Acute muscle loss assessed using panoramic ultrasound in critically ill adults: a prospective observational study.

PURPOSE: Panoramic ultrasound is one of the recently introduced ultrasound evaluation techniques. We herein examined the relationship between the cross-sectional area of the rectus femoris muscle on panoramic ultrasound and its volume based on the gold standard computed tomography (CT) evaluation. METHODS: This was a single-center prospective observational study. A panoramic ultrasound assessment of the cross-sectional area of the rectus femoris muscle and a simple CT evaluation of its volume were performed on days 1 and 7 of hospitalization. Physical functions were assessed at discharge. RESULTS: Twenty patients were examined. The rate of change in the cross-sectional area of the rectus femoris muscle on panoramic ultrasound correlated with that in its volume on CT (correlation coefficient 0.59, p = 0.0061). In addition, a correlation was observed between the absolute value for the rectus femoris muscle cross-sectional area on panoramic ultrasound and physical functions at discharge. Rectus femoris muscle distances did not correlate with either. CONCLUSION: In the acute phase of critical illness, the cross-sectional area of the rectus femoris muscle on panoramic images correlated with its volume on CT and, thus, it is a valid method for assessing muscle mass.

Proximity effect of emergent field from spin ice in an oxide heterostructure.

Geometrical frustration endows magnets with degenerate ground states, resulting in exotic spin structures and quantum phenomena. Such magnets, called quantum magnets, can display non-coplanar spin textures and be a viable platform for the topological Hall effect driven by "emergent field." However, most quantum magnets are insulators, making it challenging to electrically detect associated fluctuations and excitations. Here, we probe magnetic transitions in the spin ice insulator Dy2Ti2O7, a prototypical quantum magnet, as emergent magnetotransport phenomena at the heterointerface with the nonmagnetic metal Bi2Rh2O7. Angle-dependent longitudinal resistivity exhibits peaks at the magnetic phase boundaries of spin ice due to domain boundary scattering. In addition, the anomalous Hall resistivity undergoes a sign change with the magnetic transition in Dy2Ti2O7, reflecting the inversion of the emergent field. These findings, on the basis of epitaxial techniques, connect the fundamental research on insulating quantum magnets to their potential electronic applications, possibly leading to transformative innovations in quantum technologies.

A nationwide cross-sectional study using a web-based questionnaire survey of the duration of isolation of COVID-19 inpatients with cancer at Japanese cancer centers.

There is no clear consensus regarding the optimal isolation duration for immunocompromised patients with coronavirus disease 2019 (COVID-19). Therefore, we conducted a questionnaire survey at eight Japanese cancer centers to investigate the practices of infectious disease specialists regarding the duration of isolation for COVID-19 inpatients with cancer. For asymptomatic to severely ill COVID-19 inpatients without severe immunodeficiency, four centers reported at least 10 days of isolation without testing, and two reported at least 20 days. Two centers incorporated polymerase chain reaction (PCR) as a criterion for terminating the isolation of inpatients without severe immunodeficiency. For severely immunocompromised COVID-19 inpatients, at least 20 days of isolation were required in seven facilities, regardless of illness severity. Additionally, seven centers had implemented Ct or antigen quantification test values as criteria for de-isolating severely immunocompromised inpatients. No cases caused nosocomial outbreaks after isolation was terminated based on each facility's criteria for isolation termination. Thus, cancer patients required longer isolation periods than the general population in most facilities, and for those with severe immunodeficiency, the isolation periods were longer and more tightly controlled with tests.

Correlation between antibiotic use and antibiotic resistance: A multicenter study using the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system in Hokkaido, Japan.

BACKGROUND: The Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system aggregates information related to antimicrobial resistance (AMR) measures in participating medical institutions nationwide and is intended to be used for promotion of AMR measures in participating facilities and their communities. This multicenter study aimed to determine the usefulness of the J-SIPHE system for evaluating the correlation between antibiotic use and antibiotic resistance in Hokkaido, Japan. METHODS: Data on antibiotic use and detection rate of major resistant Gram-negative bacteria at 19 hospitals in 2020 were collected from the J-SIPHE system, and data correlations were analyzed using JMP Pro. RESULTS: The detection rate of carbapenem-resistant Pseudomonas aeruginosa was significantly positively correlated with carbapenem use (Spearman's ρ = 0.551; P = .015). There were significant positive correlations between the detection rate of fluoroquinolone-resistant Escherichia coli and the use of piperacillin/tazobactam, carbapenems, and quinolones [ρ = 0.518 (P = .023), ρ = 0.76 (P < .001), and ρ = 0.502 (P = .029), respectively]. CONCLUSIONS: This is the first multicenter study to investigate the correlation between antibiotic use and antibiotic resistance using the J-SIPHE system. The results suggest that using this system may be beneficial for promoting AMR measures.

Adaptive feedforward control of closed orbit distortion caused by fast helicity-switching undulators.

A new correction algorithm for closed orbit distortion based on an adaptive feedforward control (AFC) has been developed. At SPring-8, two helicity-switching twin-helical undulators (THUs) had been implemented with conventional feedforward corrections. However, the validity of these corrections turned out to be expiring due to unforeseen variation in the error magnetic fields with time. The developed AFC system has been applied to the THUs dynamically updating the feedforward table without stopping the helicity switching amid user experiments. The error sources in the two THUs are successfully resolved and corrected even while the two THUs are switching simultaneously with the same repetition period. The actual operation of the new AFC system enables us to keep the orbit variations suppressed with an accuracy at the sub-micrometre level in a transparent way for light source users.

Grip Strength Correlates with Mental Health and Quality of Life after Critical Care: A Retrospective Study in a Post-Intensive Care Syndrome Clinic.

Post-intensive care syndrome (PICS) is characterized by several prolonged symptoms after critical care, including physical and cognitive dysfunctions as well as mental illness. In clinical practice, the long-term follow-up of PICS is initiated after patients have been discharged from the intensive care unit, and one of the approaches used is a PICS clinic. Although physical dysfunction and mental illness often present in combination, they have not yet been examined in detail in PICS patients. Grip strength is a useful physical examination for PICS, and is reported to be associated with mental status in the elderly. We herein investigated the relationship between grip strength and the mental status using data from our PICS clinic. We primarily aimed to analyze the correlation between grip strength and the Hospital Anxiety and Depression Scale (HADS) score. We also analyzed the association between grip strength and the EuroQol 5 Dimension (EQ5D) score as quality of life (QOL). Subjects comprised 133 patients who visited the PICS clinic at one month after hospital discharge between August 2019 and December 2020. Total HADS scores were 7 (4, 13) and 10 (6, 16) (p = 0.029) and EQ5D scores were 0.96 (0.84, 1) and 0.77 (0.62, 0.89) (p ≤ 0.0001) in the no walking disability group and walking disability group, respectively. Grip strength negatively correlated with HADS and EQ5D scores. Correlation coefficients were r = -0.25 (p = 0.011) and r = -0.47 (p < 0.0001) for HADS and EQ5D scores, respectively. Grip strength was a useful evaluation that also reflected the mental status and QOL.

Immunohistochemical study for the expression of leukocyte adhesion molecules, and FGF23 and ACE2 in P. gingivalis LPS-induced diabetic nephropathy.

OBJECTIVE: The present study aims to examine the expression of leukocyte adhesion molecules and renal metabolic factors in diabetic mouse kidneys with periodontal pathogen Pg-LPS-induced nephropathy. BACKGROUND: We recently reported that the glomerular endothelium expresses toll-like receptor (TLR)2 and TLR4 in diabetic environments and TLR2/4 ligand Porphyromonas (P.) gingivalis lipopolysaccharides (Pg-LPS) induce nephropathy in diabetic mice. It is thought that Pg-LPS promotes the chronic inflammation with the overexpression of leukocyte adhesion molecules and renal-specific metabolic enzymes by the recognition of Pg-LPS via TLR in the diabetic kidneys. There have been no reports of the effects of periodontopathic bacteria on the expression of leukocyte adhesion molecules and the accumulation of physiologically active substances in the kidney. METHODS: The immunohistochemical investigation was performed on diabetic mouse kidney with Pg-LPS-induced nephropathy with glomerulosclerosis in glomeruli. RESULTS: There were no vessels which expressed vascular cell adhesion molecule-1 (VCAM-1), E-selectin, or fibroblast growth factor (FGF) 23 in streptozotocin (STZ)-induced diabetic ICR mice (STZ-ICR), or in healthy ICR mice administered Pg-LPS (LPS-ICR). However, in diabetic ICR mouse kidneys with Pg-LPS-induced nephropathy (LPS-STZ) the expression of VCAM-1 and the accumulation of FGF23 were observed in renal tubules and glomeruli, and the expression of E-selectin was observed in renal parenchyma and glomeruli. The angiotensin-converting enzyme 2 (ACE2) was detected in the proximal tubules but not in other regions of ICR, STZ-ICR, or LPS-ICR. In LPS-STZ ACE2 was detected both in renal tubules as well as in glomeruli. The Mac-1 and podoplanin-positive cells increased in the renal parenchyma with diabetic condition and there was the distribution of a large number of Mac-1-positive cells in LPS-STZ. CONCLUSIONS: The Pg-LPS may induce diabetic renal inflammation such as glomerulosclerosis and tubulitis with infiltration of Mac-1/podoplanin positive macrophages via glomerular overexpression of VCAM-1 and E-selectin, resulting in accumulation of both ACE2 and FGF23 which were unmetabolized with the inflammation-induced kidney damage under the diabetic condition. Periodontitis may be a critical factor in the progress of nephropathy in diabetic patients.

Evolution of ferroelectricity in ultrathin PbTiO3 films as revealed by electric double layer gating.

Ferroelectricity in ultrathin films is destabilized by depolarization field, which leads to the reduction of spontaneous polarization or domain formation. Here, thickness dependence of remnant polarization in PbTiO3 films is electrically revealed down to 2.6 nm by controlling the polarization direction with employing an electric double layer gating technique to suppress leakage current in ultrathin films. The remnant polarization for a 17 nm-thick film is similar to bulk value ~ 60 µC cm-2 and reduces to ~ 20 µC cm-2 for a 2.6 nm-thick film, whereas robust ferroelectricity is clearly observed in such ultrathin films. In-situ X-ray diffraction measurements under an external electric field reveal that the reduced tetragonality in ultrathin films is mostly recovered by cancelling out the depolarization field. Electric double layer gating technique is an excellent way for exploring physical properties in ultrathin ferroelectric films.

tRNA Genes Affect Chromosome Structure and Function via Local Effects.

The genome is packaged and organized in an ordered, nonrandom manner, and specific chromatin segments contact nuclear substructures to mediate this organization. tRNA genes (tDNAs) are binding sites for transcription factors and architectural proteins and are thought to play an important role in the organization of the genome. In this study, we investigate the roles of tDNAs in genomic organization and chromosome function by editing a chromosome so that it lacked any tDNAs. Surprisingly our analyses of this tDNA-less chromosome show that loss of tDNAs does not grossly affect chromatin architecture or chromosome tethering and mobility. However, loss of tDNAs affects local nucleosome positioning and the binding of SMC proteins at these loci. The absence of tDNAs also leads to changes in centromere clustering and a reduction in the frequency of long-range HML-HMR heterochromatin clustering with concomitant effects on gene silencing. We propose that the tDNAs primarily affect local chromatin structure, which results in effects on long-range chromosome architecture.

Osseous changes of the mandibular condyle affect backward-rotation of the mandibular ramus in Angle Class II orthodontic patients with idiopathic condylar resorption of the temporomandibular joint.

Objective: To evaluate whether osseous changes of the temporomandibular joint (TMJ) condyle affect backward rotation of the mandibular ramus in Angle Class II orthodontic patients with idiopathic condylar resorption (ICR). Methods: Twenty Japanese women with Class II malocclusion with ICR (ICR group) and 24 women with Class II malocclusion without ICR (non-ICR group) were examined. Pre-treatment panoramic radiographs were used to measure condylar ratios. Pre-treatment lateral cephalograms were used to evaluate maxillofacial morphology. Results: The ICR group had a significantly smaller condylar ratio, greater backward rotation of the ramus, less labially inclined upper incisors, and a steeper occlusal plane. The increased backward rotation of the ramus in the ICR group was significantly associated with a smaller condylar ratio. Conclusion: Angle Class II patients with ICR had shorter condylar height attributable to osseous changes of the TMJ condyle, and the shorter condylar height may affect subsequent backward rotation of the ramus.

Selective Detection of DNA from Viable Mycobacterium tuberculosis Complex Strains Using the EMA-PCR Method.

In this study, the ability to discriminate viable from dead cells of Mycobacterium tuberculosis complex (MTC), using an ethidium monoazide (EMA) treatment-dependent viable bacteria selection PCR kit was examined. Detection of dead bacteria was possible for bacterial concentrations in the range 1.5 × 107-3.0 × 107 CFU/mL, which was equivalent to McFarland No. 0.05-0.10. There was a significant difference between the results for viable and dead bacteria, and the sensitivity and specificity of this method for culture-negative samples from patients were 83% and 100%, respectively. To the best of our knowledge, this is the first successful selective detection of DNA from viable cells of MTC by EMA-PCR, using the viable bacteria selection kit for PCR (gram-positive), an EMA treatment kit. We believe that application of this method could promote earlier discharge of patients undergoing tuberculosis treatment by discriminating dead from viable cells.

Environmental Drivers of Bacillus-Positive Blood Cultures in a Cancer Hospital, Sapporo, Japan.

The Bacillus species is a well-documented causative pathogen of nosocomial bloodstream infection. The present study aimed to identify climatological variables that are associated with Bacillus-positive blood culture in Sapporo, Japan. All cases with Bacillus-positive blood cultures from January 2011 to December 2016 were retrospectively analysed. Climatological data from 2011 to 2016, including daily mean temperature and absolute humidity, were retrieved from the Japan Meteorological Agency. Employing a hazard-based statistical model to describe the non-homogeneous counting process in which temperature and absolute humidity act as explanatory variables, we computed all possible models with variable lengths of time lag. Akaike Information Criterion was computed to identify the best fitted model. High wavelet power at 12 months was identified for the period from 2013 onwards, which coincided with the time period in which sampling multiple sets of blood culture has been recommended. The temperature-only model with a lag of six days yielded a high sensitivity value (72.1%) and appeared to be the optimal model to predict Bacillus-positive blood culture with the highest area under the receiver operating characteristic curve value. Temperature was identified as a climatological driver of Bacillus-positive blood culture. Our statistical modelling exercise offers an important message for infection control practices to improve awareness among healthcare workers of the identified association and mechanically controlled in-room temperature.

Gram-negative rod bacteremia after cardiovascular surgery: Clinical features and prognostic factors.

BACKGROUND/PURPOSE: Our aim was to describe the clinical features and prognostic factors of Gram-negative rod bacteremia (GNRB) after cardiovascular surgery (CVS). METHODS: This retrospective observational study included adults with GNRB onset within 100 days after CVS at a single institution from April 2004 to May 2013. Clinical data regarding episodes of GNRB were collected from patients' medical charts. Those having polymicrobial bacteremia with a bacterium other than a GNR were excluded. RESULTS: Among 2017 CVS patients, GNRB occurred in 78. Klebsiella, Pseudomonas aeruginosa, Enterobacter, and Escherichia coli were the most commonly isolated organisms. Graft replacement was the most common surgical procedure in patients with GNRB after CVS (44.9%). Prophylaxis antibiotics were ampicillin/sulbactam (76.9%), and vancomycin (12.8%). The crude 90-day mortality rate was 21.8%, and the mean Acute Physiology and Chronic Health Evaluation II score was 15.6 (range, 3-39). In 34.6% of patients, the same GNR species were isolated from other samples within 30 days of GNRB occurrence. Multivariate analysis indicated that P. aeruginosa bacteremia [odds ratio (OR), 175; confidence interval (CI), 2.40-1270; p = 0.0182], Acute Physiology and Chronic Health Evaluation II scores of ≥ 25 (OR 76.2; CI 1.04-5580; p = 0.0479), and vancomycin for prophylaxis (OR 45.4; CI 1.02-202; p = 0.0488) were significant independent prognostic factors associated with death due to GNRB after CVS. CONCLUSION: Graft replacement was the most common surgical procedure in patients with GNRB after CVS. Empirical antibiotics covering Gram-negative rods including P. aeruginosa should be considered if bacteremia is suspected in unstable patients after CVS.

Multicenter Study of the Clinical Presentation of Staphylococcus lugdunensis Bacteremia in Japan.

Staphylococcus lugdunensis (SL) is a bacterium with a highly pathogenicity than most other coagulase-negative Staphylococcus spp. (CoNS). In Japan, data on this pathogen are sparse, and the current prevalence of SL bacteremia is unknown. Therefore, we investigated the prevalence of SL in blood culture specimens in a prospective multicenter study across 5 facilities. A total of 3,284 patients had positive blood cultures, and 2,478 patients had bacteremia. Among the patients with bacteremia, 7 patients (0.28%) had SL bacteremia. A total of 281 patients had CoNS bacteremia, with SL accounting for 2.49% of these cases. Of the 7 patients with SL bacteremia, 1 patient (14.3%) had infective endocarditis, and 1 patient (14.3%) died within 30 days. In this study, SL resulted in the development of bacteremia in select patients. Clinicians in Japan should be aware of the prevalence of SL and the complications of SL bacteremia.

Pulmonary Histoplasmosis in a Japanese Man Infected During Travel to Mexico and Management of His Wife's Condition: A Case Report.

We report herein on the case of a 33-year-old Japanese man in whom an abnormal shadow was detected on chest radiography during a medical checkup after a 1-year-stay in Mexico. Chest computed tomography showed a nodule in the left lower lobe adjacent to the visceral pleura. Histopathologic examination of a thoracoscopic partial pulmonary resection specimen showed coagulation necrosis with a number of yeast-like forms on Grocott staining. In addition, serum anti-Histoplasma antibody positivity was detected with an enzyme-linked immunosorbent assay, and Histoplasma-specific nested real-time polymerase chain reaction results were positive in the pulmonary region. Finally, pulmonary histoplasmosis was diagnosed, and treatment with itraconazole was initiated. The patient's wife who had accompanied him to Mexico was asymptomatic and was not found to have histoplasmosis based on diagnostic imaging and serological findings. Although rare in Japan, histoplasmosis should be considered in the differential diagnosis of pulmonary lesions in patients who have returned from travel to endemic areas.

Optical Characterization of Gold Nanoparticle Layers Formed on Plastic Microbeads.

Generally, the characterization of a metal layer formed on a planar substrate has been achieved using scanning electron microscopy and transmission electron microscopy. These techniques provide details of the surface and/or the cross-section of a planar structure with high resolution. However, the evaluation of sphere-like structures is troublesome owing to the necessity to observe a sample from various angles and/or to calculate the yield from many values obtained for many samples, since the conventional methods can observe a sample only from one direction. We have developed a simple evaluation method for a thin metal layer on plastic microbeads based on its light-scattering properties using dark-field microscopy coupled with a spectrometer. The light-scattering intensity of gold-nanoparticle-coated microbeads depends significantly on the gold coverage. We believe that our study is significant because it describes the development and evaluation of the surface coverage of a thin metal layer on a sphere-like microstructure.

Treadmill exercise ameliorates ischemia-induced brain edema while suppressing Na⁺/H⁺ exchanger 1 expression.

Exercise may be one of the most effective and sound therapies for stroke; however, the mechanisms underlying the curative effects remain unclear. In this study, the effects of forced treadmill exercise with electric shock on ischemic brain edema were investigated. Wistar rats were subjected to transient (90 min) middle cerebral artery occlusion (tMCAO). Eighty nine rats with substantially large ischemic lesions were evaluated using magnetic resonance imaging (MRI) and were randomly assigned to exercise and non-exercise groups. The rats were forced to run at 4-6m/s for 10 min/day on days 2, 3 and 4. Brain edema was measured on day 5 by MRI, histochemical staining of brain sections and tissue water content determination (n=7, each experiment). Motor function in some rats was examined on day 30 (n=6). Exercise reduced brain edema (P<0.05-0.001, varied by the methods) and ameliorated motor function (P<0.05). The anti-glucocorticoid mifepristone or the anti-mineralocorticoid spironolactone abolished these effects, but orally administered corticosterone mimicked the ameliorating effects of exercise. Exercise prevented the ischemia-induced expression of mRNA encoding aquaporin 4 (AQP4) and Na(+)/H(+) exchangers (NHEs) (n=5 or 7, P<0.01). Microglia and NG2 glia expressed NHE1 in the peri-ischemic region of rat brains and also in mixed glial cultures. Corticosterone at ~10nM reduced NHE1 and AQP4 expression in mixed glial and pure microglial cultures. Dexamethasone and aldosterone at 10nM did not significantly alter NHE1 and AQP4 expression. Exposure to a NHE inhibitor caused shrinkage of microglial cells. These results suggest that the stressful short-period and slow-paced treadmill exercise suppressed NHE1 and AQP4 expression resulting in the amelioration of brain edema at least partly via the moderate increase in plasma corticosterone levels.

Perianal tuberculosis: A case report and review of the literature.

Tuberculosis (TB) is still a major health problem worldwide. We present a rare case of an immuno-competent patient with perianal TB. A 38-year-old man visited a clinic with pain, swelling, and redness in the perineum. He had been persistently coughing for the past 6 mo. The abscess had formed a fistula to the perianal region, indicating perianal abscess. Mycobacterium tuberculosis was found in sputum and perianal abscess. Surgical drainage was performed, and oral anti-tuberculous drugs were administered for 6 mo. The patient's clinical course was favorable. On review of the literature on 58 cases of perianal TB, we found that the duration of persistent perianal lesion was much longer in patients without active pulmonary TB (APTB) than in those with APTB (66.4 mo vs 8.3 mo; confidence interval, 0.0760-0.9620, P = 0.0380). Thus, in cases of non-healing or recurrent perianal lesions, TB should be considered.

Risk factors for recurrent hospital-acquired Clostridium difficile infection in a Japanese university hospital.

BACKGROUND: Clostridium difficile infection (CDI) is a highly prevalent hospital-associated infection. Although most patients respond well to discontinuation of antibiotics, 20%-30% of patients relapse. To initiate early therapeutic measures, the risk factors for recurrent CDI must be identified, although very few Japanese studies have used standard surveillance definitions to identify these risk factors. METHODS: We retrospectively reviewed the medical records of patients with health care facility-onset CDI between August 2011 and September 2013. Patients with diarrhea who were positive for Clostridium difficile (via an enzyme immunoassay) were defined as having CDI. Clinical data (eg, demographics, comorbidities, medication, laboratory results, and clinical outcomes) were evaluated, and multivariate analysis was used to identify risk factors that were associated with recurrent CDI. RESULTS: Seventy-six health care facility-onset CDI cases were identified, with an incidence rate of 0.8 cases per 10,000 patient-days. Fourteen cases (18.4%) were recurrent, with 13 patients having experienced a single recurrent episode and one patient having experienced three recurrent episodes. The 30-day and 90-day mortality rates were 7.9% and 14.5%, respectively. Multivariate analysis revealed that recurrent patients were more likely to have underlying malignant disease (odds ratio: 7.98; 95% confidence interval: 1.22-52.2; P=0.03) and a history of intensive care unit hospitalization (odds ratio: 49.9; 95% confidence interval: 1.01-2,470; P=0.049). CONCLUSION: Intensive care unit hospitalization and malignancy are risk factors for recurrent CDI. Patients with these factors should be carefully monitored for recurrence and provided with appropriate antimicrobial stewardship.

Optical Evaluation of the Surface Coverage of Silver Nanoparticle-coated Plastic Microbeads.

A simple evaluation method has been developed for a metal thin layer on a sphere-like plastic microstructure, based on its light-scattering property since, according to our results, the light-scattering intensity of silver-coated microbeads depends significantly on the silver coverage. Our attempt was carried out by using a dark-field microscopy coupled with a spectrometer.