Impact of extracorporeal membrane oxygenation treatments on acquired von Willebrand syndrome in patients with out-of-hospital cardiac arrest: a retrospective observational study.

BACKGROUND: Von Willebrand factor (vWF) plays a crucial role in hemostasis, acting as a key factor for platelet adhesion/aggregation and as a transport protein for coagulation factor VIII. vWF is secreted as a giant multimer, and it undergoes shear stress-dependent cleavage by a specific metalloproteinase in plasma. Among vWF multimers, high-molecular-weight (large) multimers are essential for hemostasis. Acquired von Willebrand syndrome, linked to various conditions, is a hemostatic disorder due to reduced vWF activity. Extracorporeal membrane oxygenation (ECMO), utilized recently for out-of-hospital cardiac arrest patients, generates high shear stress inside the pump. This stress may induce a conformational change in vWF, enhancing cleavage by a specific metalloproteinase and thereby reducing vWF activity. However, no study has investigated the effects of ECMO on vWF-related factors in patients receiving or not receiving ECMO. This study aimed to elucidate the relationship between ECMO treatment and acquired von Willebrand syndrome-related factors in patients with out-of-hospital cardiac arrest. METHODS: This study included patients with cardiogenic out-of-hospital cardiac arrest admitted to our hospital. The patients were categorized into two groups (ECMO and non-ECMO) based on the presence or absence of ECMO treatment. Plasma samples were collected from patients admitted to the emergency department (days 0-4). The vWF antigen (vWF: Ag), vWF ristocetin cofactor activity (vWF: RCo), and factor VIII activity were measured. Additionally, a large multimer of vWF was evaluated through vWF multimer analysis, utilizing western blotting to probe vWF under non-reducing conditions. RESULTS: The ECMO and non-ECMO groups included 10 and 22 patients, respectively. The median ECMO treatment in the ECMO group was 64.6 h. No differences in vWF: Ag or factor VIII activity were observed between the two groups during the observation period. However, the ECMO group exhibited a decrease in large vWF multimers and vWF: RCo during ECMO. Strong correlations were observed between vWF: RCo and vWF: Ag in both groups, although the relationships were significantly different between the two groups. CONCLUSIONS: ECMO treatment in patients with out-of-hospital cardiac arrest resulted in the loss of large vWF multimers and decreased vWF activity. Hence, decreased vWF activity should be considered as a cause of bleeding during ECMO management.

Chemosensory input from mouthparts in response to sexually dimorphic cuticular wax mediates male sexual discrimination in Galerucella grisescens (Coleoptera: Chrysomelidae).

The surface of the insect body is covered with a hydrophobic layer called cuticular wax (CW). In addition to functioning as an anti-desiccation agent, CW is critical for chemical communication. It has been reported that in Chrysomelidae, males discriminate between sexes based on the sex-specific CW. However, little is known regarding the underlying sensory basis. Herein, we demonstrate that chemosensory input from mouthparts mediates sexual discrimination in male Galerucella grisescens (Chrysomelidae). Observations of mating behaviour, bioassays for CW, and chemical analyses revealed that G. grisescens possess qualitatively sexually dimorphic CW, and such compositional differences allow males to distinguish between sexes. Using electron microscopy, blocking male chemosensory organs, and electrophysiological experiments, we showed that male mouthparts bear chemosensory sensilla tuned to female CW components, and sensory input from them induces male aedeagal insertion, a common male behavioural response to females. Thus, detecting CW via mouthparts is essential for males to distinguish between sexes, consistent with the fact that males inspect conspecific individuals by licking their body surfaces. To our best knowledge, this is the first report describing the detailed functional roles of mouthparts in sexual discrimination in Coleoptera. We believe that this study will promote further studies on insect chemical communication.

Atypical sites of twin atrioventricular nodes in a rare form of univentricular heart.

Twin atrioventricular nodes (AVNs) associated with complex tachycardias has been described in a heart with discordant atrioventricular (AV) connection. The present case had twin AVNs (approximately 3 o'clock and 8 o'clock position) of sole AV annulus with absent right AV connection. It is a first report demonstrated the twin AVNs identified at atypical sites associated with a univentricular heart with single inlet connection.

Glomerulonephritis Associated with Infective Endocarditis Showing Serological Positivity for PR3-anti-neutrophil Cytoplasmic Antibody and Anti-glomerular Basement Membrane Antibody.

We herein report a case of crescentic glomerulonephritis (GN) associated with infective endocarditis (IE). A 61-year-old-woman presented with a fever and renal dysfunction and was diagnosed with IE. The patient was positive for proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) and anti-glomerular basement membrane (GBM) antibodies. Renal biopsy findings showed crescentic GN with isolated deposition of C3c, a serum conversion product of complement C3. Given these clinical findings, the patient was diagnosed with infective endocardis (IE)-associated GN. Antibiotic therapy was continued without immunosuppressive agents. After the initiation of the antibiotics, the fever resolved, and the renal function gradually recovered. This case highlights the notion that laboratory findings should be carefully evaluated with reference to other findings.

Spontaneous remission of minimal change nephrotic syndrome in an elderly man.

Minimal change nephrotic syndrome (MCNS) cases achieving spontaneous remission without external factors are rarely reported. We report a case of MCNS that achieved spontaneous remission without external factors that triggered its onset. An 82-year-old male patient was admitted to the hospital for close examination of nephrotic syndrome. Renal biopsy was performed and MCNS was diagnosed. Owing to the patient's age and history of foot and microvascular arteriovenous thrombosis, we did not start immunosuppressive drugs, including steroids, and opted for conservative management. After conservative treatment, proteinuria gradually decreased, and the patient achieved complete remission. Given that the patient had a history of urinary protein and thrombosis, recurrence of MCNS was considered again this time. In addition, the involvement of external factors that trigger the onset of MCNS was not found. In conclusion, in elderly-onset MCNS, clinicians generally hesitate to initiate treatment with an immunosuppressive drug, containing steroids, because of its many complications. Thus, our data provide valuable insight into MCNS.

Fast pathway ablation unmasks nodoventricular fibers in a 15-year-old patient with supraventricular tachycardia.

We described a 15-year-old boy who underwent the catheter ablation for the nodoventricular (NV) tachycardia that had difficulty in differentiation from atrioventricular nodal reentrant tachycardia with upper common pathway. The modification of the fast pathway revealed an anterograde conduction of the NV fiber. We successfully performed the catheter ablation targeting for the right ventricular insertion site of the NV fiber.

Room Temperature Resonant Photocurrent in an Erbium Low-Doped Silicon Transistor at Telecom Wavelength.

An erbium-doped silicon transistor prepared by ion implantation and co-doped with oxygen is investigated by photocurrent generation in the telecommunication range. The photocurrent is explored at room temperature as a function of the wavelength by using a supercontinuum laser source working in the µW range. The 1-µm² transistor is tuned to involve in the transport only those electrons lying in the Er-O states. The spectrally resolved photocurrent is characterized by the typical absorption line of erbium and the linear dependence of the signal over the impinging power demonstrates that the Er-doped transistor is operating far from saturation. The relatively small number of estimated photoexcited atoms (≈ 4 × 10 4 ) makes Er-dpoed silicon potentially suitable for designing resonance-based frequency selective single photon detectors at 1550 nm.

Evaluation of the pulmonary artery potential using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography.

Prolongation of the pulmonary artery potentials (PAPs) in response to short coupling intervals was related to polymorphic QRS configurations during the ventricular tachycardia originating above the pulmonary valve (PA-VT). This prospective study was aimed to investigate the mechanisms of polymorphic changes during the PA-VT. We performed the mapping above the pulmonary valve using a 20-polar circumferential catheter and three-dimensional integrated intracardiac echocardiography in 9 consecutive patients with outflow tract arrhythmias undergoing catheter ablation (UMIN ID: UMIN000021682). The location of successful ablation was right ventricular outflow tract (RVOT) in 6 patients, above the pulmonary valve in 1 patient, left coronary cusp in 1 patient, and unknown in 1 patient. The PAP was detected in six (67%) patients with bipolar voltage of 0.56 ± 0.27 mV. Pacing from bipolar electrodes of the circumferential catheter located above the pulmonary valve captured the PA myocardium only in 1 patient who had the PA-VT (100% in PA-VT vs 0% in non-PA-VT, P = 0.0046), and slight changes of the QRS morphology was observed in accordance with the conduction delay from the stimulus to activation of the RVOT myocardium. The selective PAP capture with conduction delays evoked by bipolar stimulations through a 20-polar circumferential catheter may be a characteristic property of patients with the PA-VT. Conduction delays within the PA and PA-RVOT junction appears to contribute polymorphic QRS changes during the PA-VT.

Reentrant atrial tachycardia originating from the sinus venosa region.

A 78-year old woman with palpitation exhibited an atrial tachycardia (AT) of variable cycle lengths resembling atrial fibrillation (AF). Vague centrifugal activation was noted at the sinus venosa region where overdrive pacing demonstrated entrainment with concealed fusion and the stimulus to P wave approximated the electrogram to the P wave interval of 125ms. Application of radiofrequency energy to this site resulted in termination of the AT as well as formation of a fixed block line manifested by the presence of discrete double potentials. These observations indicated the reentrant mechanism of AT originating from the sinus venosa region.

Relation between total shock energy and mortality in patients with implantable cardioverter-defibrillator.

BACKGROUND: Implantable Cardioverter-Defibrillator (ICD) shocks have been associated with mortality. However, no study has examined the relation between total shock energy and mortality. The aim of this study is to assess the association of total shock energy with mortality, and to determine the patients who are at risk of this association. METHODS: Data from 316 consecutive patients who underwent initial ICD implantation in our hospital between 2000 and 2011 were retrospectively studied. We collected shock energy for 3 years from the ICD implantation, and determined the relation of shock energy on mortality after adjusting confounding factors. RESULTS: Eighty-seven ICD recipients experienced shock(s) within 3 years from ICD implantation and 43 patients had died during the follow-up. The amount of shock energy was significantly associated with all-cause death [adjusted hazard ratio (HR) 1.26 (per 100 joule increase), p < 0.01] and tended to be associated with cardiac death (adjusted HR 1.30, p = 0.08). The survival rate of patients with high shock energy accumulation (≥182 joule) was lower (p < 0.05), as compared to low shock energy accumulation (<182 joule), likewise to no shock. Besides, the relation between high shock energy accumulation and all-cause death was remarkable in the patients with low left ventricular ejection fraction (LVEF ≤40%) or atrial fibrillation (AF). CONCLUSIONS: Increase of shock energy was related to mortality in ICD recipients. This relation was evident in patients with low LVEF or AF.

1.54 µm photoluminescence from Er:Ox centers at extremely low concentration in silicon at 300 K.

The demand for single photon emitters at λ=1.54 µm, which follows from the consistent development of quantum networks based on optical fiber technologies, makes Er:Ox centers in Si a viable resource, thanks to the I13/24→I415/2 optical transition of Er3+. While its implementation in high-power applications is hindered by the extremely low emission rate, the study of such systems in the low concentration regime remains relevant for quantum technologies. In this Letter, we explore the room-temperature photoluminescence at the telecomm wavelength from very low implantation doses of Er:Ox in Si. The lower-bound number of optically active Er atoms detected is of the order of 102, corresponding to a higher-bound value for the emission rate per individual ion of about 104 s-1.

Angiostatin prevents IL-1ß-induced down-regulation of eNOS expression by inhibiting the NF-κB cascade.

This study aimed to elucidate the protective potential of angiostatin in inflamed endothelial cells in culture. We assessed the effect of angiostatin on the expression of ICAM-1 and eNOS. Angiostatin prevented IL-1ß-induced down-regulation of eNOS expression, but produced no significant changes on IL-1ß-induced up-regulation of ICAM-1. We then explored the effect of angiostatin on IL-1ß-mediated inflammatory signaling and found that angiostatin inhibited IL-1ß-mediated nuclear translocation of NF-κB. Thus, our results suggest that angiostatin prevents IL-1ß-induced down-regulation of eNOS expression via inhibition of the NF-κB cascade; this may be the anti-inflammatory mechanism of angiostatin.

Retinoic acid-inducible gene-I-like receptor (RLR)-mediated antiviral innate immune responses in the lower respiratory tract: Roles of TRAF3 and TRAF5.

Upon viral infection, the cytoplasmic viral sensor retinoic acid-inducible gene-I (RIG-I) recognizes viral RNA to activate antiviral signaling to induce type I interferon (IFN). RIG-I-like receptors (RLRs) activate antiviral signaling in a tissue-specific manner. The molecular mechanism underlying antiviral signaling in the respiratory system remains unclear. We studied antiviral signaling in the lower respiratory tract (LRT), which is the site of many harmful viral infections. Epithelial cells of the LRT can be roughly divided into two groups: bronchial epithelial cells (BECs) and pulmonary alveolar epithelial cells (AECs). These two cell types exhibit different phenotypes; therefore, we hypothesized that these cells may play different roles in antiviral innate immunity. We found that BECs exhibited higher antiviral activity than AECs. TNF receptor-associated factor 3 (TRAF3) has been shown to be a crucial molecule in RLR signaling. The expression levels of TRAF3 and TRAF5, which have conserved domains that are nearly identical, in the LRT were examined. We found that the bronchus exhibited the highest expression levels of TRAF3 and TRAF5 in the LRT. These findings suggest the importance of the bronchus in antiviral innate immunity in the LRT and indicate that TRAF3 and TRAF5 may contribute to RLR signaling.

Structure-activity relationship study of diphenylamine-based estrogen receptor (ER) antagonists.

We have reported the design and synthesis of novel estrogen receptor (ER) agonists with a diphenylamine skeleton, which has several advantages over the formerly used diphenylmethane skeleton for drug development. Here, we confirmed the versatility of the diphenylamine skeleton by designing and synthesizing ER antagonist candidates bearing a basic alkylamino side chain on one of the two phenol groups of the diphenylamine agonist core structure. Among the tested compounds, cyclic alkylamine-containing derivatives showed more potent ER-antagonistic activity than the corresponding acyclic derivatives in cell proliferation assay using the MCF-7 cell line. Compound 5e showed the most potent antiestrogenic activity (IC50: 1.3×10(-7)M), being 10times more potent than tamoxifen.

Desferrioxamine, an iron chelator, inhibits CXCL10 expression induced by polyinosinic-polycytidylic acid in U373MG human astrocytoma cells.

Although iron is essential in physiological processes, accumulation of iron in central nervous system is associated with various neurological diseases including Alzheimer's disease and Parkinson's disease. Innate immune reactions are involved in the pathogenesis of those diseases, but roles of iron in innate immunity are not known well. In the present study, pretreatment of U373MG human astrocytoma cells with an iron chelator desferrioxamine (DFX) inhibited the expression of CXCL10 induced by a Toll-like receptor 3 (TLR3) agonist polyinosinic-polycytidylic acid (poly IC). Induction of interferon-ß (IFN-ß) was not affected, but phosphorylation of signal transducer and transcription 1 (STAT1) was decreased by DFX. We have previously reported that various IFN-stimulated genes (ISGs) are involved in CXCL10 induction by poly IC. Pretreatment with DFX also decreased the expression of these ISGs. Pretreatment of cells with FeSO4 counteracted inhibitory effects of DFX on ISG56, retinoic acid-inducible gene-I (RIG-I), CXCL10 and phosphorylation of STAT1. These results suggest that iron may positively regulate STAT1 phosphorylation and following signaling to express ISG56, RIG-I and CXCL10 in U373MG cells treated with poly IC. Iron may contribute to innate immune and inflammatory reactions elicited by the TLR3 signaling in astrocytes, and may play an important role in neuroinflammatory diseases.

Mizoribine selectively attenuates monocyte chemoattractant protein-1 production in cultured human glomerular mesangial cell: a possible benefit of its use in the treatment of lupus nephritis.

AIM: Mizoribine (MZR) is a selective inhibitor of the inosine monophosphate dehydrogenase - a key enzyme in the de novo pathway of guanine nucleotides - that was developed in Japan. Besides its immunosuppressive effects, MZR has recently been reported to suppress the progression of histologic chronicity via suppression of macrophage infiltration of the interstitium in selected patients with lupus nephritis. METHODS: We examine the direct effect of MZR in human mesangial cells on the expression of functional molecules including monocyte chemoattractants in cultured human mesangial cells (MCs) treated with polyinosinic-polycytidylic acid (poly IC), a synthetic analogue of viral dsRNA, that makes 'pseudoviral' infection, and analyzed the expression of target molecules by reverse transcriptase-polymerase chain reaction and Western blotting. Thereafter, the effect of MZR on the expressions was examined. RESULTS: Pretreatment of cells with MZR partially, but significantly, attenuates the expression of monocyte chemoattractant protein (MCP)-1 mRNA and protein, whereas the poly IC-induced expressions for the other functional molecules, such as CCL5, fractalkine and IL-8 were not influenced by MZR treatment. On the other hand, pretreatment of cells with tacrolimus did not suppress the expression of MCP-1 mRNA. CONCLUSION: Mizoribine itself selectively attenuated the expression of MCP-1 both mRNA and protein levels in MCs treated with poly IC; that is, a possible model of 'pseudoviral' infection, which may be involved in the pathogenesis of lupus nephritis.

Mapping of rice Ur1 (Undulated rachis-1) gene with effect on increasing spikelet number per panicle and sink size, and development of selection markers for the breeding by the use of Ur1.

Ur1 enhances secondary rachis-branching, resulting in more spikelets per panicle. This genic effect can increase grain yield by enlarging sink size. We conducted mapping of Ur1 using SSR markers, and detected markers usable for the MAS (marker-assisted selection) for Ur1. Three Ur1 isogenic lines of recurrent parents Taichung 65, 'Shiokari' and 'Nishihikari'('T(U)', 'S(U)' and 'N(U)', respectively) were used. SSR-marker analysis indicated that each isogenic line had a non-substituted region containing Ur1 on chromosome 6 which was inherited from its donor parent. T(U) was crossed with a non-Ur1-carrying line, and the F(2) and F(3) populations were grown. Recombination values between the Ur1 locus and SSR-marker loci were obtained from data of the F(2) and F(3). On the basis of both the linkage relationship and the non-substituted regions in T(U), S(U) and N(U), candidate region of the Ur1 locus was narrowed to 0.139 Mb between the loci of up85938 and SSR17 on the long arm of chromosome 6. Genotypes of T(U) and other five Ur1-carrying lines at each locus of ten SSR markers near the Ur1 locus were determined, and allelic frequency at each locus was investigated for 27 japonica and 21 indica varieties. Consequently, SSR12 and SSR17 could be employed as MAS markers for Ur1.

Promising core structure for nuclear receptor ligands: design and synthesis of novel estrogen receptor ligands based on diphenylamine skeleton.

Novel diphenylamine-type estrogen receptor ligands were designed and synthesized, and their biological activities were evaluated by means of binding assays for estrogen receptor-alpha and -beta and cell proliferation assay using MCF-7 cells. Compounds 4f, 11b, 12c, and 8 showed moderate estrogenic activities. We propose that the diphenylamine skeleton may be a privileged structure for various nuclear receptor ligands, including RAR, RXR, and AR ligands.