioradial muscle had two accessory muscular bundles that originated from the fascia of the brachial muscle (proximal one) and from the bicipital aponeurosis (distal one).

In vitro characterization of anti-inflammatory activities of 3RS, 7R, 11R-phytanic acid

The aim of the research described here was to investigate the in vitro immunomodulatory effects of 3RS, 7R, 11R-phytanic acid (3RS-PHY) from the perspective of efficacy against autoimmune diseases. 3RS-PHY is a milk component with strong agonist activity at the peroxisome proliferator activated receptor (PPAR). As PPAR is a therapeutic target for several human diseases, 3RS-PHY intake may have possible health benefits. Recently, we chemically synthesized a preparation of 3RS-PHY and demonstrated that 3RS-PHY inhibited T-cell production of interferon (IFN)-γ. However, the overall immunomodulatory effects were not evaluated. In this study, mouse splenocytes, purified T-cells and B-cells were stimulated by mitogens and incubated with 3RS-PHY, followed by evaluation of cytokine and antibody production. A macrophage-like cell line J774.1 was also incubated with 3RS-PHY to evaluate nitric oxide production. 3RS-PHY decreased mRNA levels not only of IFN-γ but also of interleukin (IL)-2, IL-10 and IL-17A in splenocytes and similar effects were confirmed at the protein level. In addition, 3RS-PHY had a direct action on T-cells with preferential inhibitory effects on Th1 and Th17 cytokines such as IFN-γ and IL-17A. Furthermore, 3RS-PHY suppressed antibody secretion by B-cells and nitric oxide production by J774.1 almost completely, indicating that 3RS-PHY is a bioactive fatty acid with anti-inflammatory properties. These findings encourage further investigations, including in vivo experiments, to evaluate whether 3RS-PHY actually shows the potential to prevent autoimmune diseases, and provide basic information to produce milk and dairy products with an increased 3RS-PHY concentration.

Development of the differential detection reverse transcription loop-mediated isothermal amplification method for Barley yellow mosaic virus or Japanese soil-borne wheat mosaic virus from barley

A differential detection reverse transcription loop-mediated isothermal amplification (DD-RT-LAMP) method was developed to detect either Barley yellow mosaic virus (BaYMV) or Japanese soil-borne wheat mosaic virus (JSBWMV) simultaneously. Both primer sets, which recognized either BaYMV or JSBWMV genomic RNA, amplified DNA more efficiently at 65°C using an isothermal DNA amplification and fluorescence detection device. Furthermore, these primer sets showed unique annealing curves. The peak annealing temperatures of BaYMV and JSBWMV amplification products using specific primer sets were 86.9°C-87.7°C and 84.5°C-85.0°C, respectively, and were clearly distinguishable during an annealing step following the isothermal amplification, monitored using a fluorescence detection device. In the field samples of barley (Hordeum vulgare L.) tested, BaYMV or JSBWMV were detected by DD-RT-LAMP, and the detection results of DD-RT-LAMP were correspondent with the results of reverse transcription-PCR.

Morphologic observation for anomalous patterns of the flexor carpi radialis muscle and atypical insertions: a proposal for a new classification

In the present study, four types of variations of the flexor carpi radialis with accessory muscular bundles were classified depending on the origin of the accessory muscular bundle and relationships with the bicipital aponeurosis, biceps brachii, pronator teres, and coracobrachialis. Six types of insertions of the tendon of the flexor carpi radialis were also divided according to their inserted positions on the carpal and metacarpal bones. An accessory muscular bundle of the flexor carpi radialis was found in 4 (1 female and 3 males) of 68 cadavers (5.88%), with five examples in 136 arms (3.68%). It was bilateral in one cadaver and unilateral (two on the right and one on the left) in three. The insertion of the flexor carpi radialis tendon was not only on the proximal surface of the base of the second metacarpal bone but also on the third metacarpal bone, the tubercle of the trapezium, and the scaphoid. These findings and classifications are important in anatomical education, and have important significances in clinical diagnosis and therapies.

Development of a drug distribution support device and survey of medication management burden on group home staff

In Japan, the mean time spent on preparing and administering medications each day for everyone in care facilities has been reported to be 163 min. Most caregivers that administer medications to the elderly in care facilities have reported that this responsibility is a burden. We developed a drug distribution support device (DDSD) for caregivers, which was then installed in a group home and a 3-month monitoring experiment was conducted. Caregivers then answered a questionnaire survey on medication management burden pre- and post-DDSD use. The caregivers reported no difficulties associated with medication distribution using DDSD. The DDSD reduced the daily dispensing duration by an average of 3.5 min. The questionnaire survey showed no differences in items related to the reduction of errors, and the Family Caregiver Medication Administration Hassles Scale showed no reduction of burden on caregivers. However, whether the DDSD reduces medication management burden remains undetermined.

Crystal structure of silver carbonate iodide Ag10(CO3)3I4

The new silver carbonate iodide, Ag₁₀(CO₃)₃I₄, comprises layers of I atoms, Ag atoms, and CO₃ groups stacked along [10].

The title silver carbonate iodide, Ag₁₀(CO₃)₃I₄, deca­silver(I) tris­(carbonate) tetra­iodide, was recently reported as a precursor of the new superionic conductor Ag₁₇(CO₃)₃I₁₁. Ag₁₀(CO₃)₃I₄, was prepared by heating a stoichiometric powder mixture of AgI and Ag₂CO₃ at 430 K. A single-crystal suitable for X-ray diffraction analysis was obtained by slow cooling of a melt with an AgI-rich composition down from 453 K. Ag₁₀(CO₃)₃I₄ exhibits a layered crystal structure packed along [10], in which Ag atoms are inter­calated between the layers of hexa­gonally close-packed I atoms, and CO₃ groups. Up to now, Cs₃Pb₂(CO₃)₃I is the only other compound containing carbonate groups and iodide ions registered in the Inorganic Crystal Structure Database.

Superionic Ag+ Conductor Ag17(CO3)3I11

A new superionic Ag⁺ conductor with a nominal composition Ag₁₇(CO₃)₃I₁₁ (11AgI-3Ag₂CO₃) was found in the AgI-Ag₂CO₃ system. The conductor, which was formed at temperatures from 100 to 170 °C, is a metastable phase that gradually decomposes into AgI and Ag₁₀(CO₃)I₄ over a period of a few weeks at room temperature (RT). A Ag⁺ ionic conductivity of 0.16 S/cm was measured at RT, and an activation energy of 0.33 eV was evaluated in the temperature range from -9 to 19 °C. Single-crystal X-ray analysis revealed that Ag₁₇(CO₃)₃I₁₁ crystallized in a rhombohedral unit cell with hexagonal parameters of a = 15.8831(6) Å and c = 30.0730(13) Å at -183 °C and space group R3c. The Ag atoms were distributed over 53 sites in the asymmetry unit, with a maximum occupancy of 0.33(8). The continuous distribution of the partially occupied Ag sites was associated with the conduction paths of the Ag⁺ ions in the structure.

Expressions of conventional vitellogenin and vitellogenin-like A in worker brains are associated with a nursing task in a ponerine ant

In eusocial insect colonies, non-reproductive workers often perform different tasks. Tasks of an individual worker are shifted depending on various factors, e.g., age and colony demography. Although a vitellogenin (Vg) gene play regulatory roles in both reproductive and non-reproductive division of labours in a honeybee, it has been shown that the insect Vg underwent multiple gene duplications and sub-functionalisation, especially in apical ant lineages. The regulatory roles of duplicated Vgs were suggested to change evolutionarily among ants, whereas such roles in phylogenetically basal ants remain unclear. Here, we examined the expression patterns of conventional Vg (CVg), Vg-like A, Vg-like B and Vg-like C, as well as Vg receptor, during the task shift in an age-dependent manner and under experimental manipulation of colony demography in a primitive ant Diacamma sp. Expressions of CVg and Vg-like A in a brain were associated with a nursing task. It is suggested that associations of brain expressions of these Vgs with worker tasks were acquired in the basal ant lineage, and that such Vg functions could have sub-functionalised in the derived ant lineage.

First report of pear chlorotic leaf spot-associated virus on Japanese and European pears in Japan and its detection from an eriophyid mite

In May 2018, three leaf samples were collected from Japanese pear trees cv. "Hosui" that exhibited typical chlorotic spot symptoms (Supplementary Figure S1) in a germplasm nursery in Tsukuba, Ibaraki. Total RNA was prepared using the rapid CTAB method (Gambino et al. 2008) for high-throughput sequencing, as described by Kubota et al. (2020). In brief, after removing ribosomal RNAs, a library was constructed by fragmenting RNA, synthesizing cDNA, and polymerase chain reaction (PCR) amplification. Sequencing was performed using NovaSeq 6000 sequencer (Illumina, San Diego, CA, U.S.A.) with paired-end 150 nt reads. De novo assembly was performed using CLC Genomics Workbench 11.0 Software (Qiagen, Hilden, Germany), with a minimum length of 500 bp. A total of 36,017 contigs derived from 33,565,182 reads were obtained and subjected to BLASTX search against the GenBank sequence database as of January 2019. Viruses commonly found in stone fruits, i.e., apple stem pitting virus, apple green crinkle-associated virus, apricot latent virus (foveaviruses), and apple stem grooving virus (a capillovirus), were detected. In addition, five contigs with amino acid sequence homologies to P1-P4 of known emaraviruses and the P7 of High Plains wheat mosaic virus (Tatineni et al. 2014) were detected and designated as PEV-Jp. The complete nucleotide (nt) sequences of the five segments of PEV-Jp were determined by Sanger sequencing of cloned reverse transcription (RT)-PCR amplification products using the primers shown in Supplementary Table S1; the 5'- and 3'-terminal sequences were RACE verified (Takara Bio, Shiga, Japan). In pairwise comparisons, the complete RNA1 to RNA5 of PEV-Jp (LC554756-760) shared 90.7% to 98.7% nt identities with those of PCLSaV-CG1 (MK602177-181), indicating that PEV-Jp is an isolate of PCLSaV. Using newly designed segment-specific primers (Supplementary Table S1), 12 symptomatic Japanese pear trees cv. "Kosui" sampled in 2020 from the same nursery tested positive for PCLSaV by RT-PCR while 12 symptomless trees were negative for the virus. Similar chlorotic spots, sometimes accompany necrotic spots, were observed on European pear (Pyrus communis) cv. "Le Lectier." (Fig. S1F) in Niigata in 2019; PCLSaV was detected by RT-PCR in leaf tissue samples from symptomatic trees (n = 3/3) but not in symptomless trees (n = 0/2). No vector for PCLSaV has been identified (Liu et al. 2020) but acaricide sprays in the early spring are effective for preventing occurrence of chlorotic spots in pear orchards (Nakai et al. 2018). Since the infestations of Eriophyes chibaensis Kadono, an eriophyid mite often observed on the Japanese pear (Fig. S1G to S1I) (Kadono, 1981), has been associated with occurrences of the chlorotic spots (Shimizu et al. 2019), samples of E. chibaensis individuals were collected from PCLSaV-positive Japanese pear cvs. "Akizuki" and "Kosui"and P. communis cv. "Le Lectier." for total nucleic acid isolations via phenol-chloroform extraction, followed by quantitative RT-PCR (Supplementary Table S1). The expected RNA1 and RNA5 specific 150 bp products were detected from mite samples collected from Akizuki (n = 6/12), Kosui (n = 13/18), and Le Lectier (n = 6/8). The results indicate that E. chibaensis can ingest PCLSaV and may be a potential vector for the virus, although additional experiments are needed to demonstrate its vector competency. To our knowledge, this is the first report of PCLSaV in Japan and the first report of its detection in E. chibaensis.

Progress in international collaboration on EXFOR library

The EXFOR library has served as the unique repository of experimental cross section and other nuclear reaction data for 50 years. The Nuclear Reaction Data Centres (NRDC) have compiled data sets from more than 22000 experimental works for the EXFOR library. Our collaboration and effort on improvement of EXFOR coverage are described in this paper, as well as tools for digitization of numerical data from graph images developed by us for EXFOR compilation.

Effects of dietary phytol on tissue accumulation of phytanic acid and pristanic acid and on the tissue lipid profiles in mice

Recent in vitro evidence suggests that the phytol-derived fatty acids, phytanic acid (PA) and pristanic acid (PrA), are components of animal products with the potential to cause both beneficial and harmful effects on human health. In this study, we investigated the in vivo tissue accumulation of PA and PrA and the changes in tissue lipid profiles, using mice fed a phytol-containing diet. After 4 weeks of treatment with a diet containing 1.0% phytol, plasma, adipose tissue, liver, and brain were collected and their lipid profiles were biochemically and gas-chromatographically determined. Dietary phytol caused PA and PrA accumulation in the adipose tissue and liver but not in the brain, and reduced plasma and liver triacylglycerol levels. Phytol intake also decreased the fatty acid concentrations in the adipose tissue, especially polyunsaturated fatty acids such as linoleic acid, but increased the concentrations of these fatty acids in the liver. However, dietary phytol had a low impact on the brain lipid profile. This study suggests that dietary phytol intake caused accumulation of PA and PrA and modified lipid profiles in the adipose tissue and liver, but that the brain is an insusceptible tissue to dietary phytol-induced changes.

A Microfluidic Diagnostic Device Capable of Autonomous Sample Mixing and Dispensing for the Simultaneous Genetic Detection of Multiple Plant Viruses

As an efficient approach to risk management in agriculture, the elimination of losses due to plant diseases and insect pests is one of the most important and urgent technological challenges for improving the crop yield. Therefore, we have developed a polydimethylsiloxane (PDMS)-based microfluidic device for the multiplex genetic diagnosis of plant diseases and pests. It offers unique features, such as rapid detection, portability, simplicity, and the low-cost genetic diagnosis of a wide variety of plant viruses. In this study, to realize such a diagnostic device, we developed a method for the autonomous dispensing of fluid into a microchamber array, which was integrated with a set of three passive stop valves with different burst pressures (referred to as phaseguides) to facilitate precise fluid handling. Additionally, we estimated the mixing efficiencies of several types of passive mixers (referred to as chaotic mixers), which were integrated into a microchannel, through experimental and computational analyses. We first demonstrated the ability of the fabricated diagnostic devices to detect DNA-based plant viruses from an infected tomato crop based on the loop-mediated isothermal amplification (LAMP) method. Moreover, we demonstrated the simultaneous detection of RNA-based plant viruses, which can infect cucurbits, by using the reverse transcription LAMP (RT-LAMP) method. The multiplex RT-LAMP assays revealed that multiple RNA viruses extracted from diseased cucumber leaves were successfully detected within 60 min, without any cross-contamination between reaction microchambers, on our diagnostic device.

Assignment of Dental Hygienists Improves Outcomes in Japanese Rehabilitation Wards: A Retrospective Cohort Study

OBJECTIVES

To clarify the effectiveness of ward-assigned dental hygienists (DHs) on rehabilitation outcomes in rehabilitation wards.

DESIGN

Retrospective cohort study.

SETTING

The registry data from the Japanese Rehabilitation Nutrition Database.

PARTICIPANTS

656 patients with hip fracture or stroke admitted to convalescent rehabilitation wards.

MEASUREMENTS

The main outcome measures were the Functional Independence Measure (FIM), the Food Intake Level Scale (FILS), and the home discharge rate. Patients were divided into two groups based on the ward setting: with an assigned DH (DH group) and without an assigned DH (NDH group). Clinical characteristics and outcomes were compered between the groups. Between-facility differences were adjusted by generalized estimating equation. We performed post-hoc power analysis to confirm that there were enough samples included in this study to detect a significant difference.

RESULTS

Of 656 patients (mean age, 77 years; 57.1% female; 65.5% stroke) from 10 facilities, 454 patients (69.2%) from 4 facilities were in the DH group. FIM score at discharge (107 vs 90, P<0.001), percentage improvement in FILS score from admission to discharge (44.5% vs 22.8%, P<0.001) and home discharge rate (72.5% vs 61.4%, P<0.001) were significantly higher in the DH group than in the NDH group. After multivariate analysis, the FIM score at discharge (P=0.007), FILS score at discharge (P=0.024), and home discharge rate (P=0.007) were significantly higher in the DH group than in the NDH group.

CONCLUSIONS

ADL and swallowing function were significantly improved at discharge and the home discharge rate was higher among patients in rehabilitation wards with DHs. Having a ward-assigned DH may lead to better rehabilitation outcomes in rehabilitation wards.

Localization of ATP-sensitive K+ channel subunits in rat liver

BACKGROUND

ATP-sensitive K⁺ (K_ATP) channels were originally found in cardiac myocytes by Noma in 1983. K_ATP channels were formed by potassium ion-passing pore-forming subunits (Kir6.1, Kir6.2) and regulatory subunits SUR1, SU2A and SUR2B. A number of cells and tissues have been revealed to contain these channels including hepatocytes, but detailed localization of these subunits in different types of liver cells was still uncertain.

AIM

To investigate the expression of K_ATP channel subunits in rat liver and their localization in different cells of the liver.

METHODS

Rabbit anti-rat SUR1 peptide antibody was raised and purified by antigen immunoaffinity column chromatography. Four of Sprague-Dawley rats were used for liver protein extraction for immunoblot analysis, seven of them were used for immunohistochemistry both for the ABC method and immunofluorescence staining. Four of Wistar rats were used for the isolation of hepatic stellate cells (HSCs) and Kupffer cells for both primary culture and immunocytochemistry.

RESULTS

Immunoblot analysis showed that the five kinds of K_ATP channel subunits, i.e. Kir6.1, Kir6.2, SUR1, SUR2A, and SUR2B, were detected in liver. Immunohistochemical staining showed that Kir6.1 and Kir6.2 were weakly to moderately expressed in parenchymal cells and sinusoidal lining cells, while SUR1, SUR2A, and SUR2B were mainly localized to sinusoidal lining cells, such as HSCs, Kupffer cells, and sinusoidal endothelial cells. Immunoreactivity for SUR2A and SUR2B was expressed in the hepatocyte membrane. Double immunofluorescence staining further showed that the pore-forming subunits Kir6.1 and/or Kir6.2 colocalized with GFAP in rat liver sections and primary cultured HSCs. These K_ATP channel subunits also colocalized with CD68 in liver sections and primary cultured Kupffer cells. The SUR subunits colocalized with GFAP in liver sections and colocalized with CD68 both in liver sections and primary cultured Kupffer cells. In addition, five K_ATP channel subunits colocalized with SE-1 in sinusoidal endothelial cells.

CONCLUSION

Observations from the present study indicated that K_ATP channel subunits expressed in rat liver and the diversity of K_ATP channel subunit composition might form different types of K_ATP channels. This is applicable to hepatocytes, HSCs, various types of Kupffer cells and sinusoidal endothelial cells.

An anomalous case of the flexor carpi radialis with an excessive muscular bundle

A variation of the flexor carpi radialis with an excessive muscular bundle was found on the right forearm of a Japanese male cadaver. The flexor carpi radialis had two heads, medial one arising from the medial epicondyle of the humerus, and the other, a variant excessive muscular bundle, arising from the bicipital aponeurosis deep at the medial edge of the tendon of biceps brachii. There was also a muscular slip between the pronator teres and lateral head of flexor carpi radialis. The insertion of the ending tendon of the flexor carpi radialis was also variant, which was not only inserted into the base of the second metacarpal bone, but into the proximal surface of the scaphoid and the tubercle of trapezium. The excessive muscular bundle might be a residual muscular slip which connects between the distal part of the biceps brachii and the initial part of the flexor carpi radialis during the early embryonic development.

Enhanced intrinsic photovoltaic effect in tungsten disulfide nanotubes

The photovoltaic effect in traditional p-n junctions-where a p-type material (with an excess of holes) abuts an n-type material (with an excess of electrons)-involves the light-induced creation of electron-hole pairs and their subsequent separation, generating a current. This photovoltaic effect is particularly important for environmentally benign energy harvesting, and its efficiency has been increased dramatically, almost reaching the theoretical limit¹. Further progress is anticipated by making use of the bulk photovoltaic effect (BPVE)², which does not require a junction and occurs only in crystals with broken inversion symmetry³. However, the practical implementation of the BPVE is hampered by its low efficiency in existing materials^4-10. Semiconductors with reduced dimensionality² or a smaller bandgap^4,5 have been suggested to be more efficient. Transition-metal dichalcogenides (TMDs) are exemplary small-bandgap, two-dimensional semiconductors^11,12 in which various effects have been observed by breaking the inversion symmetry inherent in their bulk crystals^13-15, but the BPVE has not been investigated. Here we report the discovery of the BPVE in devices based on tungsten disulfide, a member of the TMD family. We find that systematically reducing the crystal symmetry beyond mere broken inversion symmetry-moving from a two-dimensional monolayer to a nanotube with polar properties-greatly enhances the BPVE. The photocurrent density thus generated is orders of magnitude larger than that of other BPVE materials. Our findings highlight not only the potential of TMD-based nanomaterials, but also more generally the importance of crystal symmetry reduction in enhancing the efficiency of converting solar to electric power.

Effects of Wolbachia/Cardinium Infection on the Mitochondrial Phylogeny of Oligonychus castaneae (Acari: Tetranychidae)

A wide range of invertebrates harbor intracellular endosymbiotic bacteria. Within these endosymbionts, Wolbachia and Cardinium, have been attracting particular attention because these bacteria frequently affect the genetic structure and genetic diversity of their hosts. They cause various reproductive alterations such as cytoplasmic incompatibility, parthenogenesis induction, male-killing, and feminization. Through these alterations, they also affect the maternally inherited organelles of their hosts. Mitochondrial DNA (mtDNA) can be used for molecular phylogenetic analysis of invertebrates. However, in Wolbachia- or Cardinium-infected invertebrates, phylogenetic trees based on mtDNA are often inconsistent with those based on nuclear DNA. In the present study, we determined the Wolbachia/Cardinium infection status of 45 populations of the mite, Oligonychus castaneae Ehara & Gotoh (Acari: Tetranychidae), collected throughout Japan. Then, we compared phylogenetic trees of O. castaneae based on both the cytochrome c oxidase subunit I (COI) gene of mtDNA and the 28S rRNA gene of nuclear DNA to clarify the effects of Wolbachia and/or Cardinium infection. We found 106 Wolbachia-infected individuals and 250 Cardinium-infected individuals in a total of 450 individuals, indicating an infection rate of 79%. No double-infected individuals were observed. In the 28S tree, almost all populations formed a single group. In the COI tree, O. castaneae formed four separate groups that more closely followed Wolbachia/Cardinium infection than geographic distribution. These results strongly suggest that the endosymbionts affected mitochondrial variation of O. castaneae.

Evaluation of a one-dose package medication support system for community-based elderly patients and eldercare facilities

PURPOSE

Results of an evaluation of a one-dose package medication support system (ODP-MSS) for medication support and telecare home monitoring of elderly persons are reported.

METHODS

ODP-MSS units were provided to 10 elderly patients living at home, with adherence assistance provided by family members or other medication supporters in response to telephone alerts. In addition, ODP-MSS units were installed in 2 group homes. At the end of the designated study periods, device data logs were analyzed, and study participants were interviewed or surveyed regarding the impact of ODP-MSS use.

RESULTS

Overall, 2 patients were reported to have missed medication doses due to forgetfulness; in both cases, alerted medication supporters called the patients and reminded them to take their medicine. Five home-dwelling patients and 5 supporters reported that the ODP-MSS provided useful reminders; 4 patients and 7 supporters indicated that calls to supporters were useful as a telecare home monitoring system. Eleven group home staff members reported that the ODP-MSS was useful in reducing medication errors and the need for medication assistance.

CONCLUSION

An ODP device plus follow-up calls from a medication supporter helped prevent missed doses resulting from patients' forgetfulness and may serve as a useful component of telecare home monitoring for elderly people living independently at home. The ODP device was also useful for reducing the burdens associated with medication support and medication errors on staff members of group homes for elderly patients with dementia.

Caste-specific microRNA expression in termites: insights into soldier differentiation

Eusocial insects have polyphenic caste systems in which each caste exhibits characteristic morphology and behaviour. In insects, caste systems arose independently in different lineages, such as Isoptera and Hymenoptera. Although partial molecular mechanisms for the development of eusociality in termites have been clarified by the functional analysis of genes and hormones, the contribution of microRNAs (miRNAs) to caste differentiation is unknown. To understand the role of miRNAs in termite caste polyphenism, we performed small RNA sequencing in a subterranean termite (Reticulitermes speratus) and identified the miRNAs that were specifically expressed in the soldier and worker castes. Of the 550 miRNAs annotated in the R. speratus genome, 74 were conserved in insects and 174 were conserved in other termite species. We found that eight miRNAs (mir-1, mir-125, mir-133, mir-2765, mir-87a and three termite-specific miRNAs) are differentially expressed (DE) in soldiers and workers of R. speratus. This differential expression was experimentally verified for five miRNAs by real-time quantitative PCR. Further, four of the eight DE miRNAs in soldier and worker termite castes were also differentially expressed in hymenopteran castes. The finding that Isoptera and Hymenoptera shared several DE miRNAs amongst castes suggests that these miRNAs evolved independently in these phylogenetically distinct lineages.

Radiative cooling of cationic carbon clusters, CN+, N = 8, 10, 13-16

The radiative cooling of highly excited carbon cluster cations of sizes N = 8, 10, 13-16 has been studied in an electrostatic storage ring. The cooling rate constants vary with cluster size from a maximum at N = 8 of 2.6 × 10⁴ s^-1 and a minimum at N = 13 of 4.4 × 10³ s^-1. The high rates indicate that photon emission takes place from electronically excited ions, providing a strong stabilizing cooling of the molecules.

Relationship Between Stress Coping Mechanisms and Depression in Kidney Transplant Recipients

BACKGROUND

It has been reported that transplant recipients are exposed to physical and psychosocial stresses even after transplant surgery and exhibit psychological disorders such as depression.

PURPOSE

In this study, we extracted trends concerning how recipients of kidney transplants cope with stress, and we also examined how they cope with depression and its countermeasures.

METHOD

We administered questionnaire surveys to 109 kidney transplant recipients. These included items on personal attributes, medical information, depression, and stress-coping type scales. Statistical analysis was performed using factor analysis and multiple regression analysis.

RESULTS

Fifteen out of 109 (13.8%) were found to be high-risk patients for depression based on responses to the questionnaire using the depression scale. We extracted 2 factors of stress-coping type, namely Factor 1, "Directly coping with the problem," of patients who try to directly resolve the problem in a positive manner and Factor 2, "Stress-release while avoiding the problem," for those who relieve their feelings in response to the stress without resolving the problem itself. When multiple regression analysis was conducted with the depression scale as the dependent variable and the stress-coping factor as the independent variable, Factor 1 tended to be associated with reduced depression and Factor 2 with increased depression.

CONCLUSIONS

Results showed that to improve the mental health of those who receive kidney transplants, it is necessary to examine the depression and stress-coping types of such patients at an early stage and carry out education on stress-coping, focusing on resolving the actual problem.

EVALUATION OF PATIENT EXPOSURE IN FAST kVp SWITCHING DUAL ENERGY COMPUTED TOMOGRAPHY: PHANTOM STUDY

The aim of this study was to evaluate the suitability of size specific dose estimates (SSDE) to estimate patient dose in Fast kVp switching dual energy CT. An anthropomorphic phantom (RAN-110) was repeatedly scanned (chest, abdomen and the pelvis) using a 64 detector row MDCT (Discovery CT750 HD, GE Healthcare, Milwaukee, WI, USA) with various CT parameters, including Fast kVp switching. Dosimetry was performed using thermo-luminescent dosimeters, positioned both superficially and within the phantom. SSDE was calculated for all slices of the anthropomorphic phantom using both the localiser and axial images. In Fast kVp switching, SSDE underestimated the measured absorbed dose for the chest/abdomen region ~35% at the maximum, but were in closer agreement for the pelvic region about within 10%. In single energy techniques, SSDE could not be applied in the estimation of organ doses, but in Fast kVp switching dual energy techniques, SSDE could be applied for anatomical regions with larger thicknesses.

Emergence of coexisting ordered states in active matter systems

Active systems can produce a far greater variety of ordered patterns than conventional equilibrium systems. In particular, transitions between disorder and either polar- or nematically ordered phases have been predicted and observed in two-dimensional active systems. However, coexistence between phases of different types of order has not been reported. We demonstrate the emergence of dynamic coexistence of ordered states with fluctuating nematic and polar symmetry in an actomyosin motility assay. Combining experiments with agent-based simulations, we identify sufficiently weak interactions that lack a clear alignment symmetry as a prerequisite for coexistence. Thus, the symmetry of macroscopic order becomes an emergent and dynamic property of the active system. These results provide a pathway by which living systems can express different types of order by using identical building blocks.

Naturally occurring 3RS, 7R, 11R-phytanic acid suppresses in vitro T-cell production of interferon-gamma

BACKGROUND

Among the eight stereoisomers of phytanic acid (PA), the 3RS, 7R, 11R-isomer is naturally occurring and is present in foods and the human body. PA is considered to have possible health benefits in the immune system. However, it remains undetermined whether these effects are elicited by the 3RS, 7R, 11R-PA isomer, because previous studies used a commercially available PA whose isomer configuration is unknown. In this study, we synthesized a preparation of 3RS, 7R, 11R-PA, and investigated its in vitro immunomodulatory effects, especially the T-cell production of interferon (IFN)-γ, which is associated with various autoimmune diseases. This study also investigated the effects of 3RS, 7R, 11R-PA on NF-κB activity in order to address the mechanism of its immunomodulatory effects.

METHODS

Mouse splenocytes and purified T-cells were stimulated with T-cell mitogens and incubated with 3RS, 7R, 11R-PA, followed by evaluation of IFN-γ production. The effect of 3RS, 7R, 11R-PA on NF-κB activity was also investigated using an A549 cell line with stable expression of an NF-κB-dependent luciferase reporter gene.

RESULTS

3RS, 7R, 11R-PA significantly reduced in vitro IFN-γ production at both the protein and mRNA levels, and was accompanied by decreased expression of T-bet, a key regulator of Th1 cell differentiation. The results indicated that NF-κB-mediated transcriptional activity was significantly decreased by 3RS, 7R, 11R-PA and that GW6471, an antagonist of peroxisome proliferator activated receptor α (PPARα), abrogated the inhibitory effect of 3RS, 7R, 11R-PA on NF-κB activity.

CONCLUSIONS

The present study suggests that 3RS, 7R, 11R-PA is a functional and bioactive fatty acid, and has a potentially beneficial effect for amelioration of T-cell mediated autoimmune diseases. This study also indicates that interference in the NF-κB pathway via PPARα activation is a potential mechanism of the immunomodulatory effects of 3RS, 7R, 11R-PA.

Changes in topographical relation between the ductus arteriosus and left subclavian artery in human embryos: a study using serial sections

At birth, the ductus arteriosus (DA) merges with the aortic arch in the caudal side of the origin of the left subclavian artery (ltSCA). Since the SCA (seventh segmental arteries) were fixed on the levels of the seventh cervical-first thoracic vertebral bodies, the confluence of the DA should migrate caudally toward the lower level. We aimed to describe the changing topographical anatomy of the DA and SCA using serial sections. First, we examined serial sagittal sections of 11 embryos (Carnegie stage 15-18), but the specimens were clearly divided into 2 groups with and without the lower confluence of the DA. Next, we examined serial horizontal sections of 40 specimens (Carnegie stage 14-16) and we chose 5 specimens (CRL 11 mm, 3 specimen; 1, 14 mm; 1, 15 mm) including the DA near (within 1-vertebral segment from) the ltSCA. The final approach of the DA occurred during the heart descent in which the apex of the heart migrated from the level of the first to the fourth thoracic vertebral body. Thus, the DA reached the SCA level before establishment of the heart descent. The right aortic arch maintained its entire course in 2 of the 5 specimens. Therefore, the positioning of the DA along the left aortic arch might occur independently of degeneration of the right arch. Notably, the tracheal bifurcation level was higher when the DA-ltSCA distance was greater. A contribution of the increased pulmonary volume was suggested for the final approach of the DA.

The interaction effects between race and functional disabilities on the prevalence of self-reported periodontal diseases - National Health and Nutrition Examination Survey 2011-2012

BACKGROUND

Racial minority groups and adults with functional disabilities (FDs) disproportionally experience periodontal diseases. However, little is known about the interactions of these two characteristics in disease prevalence. The purpose of this study was to examine the association between FDs and periodontal experiences, and to identify whether race has a particular influence on this relationship.

METHODS

Data were derived from the National Health and Nutrition Examination Survey 2011-2012, in a representative sample of adults aged 30 years and older. FDs were defined as experiencing limitations in activities of daily living. The weighted logistic regression models were performed using SAS software.

RESULTS

The incidence of FDs was associated with a poor self-rated perception of teeth and gum health, gum disease, bone loss, and loss of teeth. The racial minority groups with FDs were more likely to report poor teeth and gum health, loose teeth, and a history of gum disease treatment. Mexican Americans with FDs reported poor teeth and gum health, gum disease, and had been previously treated for gum disease. African Americans with FDs were more likely to be diagnosed with bone loss and loose teeth.

PRACTICAL IMPLICATIONS

Racial minority groups with FDs were more likely to be associated with periodontal disease and poor oral health. To improve oral health, access to dental care among minority populations is important, particularly for people with FDs in community settings. Dentists should reach out to these underrepresented groups to address their oral health needs.

Time-saving and fail-safe dissection method for vestibulocochlear organs in gross anatomy classes

Because the vestibulocochlear organs are tiny and complex, and are covered by the petrous part of the temporal bone, they are very difficult for medical students to dissect and visualize during gross anatomy classes. Here, we report a time-saving and fail-safe procedure we have devised, using a hand-held hobby router. Nine en bloc temporal bone samples from donated human cadavers were used as trial materials for devising an appropriate procedure for dissecting the vestibulocochlear organs. A hand-held hobby router was used to cut through the temporal bone. After trials, the most time-saving and fail-safe method was selected. The performance of the selected method was assessed by a survey of 242 sides of 121 cadavers during gross anatomy classes for vestibulocochlear dissection. The assessment was based on the observation ratio. The best procedure appeared to be removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof. The whole procedure was completed within two dissection classes, each lasting 4.5 hr. The ratio of surveillance for the chorda tympani and three semicircular canals by students was significantly improved during 2013 through 2016. In our dissection class, "removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof" was the best procedure for students in the limited time available. Clin. Anat. 30:703-710, 2017. © 2017Wiley Periodicals, Inc.