Ideal water temperature environment for giant Marimo (Aegagropila linnaei) in Lake Akan, Japan.

Aegagropila linnaei is a filamentous green algal species that often forms beautiful spherical shapes called "lake balls" or "Marimo". A. linnaei were once globally distributed around the world, but the population has been declining for several decades. Lake Akan, in Japan, is now the only lake in the world with a colony of giant Marimo (over 20 cm in diameter). Here we show the net growth rate of Marino resulting from photosynthesis and decomposition based on laboratory experiments, MRI analysis, and quantitative element analysis, which show the decomposition rate, the maximum annual Marimo diametric growth rate, and the carbon-to-nitrogen ratio, respectively. We found an explicit dependence of the decomposition rate of Marimo on the cumulative water temperature, with a threshold of 7 °C. MRI analysis showed a high correlation among a Marimo's diameter, surface thickness, and annual diametric growth rate. Moreover, the C/N ratio was high in the exterior side of the surface thickness, indicating that this layer is the main growth area for photosynthesis. These results suggest that the central cavity and the surface thickness represent the change in the growth environment such as water temperature and light intensity. Between the 1980s and the present, Between the 1980s and the present, the cumulative water temperature has increased from about 1250 to about 1600 °C-days. Therefore, the maximum surface thickness has decreased by approximately 1 cm, as estimated by water temperature records and annual diametric growth rates10. As a measure to preserve preferable conditions for colonies of giant Marimo in the face of global warming, the flow of low-temperature river water into Marimo colonies should be protected.

Carbon dioxide uptake in a eutrophic stratified reservoir: Freshwater carbon sequestration potential.

Carbon capture and storage due to photosynthesis activities has been proposed as a carbon sink to mitigate climate change. To enhance such mitigation, previous studies have shown that freshwater lakes should be included in the carbon sink, since they may capture as much carbon as coastal areas. In eutrophic freshwater lakes, there is uncertainty about whether the equilibrium equation can estimate the partial pressure of carbon dioxide (pCO2), owing to the presence of photosynthesis due to phytoplankton, and pH measurement error in freshwater fluid. Thus, this study investigated the applicability of the equilibrium equation and revealed the need to modify it. The modified equilibrium equation was successfully applied to reproduce pCO2 based on total alkalinity and pH through field observations. In addition, pCO2 at the water surface was lower than the atmospheric partial pressure of carbon dioxide due to photosynthesis by phytoplankton during strong stratification. The stratification effect on low pCO2 was verified by using the Net Ecosystem Production (NEP) model, and a submerged freshwater plants such as Potamogeton malaianus were found to have high potential for dissolved inorganic carbon (DIC) sequestration in a freshwater lake. These results should provide a starting point toward more sophisticated methods to investigate the effect of freshwater carbon on DIC uptake in freshwater stratified eutrophic lakes.

Intra-articular injection versus interscalene brachial plexus block for acute-phase postoperative pain management after arthroscopic shoulder surgery.

BACKGROUND: The minimally invasive approach of arthroscopic shoulder surgery is beneficial; however, for optimal outcomes, perioperative pain management is essential. This cross-sectional study aimed to examine the analgesic effectiveness of intra-articular injection (IA) versus interscalene brachial plexus block (ISPB) among patients treated with arthroscopic shoulder surgeries. METHODS: We reviewed 100 consecutive patients who underwent shoulder arthroscopic surgery, of whom 50 each underwent IA (February 2019─January 2020; IA group) and ISPB (October 2018─July 2019; ISPB group). The primary outcome was the postoperative pain score measured using a Wong-Baker FACES Pain Rating Scale preoperatively and at 2, 6, 12, 24, and 48 h postoperatively. We performed multiple regression analysis to examine whether IA/ISPB selection is associated with acute-phase postoperative pain and adjusted for intra-articular injection, interscalene brachial plexus block, postoperative pain management, arthroscopic shoulder surgery, IA with 10 mg of morphine previously reported prognostic factors for postoperative pain (e.g., surgical procedures, operative time, older age, and preoperative pain). Furthermore, we examined induction time, total pentazocine dosage, and total postoperative nausea and vomiting (PONV) events. RESULTS: There were no significant differences between the IA and ISPB groups in perioperative pain control during the acute-phase periods (p = 0.12, repeated analysis of variance). The difference in anesthesia method was not a prognostic factor for acute-phase postoperative pain (p = 0.11). The IA group (15.06 ± 4.00 min) had a significantly shorter mean anesthesia induction time than the ISPB group (29.23 ± 9.22 min) (p = 0.0001). There was no significant between-group difference in the total pentazocine dosage during the first 7 days (p = 0.3934) postoperatively. PONV was observed in eight (17.0%) and two (4.2%) patients in the IA and ISPB groups, respectively. There was no significant between-group difference in the PONV incidence (p = 0.1582). CONCLUSIONS: There was no significant difference in acute-phase postoperative pain management between the IA and ISPB groups. The induction time was significantly shorter in IA. IRB: Approval number: UOEHCRB20-078, IRB approval date: September 9th, 2020; study duration: October 2018 to January 2020.

Effect of dissolved oxygen on methane production from bottom sediment in a eutrophic stratified lake.

Clarifying the role of sulfate and dissolved oxygen (DO) in methane production may allow for precise and accurate modeling of methane emissions in eutrophic lakes. We conducted field observations of sulfate, methane, and DO concentrations in Lake Abashiri, a typical brackish and eutrophic lake in a cold region, to develop a DO-based method for quantitively estimating methane production in a eutrophic lake and analyzed the results. We found that sulfate concentrations decreased rapidly from 900.0 mg/L in water overlying the sediments to nearly 0.0 mg/L in the bottom sediment. Methane production was almost uniform across sediment depths of 0.05 to 0.25 m, ranging from 1400 to 1800 µmol/m2/day. Also, methane production was found to be a function of DO concentrations in water overlying the bottom and could be modeled by a logistic function: constant production at 1,400 µmol/m2/day for DO concentrations of 0.0 to 3.0 mg/L, rapidly decreasing to 0 µmol/m2/day for DO concentrations of 3.0 to 6.0 mg/L. This methane model was verified using a simple one-dimensional numerical model that showed good agreement with field observations. Our results thus suggest that the proposed methane model reduces uncertainty in estimating methane production in a eutrophic lake.

Effects of vorticity on solitary waves.

The vorticity effect on solitary wave profiles has not been solved experimentally; previous studies theoretically and numerically showed that when a solitary wave progressed in the positive direction, the effective wavelength of a solitary wave with positive vorticity increased. Using laboratory experiments and fully nonlinear numerical simulations, we here show that the effective wavelength is extended more when positive vorticity is given to a progressive wave in the positive direction. We further show that the total energy increases with increasing positive vorticity, demonstrating that a wave with positive vorticity propagates with less attenuation and lasts longer than a solitary wave with no vorticity. We anticipate that our outcomes will provide a starting point for more sophisticated methods to investigate the effect of vorticity on solitary waves in laboratory experiments and numerical simulations.

Diffusive methane burst during a blue tide, wind-driven event in a meromictic lake.

Strong stratification has formed in Lake Abashiri, a typical meromictic lake in Hokkaido, in the subarctic zone in Japan. When the anoxic water of the lower layer is upwelled to the surface by a strong wind, fish and corbicula clams die due to a lack of dissolved oxygen. This event is called as blue tide. It was observed that the dissolved methane in the lake decreased more than 100 t after the blue tide which occurred in 2008. This is the discovery of the phenomenon that a large quantity of methane diffuses to the atmosphere caused by upwelling of anoxic water which contains dissolved methane. We named the event as "methane burst". It is also the first report that the wind-driven upwelling is reproduced using a numerical analysis code and the methane burst is analyzed. During this blue tide, the methane flux was approximately 170 times greater than usual.

Effects of oyster aquaculture on carbon capture and removal in a tropical mangrove lagoon in southwestern Taiwan.

Blue carbon ecosystems (BCEs) are a promising resource for the mitigation of global warming; however, climate spectrums and anthropogenic activities could influence the fragile balance of BCEs as carbon sinks or sources. We assess how oyster farming affects dissolved inorganic carbon (DIC) and total alkalinity (TA) on CO2 fluxes in a mangrove-dominated lagoon. Water physical, chemical and biological parameters were recorded by in-situ buoys within the lagoon and at its inflow. Structural equation modeling was adopted to clarify the factors/processes controlling the partial pressure of CO2 (pCO2). A three-dimensional environmental model followed by a conceptual DIC model was used to quantify the spatiotemporal patterns of capture and release of DIC and TA by oyster production. The results showed that 49% of TA and DIC released from mangroves was depleted by oyster shell formation. DIC was reduced by algal photosynthesis and algal was served as a food source supporting oyster production. Annual oyster production through phytoplankton photosynthesis accounted for 11% of the atmosphere carbon inflows, suggesting that oyster production served as a significant atmospheric/terrestrial carbon sink in the lagoon. The results indicate that mangroves benefit local oyster production by acting as an important source of DIC and TA, and that the oyster aquaculture contributed to carbon capture in a mangrove-dominated lagoon ecosystem.

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears.

BACKGROUND: The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin pain; however, their relationship with bony morphology related to femoroacetabular impingement (FAI) has not been established. PURPOSE: To investigate the prevalence of CS and BME in symptomatic patients with acetabular labral tears and assess their possible association with bone morphology and sport-specific activities. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This study enrolled 418 patients (469 hips) undergoing hip arthroscopic surgery for labral tears. Also included were patients with labral tears in the setting of either hip dysplasia or borderline hip dysplasia who were undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic labral repair, cam osteoplasty, and capsular plication. All patients were screened for superior CS (SCS), inferior CS (ICS), and BME of the ipsilateral side of the pubis using 3-T MRI. We measured the following angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior, and alpha. Then, we evaluated the relationship between patient characteristics and abnormal findings on MRI scans (preoperatively vs 1 year postoperatively). RESULTS: An overall 397 hips were included: 200 in men and 197 in women (mean ± SD age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in 183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18 (4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings at the pubis were seen more often in athletes than nonathletes (23.8% vs 3.3%), and contact sports athletes had the most frequent abnormalities. There was no SCS in patients with an LCE angle <22°. SCS was more frequently seen in those who had an alpha angle ≥71°. More than 60% of abnormal findings at the pubis diminished after arthroscopic surgery that included FAI correction and labral repair. CONCLUSION: In patients with labral tears, CS and BME were seen more frequently in athletes versus nonathletes, especially contact athletes with FAI-related bony abnormalities. More than 60% of abnormal MRI pubis findings resolved after arthroscopic treatment of FAI.

The impacts of the hydraulic retention effect and typhoon disturbance on the carbon flux in shallow subtropical mountain lakes.

A typhoon is extreme weather that flushes terrestrial carbon (C) loads and temporally mixes the entire water columns of lakes in subtropical regions. A C flux varies based on the trophic level associated with the ecological cycle related to hydraulic retention time (residence time). Herein, we sought to clarify how the hydraulic retention time and the disturbance from a typhoon affect the C flux regimes in two subtropical mountain lakes in a humid region of Taiwan with different trophic levels-oligotrophic and mesotrophic. We investigated the meteorological data and vertical profiles of the water temperature, dissolved inorganic carbon (DIC), dissolved organic C (DOC), and chlorophyll a (Chl. a) during the pre-typhoon period (April-July), during the typhoon period (August-November), and the post-typhoon period (December-March) for five years (2009-2010 and 2015-2017). We applied a three-dimensional environmental model (Fantom) to investigate the hydraulic retention effect on the net ecosystem production (NEP) using the residence time in stratified lakes. The results demonstrate that typhoon-induced mixing associated with the hydraulic retention effect plays one of the critical roles in controlling the NEP and C flux in shallow subtropical lakes.

The structure and formation of giant Marimo (Aegagropila linnaei) in Lake Akan, Japan.

Aegagropila linnaei is a freshwater green alga, which at one time was distributed widely in the northern hemisphere. The aggregate often forms beautiful spherical shapes known as "lake balls" or "Marimo". The population of Marimo has been rapidly decreasing worldwide, and today the large Marimo, with a diameter of more than 12 cm, exit only in Lake Akan in Japan. However, how Marimo grow and maintain their unique spherical shape in natural habitats remains unsolved. Here we show that Marimo are "polished" into spheres by the rotation induced by wind waves. Such a process enhances the water exchange between the interior and exterior of the Marimo, thereby recycling nutrients for growth. Our results provide an intriguing model of a physical environment interacting with biological processes in a self-sustaining ecosystem. We also demonstrate that Marimo have a spherical annual ring structure, and their growth rate is associated with ice cover. The balance between the ecology of Marimo and the water environment in Lake Akan is highly vulnerable and at risk of irreversible degradation. We must endeavor to rescue Marimo from the fate of a "canary in the coal mine" of global climate change.

Terrestrial loads of dissolved organic matter drive inter-annual carbon flux in subtropical lakes during times of drought.

Lentic ecosystems are important agents of local and global carbon cycling, but their contribution varies along gradients of dissolved organic matter (DOM) and productivity. We investigated how contrasting summer and autumn precipitation can shape annual and inter-annual variation in ecosystem carbon (C) flux (gross primary production (GPP), ecosystem respiration (ER), and CO2 efflux) in two subtropical lakes differing substantially in trophic state and water color. Instrumented buoys recorded time series of free-water DO, terrestrial DOM (tDOM), chlorophyll a, water temperature profiles, and meteorological measurements over five years (2009-2011 and 2014-2015). Reduced precipitation caused immediate and prolonged effects on C flux in both lakes. During the drought year (2014) GPP and ER declined by 60 to 80% and both lakes were either CO2 sinks or neutral. In the subsequent wet year (2015), GPP and ER increased by 40 to 110%, and both lakes shifted to strong net CO2 emitters. Higher ecosystem R resulted from larger GPP while higher tDOM contributed to a dramatic increase in dissolved inorganic carbon, which intensified CO2 emission in both lakes. C flux was more responsive in the clear mesotrophic lake, declining by approximately 40% in the cumulative GPP and ER, and increasing by >400% in CO2 efflux whereas changes in the oligotrophic colored lake were more modest (approximately 30% and 300% for metabolic declines and efflux increases, respectively). Temporal variation and magnitude of C flux were governed by tDOM-mediated changes in epilimnetic nutrient levels and hypolimnetic light availability. This study demonstrated terrestrial loads of DOM strongly influence the inter-annual response and sensitivity of ecosystem C flux to variation in inter-annual precipitation. Our findings have important implications for predicting the trend, magnitude, duration, and sensitivity of the response of C flux in subtropical lakes/reservoirs to future changes in precipitation patterns under altered climatic conditions.

Seasonal changes of the diurnal variation of precipitation in the upper Río Chagres basin, Panamá.

This study elucidated the characteristics of climatological seasonal changes in the diurnal variations of precipitation at four ground stations in the upper Río Chagres basin in the Panama Canal watershed. The seasonal changes differed among the stations, although they are located within an area of only 414 km2. Precipitation peaks in the early afternoon at 1500 local standard time (LST) were observed at all the stations. At Chamon, monthly-mean hourly precipitation at every hour exceeded 0.3 mm h-1 throughout November and December. The occurrence of morning precipitation in January and March distinguished the seasonal precipitation pattern at Esperanza from the pattern at the other stations. Analyses of the seasonal changes in the diurnal variation with pattern correlations and rotational empirical orthogonal functions grouped the stations into two pairs: no morning peak at Chico and Río Piedras in the downstream basin and morning peak at Chamon and Esperanza in the upstream basin.

Assessment of distributed hydrological model performance for simulation of multi-heavy-metal transport in Harrach River, Algeria.

This paper aims to assess the performance of a distributed hydrological model for simulating the transport of various heavy metals in rivers, to enhance and support environmental monitoring strategies for rivers in developing countries. In this context, we evaluated the performance of the Geophysical flow Circulation (GeoCIRC) model based on Object-Oriented Design (OOD) for the simulation of contamination from multiple heavy metals (Pb, Hg, Cr, and Zn) in Harrach River in Algeria. The results of the case study were in good agreement with the observations. Methodology for the assessment of data quality control and the improvement of monitoring procedures was proposed by using the hydrological model to simulate different scenarios. The GeoCIRC-model-based OOD allowed the prediction of the concentrations of heavy metals with minimal input data. Also, various heavy metals could be numerically treated simultaneously because the OOD increases the model's flexibility to allow the handling of many transportable materials. Therefore, the GeoCIRC model is a powerful tool for the monitoring of environmental contamination in rivers by various heavy metals.

A 29-year-old Woman with Recurrent Pregnancy-induced Hypertension Based on Vascular Compression of the Medulla Oblongata.

We present a report of a 29-year-old woman with non-dipper type refractory hypertension due to the vascular compression of the medulla oblongata. The patient was diagnosed with hypertension at 17 years of age and underwent emergency Caesarean section at 26 weeks of gestation during 2 pregnancies due to severe high blood pressure. We suspected medullary compression by the curved posterior inferior cerebellar artery as the cause of her intractable hypertension, and she underwent Jannetta's decompression surgery. After the surgery, her blood pressure swiftly decreased to almost within the normal range, and her blood pressure pattern normalized to dipper type.

Methylglyoxal as a prognostic factor in patients with chronic kidney disease.

AIM: Advanced glycation end products and their precursors cause vascular damage through oxidative stress. We investigated the hypothesis that methylglyoxal (MG), 3-deoxyglucosone (3-DG) and pentosidine influence outcomes of chronic kidney disease (CKD) patients. METHODS: We conducted a 3 years prospective observational study involving 150 outpatients at CKD stages 3-5. At enrolment, MG, 3-DG and pentosidine plasma concentrations were measured; patients were divided into tertiles according to the concentration of each substance. The primary endpoint was death, a cardiovascular event or end-stage renal disease. Survival analysis was performed using the Cox regression model. RESULTS: The patients' mean age was 62 ± 12 years, 97 were men, and 20 had diabetic nephropathy. The mean estimated glomerular filtration rate was 25.0 ± 12.1 mL/min per 1.73 m2 , which negatively correlated with MG but not with 3-DG and pentosidine. Forty-eight patients reached the primary endpoint. Compared with the lowest MG tertile, the hazard ratio for the primary endpoint was 7.57 (95% confidence interval (CI): 1.71-33.54) in the middle tertile and 27.00 (CI: 6.46-112.82) in the highest tertile. When adjusted for characteristics at baseline, the corresponding hazard ratio decreased to 2.09 (CI: 0.37-11.96) and 6.13 (CI: 0.97-38.82), but MG tertile remained an independent risk factor for the primary endpoint. However, 3-DG and pentosidine were not related to the primary outcome. CONCLUSION: Methylglyoxal has a close clinical association with CKD. Higher MG concentrations may contribute renal function deterioration in CKD. In CKD patients, MG concentration might be useful when determining the prognosis.

IgG4-unrelated type 1 autoimmune pancreatitis.

A 50-year-old male was referred to our hospital for the evaluation of hyperproteinemia. Fluorodeoxyglucose positron emission tomography revealed high fluorodeoxyglucose uptake in the pancreas, bilateral lacrimal glands, submandibular glands, parotid glands, bilateral pulmonary hilar lymph nodes, and kidneys. Laboratory data showed an elevation of hepatobiliary enzymes, renal dysfunction, and remarkably high immunoglobulin (Ig) G levels, without elevated serum IgG4. Abdominal computed tomography revealed swelling of the pancreatic head and bilateral kidneys. Endoscopic retrograde cholangiopancreatography showed an irregular narrowing of the main pancreatic duct in the pancreatic head and stricture of the lower common bile duct. Histological examination by endoscopic ultrasonography-guided fine-needle aspiration revealed findings of lymphoplasmacytic sclerosing pancreatitis without IgG4-positive plasma cells. Abnormal laboratory values and the swelling of several organs were improved by the treatment with steroids. The patient was diagnosed as having type 1 autoimmune pancreatitis (AIP) based on the International Consensus Diagnostic Criteria. Therefore, we encountered a case of compatible type 1 AIP without elevated levels of serum IgG4 or IgG4-positive plasma cells. This case suggests that AIP phenotypes are not always associated with IgG4.

High-capacity electrode materials for rechargeable lithium batteries: Li3NbO4-based system with cation-disordered rocksalt structure.

Rechargeable lithium batteries have rapidly risen to prominence as fundamental devices for green and sustainable energy development. Lithium batteries are now used as power sources for electric vehicles. However, materials innovations are still needed to satisfy the growing demand for increasing energy density of lithium batteries. In the past decade, lithium-excess compounds, Li2MeO3 (Me = Mn(4+), Ru(4+), etc.), have been extensively studied as high-capacity positive electrode materials. Although the origin as the high reversible capacity has been a debatable subject for a long time, recently it has been confirmed that charge compensation is partly achieved by solid-state redox of nonmetal anions (i.e., oxide ions), coupled with solid-state redox of transition metals, which is the basic theory used for classic lithium insertion materials, such as LiMeO2 (Me = Co(3+), Ni(3+), etc.). Herein, as a compound with further excess lithium contents, a cation-ordered rocksalt phase with lithium and pentavalent niobium ions, Li3NbO4, is first examined as the host structure of a new series of high-capacity positive electrode materials for rechargeable lithium batteries. Approximately 300 mAh ⋅ g(-1) of high-reversible capacity at 50 °C is experimentally observed, which partly originates from charge compensation by solid-state redox of oxide ions. It is proposed that such a charge compensation process by oxide ions is effectively stabilized by the presence of electrochemically inactive niobium ions. These results will contribute to the development of a new class of high-capacity electrode materials, potentially with further lithium enrichment (and fewer transition metals) in the close-packed framework structure with oxide ions.

Leptospirosis in the Tohoku region: re-emerging infectious disease.

Leptospirosis is a zoonotic and disaster-related infectious disease. It is mainly endemic in subtropical or tropical countries and has not been reported since 2009 in the Tohoku region (northern Japan), including the Yamagata and Miyagi Prefectures. However, we experienced four patients with leptospirosis in the Tohoku region from 2012 to 2014; three patients (#1-3) live in the agricultural areas of the Yamagata Prefecture and one patient (#4) was a visitor to the Miyagi Prefecture. Patient 1 (81-year-old female) is a villager, with a rat bite, while Patient 2 (77-year-old male) and Patient 3 (84-year-old female) are farmers and were infected probably during agriculture work. Patient 4 (40-year-old male US citizen) was infected while traveling in Thailand. They had chief complaint of fever, headache, and myalgia and showed manifestations of hyperbilirubinemia (mean, 4.35 mg/dL), thrombocytopenia and acute kidney injury (AKI). All patients were diagnosed by polymerase chain reaction using blood and/or urine samples and a microscopic agglutination test for the anti-Leptospira antibody. All the patients were treated with infused antibiotics, including minocycline. The patients underwent hemodialysis due to severe AKI (mean serum creatinine, 4.44 mg/dL), except for Patient 2 with the normal serum creatinine level (1.12 mg/dL). All the patients recovered and were discharged. The presence of the three patients in the Yamagata Prefecture implies that leptospirosis does re-emerge in the Tohoku region. Therefore, careful survey of the pathogen is necessary for febrile patients with AKI who engage in agriculture or have a recent history of travelling in subtropical or tropical countries.

The detection of Candida species in patients with halitosis.

To examine the effects of Candida on halitosis, the carrier state of Candida was examined in patients who made a visit with a chief complaint of halitosis. Methods. Subjects were 123 patients (42 males and 81 females) who visited our clinic, with a chief complaint of halitosis. Their average age was 45.8 years. To examine halitosis, an organoleptic test was conducted, and volatile sulfur compounds (VSCs) were measured by gas chromatography. Tongue-coating samples collected at the initial visit were cultured in CHROMagar Candida medium. The results of a Candida culture test, an organoleptic test, and VSC measurements were examined. Results. The male-to-female ratio of the patients was about 1 : 2. Patients with severe halitosis accounted for less than 20%. In the Candida culture test, the positive rate was about 25.2%, and C. albicans was the most frequently detected. Two kinds of Candida species were detected in 75% (6/8) of the strongly Candida-positive group. The VSC measurements were correlated with the Candida culture test results. Methyl mercaptan concentration was higher in the strongly C. albicans-positive group or the subjects having two kinds of Candida species. Conclusion. We suggest that imbalance of oral microbial community exists in the strongly Candida-positive group.

Pigment epithelium-derived factor as a new predictor of mortality among chronic kidney disease patients treated with hemodialysis.

Pigment epithelium-derived factor (PEDF) plays a protective role against atherosclerosis. Although serum PEDF level is increased in patients undergoing regular hemodialysis (HD), the pathophysiological role of PEDF in HD patients is unknown. We measured serum PEDF levels in 74 HD patients, and the association between serum PEDF and adverse events such as all-cause death and cardiovascular accident was evaluated prospectively. During the follow up of 45.4 ± 25.1 months, 24 patients (32.4%) experienced cardiovascular accident and 18 (24.3%) died. Significantly higher incidences of all-cause mortality and cardiovascular accident were observed in the lower PEDF group than in the higher PEDF group. After adjusting for propensity score calculated from multiple confounding factors (age, gender, systolic blood pressure, history of previous cardiovascular disease, level of carbonyl content, albumin, hemoglobin, total cholesterol, creatinine, C-reactive protein, dialysis vintage, Kt/V-urea and history of diabetes), lower predialytic PEDF was a significant risk factor for all-cause mortality (relative hazard = 6.060, standard error = 0.68467, P = 0.0085). Lower levels of predialytic PEDF was associated with an increased risk of mortality.