Development of hydroxyapatite-coated nonwovens for efficient isolation of somatic stem cells from adipose tissues.

Adipose-derived stem cells (ASCs) are an attractive cell source for cell therapy. Despite the increasing number of clinical applications, the methodology for ASC isolation is not optimized for every individual. In this study, we developed an effective material to stabilize explant cultures from small-fragment adipose tissues. Methods: Polypropylene/polyethylene nonwoven sheets were coated with hydroxyapatite (HA) particles. Adipose fragments were then placed on these sheets, and their ability to trap tissue was monitored during explant culture. The yield and properties of the cells were compared to those of cells isolated by conventional collagenase digestion. Results: Hydroxyapatite-coated nonwovens immediately trapped adipose fragments when placed on the sheets. The adhesion was stable even in culture media, leading to cell migration and proliferation from the tissue along with the nonwoven fibers. A higher fiber density further enhanced cell growth. Although cells on nonwoven explants could not be fully collected with cell dissociation enzymes, the cell yield was significantly higher than that of conventional monolayer culture without impacting stem cell properties. Conclusions: Hydroxyapatite-coated nonwovens are useful for the effective primary explant culture of connective tissues without enzymatic cell dissociation.

Heuristic bias in perception of medical students relating to out-of-hospital cardiac arrests.

AIM: The aim of this study was to assess the perceptions of medical students with respect to out-of-hospital cardiac arrests focusing on the frequency and survival and to identify potential problems in resuscitation education. METHODS: Fourth-year medical students in a six-year undergraduate educational system were asked to guess the number of out-of-hospital cardiac arrests with cardiac etiology per year in Japan, related data such as the one-month survival rate from out-of-hospital cardiac arrests with cardiac etiology and the number of deaths from traffic accidents for comparison. The guesses of students were compared with actual statistical data. RESULTS: The incidence of out-of-hospital cardiac arrests was clearly underestimated by the students compared to the real statistics. The median guessed number of out-of-hospital cardiac arrests ranged from 6000 to 20,000 while the real statistics ranged from 73.023 to 78.302 by year (P â€‹< â€‹0.001 for all years). In contrast, the guessed number of deaths from traffic accidents was markedly overestimated: the median guessed number ranged from 8000 to 20,000 and the real statistics were 3694 to 4438 (P â€‹< â€‹0.001 for all years). The one-month survival rate was also underestimated: the guessed number was 50% and the real rate was 11.5 to 13.5% (P â€‹< â€‹0.001 for all years). CONCLUSIONS: Out-of-hospital cardiac arrests are underestimated in frequency, and survival after an arrest is overestimated by medical students. To recognize and to understand the heuristic bias in perception of learners is needed for resuscitation education in addition to promote resuscitation skills of learners.

A culture substratum with net-like polyamide fibers promotes the differentiation of mouse and human pluripotent stem cells to insulin-producing cells.

Insulin-producing and -secreting cells derived from mouse pluripotent stem cells (PSCs) are useful for pancreatic development research and evaluating drugs that may induce insulin secretion. Previously, we have established a differentiation protocol to derive insulin-secreting cells from mouse embryonic stem cells (ESCs) using a combination of growth factors, recombinant proteins, and a culture substratum with net-like fibers. However, it has not been tested which materials and diameters of these fibers are more effective for the differentiation. Therefore, the present study aimed to produce net-like culture substratum formed from polyamide (PA) and polyacrylonitrile (PAN) fibers. Substrata were delineated into PA100, 300, 600, PAN100, 300, and 600 groups based on fiber diameters. The differentiation efficiencies of mouse ESCs cultured on the substrata were then examined by insulin 1 (Ins1) expression. Expression was found to be highest in PA300 differentiated cells, indicating the potential to produce high levels of insulin. To understand any differences in substratum properties, the adsorption capacities of laminin were measured, revealing that PA300 had the highest for it. We next examined the stage of differentiation affected by incubation with PA300. This showed that Sox17- and Pdx1-GFP-positive cells increased during the first step of differentiation. To show the production of insulin without absorption from the medium, we confirmed the expression of insulin C-peptide after differentiation. Finally, we tested the effects of PA300 on the differentiation of human-induced PSC, and found more Sox17-positive cells with the PA300 substratum at the definitive endoderm stage. Furthermore, these cells expressed insulin C-peptide and had glucose-responsive C-peptide secretion. In summary, our study identified and validated a novel substratum which is suitable for pancreatic differentiation of mouse and human PSCs.

The Preferential Impairment of Pupil Constriction Stimulated by Blue Light in Patients with Type 2 Diabetes without Autonomic Neuropathy.

The main aim of the present paper is to examine whether the pupillary light reflex (PLR) mediated by intrinsically photosensitive retinal ganglion cells (ipRGCs) is impaired in type 2 diabetic patients. One hundred and three diabetic patients without diabetic autonomic neuropathy (DAN) and 42 age-matched controls underwent a series of detailed neurological examinations. The patients were stratified into three groups: stage I, no neuropathy; stage II, asymptomatic neuropathy; stage III, symptomatic but without DAN. The PLR to 470 and 635 nm light at 20 cd/m2 was recorded. Small fiber neuropathy was assessed by corneal confocal microscopy and quantifying corneal nerve fiber (CNF) morphology. The 470 nm light induced a stronger and faster PLR than did 635 nm light in all subjects. The PLR to both lights was impaired equally across all of the diabetic subgroups. The postillumination pupil response (PIPR) after 470 nm light offset at ≥1.7 sec was attenuated in diabetic patients without differences between subgroups. Receiver operating characteristic analysis revealed that the PIPR mediated by ipRGCs in patients with stage II and stage III neuropathy was different from that of the control subjects. Clinical factors, nerve conduction velocity, and CNF measures were significantly correlated with PLR parameters with 470 nm light. PLR kinetics were more impaired by stimulation with blue light than with red light in diabetic patients without DAN.

The Expanded Bead Size of Corneal C-Nerve Fibers Visualized by Corneal Confocal Microscopy Is Associated with Slow Conduction Velocity of the Peripheral Nerves in Patients with Type 2 Diabetes Mellitus.

This study aims to establish the corneal nerve fiber (CNF) morphological alterations in a large cohort of type 2 diabetic patients and to investigate the association between the bead size, a novel parameter representing composite of accumulated mitochondria, glycogen particles, and vesicles in CNF, and the neurophysiological dysfunctions of the peripheral nerves. 162 type 2 diabetic patients and 45 healthy control subjects were studied in detail with a battery of clinical and neurological examinations and corneal confocal microscopy. Compared with controls, patients had abnormal CNF parameters. In particular the patients had reduced density and length of CNF and beading frequency and increased bead size. Alterations in CNF parameters were significant even in patients without neuropathy. The HbA1c levels were tightly associated with the bead size, which was inversely related to the motor and sensory nerve conduction velocity (NCV) and to the distal latency period of the median nerve positively. The CNF density and length positively correlated with the NCV and amplitude. The hyperglycemia-induced expansion of beads in CNF might be a predictor of slow NCV in peripheral nerves in type 2 diabetic patients.

Elasticity of the tibial nerve assessed by sonoelastography was reduced before the development of neuropathy and further deterioration associated with the severity of neuropathy in patients with type 2 diabetes.

AIMS/INTRODUCTION: To measure the elasticity of the tibial nerve using sonoelastography, and to associate it with diabetic neuropathy severity, the cross-sectional area of the tibial nerve and neurophysiological findings in type 2 diabetic patients. MATERIALS AND METHODS: The elasticity of the tibial nerve was measured as the tibial nerve:acoustic coupler strain ratio using high-resolution ultrasonography in 198 type 2 diabetic patients stratified into subgroups by neuropathy severity, and 29 control participants whose age and sex did not differ from the diabetic subgroups. RESULTS: The elasticity of the tibial nerve in patients without neuropathy (P < 0.001) was reduced compared with controls (0.76 ± 0.023), further decreasing (0.655 ± 0.014 to 0.414 ± 0.018) after developing neuropathy. The cut-off value of elasticity of the tibial nerve that suggested the presence of neuropathy was 0.558. The area under the curve (0.829) was greater than that for the cross-sectional area (0.612). The cross-sectional area of the tibial nerve in diabetic patients without neuropathy (6.11 ± 0.13 mm(2)) was larger than that in controls (4.84 ± 0.16 mm(2)), and increased relative to neuropathy severity (P < 0.0001). The elasticity of the tibial nerve was negatively associated with neuropathy severity (P < 0.0001), cross-sectional area (P = 0.002) and 2000 Hz current perception threshold (P = 0.011), and positively associated with nerve conduction velocities (P < 0.0001). CONCLUSIONS: Determining the elasticity of the tibial nerve in type 2 diabetic patients could reveal early biomechanical changes that were likely caused by thickened fibrous sheaths of peripheral nerves, and might be a novel tool for characterizing diabetic neuropathy.

Safety and efficacy of treatment with liposomal amphotericin B in elderly patients at least 65 years old with hematological diseases.

The safety and efficacy of treatment with liposomal amphotericin B (L-AMB) in elderly patients has not been clarified, especially in Japanese patients. Therefore, we retrospectively analyzed 33 elderly patients with hematological diseases of at least 65 years old who received L-AMB between 2009 and 2012. Their clinical outcomes were compared to those of 21 patients who were younger than 65 years. L-AMB was administered for empirical therapy (n = 2) or target therapy for possible (n = 14) or probable/proven (n = 17) invasive fungal infection. There was no discontinuation of L-AMB due to adverse events. More than 2-fold increases from the baseline Cre, AST, and ALT values were observed in 21.2%, 39.4%, and 45.5% of the older group and 38.1%, 61.9%, and 52.4% of the younger group, respectively. The concurrent use of nephrotoxic antibiotics was the only risk factor for the development of a 2-fold increase in the serum Cre level. The duration of L-AMB was significantly longer in patients who developed grade III-IV hypokalemia. A partial or complete response was observed in 54.8% and 62.5% of the elderly and younger groups, respectively. In conclusion, L-AMB therapy appeared to be acceptably safe as empirical therapy or treatment for invasive fungal infection.

Morphological changes of the peripheral nerves evaluated by high-resolution ultrasonography are associated with the severity of diabetic neuropathy, but not corneal nerve fiber pathology in patients with type 2 diabetes.

AIMS/INTRODUCTION: To evaluate the morphological changes of the median and posterior tibial nerve using high-resolution ultrasonography, and the corneal C fiber pathology by corneal confocal microscopy in type 2 diabetic patients. MATERIALS AND METHODS: The cross-sectional area, hypoechoic area and maximum thickness of the nerve fascicle of both nerves were measured by high-resolution ultrasonography in 200 type 2 diabetic patients, stratified by the severity of diabetic neuropathy, and in 40 age- and sex-matched controls. These parameters were associated with corneal C fiber pathology visualized by corneal confocal microscopy, neurophysiological tests and severity of diabetic neuropathy. RESULTS: The cross-sectional area, hypoechoic area and maximum thickness of the nerve fascicle of both nerves in patients without diabetic neuropathy were larger than those in control subjects (P < 0.05 to P < 0.001), and further increased relative to the severity of neuropathy (P < 0.0001). All morphological changes of both nerves were negatively associated with motor and sensory nerve conduction velocity (P = 0.01 to P < 0.0001), and directly associated with 2,000-Hz current perception threshold (P = 0.009 to P < 0.001). The significant corneal C fiber pathology occurred before developing the neuropathy, and deteriorated only in patients with the most severe neuropathy. The association between the morphological changes of both nerves and corneal C fiber pathology was poor. CONCLUSIONS: The morphological changes in peripheral nerves of type 2 diabetic patients were found before the onset of neuropathy, and were closely correlated with the severity of diabetic neuropathy, but not with corneal C fiber pathology.

Correlation between sudomotor function, sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus.

AIMS/INTRODUCTION: To study the correlation between sudomotor function, sweat gland duct size and corneal nerve fiber pathology in type 2 diabetes. MATERIALS AND METHODS: Sudomotor function was quantified by Neuropad test, and sweat gland duct and corneal nerve fibers were visualized by confocal microscopy in 78 patients with type 2 diabetes stratified by diabetic neuropathy and 28 control participants. RESULTS: In patients with diabetic neuropathy, sudomotor function, as judged by the time required for complete color change of a Neuropad, was impaired compared with that of controls (P < 0.0001), thereby showing deterioration was related to the severity of diabetic neuropathy (P < 0.0001). Sweat gland ducts were smaller in patients without neuropathy than in controls (P < 0.0001), and further shrinking was seen in patients with severe diabetic neuropathy (P < 0.05). Patients without diabetic neuropathy showed reduced density and length (P < 0.001) of corneal nerve fibers and beading frequency (P < 0.0001), and increased tortuosity (P < 0.0001) compared with controls, and these changes deteriorated in patients with severe diabetic neuropathy. Sudomotor function was negatively associated with corneal nerve fibers (P < 0.002) and branches (P < 0.01), and influenced by the severity of diabetic neuropathy (P < 0.0001); sweat gland duct size correlated with serum triglycerides (P < 0.02), uric acid (P < 0.01), corneal nerve branch (P < 0.03), sudomotor function (P < 0.03) and severity of neuropathy (P < 0.03). CONCLUSIONS: Type 2 diabetic patients had sudomotor dysfunction and smaller sweat gland ducts compared with controls. The stage of diabetic neuropathy and corneal nerve fiber pathology were independent predictors of sudomotor dysfunction, and serum triglycerides, uric acid, corneal nerve branch, stage of diabetic neuropathy and sudomotor function were predictors of sweat gland duct size.

System of laser pump and synchrotron radiation probe microdiffraction to investigate optical recording process.

We have developed a system of laser-pump and synchrotron radiation probe microdiffraction to investigate the phase-change process on a nanosecond time scale of Ge2Sb2Te5 film embedded in multi-layer structures, which corresponds to real optical recording media. The measurements were achieved by combining (i) the pump-laser system with a pulse width of 300 ps, (ii) a highly brilliant focused microbeam with wide peak-energy width (ΔE∕E ~ 2%) made by focusing helical undulator radiation without monochromatization, and (iii) a precise sample rotation stage to make repetitive measurements. We successfully detected a very weak time-resolved diffraction signal by using this system from 100-nm-thick Ge2Sb2Te5 phase-change layers. This enabled us to find the dependence of the crystal-amorphous phase change process of the Ge2Sb2Te5 layers on laser power.

[Successful treatment with azacitidine for a patient with relapsed myelodysplastic syndrome after cord blood transplantation].

A 72-year-old man visited our hospital in July 2009 with a major complaint of lightheadedness. Based on bone marrow aspiration, myelodysplastic syndrome (MDS), refractory anemia with excessive blast-2 was diagnosed. Complete remission (CR) was achieved after low-dose cytarabine and aclarubicin therapy. After two courses of low-dose cytarabine therapy, at the first CR, cord blood transplantation (CBT) was performed after reduced-intensity conditioning in January 2010. However, recurrence was found in September 2011. Azacitidine (AZA) was administered subcutaneously daily for either 7 or 5 days and repeated every 4 weeks at doses of 100 mg/day. During nine cycles of AZA treatment, no graft-versus-host disease was observed and no transfusions of red cells/platelet concentrate were required. As of 1 year after the relapse was detected, the patient remains alive with stable disease. As there are few reports on AZA treatment for patients with MDS who experience relapse after CBT, the efficacy of this approach remains unclear. Further clinical trials including dose, duration, and number of cycles of AZA for MDS patients who relapse after transplantation are required.

Structural transformation of Sb-based high-speed phase-change material.

The crystal structure of a phase-change recording material (the compound Ag(3.4)In(3.7)Sb(76.4)Te(16.5)) enclosed in a vacuum capillary tube was investigated at various temperatures in a heating process using a large Debye-Scherrer camera installed in BL02B2 at SPring-8. The amorphous phase of this material turns into a crystalline phase at around 416 K; this crystalline phase has an A7-type structure with atoms of Ag, In, Sb or Te randomly occupying the 6c site in the space group. This structure was maintained up to around 545 K as a single phase, although thermal expansion of the crystal lattice was observed. However, above this temperature, phase separation into AgInTe(2) and Sb-Te transpired. The first fragment, AgInTe(2), reliably maintained its crystal structure up to the melting temperature. On the other hand, the atomic configuration of the Sb-Te gradually varied with increasing temperature. This gradual structural transformation can be described as a continuous growth of the modulation period γ.

From local structure to nanosecond recrystallization dynamics in AgInSbTe phase-change materials.

Phase-change optical memories are based on the astonishingly rapid nanosecond-scale crystallization of nanosized amorphous 'marks' in a polycrystalline layer. Models of crystallization exist for the commercially used phase-change alloy Ge(2)Sb(2)Te(5) (GST), but not for the equally important class of Sb-Te-based alloys. We have combined X-ray diffraction, extended X-ray absorption fine structure and hard X-ray photoelectron spectroscopy experiments with density functional simulations to determine the crystalline and amorphous structures of Ag(3.5)In(3.8)Sb(75.0)Te(17.7) (AIST) and how they differ from GST. The structure of amorphous (a-) AIST shows a range of atomic ring sizes, whereas a-GST shows mainly small rings and cavities. The local environment of Sb in both forms of AIST is a distorted 3+3 octahedron. These structures suggest a bond-interchange model, where a sequence of small displacements of Sb atoms accompanied by interchanges of short and long bonds is the origin of the rapid crystallization of a-AIST. It differs profoundly from crystallization in a-GST.

Structural investigation of GeSb6Te10 and GeBi6Te10 intermetallic compounds in the chalcogenide homologous series.

The crystal structures of GeSb(6)Te(10) and GeBi(6)Te(10) were scrutinized using an X-ray powder diffraction method, which revealed that these compounds crystallize in trigonally distorted cubic close-packed structures with a 51-layer period (R3m). Each layer consists of a triangular atomic net; Te atoms occupy their own specific layers, whereas Ge, Sb and Bi atoms are located in the other layers. In these pseudobinary compounds, random atomic occupations of Ge and Sb/Bi are observed and the layers form two kinds of elemental structural blocks by their successive stacking along the c axis. These compounds can be presumed to be isostructural. It is known that the chemical formula of the chalcogenide compounds with the homologous structures found in these pseudobinary systems can be written as (GeTe)(n)(Sb(2)Te(3))(m) or (GeTe)(n)(Bi(2)Te(3))(m) (n, m: integer); the GeSb(6)Te(10) and GeBi(6)Te(10) investigated in this study, which correspond to the case in which n = 1 and m = 3, naturally have 3 x l = 51-layer structures according to a formation rule l = 2n + 5m commonly found in the compounds of these chalcogenide systems (l represents the number of layers in the basic structural unit). Calculations based on the density functional theory revealed that these materials are compound semiconductors with very narrow band gaps.

Structures of stable and metastable Ge2Bi2Te5, an intermetallic compound in a GeTe-Bi2Te3 pseudobinary system.

Ge(2)Bi(2)Te(5) in the GeTe-Bi(2)Te(3) pseudobinary system has two single-crystalline phases: a metastable phase with an NaCl-type structure and a stable phase with a nine-layer trigonal structure. In the metastable phase, the structure consists, in the hexagonal notation, of infinitely alternating stacks of Te and Ge/Bi layers at equal intervals along the c axis. On the other hand, in the stable phase those two layers are stacked alternately nine times to form an NaCl block. The blocks are then piled to construct a nine-layered trigonal structure with cubic close-packed stacking. Both ends of each block are covered with Te layers, contrary to the infinite alternation of Ge/Bi and Te layers in the structure of the metastable phase. The Ge/Bi layers in the metastable phase contain as much as 20 at. % vacancies; on the other hand, those in the stable phase are filled with atoms. These two crystalline phases in Ge(2)Bi(2)Te(5) have identical atomic configurations to the two corresponding phases found in Ge(2)Sb(2)Te(5).

Intensive multimodality therapy including paclitaxel and reduced-intensity allogeneic hematopoietic stem cell transplantation in the treatment of adrenal cancer with multiple metastases.

Adrenocortical carcinoma is a rare malignancy in adolescents and young adults. The prognosis of unresectable/metastatic adrenocortical carcinoma remains very poor because the rarity of the tumor has made it difficult to establish treatment guidelines, and diagnosis and the resultant treatment can be greatly delayed. We treated a 24-year-old woman who was diagnosed with adrenocortical carcinoma of the right adrenal gland which extended to the inferior vena cava. Although she underwent surgical resection of the extensive tumor as the primary treatment, the disease recurred in the lung and liver as multiple metastases shortly after surgery. She received intensive multimodality therapy, including chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP regimen), embolization of the feeding arteries, and proton irradiation for the liver mass. Finally, she underwent reduced-intensity allogeneic hematopoietic stem cell transplantation from an HLA 1-locus-mismatched sibling donor. A prolonged survival of 39 months after the onset of the disease was achieved. Although this experience is limited, we suggest that TIP chemotherapy was effective for adrenocortical carcinoma, and a graft-versus-tumor effect after reduced-intensity stem cell transplantation may have contributed to the prolonged survival.

Single structure widely distributed in a GeTe-Sb2Te3 pseudobinary system: a rock salt structure is retained by intrinsically containing an enormous number of vacancies within its crystal.

GeTe(1-x)-Sb2Te3(x) sputtered amorphous film was crystallized into a simple NaCl-type structure through instantaneous laser irradiation over a wide composition range from x = 0 to at least 2/3. When the ratio of Sb2Te3 increases, a vacancy is generated at every Na site for two Sb atoms. The fraction of vacancies, v(x), changes according to x/(1 + 2x), and the cubic root unit cell volume varies with a strong correlation to v(x). Through these created vacancies, valence electrons provided by adjacent Ge/Sb and Te atoms remain constant regardless of the composition, ensuring that these electrons occupy predominantly the bonding molecular orbitals. This results in crystal chemical stability, with the closed shell p-p bondings in the valence electrons arranging the crystal's atomic configuration into an NaCl-type structure.

Feasibility of early tapering of cyclosporine following reduced-intensity stem cell transplantation for advanced hematologic or solid malignancies.

Although some researchers have reported that early tapering of cyclosporine is feasible and beneficial to augment graft-versus-leukemia effects after conventional stem-cell transplantation, there is little information on the feasibility of this strategy following reduced-intensity stem cell transplantation (RIST). We summarized outcomes of 17 patients who underwent early tapering of cyclosporine following RIST from HLA-identical siblings.

Chest computed tomography of late invasive aspergillosis after allogeneic hematopoietic stem cell transplantation.

Computed tomography (CT) is a powerful diagnostic tool for invasive aspergillosis (IA) after allogeneic stem cell transplantation (allo-SCT); however, little information is available concerning CT findings of late IA after allo-SCT. To characterize CT findings of late IA, we retrospectively examined medical records and high-resolution CT findings of 27 allo-SCT recipients with late IA. Either acute or chronic GVHD was diagnosed in 24 patients. All 27 patients were given corticosteroids at IA diagnosis. High-resolution CT findings included halo (n=12), centrilobular nodules (n=12), ill-defined consolidation (n=13), ground-glass attenuation (n=8), pleural effusion (n=7), pleural-based consolidation (n=4), and cavitation (n=4). CT findings showing centrilobular nodules and either halo or cavitation were classified into bronchopneumonia type and angioinvasive type, respectively. Angioinvasive-type, bronchopneumonia-type, and combination-type IA were diagnosed in 11, 8, and 4 patients, respectively. CT findings were nonspecific in the other 4 patients. One bronchopneumonia-type case and 2 angioinvasive-type IA cases were subsequently diagnosed as combination type. Although there were no significant differences in patient characteristics between the 2 types of IA, bronchopneumonia-type IA had a poorer prognosis than angioinvasive IA ( P=.022). Halo is a useful diagnostic marker in late IA as well as early IA, and late IA frequently manifests as bronchopneumonia.