Impaired Consciousness in a Coronavirus Disease 2019 Patient Caused by Low Serum Sodium: A Case Report.

A 30 year-old man with a high fever (37.5°C-40°C), vomiting, slurred speech, and mild cognitive impairment was admitted to our Emergency Department. He had traveled from Spain to the UK on business at the end of February 2020. A nasopharyngeal swab was positive by RT-PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but a cerebrospinal fluid (CSF) sample was negative. His neurological abnormalities recovered completely on saline infusion to normalize his low serum sodium level. Although neurological abnormalities in patients with COVID-19 are rare, it is important to distinguish the etiologies including encephalitis, meningitis, or merely electrolyte abnormalities.

Evaluation of the genotoxicity of PM2.5 collected by a high-volume air sampler with impactor.

BACKGROUND: The harmful effects of fine particles with an aerodynamic diameter less than 2.5 µm (PM2.5) on respiratory organs are emphasized in pollution studies because PM2.5 have high deposition rates in the respiratory organs and contain various hazardous compounds. In this study, a sampling method combining a high-volume air sampler (HV) with a PM2.5 impactor was developed for collecting large quantities of PM2.5. The concentrations of elemental carbon (EC), organic carbon (OC), inorganic ions, and polycyclic aromatic hydrocarbons (PAHs) were measured in PM2.5 collected by the high-and low-volume air samplers (LV). RESULTS: Similar results were obtained from the HV and LV methods, with respect to inorganic carbon, organic carbon, sodium ions, ammonium ions, and PAHs with more than four rings. Because of the much larger amount of PM2.5 could be collected by the HV method, the trace constituents, that were difficult to detect by the conventional LV method, were readily detected by the HV method. Furthermore, when the microsuspension method that was modified more sensitive Ames mutagenicity test, was used to test the PM2.5 samples at four sites, mutagenic activities were detected by strains TA100 and TA98. Most of the mutagenic activity was associated with the PM2.5 fraction and mutagenic activity in winter was greater than that in summer. CONCLUSIONS: The HV method produced results similar to those from the conventional LV method with respect to the PM2.5 components present in the atmosphere in relatively high concentrations, but its 40-fold greater flow rate enabled the detection of mutagenic compounds present in only trace concentrations.

Development and Validation of a Novel Cuff-Less Blood Pressure Monitoring Device.

Ordinary cuff-based blood pressure-monitoring devices remain a technical limitation that disturbs activities of daily life. Here we report a novel system for the cuff-less blood pressure estimation (CLB) that requires only 1 sensor for photoplethysmography. The present study is the first report to validate and assess the clinical application of the CLB in accordance with the latest wearable device standard (issued by the Institute of Electrical and Electronics Engineers, standard 1708-2014). Our CLB is expected to offer a flexible and wearable device that permits blood pressure monitoring in more continuous and stress-free settings.

A dipeptidyl peptidase-4 inhibitor ameliorates hypertensive cardiac remodeling via angiotensin-II/sodium-proton pump exchanger-1 axis.

BACKGROUND: To address the impact of antidiabetic drugs on cardiovascular safety is a matter of clinical concern. Preclinical studies revealed that various protective effects of dipeptidyl peptidase-4 inhibitor (DPP4i) on cardiovascular disease; however, its impact of on hypertension remains controversial. METHODS AND RESULTS: Teneligliptin (TEN; 10mg/kg/day/p.o.) ameliorates hypertension and cardiac remodeling by normalizing a rise of angiotensin-II (AngII) that specifically observed in spontaneously hypertensive rats (SHR). TEN had no effects on vasculature and concentrations of the DPP4-related vasoactive peptides (bradykinin, neuropeptide Y, and atrial natriuretic peptide). The primary action of TEN on BP lowering was due to restoring the AngII-induced manifestation of congestive heart failure observed in SHR. Sodium-proton pump exchanger type 1 (NHE-1) is a regulator of intracellular acidity (pHi) and implicated pathophysiological role in cardiac remodeling occurred in diseased myocardium. Cardiac NHE-1 expression level was increased in SHR and this was restored in TEN-treated SHR. AngII directly augmented cardiac NHE-1 expression and its activity that contributed to hypertrophic response. TEN attenuated the AngII-induced cardiac hypertrophy with decline in pHi via suppression of NHE-1. Loss of NHE-1 activity by specific inhibitor or RNA silencing promoted intracellular acidification and consistently attenuated the AngII-mediated cardiac hypertrophy. CONCLUSION: The present study revealed the protective actions of TEN on hypertension and comorbid cardiac remodeling via AngII/NHE-1 axis and the novel pathophysiological roles of intracellular acidification via NHE-1 in cardiac hypertrophy.

Relationship between QRS score and microvascular obstruction after acute anterior myocardial infarction.

BACKGROUND: The QRS score on electrocardiogram (ECG) in patients with myocardial infarction (MI) reportedly reflects the severity of myocardial damage. The presence of microvascular obstruction (MO) assessed by cardiac magnetic resonance (CMR) imaging is associated with irreversible myocardial damage. MO assessed by CMR is known to be a predictor for adverse clinical outcome after ST-elevation MI. The aim of the present study was to examine the relationship between QRS score and MO in acute anterior MI patients. METHODS: Sixty-two patients with first acute anterior MI who successfully underwent primary percutaneous coronary intervention (PCI) were enrolled. The QRS score after PCI on admission ECG was calculated by a Selvester-Wagner QRS scoring system. CMR imaging was performed at 11.4±3.9 days after MI. MO was defined as delayed enhancement with contrast-devoid core. Patients were divided into two groups as follows: 37 patients who showed MO (MO group) and 25 patients who did not show it (non-MO group). RESULTS: The QRS score was significantly greater in the MO group than in the non-MO group. The QRS score significantly correlated with MO volume (r=0.418, p=0.010). Multivariate analysis showed that the QRS score (odds ratio 1.362, 95% CI: 1.038-1.951, p=0.024) and the peak creatine kinase levels (odds ratio 1.001, 95% CI: 1.000-1.002, p<0.001) were independent predictors for MO. CONCLUSIONS: Our results indicate that the QRS score derived from simple and widely available ECG may be a useful parameter for assuring the presence of MO.

[A case of broncholiths derived from calcification of peripheral tuberculous lesions subsequently infected by Actinomyces].

A 72-year-old woman who had been treated for coxotuberculosis was examined because of persistent hemoptysis. Chest X-ray films and CT scans revealed atelectasis of the right middle lobe and bronchial calcification. Bronchoscopy showed a yellow broncholith with pus 1 cm from the orifice of the right B4 bronchus. Actinomyces israelii was isolated by anaerobic culture of bronchial lavage fluid. Since the broncholith occluded the right middle lobe bronchus and had caused repeated episodes of infection the right middle lobe was resected by video-assisted thoracoscopic surgery. Histological examination revealed broncholiths due to calcification of peripheral caseating nodules of tuberculosis, which is a rarely finding.

Fibrous adsorbent for removal of aqueous aromatic hydrocarbons.

Bundles of a strongly hydrophobic fibrous material (p-phenylene-2,6-benzobisoxazole; PBO; Zylon) were employed as an adsorbent for the removal of aqueous aromatic compounds, because the PBO fibers are too rigid to be woven and did not entrap suspended solids. The removal performance for nine kinds of polyaromatic hydrocarbons (PAHs) and di-(2-ethylhexyl) phthalate (DEHP) was evaluated. PAHs and DEHP at initial concentrations of 50 microg L(-1) were removed at 72.5-99.9% and ca. 95%, respectively, although the removal efficiencies were affected by the phase ratio (fiber weight/solution volume). The logarithm of the partition coefficient (log K) for planar PAHs was linearly correlated with the logarithm of the n-octanol/water partition coefficient (log P), but nonplanar PAHs, such as cis-stilbene, p-terphenyl, and o-terphenyl, showed significantly lower adsorption performance. The adsorbed PAHs were not desorbed effectively with CH3CN, CH2Cl2, and toluene. On the other hand, DEHP was effectively desorbed with methanol.

Adenosine A(3) receptor-mediated potentiation of mucociliary transport and epithelial ciliary motility.

To examine the effect of adenosine A(3) receptor stimulation on airway mucociliary clearance, we measured transport of Evans blue dye in rabbit trachea in vivo and ciliary motility of epithelium by the photoelectric method in vitro. Mucociliary transport was enhanced dose dependently by the selective A(3) agonist N(6)-(3-iodobenzyl)-5'-N-methylcarbamoyladenosine (IB-MECA) and to a lesser extent by the less-selective N(6)-2-(4-amino-3-iodophenyl)ethyladenosine, whereas the A(1) agonist N-cyclopentyladenosine (CPA) and the A(2) agonist CGS-21680 had no effect. The effect of IB-MECA was abolished by pretreatment with the selective A(3) antagonist MRS-1220 but not by the A(1) antagonist 1,3-dipropyly-8-cyclopentylxanthine or the A(2) antagonist 3,7-dimethyl-L-propargylxanthine. Epithelial ciliary beat frequency was increased by IB-MECA in a concentration-dependent manner, the maximal increase being 33%, and this effect was inhibited by MRS-1220. The IB-MECA-induced ciliary stimulation was not altered by the Rp diastereomer of cAMP but was greatly inhibited by Ca(2+)-free medium containing BAPTA-AM. Incubation with IB-MECA increased intracellular Ca(2+) contents. Therefore, A(3) agonist enhances airway mucociliary clearance probably through Ca(2+)-mediated stimulation of ciliary motility of airway epithelium.