Sphingobium yanoikuyae Bacteremia, Japan.

We report a case of Sphingobium yanoikuyae bacteremia in an 89-year-old patient in Japan. No standard antimicrobial regimen has been established for S. yanoikuyae infections. However, ceftriaxone and ceftazidime treatments were effective in this case. Increased antimicrobial susceptibility data are needed to establish appropriate treatments for S. yanoikuyae.

Polymethylmethacrylate Membrane Dialyzer: Historic but Modern.

Polymethylmethacrylate (PMMA) hollow fiber membranes are one of the synthetic polymer hollow fiber membranes used to the hollow fiber artificial kidney. A PMMA hollow fiber membrane (PMMA membrane) has unique properties including the uniform structure and the adsorption property. Hemodialyzers using PMMA membranes, Filtryzer®, were approved in Japan in 1977 and have been used worldwide for over 40 years and so is a historical hemodialyzer.Various types in Filtryzer® having different pore sizes are developed and used in the clinical field. Filtryzer® B3 is a low-flux dialyzer. Filtryzer® BK has three types having different pore sizes, and above all, BK-F has the largest pores in the Filtryzer® series. Filtryzer® BG has a more uniform membrane structure by using weak anionic polymers compared with the earlier Filtryzer® series to remove ß2-MG more. Filtryzer® NF is the latest Filtryzer® series and was developed as a dialyzer having improved antithrombogenicity compared with previous models and having protein adsorption property as the same with them. There have been many reports concerning Filtryzer® including improvement of patients' symptoms such as pruritus and nutrition on the advantages for dialysis patients. Although PMMA membranes are historic dialysis tools used for over 40 years, they are also modern dialysis membranes that have been updated to respond to dialysis therapy at those time.

Pre-Reconstruction Processing with the Cycle-Consist Generative Adversarial Network Combined with Attention Gate to Improve Image Quality in Digital Breast Tomosynthesis.

The current study proposed and evaluated "residual squeeze and excitation attention gate" (rSEAG), a novel network that can improve image quality by reducing distortion attributed to artifacts. This method was established by modifying the Cycle Generative Adversarial Network (cycleGAN)-based generator network using projection data for pre-reconstruction processing in digital breast tomosynthesis. Residual squeeze and excitation were installed in the bridge of the generator network, and the attention gate was installed in the skip connection between the encoder and decoder. Based on the radiation dose index (exposure index and division index) incident on the detector, the cases approved by the ethics committee and used for the study were classified as reference (675 projection images) and object (675 projection images). For the cases, unsupervised data containing a mixture of cases with and without masses were used. The cases were trained using cycleGAN with rSEAG and the conventional networks (ResUNet and U-Net). For testing, predictive processing was performed on cases (60 projection images) that were not used for learning. Images were generated using filtered backprojection reconstruction (kernel: Ramachandran and Lakshminarayanan) from projection data for testing data and without pre-reconstruction processing data (evaluation: in-focus plane). The distortion was evaluated using perception-based image quality evaluation (PIQE) analysis, texture analysis (feature: "Homogeneity" and "Contrast"), and a statistical model with a Gumbel distribution. PIQE has a low rSEAG value. Texture analysis showed that rSEAG and a network without cycleGAN were similar in terms of the "Contrast" feature. In dense breasts, ResUNet had the lowest "Contrast" feature and U-Net had differences between cases. The maximal variations in the Gumbel plot, rSEAG reduced the high-frequency ripple artifacts. In this study, rSEAG could improve distortion and reduce ripple artifacts.

Involvement of the parasympathetic nervous system in the initiation of regeneration of pancreatic ß-cells.

The mechanism that initiates regeneration of pancreatic ß-cells is not clear at present. The vagal nerve is implicated in the regulation of gastrointestinal functions, glucose metabolism and proliferation of pancreatic ß-cells under physiological conditions. To elucidate the triggering mechanism of the regeneration of pancreatic ß-cells, we examined the involvement of the vagal nerve. To this end, we employed a rat pancreatic duct ligation (DL) model, in which profound ß-cell neogenesis and ß-cell proliferation were observed within a week. We administered atropine to block the vagal nerve. Administration of atropine inhibited proliferation of ß-cells in both islets and islet-like cell clusters (ICC), without affecting ductal cell proliferation in the ligated pancreas. The numbers of PDX-1 and MafB-positive cells in or attaching to the ducts were significantly reduced by atropine. MafB/glucagon and MafB/insulin double-positive cells were also decreased by atropine. Finally, atropine reduced the number of MafA-positive ductal cells, all of which were positive for insulin, by 50% on day 5. These results strongly suggest that the vagal nerve is involved in ß-cell proliferation, induction of endocrine progenitors and neogenesis of α- and ß-cells.

Essential roles of clinical nurse instructors in Japan: a Delphi study.

In Japan, the clinical nurse instructor is a staff nurse who teaches in clinical practicums. However, there is no consensus on the essential roles that clinical nurse instructors are expected to perform. We conducted a three-round Delphi survey to clarify the essential roles of the clinical nurse instructor in clinical practicums in undergraduate nursing education. The participants were an expert panel of 48 professionals in nursing education and clinical practicums, who rated the importance of 58 role items that were established through a literature review and pilot survey. Thirty one of these items were identified as essential roles, based on agreement of 80% or more of respondents. Further investigation revealed nine of the 31 items to be core roles, defined as the minimum essential roles that must be performed by clinical nurse instructors, however busy they become. The nine core roles are related to proper preparation for the clinical practicum, patient safety, and coordination with the nursing school faculty. It is important for the nursing school faculty to support and work in cooperation with clinical nurse instructors to help them fulfill these roles.

[Arbekacin sulfate concentrations in peripheral lymph and in serum after intravenous injection: report of four cases].

Antibiotic levels in serum are commonly used to guide antibiotic therapy. The antibiotic levels in peripheral lymph are a more accurate reflection of the efficacy of antibiotic penetration into the tissues of patients with complicated skin and soft-tissue infections. The pharmacokinetics of arbekacin sulfate (ABK) in peripheral lymph after systemic administration has not been studied. Four patients (cases 1-4) with skin and soft-tissue infections (average age 74.3 years, range 54 to 85) received 200 mg of ABK intravenously once a day either by slow bolus (5min.) or by slow infusion (60 min.). The serum concentrations collected 60min. after the start ofABK infusion (C60) and the peripheral lymph concentrations of ABK were measured. 55 min. after initiation of slow 5-min. bolus (case 1), C60 was 32.5l microg/mL. The daily average concentration of ABK in peripheral lymph after slow bolus (case 1) was 14.84 microg/mL. The ratio peripheral lymph on daily average/C60 was 0.46. Patients (cases 2, 3 and 4) had been intravenously administered ABK at an infusion time of 60 min. C60 (cases 2, 3 and 4) were 14.10, 11.48 and 8.26 microg/mL, respectively. The daily average concentration of ABK in peripheral lymph after slow infusion (case 2) was 7.80 microg/mL. The average concentrations of ABK in peripheral lymph during the third eight hours since slow infusion (cases 3 and 4) were 0.72 and 2.23 microg/mL. The ratio peripheral lymph/C60 was 0.55, 0.06 and 0.27, respectively. An increase in the serum peak concentration of ABK may lead to considerable elevation of the concentration of ABK in peripheral lymph.

Extracellular matrix modulates insulin production during differentiation of AR42J cells: functional role of Pax6 transcription factor.

Extracellular matrix (ECM) modulates differentiation of pancreatic ß-cells during development. However, the mechanism by which ECM proteins modulate differentiation is not totally clear. We investigated the effect of ECM proteins on differentiation ß-cells in vitro. We investigated the effect of basement membrane ECM on differentiation of AR42J cells and rat ductal cells. First, we examined the effect of reconstituted basement membrane, Matrigel on differentiation of AR42J cells induced by activin and betacellulin. Matrigel augmented insulin production and increased the expression of GLUT2, SUR1, and glucokinase. Among various transcription factors investigated, Matrigel markedly upregulated the expression of Pax6. When Pax6 was overexpressed in cells treated with activin and betacellulin, the expression of insulin was upregulated. Conversely, knockdown of Pax6 significantly reduced the insulin expression in cells cultured on Matrigel. The effects of Matrigel on insulin-production and induction of Pax6 were reproduced partially by laminin-1, a major component of Matrigel, and inhibited by anti-integrin-ß1 antibody. Matrigel also enhanced the activation of p38 mitogen-activated kinase induced by activin and betacellulin, which was inhibited by anti-ß1 antibody. Finally, the effect of Matrigel on differentiation was reproduced in rat cultured ductal cells, and Matrigel also increased the expression of Pax6. These results indicate that basement membrane ECM augments differentiation of pancreatic progenitor cells to insulin-secreting cells by upregulating the expression of Pax6. .

Cellulitis with persistent bacteremia caused by Campylobacter lari in a patient with mantle-cell lymphoma.

Campylobacter lari is an organism occasionally isolated in humans but rarely causes bacteremia. We report the first case of cellulitis with bacteremia due to C. lari in a patient undergoing mantle-cell lymphoma. A 51-year-old man presented with a two-month history of fever and bilateral leg pain and redness. Despite oral ciprofloxacin administration, his symptoms had not improved. The blood culture sample in the anaerobic bottle yielded positive results and C. lari was identified by mass spectrometry. The bacteremia did not initially respond to oral azithromycin but responded to intravenous meropenem and amikacin for five days followed by oral minocycline. This report indicates that C. lari bacteremia may be treated with oral minocycline following short-term intravenous antimicrobial therapy even among patients undergoing hematological malignancies.

Proxy evaluation of dignity expectations and satisfaction of older patients with dementia by family members and nurses.

AIM: Develop a proxy evaluation questionnaire for patients' family members and nurses to evaluate dignity expectations and satisfaction of patients with dementia. DESIGN: Cross-sectional study. METHOD: A proxy questionnaire draft was prepared with 30 items on expectations for dignity and 23 items on satisfaction with dignity. And administered to three paired groups: 81 older patients with intact cognitive function, 75 family members, and 77 nurses. RESULTS: 18 of 30 items and 21 of 23 were correlated between patients and their family members' responses on dignity expectations and satisfaction, respectively. When limited to nurses with clinical experience of ≥20 years, there were significant correlations between patients' and nurses' responses (p < .05). Exploratory factor analysis of patient's responses to significantly correlated items extracted 3 factors with 13 items of expectations for dignity but no factors of satisfaction with dignity. Using a questionnaire provides insight for proxy evaluation of expectations for dignity.

Identification of differentially expressed genes during proliferative response of the liver induced by follistatin.

The liver mass is controlled strictly and maintained constant in normal and pathological situations. An exception is observed after an administration of follistatin, which induces proliferation in intact liver. In the present study, we identified genes differentially expressed in proliferating liver caused by overexpression of follistatin-288. Adenovirus vector encoding follistatin-288 (Ad-FS) or green fluorescent protein was injected intraperitoneally in rats. Changes in the liver weight, expression of follistatin and nuclear bromodeoxyuridine labeling were measured. Samples taken on day 5 and day 7 were used to prepare RNA for microarray analysis. The expression of the genes was confirmed by quantitative reverse transcriptase PCR. After the injection of Ad-FS follistatin mRNA peaked on day 3, which was followed by progressive increase in the protein expression. A peak in bromodeoxyuridine labeling was observed on day 7. Microarray data from day 5 and day 7 samples showed that follistatin modified the expression of 907 genes, of which 575 were overexpressed and 332 were downregulated taking into consideration a two fold change reference compared to control rats. In particular, significant increases and time related changes in gene expression after the Ad-FS injection were found in nine genes including growth differentiation factor 15 and fibroblast growth factor 21. This study confirmed that follistatin induced proliferation in intact liver, and identified candidate genes involved in follistatin-induced liver cell growth.

Administration of conophylline and betacellulin-delta4 increases the beta-cell mass in neonatal streptozotocin-treated rats.

The present study was conducted to examine the effect of administration of conophylline (CnP) and betacellulindelta4 (BTCdelta4) on the beta-cell mass in neonatal streptozotocin-treated rats (neonatal STZ rats). STZ (100 microg/g) was injected into neonatal rats, and then CnP (2 microg/g) and/or BTCdelta4 (200 pmol/g) were administered to neonatal STZ rats for 1 week. The plasma glucose concentration was monitored, and an intraperitoneal glucose tolerance test (ipGTT) was performed on day 8 and at 8 weeks after the STZ injection. In neonatal STZ rats treated with control solution (S group), the plasma glucose concentration increased for several days after the STZ injection, returned to nearly normal levels, and then increased gradually after six weeks of age. Eight weeks after the STZ-injection, the plasma glucose concentration was increased significantly compared to that of normal rats. The glucose response to ipGTT was significantly reduced in neonatal STZ rats treated with CnP (CnP group), BTCdelta4 (delta4 group) and CnP+BTCdelta4 (CnP+delta4 group). The beta-cell mass and the insulin content of the pancreas were significantly increased in the CnP group and delta4 group. The effect of CnP+delta4 was greater than that of CnP alone or BTCdelta4 alone. CnP+BTCdelta4 significantly increased the number of PDX-1-positive ductal cells and the number of insulin/BrdU double-positive ductal cells. These results indicate the efficacy of CnP and BTCdelta4 in increasing the beta-cells mass of neonatal STZ-treated rats.

A simple method to induce differentiation of murine bone marrow mesenchymal cells to insulin-producing cells using conophylline and betacellulin-delta4.

The present study was conducted to establish a method to induce differentiation of bone marrow (MB)-derived mesenchymal cells into insulin-producing cells. When mouse BM-derived mesenchymal cells were cultured for 60 days in medium containing 10% fetal calf serum and 25 mM glucose, they expressed insulin. Addition of activin A and betacellulin (BTC) accelerated differentiation, and immunoreactive insulin was detected 14 days after the treatment. Insulin-containing secretory granules were observed in differentiated cells by electron microscopy. Treatment of BM-derived mesenchymal cells with conophylline (CnP) and BTC-delta4 further accelerated differentiation, and mRNA for insulin was detected 5 to 7 days after the treatment. Mesencymal cells treated with CnP and BTC-delta4 responded to a high concentration of glucose and secreted mature insulin. When these cells were transplanted into streptozotocin-treated mice, they markedly reduced the plasma glucose concentration, and the effect continued for at least 4 weeks. These results indicate an efficacy of the combination of CnP and BTC-delta4 in inducing differentiation of BM-derived mesenchymal cells into insulin-producing cells.

Triggering of insulin release by a combination of cAMP signal and nutrients: an ATP-sensitive K+ channel-independent phenomenon.

Nutrient augmentation of Ca(2+)-triggered insulin release occurs in an ATP-sensitive K(+) (K(ATP)) channel--independent manner. Here, using rat islets, we explored the possibility of the K(ATP) channel-independent nutrient triggering of insulin release. In the presence of 250 micromol/l diazoxide, simultaneous application of forskolin and 16.7 mmol/l glucose strongly stimulated insulin release: fourfold and eightfold increases with 1 and 30 micromol/l forskolin, respectively. alpha-Ketoisocaproate (KIC) and 3-isobutylmethylxanthine (IBMX) could be used in place of glucose and forskolin, respectively, to trigger insulin release in the presence of diazoxide. Triggering of insulin release by a combination of nutrients and forskolin was not attenuated by 10 micromol/l nifedipine (a blocker of voltage-dependent Ca(2+) channels) and 2 micromol/l thapsigargin (an inhibitor of intracellular Ca(2+)-ATPase), ascertaining independence of this phenomenon from Ca(2+) entry and from intracellular Ca(2+) liberation. As anticipated, the action of glucose and KIC was greatly (>80%) suppressed by inhibition of mitochondrial metabolism by 2 mmol/l sodium azide (NaN(3)). A combination of palmitate and dimethyl glutamate (a cell-permeable glutamate donor), but not either one alone, weakly but unequivocally triggered insulin release when applied simultaneously with forskolin. In this case, however, mitochondrial poisoning by azide was without effect. The finding suggests that a combination of induced palmitoylation and cytosolic glutamate accumulation partially reconstituted signaling beyond mitochondrial metabolism in the beta-cell upon glucose stimulation. In conclusion, a combination of cAMP signal and nutrients potently triggers insulin release under full activation of the K(ATP) channel, indicating the multiplicity of driving force for insulin exocytosis.

Promotion of beta-cell differentiation by conophylline in fetal and neonatal rat pancreas.

Conophylline is a vinca alkaloid extracted from the tropical plant Ervatamia microphylla and has been shown to induce differentiation of pancreatic AR42J cells. In the present study, we investigated the effect of conophylline on the differentiation of pancreatic precursor cells. In the rat pancreatic rudiment in organ culture, conophylline inhibited the formation of cystic structure and increased the number of insulin-positive cells. Conophylline also markedly increased the expression of mRNA for insulin and the number of pancreatic duodenal homeobox-1-positive cells. These effects of conophylline were similar to those of activin A. We also examined the effect of conophylline on neonatal rats treated with streptozotocin, a model of type 2 diabetes. Treatment with conophylline significantly reduced the plasma glucose concentration and improved glucose tolerance in response to glucose loading. The insulin content and the beta-cell mass at 2 months were significantly increased by conophylline. The number of islet-like cell clusters and pancreatic duodenal homeobox-1-positive ductal cells was greater in conophylline-treated rats. These results suggest that conophylline induces differentiation of pancreatic precursor cells and increases the formation of beta-cells.

Differentiation of adult hepatic stem-like cells into pancreatic endocrine cells.

To apply cell transplantation for treatment of diabetes mellitus, a sufficient number of beta-cell sources are required. In the present study, we examined whether an epithelial cell line obtained from normal adult rat liver, namely hepatic stem-like (HSL) cells, which can be converted to both hepatocytes and billiary epithelial cells, could be a potential beta-cell source. The growth speed of HSL cells was rapid and these cells were easily expanded in vitro. Bipotential hepatic stem cells, HSL cells, also expressed PGP9.5, which is expressed in neurons, beta-cells, and progenitor cells of the pancreatic endocrine cells as well. Sodium butyrate induced morphological changes in HSL cells and converted them into flattened cells with large cytoplasm. When HSL cells were incubated with a combination of 5 mM sodium butyrate and 1 nM betacellulin, most of the cells were converted into morphologically neuron-like cells. RT-PCR analysis revealed that a series of transcriptional factors involved in differentiation of pancreatic endocrine cells was induced by the treatment with sodium butyrate and betacellulin. mRNAs for insulin, pancreatic polypeptide, and somatostatin were also observed. Immunoreactive pancreatic polypeptide, somatostatin, and insulin were detected in sodium butyrate and betacellulin-treated HSL cells. In conclusion, HSL cells obtained from adult normal liver also have the potential to differentiate into pancreatic endocrine cells in vitro. HSL cells may be one of the potential beta-cell sources for cell transplant therapy for insulin-dependent diabetes.

Time-dependent stimulation of insulin exocytosis by 3',5'-cyclic adenosine monophosphate in the rat islet beta-cell.

Isolated rat islets were exposed to cAMP-elevating agents and/or nutrients. Insulin exocytosis subsequently triggered by a depolarizing concentration of K(+) or a stimulatory concentration of glucose was employed as an index of time-dependent potentiation (TDP). Stimulatory concentrations (>or=5.5 mM) of glucose caused TDP, and 6 micro M forskolin (an activator of adenylyl cyclase) significantly enhanced it (3.1-fold at most). Forskolin produced an 8.0-fold increase in islet cell cAMP; however, it returned to the baseline after washout by the time of stimulation of exocytosis. Two millimoles of dibutyryl cAMP (a cAMP analog), 0.1 mM isobutylmethylxanthine (a phosphodiesterase inhibitor), and 100 nM glucagon-like peptide-1 (an incretin hormone) also enhanced glucoseinduced TDP. The time-dependent effect of cAMP was not attenuated by protein kinase A inhibitors (200 micro M adenosine 3',5'-cyclic monophosphothioate, Rp isomer, and 10 micro M H89). Although glucose-induced TDP was attenuated by NaN(3) (a mitochondrial poison) and cerulenin (an inhibitor of protein acylation), cAMP enhancement of it was unaffected by these agents. In conclusion, cAMP time-dependently stimulates insulin exocytosis, provided the extracellular glucose concentration is equivalent to or higher than ambient plasma levels. Protein kinase A, mitochondrial metabolism, and protein acylation are not involved in this cAMP action. Incretin stimulation of insulin exocytosis may occur in part via this mechanism.

Nutrient modulation of palmitoylated 24-kilodalton protein in rat pancreatic islets.

Protein acylation in glucose stimulation of insulin secretion in the beta-cells has been implicated. Accordingly, we attempted to identify the target(s) of acylation in the pancreatic islets. Rat pancreatic islets were labeled with [3H]palmitic acid for 1 h at 37 C, and the whole cell lysate was analyzed by SDS-PAGE and two-dimensional gel electrophoresis. The labeling of the proteins by [3H]palmitic acid was shown to be palmitoylation by chemical analyses. Palmitoylation of four distinct bands was recognized, and the palmitoylation was significantly reduced in all of them when the labeling was performed with high glucose. Quite interestingly, the degree of attenuation was particularly dominant for a 24-kDa doublet. Palmitoylation of the 24-kDa doublet was preferentially attenuated also by the mitochondrial fuels and an acylation inhibitor, cerulenin. The half-life of the labeling of the doublet was apparently shorter (approximately 45 min) than that of other bands on pulse chasing of the islets, irrespective of the presence or absence of high glucose. High glucose attenuation of the palmitoylation of the 24-kDa doublet was partially blocked by 20 mm mannoheptulose, a glucokinase inhibitor. Two-dimensional gel electrophoresis revealed that the doublet was composed of acidic peptides, and, by immunoprecipitation, it was shown not to be synaptosome-associated protein of 25 kDa. We identified rapidly turning over palmitoylated 24-kDa acidic proteins distinct from synaptosome-associated protein of 25 kDa in the pancreatic islets, which are preferentially modulated by fuel secretagogues. The data suggested a functional role of the palmitoylated 24-kDa doublet in nutrient stimulation of insulin secretion.

Preliminary evidence that different mechanisms underlie the anger superiority effect in children with and without Autism Spectrum Disorders.

Previous studies have demonstrated that angry faces capture humans' attention more rapidly than emotionally positive faces. This phenomenon is referred to as the anger superiority effect (ASE). Despite atypical emotional processing, adults and children with Autism Spectrum Disorders (ASD) have been reported to show ASE as well as typically developed (TD) individuals. So far, however, few studies have clarified whether or not the mechanisms underlying ASE are the same for both TD and ASD individuals. Here, we tested how TD and ASD children process schematic emotional faces during detection by employing a recognition task in combination with a face-in-the-crowd task. Results of the face-in-the-crowd task revealed the prevalence of ASE both in TD and ASD children. However, the results of the recognition task revealed group differences: In TD children, detection of angry faces required more configural face processing and disrupted the processing of local features. In ASD children, on the other hand, it required more feature-based processing rather than configural processing. Despite the small sample sizes, these findings provide preliminary evidence that children with ASD, in contrast to TD children, show quick detection of angry faces by extracting local features in faces.

Characterization of the intronic VNTR polymorphisms found in a paralog of chicken serotonin transporter gene.

Polymorphisms in the neurotransmitter-related genes can be a major source of behavioral variations. We searched for polymorphic sites in chicken neurotransmitter-related genes and identified two variable number of tandem repeat (VNTR) loci encompassing the paralog of chicken serotonin transporter gene (5-HTT). Both intronic VNTR were highly polymorphic across chicken breeds and the other Galliformes species, even though predominant alleles were considerably different among breeds. One VNTR locus contained sequences complementary to a conserved motif of CCCTC-binding factor (CTCF) within each repetitive unit, indicating that transcription of chicken 5-HTT paralog may be regulated by the CTCF protein. It is of great interest to contrast these results with previous knowledge on the human 5-HTT that also has CTCF binding sites in the repetitive units of intronic VNTR. Additionally, we measured the degree of impulsiveness in domestic chicks for their preference of immediate/small to large/delayed rewards. A significant difference in the impulsiveness score was detected between two chicken breeds (White Leghorn vs. Boris Brown; P < 0.01), as well as between White Leghorn chicks with different 5-HTT genotypes. These findings imply the possibility that 5-HTT VNTR genotypes may have some impact on chicks' impulsive choice by modifying the serotonergic neurotransmission.