Electrochemistry in bicontinuous microemulsions derived from two immiscible electrolyte solutions for a membrane-free redox flow battery.

HYPOTHESES: Bicontinuous microemulsions (BMEs) have attracted attention as unique heterogeneous mixture for electrochemistry. An interface between two immiscible electrolyte solutions (ITIES) is an electrochemical system that straddles the interface between a saline and an organic solvent with a lipophilic electrolyte. Although most BMEs have been reported with nonpolar oils, such as toluene and fatty acids, it should be possible to construct a sponge-like three-dimensionally expanded ITIES comprising a BME phase. EXPERIMENTS: Dichloromethane (DCM)-water microemulsions stabilized by a surfactant were investigated in terms of the concentrations of co-surfactants and hydrophilic/lipophilic salts. A Winsor III microemulsion three-layer system, consisting of an upper saline phase, a middle BME phase, and a lower DCM phase, was prepared, and electrochemistry was conducted in each phase. FINDINGS: We found the conditions for ITIES-BME phases. Regardless of where the three electrodes were placed in the macroscopically heterogeneous three-layer system, electrochemistry was possible, as in a homogeneous electrolyte solution. This indicates that the anodic and cathodic reactions can be divided into two immiscible solution phases. A redox flow battery comprising a three-layer system with a BME as the middle phase was demonstrated, paving the way for applications such as electrolysis synthesis and secondary batteries.

Human periodontal ligament fibroblasts are the optimal cell source for induced pluripotent stem cells.

Among the various kinds of fibroblasts existing in the human body, the periodontal ligament (PDL) fibroblasts have been suggested as multipotent cells. Periodontal ligament fibroblasts are characterized by rapid turnover, a high remodeling capacity and remarkable capacity for renewal and repair. They also differentiate into osteoblasts and cementoblasts. We established iPS cells from human PDL fibroblasts by introducing the ES cell markers Oct3/4, Sox2, Nanog, Klf4 and Lin28 by retrovirus transduction, even without the oncogene c-Myc. The iPS cells established in this study expressed the ES cell markers and formed teratomas in SCID mice. The c-Myc expression level in the PDL fibroblasts was higher than that in the iPS cells by quantitative RT-PCR. Therefore, we have concluded that PDL fibroblasts could be an optimal cell source for iPS cells.

Evaluation of hybrid depth scanning for carbon-ion radiotherapy.

PURPOSE: In radiotherapy with a scanned carbon-ion beam, its Bragg peak is shifted along the depth direction either by inserting the range shifter plates or by changing the beam-extraction energy of a synchrotron. In the former technique (range shifter scanning: RS), the range shifter plates broaden the beam size and produce secondary fragments through nuclear reactions. In the latter technique (active-energy scanning: ES), it may take several seconds to change the beam energy depending on the synchrotron operation cycle, leading to a long treatment time. The authors propose a hybrid depth scan technique (hybrid scanning: HS), where several beam energies are used in conjunction with the range shifter plates for finer range shift. In this study, HS is evaluated from the viewpoints of dose distribution and treatment time. METHODS: Assuming realistic accelerator and beam-delivery systems, the authors performed computer simulations using GEANT4 Monte Carlo code for beam modeling and a treatment planning system to evaluate HS. Three target volumes with the same dimensions of 60 × 60 × 60 mm(3) were generated at depths of 45, 85, and 125 mm in water phantom, and uniform clinical dose was planned for these targets. The sizes of lateral dose falloff and the peak to plateau ratio defined as the ratio of the clinical dose averaged over the target to the clinical dose at the entrance as well as the treatment time were compared among the three depth scan techniques. RESULTS: The sizes of lateral dose falloffs at the center of SOBP are 11.4, 8.5, and 5.9 mm for the three targets in RS, while they are 5.7, 4.8, and 4.6 mm in ES and 6.6, 5.7, and 5.0 mm in HS, respectively. The peak to plateau ratios are 1.39, 1.96, and 2.15 in RS, while they are 1.48, 2.04, and 2.19 in ES and 1.47, 2.03, and 2.18 in HS, respectively. The treatment times are 128.7, 128.6, and 128.6 s in ES, while they are 61.2, 54.6, and 47.8 s in RS and 43.2, 44.1, and 44.7 s in HS, respectively. The multiple scattering and the nuclear reaction by range shifter degraded the beam qualities such as lateral dose falloff and peak to plateau ratio, which was especially pronounced for the shallow target in RS. The depth scan timing was limited by accelerator cycle in ES. That increased the treatment time by a few times. CONCLUSIONS: This study revealed that HS can provide dose distributions with steeper lateral dose falloffs and higher peak to plateau ratio comparing to RS and comparable to ES. In addition, the treatment time can be considerably reduced in HS compared to ES.

Patient handling system for carbon ion beam scanning therapy.

Our institution established a new treatment facility for carbon ion beam scanning therapy in 2010. The major advantages of scanning beam treatment compared to the passive beam treatment are the following: high dose conformation with less excessive dose to the normal tissues, no bolus compensator and patient collimator/multi-leaf collimator, better dose efficiency by reducing the number of scatters. The new facility was designed to solve several problems encountered in the existing facility, at which several thousand patients were treated over more than 15 years. Here, we introduce the patient handling system in the new treatment facility. The new facility incorporates three main systems, a scanning irradiation system (S-IR), treatment planning system (TPS), and patient handling system (PTH). The PTH covers a wide range of functions including imaging, geometrical/position accuracy including motion management (immobilization, robotic arm treatment bed), layout of the treatment room, treatment workflow, software, and others. The first clinical trials without respiratory gating have been successfully started. The PTH allows a reduction in patient stay in the treatment room to as few as 7 min. The PTH plays an important role in carbon ion beam scanning therapy at the new institution, particularly in the management of patient handling, application of image-guided therapy, and improvement of treatment workflow, and thereby allows substantially better treatment at minimum cost.

Development of digital reconstructed radiography software at new treatment facility for carbon-ion beam scanning of National Institute of Radiological Sciences.

To increase the accuracy of carbon ion beam scanning therapy, we have developed a graphical user interface-based digitally-reconstructed radiograph (DRR) software system for use in routine clinical practice at our center. The DRR software is used in particular scenarios in the new treatment facility to achieve the same level of geometrical accuracy at the treatment as at the imaging session. DRR calculation is implemented simply as the summation of CT image voxel values along the X-ray projection ray. Since we implemented graphics processing unit-based computation, the DRR images are calculated with a speed sufficient for the particular clinical practice requirements. Since high spatial resolution flat panel detector (FPD) images should be registered to the reference DRR images in patient setup process in any scenarios, the DRR images also needs higher spatial resolution close to that of FPD images. To overcome the limitation of the CT spatial resolution imposed by the CT voxel size, we applied image processing to improve the calculated DRR spatial resolution. The DRR software introduced here enabled patient positioning with sufficient accuracy for the implementation of carbon-ion beam scanning therapy at our center.

Mechanism of active eruption of molars in adolescent rats.

The mechanism of active eruption of molars was examined in 36 male adolescent Wistar rats. Histological, histochemical [tetracycline (TC) labelling and alkaline phosphatase (ALP) activity], and immunohistochemical [transforming growth factor (TGF)-ß1, -ß2, and -ß3] investigations were conducted of the rat molar areas. Real-time reverse transcription-polymerase chain reaction (RT-PCR) for mRNA of TGF-ß was performed on the periodontal ligament (PDL) dissected out by laser capture microdissection. TC labelling lines showed that a considerable amount of bone formation occurred in the alveolar crest region, apical region, and intraradicular septum, indicating that the maxillary molars had moved downward. However, the periodontal fibres revealed a regular arrangement (alveolar crest, horizontal and oblique fibres) during the experimental period. This suggests that new formation of alveolar crest fibres and rearrangement of the periodontal fibres occurred in the PDL. ALP activity was intense on the bone surface and in the PDL. TGF-ß1 was also detected in osteoblasts and fibroblasts but less so in cementoblasts. Real-time RT-PCR also demonstrated significant expression of mRNA of TGF-ß1 in the PDL, indicating that TGF-ß1 was involved in active eruption. These results suggest that active eruption occurs in adolescent rats and can be managed by TGF-ß1.

HSPA1A is upregulated in periodontal ligament at early stage of tooth movement in rats.

Heat shock proteins (HSPs) are molecular chaperones that maintain intracellular protein homeostasis and ensure survival of cells. Continuous orthodontic force on the tooth is considered to be a type of physical stress loaded to the periodontal ligament (PDL). However, little is known about the role of HSPs during tooth movement. This study was performed to examine the expression of HSPs in the PDL during tooth movement using laser microdissection, microarray analysis, real-time RT-PCR and immunohistochemistry. Gene expression of HSPA1A in the pressure zone of the PDL was higher during 6 h of tooth movement than in the control group. Expression of HSPA1A decreased with time. HSPA1A was also detected in the pressure zone of the PDL at the protein level 24 h after the initial tissue change. These results strongly suggest that expression of HSPA1A in the PDL during early stages of tooth movement is a critical factor for tissue reaction.

Moving target irradiation with fast rescanning and gating in particle therapy.

PURPOSE: In moving target irradiation with pencil beam scanning, the interplay effect between the target motion and the scanned beam is a problem because this effect causes over or under dosage in the target volume. To overcome this, we have studied rescanning using a gating technique. METHODS: A simulation and experimental study was carried out. In the experiment, we used the fast scanning system developed at the HIMAC to verify the validity of phase controlled rescanning method, in which the time for rescanning irradiation of each slice is matched to the gating duration. RESULTS: Simulation and experimental results showed that controlling the scan speed to match the respiration cycle with rescans can deliver the blurred dose distribution. In the comparison between the static measurements and the moving measurements with the phase controlled rescanning method, the dose difference was less than 2% for pinpoint chambers in the target volume. CONCLUSIONS: The simulation and experimental results demonstrated that the phase controlled rescanning method makes it possible to deliver the dose distribution close to the expected one. As an experimental result for 3D irradiation, it was estimated that blurring by the probability density function was not only for a lateral distribution, but also for a distal distribution, even in the lateral rescanning.

Performance of the NIRS fast scanning system for heavy-ion radiotherapy.

PURPOSE: A project to construct a new treatment facility, as an extension of the existing HIMAC facility, has been initiated for the further development of carbon-ion therapy at NIRS. This new treatment facility is equipped with a 3D irradiation system with pencil-beam scanning. The challenge of this project is to realize treatment of a moving target by scanning irradiation. To achieve fast rescanning within an acceptable irradiation time, the authors developed a fast scanning system. METHODS: In order to verify the validity of the design and to demonstrate the performance of the fast scanning prior to use in the new treatment facility, a new scanning-irradiation system was developed and installed into the existing HIMAC physics-experiment course. The authors made strong efforts to develop (1) the fast scanning magnet and its power supply, (2) the high-speed control system, and (3) the beam monitoring. The performance of the system including 3D dose conformation was tested by using the carbon beam from the HIMAC accelerator. RESULTS: The performance of the fast scanning system was verified by beam tests. Precision of the scanned beam position was less than +/-0.5 mm. By cooperating with the planning software, the authors verified the homogeneity of the delivered field within +/-3% for the 3D delivery. This system took only 20 s to deliver the physical dose of 1 Gy to a spherical target having a diameter of 60 mm with eight rescans. In this test, the average of the spot-staying time was considerably reduced to 154 micros, while the minimum staying time was 30 micros. CONCLUSIONS: As a result of this study, the authors verified that the new scanning delivery system can produce an accurate 3D dose distribution for the target volume in combination with the planning software.

Root resorption after experimental tooth movement using superelastic forces in the rat.

The purpose of this study was to assess the rate of root resorption in relation to different magnitudes of continuous force during experimental tooth movement using nickel-titanium (NiTi) alloy wire. Four force magnitudes of 0.8, 1.6, 4, and 8 g were applied to the upper first molars of 75 male Wistar rats (300-320 g, 10-week-old) for 1, 7, 14, 21, and 28 days and compared with a control group without an orthodontic appliance. Light microscopic images of the compressed periodontal ligament (PDL) were processed by computer, and the ratio of the root resorption lacuna length to root surface length without the lacuna was analysed and statistically compared using Tukey-Kramer multiple comparison honestly significant difference test. The experimental groups with 4 and 8 g force showed undermining bone resorption with degenerating tissue and marked root resorption, the 1.6 g group showed only root resorption, while the 0.8 g group was similar to the control. Comparison of the ratios showed that the 0.8 g group was similar to the control with no significant difference. The ratio on day 28 in the 1.6 g group was larger than that in the 0.8 g and control groups, while on days 14, 21, and 28, the ratios in the 4 and 8 g groups were larger than those in the control (P < 0.01); these two experimental groups showed the same significant differences. It is suggested that significant root resorption occurs when the force magnitude exceeds 1.6 g in the rat upper first molar during tipping tooth movement by continuous force, and the amount of root resorption increases with serial force magnitudes from 0.8 to 4 g.

Effect of External Magnetic Fields on Biological Effectiveness of Proton Beams.

PURPOSE: The purpose is to verify experimentally whether application of magnetic fields longitudinal and perpendicular to a proton beam alters the biological effectiveness of the radiation. METHODS AND MATERIALS: Proton beams with linear energy transfer of 1.1 and 3.3 keV/µm irradiated human cancer and normal cells under a longitudinal (perpendicular) magnetic field of BL (BP) = 0, 0.3, or 0.6 T. Cell survival curves were constructed to evaluate the effects of the magnetic fields on the biological effectiveness. The ratio of dose that would result in a survival fraction of 10% without the magnetic field Dwo to the dose with the magnetic field Dw, R10 = Dwo/Dw, was determined for each cell line and magnetic field. RESULTS: For cancer cells exposed to the 1.1- (3.3-) keV/µm proton beams, R10s were increased to 1.10 ± 0.07 (1.11 ± 0.07) and 1.11 ± 0.07 (1.12 ± 0.07) by the longitudinal magnetic fields of BL = 0.3 and 0.6 T, respectively. For normal cells, R10s were increased to 1.13 ± 0.06 (1.17 ± 0.06) and 1.17 ± 0.06 (1.30 ± 0.06) by the BLs. In contrast, R10s were not changed significantly from 1 by the perpendicular magnetic fields of BP = 0.3 and 0.6 T for both cancer and normal cells exposed to 1.1- and 3.3-keV/µm proton beams. CONCLUSIONS: The biological effectiveness of proton beams was significantly enhanced by longitudinal magnetic fields of BL = 0.3 and 0.6 T, whereas the biological effectiveness was not altered by perpendicular magnetic fields of the same strengths. This enhancement effect should be taken into account in magnetic resonance imaging guided proton therapy with a longitudinal magnetic field.

Field-size effect of physical doses in carbon-ion scanning using range shifter plates.

A field-size effect of physical doses was studied in scanning irradiation with carbon ions. For the target volumes of 60 x 60 x 80, 40 x 40 x 80, and 20 x 20 x 80 mm3, the doses along the beam axis within the spread-out Bragg peaks reduced to 99.4%, 98.2%, and 96.0% of the dose for the target of 80 x 80 x 80 mm3, respectively. The present study revealed that the observed reductions can be compensated for by adopting the three-Gaussian form of lateral dose distributions for the pencil beam model used in the treatment planning system. The parameters describing the form were determined through the irradiation experiments making flat concentric squared frames with a scanned carbon beam. Since utilizing the three-Gaussian model in the dose optimization loop is at present time consuming, the correction for the field-size effect should be implemented as a "predicted-dose scaling factor." The validity of this correction method was confirmed through the irradiation of a target of 20 x 20 x 80 mm3.

Morphological changes in the rat periodontal ligament and its vascularity after experimental tooth movement using superelastic forces.

The aim of this study was to statistically assess the morphological changes of the rat periodontal ligament (PDL) and its vascularity in relation to varied magnitudes of superelastic force in experimental tooth movement using nickel-titanium (NiTi) alloy wire. Forces of 0.8, 1.6, 4, 8, and 18 g were applied to the upper first molars of five groups of 10-week-old male Wistar rats (300-320 g) for 1, 7, 14, 21, and 28 days. A control group with no orthodontic appliance application was assessed in accordance with the five experimental periods. The specimens were observed under light microscopy, processed by computer imaging, and analysed statistically with Tukey's HSD non-parametric test. One day after the start of the experiment, a few blood vessels could be seen in the compressed PDL with forces of 0.8 and 1.6 g. The cross-sectional areas of blood vessels (CAV) and periodontal ligament (CAPL) in the experimental groups where a force of over 4 g was applied were significantly smaller than those where 0.8 and 1.6 g forces were used, and in the control group. On day 7, large CAV were seen in the 1.6, 4, and 8 g groups. On day 28, the 8 and 18 g groups showed significantly larger CAPL than the 0.8, 4 g, or control groups. The findings suggest that a light continuous force, under 1.6 g, maintains the vascular structure during experimental tooth movement. In contrast, a heavy continuous force over 4 g causes the vascular structure to be absent in the early stages of tooth movement, but a dynamic regeneration of the PDL with vascularity and expansion follows.

Influence of a perpendicular magnetic field on biological effectiveness of carbon-ion beams.

Purpose: Our previous study revealed that the application of a magnetic field longitudinal to a carbon-ion beam of 0.1 ≤ B//≤ 0.6 T enhances the biological effectiveness of the radiation. The purpose of this study is to experimentally verify whether the application of a magnetic field perpendicular to the beam also alters the biological effectiveness. Methods and materials: Most experimental conditions other than the magnetic field direction were the same as those used in the previous study to allow comparison of their results. Human cancer and normal cells were exposed to low (12 keV/µm) and high (50 keV/µm) linear energy transfer (LET) carbon-ion beams under the perpendicular magnetic fields of B⊥ = 0, 0.15, 0.3, or 0.6 T generated by a dipole magnet. The effects of the magnetic fields on the biological effectiveness were evaluated by clonogenic cell survival. Doses that would result in the survival of 10%, D10s, were determined for the exposures and analyzed using Student's t-tests. Results: For both cancer and normal cells treated by low- and high-LET carbon-ion beams, the D10s measured in the presence of the perpendicular magnetic fields of B⊥ ≥ 0.15 T were not statistically different (p ≫ .05) from the D10s measured in the absence of the magnetic fields, B⊥ = 0 T. Conclusions: Exposure of human cancer and normal cells to the perpendicular magnetic fields of B⊥ ≤ 0.6 T did not alter significantly the biological effectiveness of the carbon-ion beams, unlike the exposure to longitudinal magnetic fields of the same strength. Although the mechanisms underlying the observed results still require further exploration, these findings indicate that the influence of the magnetic field on biological effectiveness of the carbon-ion beam depends on the applied field direction with respect to the beam.

Compression and tension variably alter Osteoprotegerin expression via miR-3198 in periodontal ligament cells.

BACKGROUND: Osteoclasts play a critical role in bone resorption due to orthodontic tooth movement (OTM). In OTM, a force is exerted on the tooth, creating compression of the periodontal ligament (PDL) on one side of the tooth, and tension on the other side. In response to these mechanical stresses, the balance of receptor activator of nuclear-factor kappa-B ligand (RANKL) and osteoprotegerin (OPG) shifts to stimulate osteoclastogenesis. However, the mechanism of OPG expression in PDL cells under different mechanical stresses remains unclear. We hypothesized that compression and tension induce different microRNA (miRNA) expression profiles, which account for the difference in OPG expression in PDL cells. To study miRNA expression profiles resulting from OTM, compression force (2 g/cm2) or tension force (15% elongation) was applied to immortalized human PDL (HPL) cells for 24 h, and miRNA extracted. The miRNA expression in each sample was analyzed using a human miRNA microarray, and the changes of miRNA expression were confirmed by real-time RT-PCR. In addition, miR-3198 mimic and inhibitor were transfected into HPL cells, and OPG expression and production assessed. RESULTS: We found that certain miRNAs were expressed differentially under compression and tension. For instance, we observed that miR-572, - 663, - 575, - 3679-5p, UL70-3p, and - 3198 were upregulated only by compression. Real-time RT-PCR confirmed that compression induced miR-3198 expression, but tension reduced it, in HPL cells. Consistent with previous reports, OPG expression was reduced by compression and induced by tension, though RANKL was induced by both compression and tension. OPG expression was upregulated by miR-3198 inhibitor, and was reduced by miR-3198 mimic, in HPL cells. We observed that miR-3198 inhibitor rescued the compression-mediated downregulation of OPG. On the other hand, miR-3198 mimic reduced OPG expression under tension. However, RANKL expression was not affected by miR-3198 inhibitor or mimic. CONCLUSIONS: We conclude that miR-3198 is upregulated by compression and is downregulated by tension, suggesting that miR-3198 downregulates OPG expression in response to mechanical stress.

Effects of Magnetic Field Applied Just Before, During or Immediately after Carbon-Ion Beam Irradiation on its Biological Effectiveness.

Previously reported studies have revealed that the application of a magnetic field longitudinal to a carbon-ion beam enhances its biological effectiveness. Here we investigated how timing of the magnetic field application with respect to beam irradiation influenced this effect. Human cancer cells were exposed to carbon-ion beams with linear energy transfer (LET) of 12 and 50 keV/µm. The longitudinal magnetic field of 0.3 T was applied to the cells just before, during or immediately after the beam irradiation. The effects of the timing on the biological effectiveness were evaluated by cell survival. The biological effectiveness increased only if the magnetic field was applied during beam irradiation for both LETs.

Enhancement of biological effectiveness of carbon-ion beams by applying a longitudinal magnetic field.

Purpose: A magnetic field longitudinal to an ion beam will potentially affect the biological effectiveness of the radiation. The purpose of this study is to experimentally verify the significance of such effects. Methods and materials: Human cancer and normal cell lines were exposed to low (12 keV/µm) and high (50 keV/µm) linear energy transfer (LET) carbon-ion beams under the longitudinal magnetic fields of B// = 0, 0.1, 0.2, 0.3, or 0.6 T generated by a solenoid magnet. The effects of the magnetic fields on the biological effectiveness were evaluated by clonogenic cell survival. Doses that would result in a survival fraction of 10% (D10s) were determined for each cell line and magnetic field. Results: For cancer cells exposed to the low (high)-LET beams, D10 decreased from 5.2 (3.1) Gy at 0 T to 4.3 (2.4) Gy at 0.1 T, while no further decrease in D10 was observed for higher magnetic fields. For normal cells, decreases in D10 of comparable magnitudes were observed by applying the magnetic fields. Conclusions: Significant decreases in D10, i.e. significant enhancements of the biological effectiveness, were observed in both cancer and normal cells by applying longitudinal magnetic fields of B// ≥ 0.1 T. These effects were enhanced with LET. Further studies are required to figure out the mechanism underlying the observed results.

Delivery verification using 3D dose reconstruction based on fluorescence measurement in a carbon beam scanning irradiation system.

The authors have developed a method to reconstruct the 3D dose distribution in a particle beam scanning irradiation system. In this scheme, 3D dose distribution is reconstructed by using the measured images of fluence distribution, which are taken for each iso-energy slice (i.e., the unit of the depth scanning). A fluorescent screen with a CCD camera is used to measure the fluence distribution. This system was installed at the HIMAC experimental port and tested by using carbon ion beams. Since a maximum difference between the reconstructed dose and the ionization chamber measurement was around 5% in the target volume, this system can be useful for quick verification of 3D dose distribution.

Time-lapse observation of rat periodontal ligament during function and tooth movement, using microcomputed tomography.

The aim of this study was to observe the time-lapse changes in the rat periodontal ligament (PDL) during function and tooth movement. Under Nembutal anaesthesia, time-lapse changes in the thickness of the PDL of the first molars were investigated in five 12-week-old adolescent rats with microcomputed tomography. Three-dimensional (3D) images were reconstructed from the data. Histological observation was also performed, using undecalcified frozen sections of the maxillary first molar area. The PDL appeared as a radiolucent furrow on the 3D images. A slight change in the thickness of the PDL was observed 1 hour after initiation of orthodontic force loading, which became significant after 6 hours, with the appearance of pressure-tension zones during the tooth movement. These changes were more significant 3 days after orthodontic loading. Histological observation of the lingual cervical PDL (pressure zone) in nine 12- to 13-week-old rats demonstrated that the periodontal space had become narrow and the cellular elements appeared to be densely packed in the narrowed PDL 6 hours after orthodontic loading. Degeneration of tissues appeared 3 days after loading. Observation of the buccal cervical PDL (tension zone) demonstrated that the PDL was extended 6 hours after orthodontic force loading, and the extension continued for up to 3 days. Alkaline phosphatase activity was distributed in the PDL, except for the degenerating tissues in the pressure zone 3 days after loading. The results suggest that the periodontal reaction was initiated within 6 hours after orthodontic force loading, which was related to the structural changes of the PDL. The changes probably induced an early response in individual cells of the PDL.

Difference in normal limit values of nerve conduction parameters between Westerners and Japanese people might need to be considered when diagnosing diabetic polyneuropathy using a Point-of-Care Sural Nerve Conduction Device (NC-stat®/DPNCheck™).

AIM/INTRODUCTION: Studies on a novel point-of-care device for nerve conduction study called DPNCheck have been limited to Westerners. We aimed to clarify Japanese normal limits of nerve action potential amplitude (Amp) and conduction velocity by DPNCheck (investigation I), and the validity of DPNCheck to identify diabetic symmetric sensorimotor polyneuropathy (DSPN; investigation II). MATERIALS AND METHODS: For investigation I, 463 non-neuropathic Japanese participants underwent DPNCheck examinations. Regression formulas calculating the normal limits of Amp and conduction velocity (Japanese regression formulas [JRF]) were determined by quantile regression and then compared with regression formulas of individuals from the USA (USRF). For investigation II, in 92 Japanese diabetes patients, 'probable DSPN' was diagnosed and nerve conduction abnormalities (NCA1: one or more abnormalities, and NCA2: two abnormalities in Amp and conduction velocity) were determined. Validity of NCAs to identify 'probable DSPN' was evaluated by determining sensitivity, specificity, reproducibility (kappa-coefficient) and the area under the curve of receiver operating characteristic curves. RESULTS: For investigation I, JRF was different from USRF, and normal limits by JRF were higher than that of USRF. The prevalence of Amp abnormality calculated by JRF was significantly higher than that of USRF. For investigation II, the sensitivity, specificity and reproducibility of NCA1 and NCA2 judged from JRF were 85%, 86% and 0.57, and 43%, 100% and 0.56, respectively. These values of JRF were higher than those of USRF. The area under the curve of JRF (0.89) was larger than USRF (0.82). CONCLUSIONS: A significant difference in the normal limits of nerve conduction parameters by DPNCheck between Japanese and USA individuals was suggested. Validity to identify DSPN of NCAs might improve by changing the judgment criteria from USRF to JRF.