[Survey on the Number and Percentage of MR Safety Labeling Changed for Implantable Medical Devices].

PURPOSE: The purposes of this study were to investigate the number and percentage of items that changed magnetic resonance (MR) safety information labeling for implantable medical devices (IMDs) and to confirm the importance of checking the latest MR safety information database (117 types and 10031 items). METHODS: We investigated the number and percentage of MR safety labeling changed for IMDs in the MR safety information database as of December 2021 and August 2022. RESULTS: IMDs of MR Safety Unlabeled decreased from 4116 items (41.1%) to 859 items (8.6%). IMDs of MR Conditional increased from 4141 items (41.3%) to 5896 items (58.8%). CONCLUSIONS: Since there have been changes in the MR safety labeling for many IMDs, this study shows that it is important to confirm the latest MR safety information for IMDs.

Safe administration of sotrovimab to a COVID-19 patient with acute phase type 1 diabetes mellitus.

Type 1 diabetes mellitus (T1DM) and poor glycemic control are risk factors for severe coronavirus disease 2019 (COVID-19). Sotrovimab can treat mild-to-moderate COVID-19 in patients at a high risk of progression to severe COVID-19. However, its safety and efficacy in T1DM patients remain to be elucidated. We report the case of a 12-yr-old patient who was treated with sotrovimab for COVID-19 immediately after treatment for diabetic ketoacidosis (DKA) due to new-onset T1DM. He presented with nausea and sore throat and was diagnosed with severe DKA and COVID-19. A productive cough and sputum developed after admission. On the 3rd day of admission, the DKA resolved, and sotrovimab was administered to prevent exacerbation of COVID-19. Although the blood glucose levels increased after the administration of sotrobimab, there was no recurrence of DKA. Hyperglycemia may be a sotrovimab-related adverse event in T1DM patients. Nevertheless, the benefits of sotrovimab treatment may far outweigh the potential risks. Thus, sotrovimab was considered safe for patients with T1DM immediately after treatment of severe DKA.

Immunoglobulin G4-related disease diagnosed by prostate biopsy: a case report.

BACKGROUND: Immunoglobulin G4-related disease is characterized by swelling of various organs throughout the body and nodules/hypertrophic lesions. However, its cause remains unknown. We report a case of immunoglobulin G4-related disease that was diagnosed based on the histopathological findings of prostate biopsy. CASE PRESENTATION: A 72-year-old Japanese man had been treated by a nearby doctor for hypertension, but subsequently developed lower urinary tract symptoms and was prescribed an α1 blocker for 1 year. However, the patient was subsequently referred to our department because his symptoms did not improve. Prostate-specific antigen was 1.258 ng/ml; however, the nodule was palpable in the right lobe on digital rectal examination, and magnetic resonance imaging suggested Prostate Imaging and Reporting and Data System category 3. Therefore, transrectal prostate needle biopsy (12 locations) under ultrasound was performed. Histopathological examination revealed no malignant findings, although infiltration of lymphocytes and plasma cells, and partial fibrosis were observed. No remarkable findings of obstructive phlebitis were observed. Immunoglobulin G4-related disease was suspected, and immunoglobulin and immunoglobulin G4 immunostaining was performed. Immunoglobulin G4 positive plasma cells were observed in a wide range, immunoglobulin G4 positive cells were noted at > 10 per high-power field, and the immunoglobulin G4 positive/immunoglobulin G positive cell ratio was > 40%. Serum immunoglobulin G4 levels were high at 1600 mg/dl. Enhanced abdominal computed tomography findings suggested periaortitis. Additionally, multiple lymphadenopathies were observed around the abdominal aorta. The patient was accordingly diagnosed with immunoglobulin G4-related disease definite, diagnosis group (definite). We proposed steroid treatment for periaortic soft tissue lesions and lower urinary tract symptoms; however, the patient was refused treatment. A computed tomography scan 6 months after diagnosis revealed no changes in the soft tissue lesions around the aorta. Follow-up computed tomography examinations will be performed every 6 months. CONCLUSION: If immunoglobulin G4-related disease is suspected and a highly invasive examination is required for histopathological diagnosis, this can be performed by a relatively minimally invasive prostate biopsy for patients with lower urinary tract symptoms. Further evidence is needed to choose an optimal candidate for prostate biopsy for lower urinary tract symptoms patients with suspicion of immunoglobulin G4-related disease. For patients with lower urinary tract symptoms with immunoglobulin G4-related disease or a history, performing a prostate biopsy may avoid unnecessary treatment. However, if steroid therapy is ineffective, surgical treatment should be considered.

Chemical synthesis and functional evaluation of the crayfish insulin-like androgenic gland factor.

Insulin-like androgenic gland factor (IAG) from the marbled crayfish Procambarus virginalis is an insulin-like heterodimeric peptide composed of A and B chains and has an Asn-linked glycan at the B chain. IAG is considered to be a male sex hormone inducing the sex differentiation to male in decapod crustacean, although there is no report on the function of IAG peptide in vivo. In order to characterize P. virginalis IAG, we chemically synthesized it and evaluated its biological function in vivo. A and B chains were prepared by the ordinary solid-phase peptide synthesis, and three disulfide bonds were formed regioselectively by dimethyl sulfoxide oxidation, pyridylsulfenyl-directed thiolysis and iodine oxidation reactions. An IAG disulfide isomer was also prepared by the same manner. Circular dichroism spectral analysis revealed that the disulfide bond arrangement affected the peptide conformation, which was similar to the other insulin-family peptides analyzed so far. On the other hand, the glycan moiety attached at the B chain had no effect on the peptide secondary structure. Injection of the synthetic IAG and its disulfide isomer to female crayfish did not induce male characteristics on the external morphology, but both peptides suppressed the oocyte maturation in vivo. These results suggest that IAG has a pivotal role on the suppression of female secondary sex characteristics.

One-Pot γ-Lactonization of Homopropargyl Alcohols via Intramolecular Ketene Trapping.

A one-pot γ-lactonization of homopropargyl alcohols via an alkyne deprotonation/boronation/oxidation sequence has been developed. Oxidation of the generated alkynyl boronate affords the corresponding ketene intermediate, which is trapped by the adjacent hydroxy group to furnish the γ-lactone. We have optimized the conditions as well as examined the substrate scope and synthetic applications of this efficient one-pot lactonization.

Nationwide in-hospital mortality following major fractures among hemodialysis patients and the general population: An observational cohort study.

BACKGROUNDS: End-stage kidney disease (ESKD) is associated with increased risk of fracture and subsequent morbidity and mortality. However, fracture site-specific mortality in ESKD patients have yet to be elucidated in comparison with the general population. METHODS: In this population-based cohort derived from the Diagnosis Procedure Combination database of Japan from 2012 to 2014, we included 9320 ESKD patients undergoing hemodialysis and 547,726 patients without ESKD who were hospitalized for five major fractures, including hip (proximal femur), spine, forearm, upper arm, and leg (distal femur and proximal tibia). Overall and site-specific risks of in-hospital death were determined by logistic regression models. RESULTS: The age- and sex-adjusted mortality rates were 4.91% (95% confidence interval [CI], 4.46-5.37) and 1.02% (95% CI, 0.99-1.06) in the hemodialysis and general population groups, respectively. The multivariate odds ratio (OR) of death in hemodialysis patients versus the general population was 2.48 (95% CI, 2.25-2.74) for overall fractures, and was particularly high for a subgroup of upper arm fracture (OR 4.82, 95% CI, 3.19-7.28). The site-specific odds of death (95% CI) among hip, spine, forearm, upper arm, and leg (reference) fractures were 1.77 (0.98-3.18), 1.48 (0.79-2.75), 0.19 (0.04-0.86), and 2.01 (1.01-4.01) in hemodialysis patients, and 1.28 (1.13-1.45), 1.00 (0.88-1.14), 0.13 (0.10-0.17), and 0.83 (0.70-0.97) in the general population, respectively. CONCLUSION: Hemodialysis patients experienced a 4.8-fold higher mortality rate after fractures than the general population. Mortality after upper arm fracture was specifically high in patients on hemodialysis, likely due to the involvement of vascular access located on the fractured arm.

Development of a Searchable System to Confirm MR Imaging Safety Information for Implantable Medical Devices.

The purpose of this study was to develop a searchable system to confirm magnetic resonance (MR) safety information of implantable medical devices (IMDs) to safely perform magnetic resonance imaging examinations. We labeled MR safety information for IMDs based on package insert descriptions and then categorized allowed MR conditions for IMDs. Finally, a searchable system was developed to use the database via the internet. This system enables efficient and accurate confirmation of MR safety information for IMDs.

Persistent left superior vena cava with thrombus formed in the catheter lumen 4 h after dialysis catheter placed.

Persistent left superior vena cava (PLSVC) is one of the most common thoracic venous anomaly and rarely noticed, because it is asymptomatic. However, for nephrologists, it is frequent enough to be encountered while placing hemodialysis catheters through the jugular vein. We report the case of 66-year-old patient with PLSVC presenting intrinsic thrombosis formation 4 h after dialysis catheter placed. Dialysis catheter was placed in the left internal jugular vein without resistance and any complication. PLSVC was detected after dialysis catheter insertion. We decided to remove the catheter, because the patient has other veins in which the catheter can be placed. When it was removed 4 h after catheter placing, thrombus was recognized in the catheter lumen. Transesophageal echocardiography was performed and no thrombus formation was observed in the heart chamber. For patients with PLSVC, if there were other veins in which the catheter can be placed, catheter replacement should be considered.

Different combinations of Notch ligands and receptors regulate V2 interneuron progenitor proliferation and V2a/V2b cell fate determination.

The broad diversity of neurons is vital to neuronal functions. During vertebrate development, the spinal cord is a site of sensory and motor tasks coordinated by interneurons and the ongoing neurogenesis. In the spinal cord, V2-interneuron (V2-IN) progenitors (p2) develop into excitatory V2a-INs and inhibitory V2b-INs. The balance of these two types of interneurons requires precise control in the number and timing of their production. Here, using zebrafish embryos with altered Notch signaling, we show that different combinations of Notch ligands and receptors regulate two functions: the maintenance of p2 progenitor cells and the V2a/V2b cell fate decision in V2-IN development. Two ligands, DeltaA and DeltaD, and three receptors, Notch1a, Notch1b, and Notch3 redundantly contribute to p2 progenitor maintenance. On the other hand, DeltaA, DeltaC, and Notch1a mainly contribute to the V2a/V2b cell fate determination. A ubiquitin ligase Mib, which activates Notch ligands, acts in both functions through its activation of DeltaA, DeltaC, and DeltaD. Moreover, p2 progenitor maintenance and V2a/V2b fate determination are not distinct temporal processes, but occur within the same time frame during development. In conclusion, V2-IN cell progenitor proliferation and V2a/V2b cell fate determination involve signaling through different sets of Notch ligand-receptor combinations that occur concurrently during development in zebrafish.

Amounts and compositional analysis of glycosaminoglycans in the tissue of fish.

We isolated GAGs from the inedible parts; head, skin, internal organs, fins, scales and spine, of atlantic mackerel (Scomber scombrus), japanese jack mackerel (Trachurus japonicus), pacific bluefin tuna (Thunnus orientalis), yellowfin sole (Limanda aspera), broadbanded thornyhead (Sebastolobus macrochir), golden threadfin bream (Nemipterus virgatus), and nile tilapia (Oreochromis niloticus). We also investigated deep-sea fish, eelpouts (Bothrocara hollandi, Lycodes toyamensis, and Lycodes nakamurae), rough snailfish (Careproctus trachysoma), and squids (Watasenia scintillans, Enoploteuthis chunii, and Berryteuthis magister). Enzymatic digestion of the GAGs enabled a compositional analysis of CS, DS, and HA including the sulfation patterns of CS and DS, as well as the amount of each GAG. The molecular weights and distributions of these GAGs were also examined. The amounts of GAGs contained in the tissues and CS/DS ratios differed remarkably among the fish. The dorsal fin of the yellowfin sole contained more than 1300mg of CS-DS per 100g of defatted-dry tissue. Although the fish generally contained A-type rich CS-DS, bottom fish and deep-sea fish often possessed C-type CS-DS in larger ratios. Squid characteristically had E-type CS-DS which was normally less common in fish except in cartilaginous fish. These analytical results had no relation to the biological classification.

[Investigation of pain assessment trends among residents in Japanese long-term care facilities].

AIM: Pain management is vital for both the maintenance and improvement of the quality of life of residents, in Japanese long-term care facilities. However, few studies examining pain assessment in older populations have been published. The purpose of this study is to investigate the actual conditions related to pain assessment of residents by nurses in Japanese long-term care facilities. Included in this investigation are the actual frequency of pain assessments, the nurses own perceptions of the pain assessment of their residents, whether or not nurses have undertaken any training related to pain assessment, and the need for a pain assessment training period. METHODS: A questionnaire was distributed to 487 nurses in 60 Japanese long-term care facilities. RESULTS: A total of 443 valid responses were collected. The data revealed that 74.7% of these nurses lack the confidence to suitably assess the residents' pain and 44.2% of these nurses do not conduct pain assessments on a regular basis. Additionally, only 9.9% of the nurses surveyed have participated in seminars concerning pain in older people. CONCLUSION: The results indicate that over 70% of nurses lack the confidence to suitably assess their residents' pain. In addition, the number of residents who cannot self-report their pain because of cognitive impairment is increasing. Therefore, it is necessary to develop new approaches which provide nurses with sufficient knowledge and confidence to conduct appropriate pain assessments on their residents.

Photopromoted Ru-catalyzed asymmetric aerobic sulfide oxidation and epoxidation using water as a proton transfer mediator.

Ru(NO)-salen complexes were found to catalyze asymmetric aerobic oxygen atom transfer reactions such as sulfide oxidation and epoxidation in the presence of water under visible light irradiation at room temperature. Oxidation of sulfides including alkyl aryl sulfides and 2-substituted 1,3-dithianes using complex 2 as the catalyst proceeded with moderate to high enantioselectivity of up to 98% ee, and epoxidation of conjugated olefins using complex 3 as the catalyst proceeded with good to high enantioselectivity of 76-92% ee. Unlike biological oxygen atom transfer reactions that need a proton and electron transfer system, this aerobic oxygen atom transfer reaction requires neither such a system nor a sacrificial reductant. Although the mechanism of this oxidation has not been completely clarified, some experimental results support the notion that an aqua ligand coordinated with the ruthenium ion serves as a proton transfer agent for the oxygen activation process, and it is recycled and used as the proton transfer mediator during the process. Thus, we have achieved catalytic asymmetric oxygen atom transfer reaction using molecular oxygen that can be carried out under ambient conditions.