Analysis of an antioxidative defence system of hydrogen peroxide-treated pancreatic islet-derived 1.1B4 cells and siRNA targeting NR4A3-treated cells by microarray.

Pancreatic islet ß-cells weaken under oxidative stress. In this study, human pancreatic islet-derived 1.1B4 cells were exposed to H2O2 and analysed using a human microarray, which revealed that heme oxygenase 1 (HMOX1), glutamate-cysteine ligase, early growth response 1, nuclear receptor subfamily 4 group A member 3 (NR4A3) and jun B proto-oncogene were upregulated, whereas superoxide dismutase 1 and catalase were not. Expression of NR4A3 rapidly increased after H2O2 addition, and the 1.1B4 cells treated with siRNA targeting NR4A3 became sensitive to H2O2; further, HMOX1 expression was strongly inhibited, suggesting that NR4A3 is an oxidative stress-responsive transcription factor that functions through HMOX1 expression in pancreatic islet ß-cells. Expression of cyclin E1 and cyclin-dependent kinase 1 was also inhibited by siRNAs targeting NR4A3.

No significant changes in preterm birth, low-birth-weight, and small-for-gestational-age infants during the first year of the COVID-19 pandemic in a rural area in Japan.

AIMS: To evaluate the coronavirus disease 2019 pandemic's impact on pregnancy outcomes in a Japanese rural area. METHODS: This retrospective study focused on the periods between March 1, 2020, and February 28, 2021 (during the coronavirus disease 2019 pandemic), and January 1, 2017, and December 31, 2019. Singleton pregnancies delivered at or after 22 gestational weeks were included. Preterm delivery, low-birth-weight, and small-for-gestational-age infant rates during the pandemic were compared to those in the preceding 3 years. RESULTS: In the pandemic and control groups, 1650 and 5762 pregnant women were included, respectively. Two pregnant women with coronavirus disease 2019 were identified (0.1%). There were no significant intergroup differences in preterm delivery rates (control, 4% vs. pandemic, 3.3%; difference: -0.7% [95% confidence interval: -1.7%-0.3%], p = 0.22). The low-birth-weight rate tended to decrease; however, the difference was insignificant (7.9% vs. 6.5%; difference: -1.4% [95% confidence interval: -2.8-0%], p = 0.06). The small-for-gestational-age infant rate was significantly lower in the pandemic than in the control group (7.3% vs. 5.2%; difference: -2.1% [95% confidence interval: -3.3-0.8%], p < 0.01). However, the interrupted time series analysis showed no significant trend. CONCLUSIONS: There were no significant changes in the rates of preterm delivery, low-birth-weight infants, and small-for-gestational-age infants during the pandemic's first year compared to those in the preceding 3 years. Behavioral changes, such as "stay-at-home" measures, may not improve pregnancy outcomes in Japan.

[A case of Klippel-Trenaunay-Weber syndrome associated with progressive pulmonary hypertension].

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital disorder characterized by varicose veins, cutaneous hemangiomas, hypertrophy of soft tissue and bone and arteriovenous malformations. We present a case of a 43-year-old man with KTWS. He experienced progressive pulmonary hypertension due to recurrent pulmonary embolism, which developed despite adequate anticoagulation. This case report suggests that patients with KTWS need more aggressive management and treatment of their thromboembolitic state and pulmonary hypertension.

[A case of miliary tuberculosis showing diffuse alveolar hemorrhage].

A 43-year-old diabetic man had a productive cough and high fever and was admitted to another hospital. His condition did not improve despite treatment with Cefepime, and he was transferred to our hospital. Chest X-ray films and CT findings showed pulmonary infiltration and diffuse ground-glass opacities in bilateral lung fields, but disseminated nodules were not identified. Since his bronchial lavage fluid (BALF) was bloody, we suspected diffuse alveolar hemorrhage due to vasculitis. Steroid pulse therapy was given, and his fever and chest X-ray findings completely improved. However, 1 week later, he again suffered a high fever and bloody sputum, and a chest X-ray film showed granular shadows in bilateral lung fields. He died of respiratory failure on the 18th hospital day despite treatment and mechanical ventilation. An autopsy revealed many necrotizing epithelioid granulomas in both lungs, the liver, the spleen, both kidneys and both adrenal glands. These findings indicated miliary tuberculosis, and a culture of his sputum and BALF finally revealed mycobacterium tuberculosis. Marked alveolar hemorrhage and a hyaline membrane were also found in both lungs, but vasculitis was not recognized in any organ. We report this case, because to the best of our knowledge diffuse alveolar hemorrhage has not been reported as the primary symptom of miliary tuberculosis.

Dengue virus type 2 isolated from an imported dengue patient in Japan: first isolation of dengue virus from Nepal.

We report the isolation of dengue virus type 2 from a dengue patient returning to Japan from Nepal in October, 2004. This is the first isolate of dengue virus in Nepal. According to nucleotide homology, the virus was closest to a dengue virus type 2 isolate from India.

[A case of diffuse telangiectatic pulmonary arteriovenous malformations treated surgically].

A 19-year-old woman admitted for hemoptysis had remarkable hypoxemia. Pulmonary artery angiography indicated diffuse telangiecatic arteriovenous malformations in the left upper lobe and part of the left lower lobe. The shunt ratio was calculated as 48.7%. Many patients of this diffuse telangiecatic type have a poor outcome, because of its seriousness, difficulty to treat and high risk of complications. In this patient, it was judged that embolization was impossible due to the form of the lesions. We performed resection of left upper lobe and a part of left lower lobe. After the operation, hypoxemia improved remarkably, as well as the shunt ratio (28.8%). No clinical sign of recurrence has been observed two years after the operation.

[An 80-year-old woman with non-resectable pulmonary adenocarcinoma that responded to concomitant use of gemcitabine and vinorelbine].

An 80-year-old female with non-resectable pulmonary adenocarcinoma was treated with five courses of chemotherapy consisting of gemcitabine (GEM) 1,000 mg/m2 plus vinorelbine (VNR) 25 mg/m2 (days 1 and 8, every 4 weeks). A partial response (PR) was achieved, and her complaints abated and quality of life (QOL) improved. Although gastro-intestinal symptoms and bone marrow suppression were observed as side effects, they were within a tolerable range and did not interfere with the therapy. Anti-cancer chemotherapy for non-resectable lung cancer might be worth consideration even for elderly patients more than 80 years of age.

[3 dengue fever cases, infected during a group tour to the Philippines].

We report three dengue fever cases, infected during a group tour to the Philippines. A 58-year old male experienced sudden onset of high fever 5 days after returning to Japan, followed by rash and thrombocytopenia. The other 2 cases experienced similar symptoms. Clinically suspected from the travel history, incubation time and the state of dengue fever epidemic in the Philippines, dengue virus infection was confirmed by the laboratory tests. The incidence and geographical distribution of dengue virus infection have greatly increased in recent years. There have been reports of Japanese travelers who visited dengue endemic countries, infected and developed symptoms after returning home. Dengue virus infection should be included in the differential diagnosis of the patients who develop high fever and rash after returning from tropical areas.