The sinusoidal hematopoietic niche is formed by Jam1a via Notch signaling in the zebrafish kidney.

The zebrafish is a unique model to understand hematopoietic niches as hematopoietic stem/progenitor cells are maintained in the kidney. However, little is known about which cell types in the kidney play a role in hematopoietic niches. Here, we demonstrate that the sinusoidal endothelium is an essential and conserved niche component in the zebrafish kidney. Histological analysis revealed that runx1:mCherry + hematopoietic cells were predominantly detected in the dorsolateral region of the kidney where sinusoids are highly developed. Loss of Junctional adhesion molecule 1a (Jam1a), which is expressed in both sinusoidal endothelial cells and hematopoietic cells, resulted in a remarkable reduction in sinusoids and a defect in hematopoietic niches. We found that Jam1a regulates jagged-1a expression in vascular endothelial cells to form a sinusoidal structure in the kidney. Collectively, these data suggest that sinusoids are formed by Jam1a via endothelial Notch signaling to provide hematopoietic niches in the zebrafish kidney.

Inhibition of Canonical Wnt Signaling Promotes Ex Vivo Maintenance and Proliferation of Hematopoietic Stem Cells in Zebrafish.

The maintenance and proliferation of hematopoietic stem cells (HSCs) are tightly regulated by their niches in the bone marrow. The analysis of niche cells or stromal cell lines that can support HSCs has facilitated the finding of novel supporting factors for HSCs. Despite large efforts in the murine bone marrow; however, HSC expansion is still difficult ex vivo, highlighting the need for new approaches to elucidate the molecular elements that regulate HSCs. The zebrafish provides a unique model to study hematopoietic niches as HSCs are maintained in the kidney, allowing for a parallel view of hematopoietic niches over evolution. Here, using a stromal cell line from the zebrafish kidney, zebrafish kidney stromal (ZKS), we uncover that an inhibitor of canonical Wnt signaling, IWR-1-endo, is a potent regulator of HSCs. Coculture assays revealed that ZKS cells were in part supportive of maintenance, but not expansion, of gata2a:GFP+runx1:mCherry+ (gata2a+runx1+) HSCs. Transcriptome analysis revealed that, compared with candidate niche cells in the kidney, ZKS cells weakly expressed HSC maintenance factor genes, thpo and cxcl12, but highly expressed canonical Wnt ligand genes, wnt1, 7bb, and 9a. Thpo supplementation in ZKS culture slightly increased, but inhibition of canonical Wnt signaling by IWR-1-endo treatment largely increased the number of gata2a+runx1+ cells (>2-fold). Moreover, we found that gata2a+runx1+ cells can be maintained by supplementing both IWR-1-endo and Thpo without stromal cells. Collectively, our data provide evidence that IWR-1-endo can be used as a novel supporting factor for HSCs.

Intra-carina reentrant atrial tachycardia after pulmonary vein isolation of atrial fibrillation.

A 77-year-old man underwent catheter ablation of an atrial tachycardia (AT) after a pulmonary vein (PV) isolation of atrial fibrillation. The AT appeared to be a figure-of-eight reentrant AT by high-resolution mapping: one reentrant circuit rotated clockwise within the right PV (RPV) carina and the other rotated counterclockwise via two conduction gaps along the previous RPV isolation line. However, entrainment pacing from the carina and conduction gaps suggested that the AT was an intra-carina localized reentrant AT with a passive loop around the anterior RPV isolation line via those gaps. A radiofrequency application at the RPV carina terminated the AT.

Symptomatic and asymptomatic intracerebral hemorrhages detected by magnetic resonance imaging after catheter ablation of atrial fibrillation.

PURPOSE: Symptomatic intracerebral hemorrhages (ICHs) are a rare complication after atrial fibrillation (AF) catheter ablation, while the incidence of asymptomatic ICHs detected by magnetic resonance (MR) imaging remains unclear. This study aimed to investigate the incidence, characteristics, and predictors of new-onset ICHs on MR imaging after AF ablation. METHODS: We retrospectively studied 1257 consecutive AF ablation procedures in 1201 patients who underwent MR imaging on the day after the procedure. Repeat MR imaging within 3 months post-ablation was available in 352 procedures. RESULTS: Old ICHs on the initial MR imaging were observed in 28 procedures (2.2%). Post-ablation new ICHs were observed in 14 procedures (4.0%), including one symptomatic (0.3%) and 13 (3.7%) asymptomatic ICHs. One patient had a new ICH on the initial MR imaging, while the remaining 13 had such on the repeat MR imaging. A univariate analysis revealed that a previous ischemic stroke or transient ischemic attack (TIA) and the CHA2DS2-VASc score were positive predictors of new ICHs (odds ratios, 5.502 and 1.435; P = 0.004 and 0.044). The lesion diameter did not significantly differ between the old and new ICHs (median, 6.1 mm vs. 8.0 mm, P = 0.281), while the predominant location differed (lobar areas, 22.6% vs. 53.3%; cerebellum, 22.6% vs. 20.0%; others, 54.8% vs. 26.7%; P = 0.026). CONCLUSIONS: A few asymptomatic ICHs may occur after AF ablation. Most of the post-ablation new ICHs occurred a few days or later after the procedure. A previous ischemic stroke/TIA and the CHA2DS2-VASc score may be risk factors for post-ablation ICHs.

Association between induction of the self-management system for preventing readmission and disease severity and length of readmission in patients with heart failure.

OBJECTIVE: We recently developed the self-management system using the HF points and instructions to visit hospitals or clinics when the points exceed the pre-specified levels. We found that the self-management system decreased the hospitalization for HF with an increase in unplanned visits and early intervention in the outpatient department. However, it is unclear whether we managed severe HF outpatients who should have been hospitalized. In this study, we aimed to compare HF severity in rehospitalized patients with regard to self-management system use. RESULTS: We retrospectively enrolled 306 patients (153 patients each in the system user and non-user groups) using propensity scores (PS). We compared HF severity and length of readmission in rehospitalized patients in both groups. During the 1-year follow-up period, 24 system users and 43 non-system users in the PS-matched cohort were hospitalized. There were no significant differences between the groups in terms of brain natriuretic peptide levels at readmission, maximum daily intravenous furosemide dose, percentage of patients requiring intravenous inotropes, duration of hospital stay and in-hospital mortality. These results suggest that the HF severity in rehospitalized patients was not different between the two groups.

Dynamics of laser-induced cavitation bubble during expansion over sharp-edge geometry submerged in liquid - an inside view by diffuse illumination.

Laser ablation in liquids is growing in popularity for various applications including nanoparticle production, breakdown spectroscopy, and surface functionalization. When laser pulse ablates the solid target submerged in liquid, a cavitation bubble develops. In case of "finite" geometries of ablated solids, liquid dynamical phenomena can occur inside the bubble when the bubble overflows the surface edge. To observe this dynamics, we use diffuse illumination of a flashlamp in combination with a high-speed videography by exposure times down to 250 ns. The developed theoretical modelling and its comparison with the experimental observations clearly prove that this approach widens the observable area inside the bubble. We thereby use it to study the dynamics of laser-induced cavitation bubble during its expansion over a sharp-edge ("cliff-like" 90°) geometry submerged in water, ethanol, and polyethylene glycol 300. The samples are 17 mm wide stainless steel plates with thickness in the range of 0.025-2 mm. Bubbles are induced on the samples by 1064-nm laser pulses with pulse durations of 7-60 ns and pulse energies of 10-55 mJ. We observe formation of a fixed-type secondary cavity behind the edge where low-pressure area develops due to bubble-driven flow of the liquid. This occurs when the velocity of liquid overflow exceeds ~20 m s-1. A re-entrant liquid injection with up to ~40 m s-1 velocity may occur inside the bubble when the bubble overflows the edge of the sample. Formation and characteristics of the jet evidently depend on the relation between the breakdown-edge offset and the bubble energy, as well as the properties of the surrounding liquid. Higher viscosity of the liquid prevents the generation of the jet.

Association of the induction of a self-care management system with 1-year outcomes in patients hospitalized for heart failure.

BACKGROUND: To perform self-care in patients with heart failure (HF), we developed and implemented a new HF point self-care system, which was characterized by 1) the way weight and HF symptoms were scored ("Heart Failure Points") and 2) the timing of consultations defined for both patients and health care providers. We examined the association between the induction of the new system and 1-year outcomes in patients hospitalized for HF. METHODS: We retrospectively enrolled 569 consecutive patients into our study who were admitted for HF treatment at our hospital: 275 patients between November 2011 and October 2013 (before the induction of the self-management system) and 294 patients between November 2015 and October 2017 (after the induction). We sought to compare the clinical outcomes between patients using the self-management system and those not using the system after propensity-score (PS) matching. The primary outcome measure was a composite of all-cause death or HF rehospitalization. RESULTS: The cumulative 1-year incidence of the primary outcome measure in the use group (n = 153) was significantly lower than that in the non-use group (n = 153) (24.5% vs. 34.9%, respectively; p = 0.031; hazard ratio: 0.62; 95% confidence interval: 0.40-0.96), mainly due to a reduction in HF hospitalization. CONCLUSIONS: The induction of the new self-care system was associated with better 1-year outcomes in patients hospitalized for HF. This system may help patients with HF to achieve more efficient self-care.

Laparoscopic retroperitoneal splenopexy for wandering spleen: A novel technique using a three-incision retroperitoneal pouch.

INTRODUCTION: Wandering spleen is a rare condition for which splenopexy is indicated to prevent splenic torsion. We present a novel laparoscopic splenopexy technique for wandering spleen based on creation of a three-incision retroperitoneal pouch. MATERIALS AND SURGICAL TECHNIQUE: A 12-year-old male patient with abdominal distention and vomiting was transferred to our institution. Contrast-enhanced CT revealed a swollen wandering spleen with associated gastric volvulus, and the patient underwent laparoscopic surgery. A 5-mm camera port was inserted through an umbilical incision with two additional ports, one in the right upper abdomen and one in the left flank. Normal saline was injected into the retroperitoneal space from the left flank with a 23-G needle to create a retroperitoneal pouch. Three ventrodorsal peritoneal incisions were created at the same site in the peritoneum. The swollen spleen was inserted into the retroperitoneal pouch from the central incision, and the upper and lower poles of the spleen were exposed to the abdominal cavity from the cranial and caudal incisions to prevent splenic torsion. Finally, anterior gastropexy was performed. The postoperative period was uneventful. The patient was discharged on postoperative day 11 without complaints. As of 10 months after surgery, the patient had no recurrences of splenic torsion or gastric volvulus. DISCUSSION: In the present method, the retroperitoneal pouch was created without difficulty by injection of normal saline. Even in a patient with a swollen spleen, this novel method could prevent splenic torsion without using artificial materials or extensively dissecting the retroperitoneal space.

Cardiovascular and cerebrovascular diseases risk associated with the incidence of presenteeism and the costs of presenteeism.

OBJECTIVES: The objective of this study was to estimate a risk of cardiovascular and cerebrovascular diseases for each worker and to determine whether this risk is associated with the incidence and costs of presenteeism, absenteeism, and medical/drug treatments. METHODS: Established risk equations were used to estimate the 10-year probability of developing coronary artery disease and ischemic stroke in male workers aged 40-65 years who were recruited from four pharmaceutical companies in Japan. The incidence of presenteeism was defined as existence of presenteeism for the past a month, and the incidence of absenteeism was defined as existence of sick-leave for the past three months by a self-administered questionnaire. Each cost was calculated based on the human capital method. Data on medical/drug treatments were collected from health insurance claims. RESULTS: The risks were calculated for 6047 workers. Individuals at moderate and high risk of coronary artery disease had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Workers at moderate and high risk of ischemic stroke also had a significantly higher rate of presenteeism and absenteeism than workers at low risk. Mean costs for absenteeism and medical/drug treatments increased with the risk of developing coronary artery disease or ischemic stroke, while costs for presenteeism did not. CONCLUSIONS: To prevent the costs of presenteeism, workers not only at high risk but also at low and moderate risk of developing cardiovascular and cerebrovascular diseases should receive health care services.

Factors of occurrence and improvement methods of presenteeism attributed to diabetes: A systematic review.

OBJECTIVE: A systematic review was performed to study factors of occurrence and improvement methods of presenteeism attributed to diabetes. METHODS: We set 2 clinical questions; (a) how comorbidities and complications of diabetes induce presenteeism and (b) what interventions or conditions effectively improve presenteeism. Then, we conducted a comprehensive search with MEDLINE/PubMed and Scopus databases and extracted those that met the clinical questions. RESULTS: Eighteen papers studied occurrence of presenteeism by comorbidities and complications of diabetes. Most studies were cross-sectional and had a low quality of evidence. However, the associations of hypoglycemia, diabetic neuropathy, and mood disorders with presenteeism were relatively well studied. The papers that discussed effective interventions or conditions for improving presenteeism were very limited. CONCLUSIONS: Our review suggests that presenteeism attributed to diabetes is mainly caused by hypoglycemia, diabetic neuropathy, and mood disorders. There are very limited evidences, but available information suggests that improving glycemic control, adjusting treatment regimen by evaluating the impact on work, providing psychological support, and developing suitable work accommodations may effectively reduce presenteeism.

Laparoscopic repair of sliding inguinal hernia in female children.

PURPOSE: To evaluate the safety and feasibility of laparoscopic repair of sliding inguinal hernia in female children. METHODS: Laparoscopic percutaneous extraperitoneal closure (LPEC) was performed in 482 female inguinal hernia children between 2006 and 2015. Fourteen of these patients were associated with sliding inguinal hernia, and these 14 patients were enrolled and reviewed retrospectively. RESULTS: The mean age and the body weight at the operation was 9.6 months and 7.8 kg. Seven patients required the reduction of the ovary under general anesthesia. Laparoscopy, however, revealed that five patients had severe sliding of fallopian tube into the inguinal canal. One of these five patients received a simple LPEC, but developed the recurrence due to the low ligation of the hernia sac, and needed the second hernia repair under inguinal approach. Other four patients with fallopian tube sliding required the dissection of the fallopian tube and peritoneal repair, or the conversion to inguinal approach; therefore they had longer surgical time compared to those without fallopian tube sliding. CONCLUSION: LPEC is safe and feasible for the sliding inguinal hernia repair except the cases with fallopian tube sliding. Patients with fallopian tube sliding required additional procedure or conversion to inguinal approach.

[Factors Associated with Diagnostic Yield of Endobronchial Ultrasonography with a Guide Sheath for Peripheral Lung Cancer].

Endobronchial ultrasonography with a guide sheath (EBUS-GS) has recently been used for improved diagnostic yields for peripheral pulmonary lesions. This study retrospectively evaluated the factors related to the diagnostic yield of EBUS-GS for peripheral lung cancer. The medical records of 76 patients who had been diagnosed with lung cancer and had undergone bronchoscopy with EBUS-GS in our hospital between August 2014 and September 2015 were reviewed. The total diagnostic ratio of peripheral lung cancer was 71.1%. The following factors of the diagnostic yield were evaluated: location of pulmonary lesion; size; feature; bronchus sign; location of EBUS probe; EBUS detection; number of biopsies performed; procedure time; use of virtual bronchoscopic navigation; use of EBUS-guided transbronchial needle aspiration with EBUS-GS; CT slice thickness; operator's years of medical experience; and specialized training in bronchoscopy at the National Cancer Center. In all cases, lesion size ≧ 20 mm (80.8% vs. 50.0%, P = 0.006), EBUS probe location "within" (90.0% vs. 50.0%, P < 0.001), EBUS detection (80.7% vs. 28.6%, P < 0.001), number of biopsies ≧ 5 (78.0% vs. 47.1%, P = 0.013), and bronchoscopy training (81.6% vs. 60.5%, P = 0.043) significantly contributed to an increase in the diagnostic yield. Following a multivariate analysis, EBUS probe location "within" was found to be the most significant factor affecting the diagnostic yield (odds ratio 14.10, 95% CI 3.53-56.60, P < 0.001), and bronchoscopy training was the second most significant factor (odds ratio 6.93, 95% CI 1.86-25.80, P = 0.004). EBUS probe location "within" and bronchoscopy training are the most important factors for improved diagnostic yield by bronchoscopy with EBUS-GS for peripheral lung cancer.