A multicentre study of clinical features and HLA typing in Japanese patients with ankylosing spondylitis.

OBJECTIVES: Due to the low prevalence of HLA-B27 and ankylosing spondylitis (AS) in Japan, rheumatologists have little experience with AS. We conducted a multicentre study to identify the characteristics and frequency of HLA-B types. METHODS: We analysed epidemiological and clinical data, blood tests, spine radiographs, and HLA-B types in Japanese AS patients. RESULTS: We evaluated 111 AS patients, predominantly men (82.9%). The mean age, disease onset, diagnosis, and time from onset to diagnosis were 43.7, 24.2, 36.0, and 11.6 years, respectively. Inflammatory low back pain was found in 96 cases (86.5%); peripheral arthritis in 59 (53.2%), enthesitis in 35 (31.5%), and dactylitis in 6 (5.4%). Extra-articular symptoms included uveitis, psoriasis, and inflammatory bowel disease in 41 (36.9%), 1 (0.9%), and 5 (4.5%) cases, respectively. HLA-B27 was positive in 83 cases (74.8%; odds ratio, 1146.0); and HLA-B48 in 9 (8.1%; odds ratio, 3.0). HLA-B27-positive patients were younger at onset and had a shorter diagnostic delay. CONCLUSIONS: AS clinical symptoms were almost the same as other countries except for the low coexistence of psoriasis. HLA-B27 positivity in Japanese patients was 78%. HLA-B27-positive patients were younger and diagnosed earlier. In addition to HLA-B27, a relationship with HLA-B48 was suggested.

Universal Bound to the Amplitude of the Vortex Nernst Signal in Superconductors.

A liquid of superconducting vortices generates a transverse thermoelectric response. This Nernst signal has a tail deep in the normal state due to superconducting fluctuations. Here, we present a study of the Nernst effect in two-dimensional heterostructures of Nb-doped strontium titanate (STO) and in amorphous MoGe. The Nernst signal generated by ephemeral Cooper pairs above the critical temperature has the magnitude expected by theory in STO. On the other hand, the peak amplitude of the vortex Nernst signal below T_{c} is comparable in both and in numerous other superconductors despite the large distribution of the critical temperature and the critical magnetic fields. In four superconductors belonging to different families, the maximum Nernst signal corresponds to an entropy per vortex per layer of ≈k_{B}ln2.

Polaronic behavior in a weak-coupling superconductor.

The nature of superconductivity in the dilute semiconductor SrTiO3 has remained an open question for more than 50 y. The extremely low carrier densities ([Formula: see text]-[Formula: see text] cm-3) at which superconductivity occurs suggest an unconventional origin of superconductivity outside of the adiabatic limit on which the Bardeen-Cooper-Schrieffer (BCS) and Migdal-Eliashberg (ME) theories are based. We take advantage of a newly developed method for engineering band alignments at oxide interfaces and access the electronic structure of Nb-doped SrTiO3, using high-resolution tunneling spectroscopy. We observe strong coupling to the highest-energy longitudinal optic (LO) phonon branch and estimate the doping evolution of the dimensionless electron-phonon interaction strength ([Formula: see text]). Upon cooling below the superconducting transition temperature ([Formula: see text]), we observe a single superconducting gap corresponding to the weak-coupling limit of BCS theory, indicating an order of magnitude smaller coupling ([Formula: see text]). These results suggest that despite the strong normal state interaction with electrons, the highest LO phonon does not provide a dominant contribution to pairing. They further demonstrate that SrTiO3 is an ideal system to probe superconductivity over a wide range of carrier density, adiabatic parameter, and electron-phonon coupling strength.

Relationship between characteristics of spinopelvic alignment and quality of life in Japanese patients with ankylosing spondylitis: a cross-sectional study.

BACKGROUND: Studies on characteristic spinal deformities in Japanese patients with ankylosing spondylitis (AS) and data demonstrating a relationship between health-related quality of life (HRQOL) and spinopelvic alignment in these patients are lacking. METHODS: In this cross-sectional study, 50 patients with AS and without a surgical history, vertebral body fracture, or scoliosis as well as 30 control patients with degenerative lumbar kyphoscoliosis (DLKS) were included. Data collected included patient sex, age, spinopelvic parameters on sagittal full-spine standing radiographs, and HRQOL questionnaire responses. Student's t-test was used to compare the characteristics of spinopelvic parameters between the groups. A multiple regression analysis was performed to analyze correlations between spinopelvic parameters and HRQOL in the AS group. RESULTS: Global kyphosis (GK; T1-12 angle) was significantly greater in the AS group than in the DLKS group (P < 0.001), whereas the pelvic tilt (PT; posterior PT angle) was smaller in the AS group (P = 0.006). Radiographic parameters correlated with HRQOL in the AS group. Multiple regression analysis identified the sagittal vertical axis (SVA) and sacral slope (SS) as factors influencing the SRS-22 total score and SVA and GK as factors influencing Japanese Orthopaedic Association Back Pain Evaluation Questionnaire mental health (subdomain). CONCLUSIONS: Patients with AS did not use lumbar lordosis or posterior PT to compensate for their large thoracic kyphosis due to spinopelvic ankylosis. These patients showed a unique compensation pattern. The correlation/regression analysis revealed a correlation between radiographic parameters and HRQOL in patients with AS, with particular importance of SVA, SS, and GK for clinical results in AS.

HLA-B46 is associated with severe sacroiliitis in Japanese patients with psoriatic arthritis.

Objectives: The aim of the present study was to determine if the HLA phenotype is related to severe sacroiliitis in Japanese patients with psoriatic arthritis.Methods: This study was a single-center, retrospective, cross-sectional, observational study. We reviewed the clinical information and radiologic examinations of patients with psoriatic arthritis (PsA) who visited our hospital from January 2011 to December 2016. Radiographic changes in the sacroiliac joints were assessed by four independent investigators according to the recommendations of the Assessment of Spondyloarthritis International Society.Results: Of 113 PsA patients, 63 (55.8%) had sacroiliitis. The HLA phenotype was investigated in 39 patients. Ordered logistic regression analysis revealed that the presence of HLA-B46 was an independent risk factor for severe sacroiliitis in Japanese PsA patients (odds ratio 3.2; 95% confidence interval 1.16-9.81). Therefore, the clinical features were divided into two groups according to the presence of HLA-B46. Both the Nail Psoriasis Severity Index and grade of sacroiliitis were significantly higher in the HLA-B46-positive group (Mann-Whitney U test; p = .0003 and p = .028, respectively).Conclusion: HLA-B46 is considered a risk factor for severe sacroiliitis in Japanese patients with PsA.

Dual-Gate Modulation of Carrier Density and Disorder in an Oxide Two-Dimensional Electron System.

Carrier density and disorder are two crucial parameters that control the properties of correlated two-dimensional electron systems. In order to disentangle their individual contributions to quantum phenomena, independent tuning of these two parameters is required. Here, by utilizing a hybrid liquid/solid electric dual-gate geometry acting on the conducting LaAlO3/SrTiO3 heterointerface, we obtain an additional degree of freedom to strongly modify the electron confinement profile and thus the strength of interfacial scattering, independent from the carrier density. A dual-gate controlled nonlinear Hall effect is a direct manifestation of this profile, which can be quantitatively understood by a Poisson-Schrödinger sub-band model. In particular, the large nonlinear dielectric response of SrTiO3 enables a very wide range of tunable density and disorder, far beyond that for conventional semiconductors. Our study provides a broad framework for understanding various reported phenomena at the LaAlO3/SrTiO3 interface.

Acetylation of amines and alcohols catalyzed by acetylcholinesterase from Pseudomonas aeruginosa PAO1.

Acetylcholinesterase (AChE) from Pseudomonas aeruginosa PAO1 has a catalytic Ser residue in its active site. In this study, we examined the aminolysis and alcoholysis reactions of AChE that occurred alongside its hydrolysis reaction. The recombinant AChE recognized ethyl acetate as a substrate. Therefore, we evaluated acetylation of the amine and hydroxyl group by AChE, using acetylcholine and ethyl acetate as the acetyl donor. AChE recognized diaminoalkanes with 4- to 12-carbon chains and aminoalcohols with 4- to 8-carbon chains as acetyl acceptors, resulting in their acetylated products. In the acetylation of 1,6-diaminohexane, AChE preferentially used ethyl acetate as the acetyl donor above pH 8.0 and the efficiency increased with increasing pH. In contrast, the acetylation of 6-amino-1-hexanol was efficient with acetylcholine as the acetyl donor in the pH range of 4-10. In addition, acetylated 6-amino-1-hexanol was decomposed by AChE. The kinetic study indicated that the acetyl donor and acceptor are competitively recognized by AChE as substrates.

Comparison of radiological characteristics between diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a multicenter study.

To evaluate the radiological differences between diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) using whole spine computed tomography (CT), including the spine and sacroiliac joint (SIJ). The ossification and bridging of spinal ligament and fusion of the facet joint and SIJ were evaluated in 111 patients who were diagnosed with DISH and 27 patients with AS on the whole spine CT. The number of anterior bridging and shape of bridging (candle-wax-type/ smooth-type) were also evaluated. We further evaluated patients with DISH and AS by matching their age and sex. Complete SIJ fusion was more common in AS, whereas anterior and posterior bony bridging around SIJ was more common in DISH. However, 63% of patients with DISH had a partial or complete fusion. In spinal anterior bony bridging, the majority of patients with AS had the smooth-type, whereas those with DISH had the candle-wax-type. However, some of the patients with DISH (11%) had smooth-type. Intervertebral facet joint fusion is more common in AS. The number of anterior spinal bony bridging was greater in AS than in DISH, especially in the lumbar spine. These results are useful in differentiating DISH from AS and should therefore be considered when making a diagnosis.

Evidence of two-dimensional flat band at the surface of antiferromagnetic kagome metal FeSn.

The kagome lattice has long been regarded as a theoretical framework that connects lattice geometry to unusual singularities in electronic structure. Transition metal kagome compounds have been recently identified as a promising material platform to investigate the long-sought electronic flat band. Here we report the signature of a two-dimensional flat band at the surface of antiferromagnetic kagome metal FeSn by means of planar tunneling spectroscopy. Employing a Schottky heterointerface of FeSn and an n-type semiconductor Nb-doped SrTiO3, we observe an anomalous enhancement in tunneling conductance within a finite energy range of FeSn. Our first-principles calculations show this is consistent with a spin-polarized flat band localized at the ferromagnetic kagome layer at the Schottky interface. The spectroscopic capability to characterize the electronic structure of a kagome compound at a thin film heterointerface will provide a unique opportunity to probe flat band induced phenomena in an energy-resolved fashion with simultaneous electrical tuning of its properties. Furthermore, the exotic surface state discussed herein is expected to manifest as peculiar spin-orbit torque signals in heterostructure-based spintronic devices.

[Use of the airway scope for rapid sequence induction in the emergency operation].

Rapid sequence intubation is a common procedure in emergency patients at risk for pulmonary gastric aspiration. However, in some of these cases may accompany a difficult airway. The Airway Scope (AWS) has been shown to be useful for difficult airway. We used AWS for rapid sequence intubation in 19 such patients. All patients were successfully intubated without any complication. We believe that AWS is a useful device for rapid sequence intubation.

[Case of undiagnosed vasospastic angina first noted during anesthesia].

A 75-year-old man patient was scheduled for total gastrectomy, splenectomy, and cholecyctectomy who had been hypertensive. The patient had no symptoms related to cardiac disease before surgery. Preoperative ECG showed only complete right bundle branch block. After arriving in the operating room, epidural anesthesia was performed at the T8-9 inter space and general anesthesia was induced with propofol without difficulty. Before operation, suddenly PVCs appeared, followed by VT and VF. Immediately the patient was treated with defibrillation, nitroglycerin and nicorandil. The operation was canceled. Vasospastic angina was diagnosed by acetylcholine infusion test postoperatively. Most of patients with vasospastic angina show elevation of ST segment on ECG at first, but our case showed VT and VF without ST elevation on ECG.

[Control of postoperative bladder spasm by caudal anesthesia in children undergoing ureteral reimplantation].

BACKGROUND: For management of postoperative bladder spasm by the ureteral reimplantation, general anesthesia and epidural anesthesia are selected in many hospitals, but epidural anesthesia is not a common technique for various complications and risks. We examined whether postoperative bladder spasms can be prevented by general anesthesia combined with single shot caudal anesthesia. METHODS: We studied 18 patients undergoing ureteral reimplantation. Premedicated by diazepam syrup (0.5 mg x kg(-1), maximum dose 10 mg). In combination with caudal anesthesia with 0.3% ropivacaine (3 mg x kg(-1), maximum dose 60 mg), general anesthesia was maintained with oxygen, nitrous oxide and sevoflurane. For the evaluation of pain relief we used face pain scale when the patients returned to the ward, postoperative 5 hours, 24 hours and at discharge. RESULTS: At postoperative 5 and 24 hours, some patients had a pain scale of above 3. But, those under pain scale 1 was 83%. At discharge, all patients were evaluated as pain scale 0 or 1. CONCLUSIONS: General anesthesia combined with single shot caudal anesthesia suppressed postoperative bladder spasm. All patients were discharged within 3 postoperative days.

Clinical Characteristics of Patients with Spondyloarthritis in Japan in Comparison with Other Regions of the World.

OBJECTIVE: To delineate clinical characteristics of patients with spondyloarthritis (SpA) in Japan in comparison to other areas of the world. METHODS: Using the ASAS-COMOSPA (Assessment of Spondyloarthritis international Society-COMOrbidities in SPondyloArthritis) data, an international cross-sectional observational study of patients with SpA, we analyzed information on demographics, disease characteristics, comorbidities, and risk factors. Patients were classified by region: Japan, other Asian countries (China, Singapore, South Korea, Taiwan), and non-Asian countries (Europe, the Americas, Africa). Patient characteristics, including diagnosis and treatment, were compared. RESULTS: Among 3984 patients included in the study, 161 were from centers in Japan, 933 from other Asian countries, and 2890 from other regions. Of patients with SpA in Japan, 42 (26.1%) had peripheral SpA, substantially more than in other countries. This trend was explained by the predominance of psoriatic arthritis (PsA) among Japanese patients with SpA. In contrast to the relatively low number in Japan, 54% of patients from other Asian countries had pure axial SpA (axSpA) without peripheral features. HLA-B27 testing, considered an integral part of the classification of axSpA, was performed in only 63.6% of Japanese patients with axSpA. More than half of Japanese patients with axSpA were classified using imaging criteria. CONCLUSION: In our study, there was a more substantial number of peripheral SpA cases observed in Japan compared to other parts of Asia and other regions of the world. Aside from ethnic differences, increasing recognition of PsA in Japan, as well as a potential underdiagnosis of axSpA due to the insufficient use of HLA-B27 testing, may partly explain regional discrepancies.

[Anesthetic management of coronary artery bypass grafting for unstable angina pectoris in a patient undergoing home oxygen therapy].

A 70-year-old man with pneumoconiosis receiving home oxygen therapy presented with chest pain. Coronary angiogram showed severe stenosis of his left main trunks and required emergency off-pump coronary artery bypass grafting. Anesthesia was induced and maintained with propofol, fentanyl and vecuronium. The trachea was intubated and the lungs were ventilated with oxygen and air maintaining the PaO2 between 80-100 mmHg and the PaCO2 between 55-65 mmHg. The operation was performed uneventfully. In the intensive care unit, the trachea was extubated after ensuring adequate respiratory function. The postoperative course was satisfactory.

[Use of a gum elastic bougie for tracheal intubation with Pentax-AWS airway scope].

Pentax-AWS laryngoscope (Pentax, Tokyo, Japan) consists of a disposable anatomically shaped blade, a 12-cm cable with a charge-coupled device (CCD) camera and a 2.4-inch liquid crystal device (LCD) color monitor display. A tracheal tube can be attached to the right side of the blade. The device may be useful in patients with difficult airways. One limitation of the device is that intubation may be difficult if it is difficult to position the glottis to the target symbol on the monitor display. We experienced such a difficulty in four patients, and the use of a gum elastic bougie enabled intubation. In a 57-year-old woman with a difficult airway, tracheal intubation using either a Macintosh laryngoscope or a fiberscope had failed. By inserting the AWS laryngoscope, the glottis was easily seen on the monitor display. Nevertheless, it was difficult to position the glottis to the target symbol, and advancing a tracheal tube collided with the tissue around the glottis. A bougie was passed through the tracheal tube, and it became possible to insert the bougie into the trachea by adjusting the angle of its tip. The tracheal tube was then easily passed over the bougie into the trachea. We successfully used the same technique in other three patients. We believe that the gum elastic bougie can be useful for tracheal intubation using the Pentax-AWS laryngoscope.

[Comparison of the Pentax-AWS and Fineview video laryngoscopes in the ease of laryngoscopy in 50 patients].

BACKGROUND: We compared the Pentax-AWS and Fineview video laryngoscopes in the ease of laryngoscopy in 50 patients. METHODS: Preoperatively, the view of the pharynx (Mallampati score), the thyromental distance and the inter-incisor distance at opening the month were assessed. After induction of anesthesia and neuromuscular blockade, the two devices were inserted in turn in a randomized order. The views of the glottis (Cormack and Lehane classification) was compared between the two devices. RESULTS: Mallampati score was 3 in one patient; the thyromental distance was less than 6 cm in 5 patients; and the inter-incisor distance was less than 4 cm in 2 patients. With the Pentax-AWS, the view of glottis was always grade 1, whereas with the Fineview, the view was grade 1 in 36 patients, grade 2 in 13 patients and grade 3 in one patient. The view was significantly better with the Pentax-AWS compared with the Fineview (P < 0.001). CONCLUSIONS: We conclude that the view of the glottis obtained using the Pentax-AWS was significantly better than the view obtained with the Fineview.

[Anesthetic management for surgery of the ankle joint fracture in a patient with Ebstein's anomaly].

The authors describe the successful anesthetic management of a patient with Ebstein's anomaly and Wolff-Parkinson-White syndrome who underwent repair for foot joint fracture. Anesthesia was provided by combined spinal-epidural block to minimize hemodynamic changes which cause an increase in right-to-left shunt and hypoxemia. We estimated hemodynamic status using radial arterial pressure, central venous pressure and ECG from the start of anesthesia. During anesthesia, his vital signs were unchanged to any significant degree. The recovery was rapid and the postoperative course was uneventful.

[Successful nasal intubation using airway scope with gum elastic bougie in a case of difficult airway].

AWS (Airway Scope, Pentax, Tokyo), a new videolaryngoscope, was originally designed to facilitate oral laryngoscopy and tracheal intubation. We describe a successful case of nasal intubation with a combination of AWS and GEB (gum elastic bougie). A 50-year-old man with a past history of difficult intubation was scheduled to undergo subtotal esophagectomy. As the patient was scheduled to be ventilated overnight after the operation in the intensive care unit, nasal intubation with a combination of AWS and GEB was planed. Anesthesia was induced with intravenous propofol 100 mg, fentanyl 200 microg and vecuronium 7 mg and endotracheal tube was inserted through the nostril. Oral insertion of AWS showed full view of the glottis and nasal insertion of GEB was easily advanced into the trachea through an endotracheal tube, allowing tracheal intubation while utilizing GEB as a stylet. No complication occured in this case. In conclusion, nasal intubation using AWS combination with GEB is useful for patients with difficult airways and is easy to perform.

[Case of peripartum cardiomyopathy developed after an emergency cesarean section--a case report].

A 28-year-old woman was admitted because of pregnancy induced hypertension at 35 weeks of gestation with twin babies. The premature labor had been inhibited for 2 weeks with ritodrine (100 microg min(-1) continuous infusion). At 37 weeks of gestation, an emergency cesarean section was carried out under combined spinal epidural anesthesia. After the delivery, oxytocin 5 units was injected to the uterine muscle and methylergometrin 0.2 mg was given intravenously to induce uterine contraction. One hour after the operation, she developed severe pulmonary edema. An echocardiography showed diffuse hypokinesis of the left ventricle with ejection fraction of 23%. She was diagnosed as having peripartum cardiomyopathy by cardiologist. The patient's condition improved in a few days but the abnormal cardiac function continued for two months.

Carrier density and disorder tuned superconductor-metal transition in a two-dimensional electron system.

Quantum ground states that arise at atomically controlled oxide interfaces provide an opportunity to address key questions in condensed matter physics, including the nature of two-dimensional metallic behaviour often observed adjacent to superconductivity. At the superconducting LaAlO3/SrTiO3 interface, a metallic ground state emerges upon the collapse of superconductivity with field-effect gating and is accompanied with a pseudogap. Here we utilize independent control of carrier density and disorder of the interfacial superconductor using dual electrostatic gates, which enables the comprehensive examination of the electronic phase diagram approaching zero temperature. We find that the pseudogap corresponds to precursor pairing, and the onset of long-range phase coherence forms a two-dimensional superconducting dome as a function of the dual-gate voltages. The gate-tuned superconductor-metal transitions are driven by macroscopic phase fluctuations of Josephson coupled superconducting puddles.