Lymphoscintigraphy Findings are Associated with Outcome in Children with Chylothorax After Cardiac Surgery.

Postoperative chylothorax in patients with congenital heart diseases (CHD) results in poor outcomes if anatomical and functional abnormalities of the lymphatic system are present. While these abnormalities are typically diagnosed by intranodal lymphangiography and dynamic contrast magnetic resonance lymphangiography, the usefulness of lymphoscintigraphy in these patients has not been evaluated. Between January 2019 and December 2021, 28 lymphoscintigraphies were performed in our institution for investigating prolonged pleural effusion after cardiac surgery. The images were assessed by three board-certified pediatric cardiologists retrospectively to determine the likelihood of a central lymphatic flow disorder. The likelihood was scored (range 1-3) based on structural abnormalities and congestive flow in the lymphatic system. Those scores were summed and the likelihood was categorized as low to intermediate (< 8 points) or high (8 or 9 points). Median age at lymphoscintigraphy was 129 days (IQR, 41-412 days), it was performed at a median of 22 days (IQR, 17-43) after surgery, and median score was 6 points (IQR, 4-7.5). Kendall's coefficient of concordance (0.867; p < 0.05) indicated high inter-rater reliability. Overall survival at 6 months after surgery was 92.5% in the low-to-intermediate group but 68.6% in the high group (p < 0.05), and duration of postoperative thoracic drainage was 27 and 58 days, respectively (p < 0.05). Lymphatic abnormalities detected by lymphoscintigraphy were associated with poorer outcomes. Lymphoscintigraphy was thought to be useful in assessing anatomic and functional lymphatic abnormalities, despite its minimal invasiveness.

Prediction of voluntary movements of the upper extremities by resting state-brain regional glucose metabolism in patients with chronic severe brain injury: A pilot study.

Confirmation of the exact voluntary movements of patients with disorder of consciousness following severe traumatic brain injury (TBI) is difficult because of the associated communication disturbances. In this pilot study, we investigated whether regional brain glucose metabolism assessed by 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) at rest could predict voluntary movement in severe TBI patients, particularly those with sufficient upper limb capacity to use communication devices. We visually and verbally instructed patients to clasp or open their hands. After video capture, three independent rehabilitation therapists determined whether the patients' movements were voluntary or involuntary. The results were compared with the standardized uptake value in the primary motor cortex, referring to the Penfield's homunculus, by resting state by FDG-PET imaged 1 year prior. Results showed that glucose uptake in the left (p = 0.0015) and right (p = 0.0121) proximal limb of the primary motor cortex, based on Penfield's homunculus on cerebral cartography, may reflect contralateral voluntary movement. Receiver operating characteristic curve analysis showed that a mean cutoff standardized uptake value of 5.47 ± 0.08 provided the best sensitivity and specificity for differentiating between voluntary and involuntary movements in each area. FDG-PET may be a useful and robust biomarker for predicting long-term recovery of motor function in severe TBI patients with disorders of consciousness.

The c-terminal region of BLT2 restricts its localization to the lateral membrane in a LIN7C-dependent manner.

Leukotriene B4 receptor type 2 (BLT2) is a G protein-coupled receptor (GPCR) mainly expressed in epithelial cells, where it enhances barrier function. A unique characteristic of BLT2 is its restricted localization to the lateral membrane. However, the molecular mechanism underlying the localization of BLT2 to the lateral membrane and the physiological roles of laterally localized BLT2 are unknown. BLT1 is the most homologous GPCR to BLT2 and localizes to both the apical and lateral membranes. In this study, we generated chimeric receptors of BLT2 and BLT1 as well as deletion mutants of BLT2 to determine the region(s) of BLT2 responsible for its localization. Chimeric receptors containing the C-terminal domain of BLT2 localized only to the lateral membrane, and the C-terminal deletion mutant of BLT2 accumulated at the Golgi apparatus. Furthermore, the middle and C-terminal regions of BLT2 were important for maintaining epithelial barrier function. Proteomics analysis using the chimeric BLT-ascorbate peroxidase 2 biotinylation method showed that some proteins involved in intracellular protein transport, cell-cell junctions, and actin filament binding were located very close to the C-terminal domain of BLT2. Knockdown of lin-7 homolog C (LIN7C), a membrane trafficking protein, led to accumulation of BLT2 in the Golgi apparatus, resulting in diminished epithelial barrier function. These results suggest that the C-terminal region of BLT2 plays an important role in the transport of BLT2 from the Golgi apparatus to the plasma membrane in a LIN7C-dependent manner.

Role of Nrf2 in Methotrexate-Induced Epithelial-Mesenchymal Transition in Alveolar A549 Cells.

Methotrexate (MTX) is known to induce serious lung diseases, such as pulmonary fibrosis. Although we demonstrated that MTX is associated with epithelial-mesenchymal transition (EMT), the underlying mechanism remains unclear. Nuclear factor erythroid 2-related factor 2 (Nrf2), an oxidative stress response regulator, is related to EMT induction. In the present study, we examined the association of Nrf2 with the MTX-induced EMT in the alveolar epithelial cell line A549. MTX treatment decreased the mRNA expression of heme oxidase-1 (HO-1), a target of Nrf2, which was inhibited by co-treatment with diethyl maleate (DEM), an Nrf2 activator. Additionally, the MTX-induced increase in reactive oxygen species (ROS) production was significantly suppressed by DEM. Furthermore, DEM decreased mRNA/protein expression levels of α-smooth muscle actin (SMA), a representative EMT marker, which were upregulated by MTX. Nuclear expression and localization of Nrf2 were suppressed by MTX treatment, which led to a decrease in Nrf2 activity. Finally, in Nrf2 knockdown cells, the MTX-induced enhancement of α-SMA mRNA/protein expression was not observed, indicating that downregulation of Nrf2 may play a critical role in the MTX-induced EMT in A549 cells. These results suggest that Nrf2-regulated transcriptional activity would be associated with the MTX-induced EMT induction.

Optimized 4D time-of-flight MR angiography using saturation pulse.

PURPOSE: To assess arterial visibility on 4D time-of-flight (4D-TOF) by temporal magnetization transfer contrast pulse (t-MTC) and temporal tilted optimized nonsaturating excitation (t-TONE). 3D-TOF magnetic resonance angiography (MRA) is used for the noninvasive assessment of the intracranial arteries. However, it does not provide temporal information for diagnosing hemodynamics. To noninvasively obtain more detailed hemodynamics-related information, we developed a novel time-resolved MRA without the arterial spin labeling technique, termed 4D-TOF MRA using saturation pulse. MATERIALS AND METHODS: On a 3.0T MRI, three techniques were compared to optimize the visibility of the arteries above the circle of Willis; 1) simple 4D-TOF, 2) 4D-TOF with t-MTC, and 3) 4D-TOF with t-MTC and t-TONE. Eight healthy volunteers were scanned with these three sequences. The contrast changes between the background tissue and the arteries in temporal phases were assessed and compared quantitatively and qualitatively. RESULTS: The contrast between the background and the arteries for 4D-TOF with t-MTC and t-TONE was significantly higher than those for the other methods in delayed phases (P < 0.001).The qualitative assessment showed that 4D-TOF with t-MTC and with t-MTC and t-TONE provided better visualization of the intracranial artery than simple 4D-TOF (P < 0.001). CONCLUSION: 4D-TOF with t-TONE and t-MTC enabled observation of the intracranial hemodynamics. Optimized 4D-TOF provides high-quality images without image subtraction, and good visibility of the intracranial arteries even in the prolonged observation time. J. Magn. Reson. Imaging 2016;43:1320-1326.

Construction of a linkage map based on retrotransposon insertion polymorphisms in sweetpotato via high-throughput sequencing.

Sweetpotato (Ipomoea batatas L.) is an outcrossing hexaploid species with a large number of chromosomes (2n = 6x = 90). Although sweetpotato is one of the world's most important crops, genetic analysis of the species has been hindered by its genetic complexity combined with the lack of a whole genome sequence. In the present study, we constructed a genetic linkage map based on retrotransposon insertion polymorphisms using a mapping population derived from a cross between 'Purple Sweet Lord' (PSL) and '90IDN-47' cultivars. High-throughput sequencing and subsequent data analyses identified many Rtsp-1 retrotransposon insertion sites, and their allele dosages (simplex, duplex, triplex, or double-simplex) were determined based on segregation ratios in the mapping population. Using a pseudo-testcross strategy, 43 and 47 linkage groups were generated for PSL and 90IDN-47, respectively. Interestingly, most of these insertions (~90%) were present in a simplex manner, indicating their utility for linkage map construction in polyploid species. Additionally, our approach led to savings of time and labor for genotyping. Although the number of markers herein was insufficient for map-based cloning, our trial analysis exhibited the utility of retrotransposon-based markers for linkage map construction in sweetpotato.

Percutaneous Covered Stenting in Splenic Vein for Left-sided Portal Hypertension Caused by Chronic Splenic Vein Obstruction.

Left-sided portal hypertension (LSPH), an uncommon manifestation of portal hypertension, is characterized by conditions such as isolated gastric varices and splenomegaly, which result from impeded splenic venous drainage in the presence of pancreatic disease. We employed a percutaneous transhepatic technique to achieve regression of isolated gastric varices by implanting a covered stent within a blocked splenic vein and by embolizing the posterior gastric vein and varices using N-butyl-2-cyanoacrylate. We report the successful treatment of stenting for LSPH by the covered stent placement.

Characterization of peritoneal dialysis effluent-derived cells: diagnosis of peritoneal integrity.

To assess the integrity of the peritoneal membrane, we characterized the functionality of the cellular components derived from peritoneal dialysis effluent (PDE). About 3 % of all cells collected from the PDE attached to the plastic dish, and 97.1 ± 3.1 % of the adherent cells expressed CK-18 (PDE-HPMC). A typical cobble-stone-like morphology under neutralized PD solution was obtained over 65 out of 74 primary cultures (88 %) while only 53 % under acidic PD solution in a previous report by Yanez-Mo et al. However, 26.6 ± 10.3 % of PDE-HPMC expressed the EMT marker α-SMA. Transepithelial resistance (TER) as a marker of cell polarity was 34 % lower than that of omentum-derived(OM)-HPMC. We found a significant decrease in the rate of PDE-HPMC proliferation compared to OM-HPMC, accompanied by a significant increase of cell area within the tertiary passage. Comparison of TER, α-SMA and SA-ß-Gal between CAPD durations suggests that cell polarity weakens with increased duration of CAPD, reflecting the occurrence of EMT and cell senescence. We conclude that functional characterization of cellular components in PDE reflects how well the peritoneum is preserved.

Mechanism that determines the economics of 100% renewable power systems.

Many studies have evaluated the economic feasibility of 100% renewable power systems using the optimization approach, but the mechanisms determining the results remain unclear, making this issue still debatable. This study presents a mathematical formulation of the mechanism that only the demand and power generation profiles determine the optimal capacities of generation and storage and their trade-off relationship. Furthermore, this study demonstrates the comprehensive quantification of the corresponding relationships among the factor cost of technologies, their optimal capacities, and total system cost. Based on these findings, the study also shows that hybrid systems comprising multiple renewable energy sources and different types of storage, including long-duration energy storage, are critical to reducing the total system cost by using actual profile data for multiple years and regions in Japan. This suggests that large-scale deployment of current-level power-to-gas technologies, such as water electrolysis, can contribute to the economics of 100% renewable power systems.

Fusion imaging of single-photon emission computed tomography and magnetic resonance lymphangiography for post-Fontan chylothorax.

A preschool male patient with an extensive cardiac surgical history developed refractory chylothorax after a total cavopulmonary connection. Neither lymphoscintigraphy nor single-photon emission computed tomography (SPECT)/computed tomography could identify the lymphatic system leakage sites. Non-contrast heavy T2-weighted magnetic resonance lymphangiography (MRL) was performed to visualize the lymphatic system. Nevertheless, distinguishing lymphatic ducts from other watery structures of the patient remained difficult. Therefore, non-contrast MRL and SPECT images were fused. This hybrid diagnostic tool elucidated the pathophysiology of the prolonged chylothorax; pulmonary lymphatic perfusion syndrome and illustrated the anatomical connection of the thoracic duct and an abnormally dilated lymphatic network in the neck and left hilar regions. Subsequent intranodal lymphangiography with ethiodized oil confirmed these findings. SPECT/MRL may become an alternative modality for revealing the mechanism of prolonged chylothorax by visualizing the lymphatic system when dynamic contrast-enhanced magnetic resonance lymphangiography is unavailable.

Simultaneous Visualization of the Thoracic Duct and Blood Vessels Using MRI: A Comparison Between Balanced Turbo-field-echo and Spin-echo.

OBJECTIVE: Magnetic resonance thoracic ductography (MRTD), concomitant with blood vessel imaging, provides useful anatomical information. The purpose of this study was to assess the visibility of the thoracic duct and blood vessels simultaneously by MRTD using balanced turbo-field-echo (bTFE) and turbo spin-echo (TSE). METHODS: MRTDs concomitant with blood vessel imaging on bTFE and TSE were obtained for 10 healthy volunteers with a 1.5T-magnetic resonance unit. Visibility of the thoracic duct, blood vessels in the thoracic region; motion artifacts; and overall image quality were scored by two radiologists using three-to-five-point scales; those were compared between bTFE and TSE. RESULTS: The thoracic duct was generally well-visualized on MRTD sequences. The upper part of the thoracic duct was better visualized on TSE than on bTFE (p < 0.05). The blood vessels were well visualized on bTFE and TSE; the bilateral subclavian arteries and the right subclavian veins were better visualized on TSE than on bTFE (all p < 0.05). Motion artifacts and overall image quality were better on TSE than on bTFE (p = 0.0039 and 0.0020, respectively). CONCLUSION: MRTD concomitant with blood vessel imaging on TSE has better visibility of the thoracic duct and blood vessels than bTFE.

First reports of clinical effects of transjugular intrahepatic portosystemic shunt in four patients with cirrhotic ascites refractory to tolvaptan.

OBJECTIVE: Ascites in patients with decompensated cirrhosis can lead to abdominal distention and decrease quality of life. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective agent in the treatment of ascites, whereas some patients are refractory to tolvaptan. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for these patients is not known. In this study, we performed TIPS for tolvaptan-refractory cirrhotic patients and analysed its efficacy and safety in these patients. DESIGN: This retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS. RESULTS: This study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m2 in a month after TIPS procedure. CONCLUSION: TIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.

Carbon dioxide (CO2) vs iodinated contrast digital subtraction angiography during balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerosant for gastric varices.

PURPOSE: To compare the visualization of the target gastric varices (GV) on balloon-occluded retrograde transvenous venography (BRTV) using iodinated contrast material vs carbon dioxide (CO(2)) in preparation for subsequent balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerotherapy. MATERIALS AND METHODS: In 16 consecutive patients with nonruptured GV, BRTV was performed first using iodinated contrast material and then with CO(2). BRTV was repeated whenever there were changes in the catheter or patient position or when coil embolization of collaterals was needed. Each visualization grade of GV (grade 1 = GV only; grade 2 = GV > collaterals; 3 = GV < collaterals; grades 4-5 = collaterals only) was determined by two observers in consensus. During foam BRTO, the GV visualization grade was recorded again and confirmed by C-arm computed tomography (CT). RESULTS: In 38 pairs of BRTV, GV grades were significantly (P < .0001) lower (ie, favoring BRTO) on CO(2) BRTV (mean ± standard deviation, 1.8 ± 0.8) than on iodine BRTV (3.4 ± 0.8). GV grades on foam BRTO (1.4 ± 0.7) were similar to the grades obtained on the most recent CO(2) BRTV (1.3 ± 0.5) but were significantly smaller (P < .0001) than on iodinated BRTV (3.1 ± 0.9). GV were opacified by foam on initial C-arm CT in 14 patients (87.5%), and complete thrombosis of GV was obtained without any complication in all 16 patients (100%). CO(2) reached the GV even when iodinated contrast material could not (grade 4) in seven of our 16 patients (43.8%), leading to successful BRTO. CONCLUSIONS: CO(2) BRTV visualized GV better than did iodine BRTV and changed the management of more than 40% of patients by enabling successful foam BRTO in patients in which conventional liquid BRTO could not be performed.

Injury-induced accumulation of glial cell line-derived neurotrophic factor in the rostral part of the injured rat spinal cord.

The spinal cord of a 7-week-old female Wistar rat was hemi-transected at thoracic position 10 with a razor blade, and changes in glial cell line-derived neurotrophic factor (GDNF) protein and mRNA expression levels in the spinal cord were examined. GDNF protein and mRNA expression levels were evaluated by enzyme immunoassay and reverse transcription polymerase chain reaction, respectively. Although GDNF is distributed in the healthy spinal cord from 150 to 400 pg/g tissue in a regionally dependent manner, hemi-transection (left side) of the spinal cord caused a rapid increase in GDNF content in the ipsilateral rostral but not in the caudal part of the spinal cord. On the other hand, injury-induced GDNF mRNA was distributed limitedly in both rostral and caudal stumps. These observations suggest the possibility that increased GDNF in the rostral part is responsible for the accumulation of GDNF that may be constitutively transported from the rostral to caudal side within the spinal cord. Although such local increase of endogenous GDNF protein may not be sufficient for nerve regeneration and locomotor improvement, it may play a physiological role in supporting spinal neurons including motoneurons.

Morphometric assessment of the left inferior phrenic vein in patients with portal hypertension.

The left inferior phrenic vein (LIPV) is a major drainage vessel of gastric varices and serves as an important conduit in endovascular treatment for gastric varices. The narrowing of LIPV has been empirically demonstrated and sometimes hinders catheter insertion for the treatment of gastric varices. We herein investigated the morphology of narrowed LIPV in patients with portal hypertension. Venograms of LIPV on 25 patients with gastric varices (15 males; 10 females; age range, 45-79 years with a mean of 67 years) were retrospectively reviewed, the following four parameters were measured: the diameter of LIPV, the diameter of narrowed LIPV, the narrowing rate, and the distance to narrowed LIPV from the left renal vein. On all 25 venograms, a narrowing was detected just above the common trunk with the left adrenal vein. The diameter of LIPV was 9.0 ± 4.2 mm, the diameter of narrowed LIPV was 5.1 ± 2.3 mm, the narrowing rate was 40.6 ± 16.0%, and the distance to narrowed LIPV from the left renal vein was 20.0 ± 7.4 mm. This anatomical information about the narrowing of LIPV may contribute to the safe and efficacious treatment of gastric varices.

Planar or Biaxial Stretching of Poly(ethylene terephthalate) Fiber Webs Prepared by Laser-Electrospinning.

In this work, laser-heated electrospinning (LES) process using carbon dioxide laser was explored as an eco-friendly method for producing ultrafine fibers. To enhance the thinning of fibers and the formation of fiber structure, planar or equibiaxial stretching and subsequent annealing processes were applied to poly(ethylene terephthalate) (PET) fiber webs prepared by LES. The structure and properties of the obtained webs were investigated. Ultrafine fiber webs with an average diameter of approximately 1 µm and a coefficient of variation of 20-25% were obtained when the stretch ratios in the MD (machine direction) × TD (transverse direction) were 3 × 1 and 3 × 3 for the planar and equibiaxial stretching, respectively. In the wide-angle X-ray diffraction analysis of the web samples, preferential orientation of crystalline c-axis were confirmed along the MD for planar stretching and only along the web plane for equibiaxial stretching, which was in contrast to the stretching of film samples, where additional preferential orientation of benzene ring along the film plane proceeded. The results obtained suggest that PET fiber webs fabricated through LES and subsequent planar or biaxial stretching processes have potential for a wide variety of applications, such as packaging and battery separator materials.

Onset of pulmonary Epstein-Barr virus-positive diffuse large B-cell lymphoma in a patient with silicosis.

How Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) occasionally occurs following chronic inflammation remains to be elucidated. The case of a 57-year-old man who developed pulmonary EBV-positive DLBCL from underlying silicosis lesions is presented. Immunohistochemical examination of the resected silicosis lesions showed predominant helper T cells and M1/M2 macrophages, with a lack of B cells, regulatory T cells, and resident memory T cells. Two years later, EBV-positive DLBCL emerged unexpectedly from the silicosis. The imbalance of the immune cells in the microenvironment, at least in part, may help explain how chronic inflammation contributes to EBV-positive DLBCL.

Determination of Nd isotopic composition in seawater using newly developed solid phase extraction and MC-ICP-MS.

Determination of neodymium (Nd) isotopic composition in seawater is useful for tracing water masses and geochemical cycles for lithogenic elements in the ocean. A new separation procedure for determination of the Nd isotopic composition of in seawater samples was developed that offers enhanced sample throughput and improved measurement reliability. The procedure consists of conventional Fe hydroxide coprecipitation, solid phase extraction using DGA chelating resin column chromatography, and Ln Resin column chromatography to preconcentrate samples. High selectivity in HNO3 medium and elution by low concentration HCl medium for Nd are characteristics of extraction using DGA Resin®, and they allowed an evaporation step to be omitted between the chromatographic steps. These chromatographic steps, using DGA Resin to separate REEs and Ln Resin® to remove Sm, were refined from a previous study. The procedural blank value of Nd was obtained as 2 pg (n = 6) from 3 L of water samples. Chemical yield of Nd from 3 L of seawater ranged within 90-95%. The developed procedure was combined with multiple collector-ICP-MS and applied to analysis of vertical seawater samples obtained from the western subarctic gyre of the North Pacific Ocean, where εNd ranged from -1.29 ± 0.42 at the surface to -3.80 ± 0.41 at 4000 m depth. These results were validated by comparing them with results obtained by the conventional method verified in the GEOTRACES inter-calibration program.