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Objectives: Desmopressin is widely used for nocturia in patients with nocturnal polyuria. We investigated the continuation rate and adherence for desmopressin in patients with overactive bladder and nocturia using a claims database and evaluated factors that improved adherence. Methods: Patients with nocturia in a Japanese claims database who started desmopressin between September 2019 and July 2021 were evaluated. Drug persistence was assessed using the Kaplan–Meier method for initial prescription of desmopressin. The proportion of days covered (PDC) was also evaluated among patients with prescription persistence. Multivariate analysis was performed using logistic regression analysis to identify factors predicting adherence to desmopressin. Results: The study included 72,888 patients entered into Japan Medical Data Center (JMDC) database between September 2019 and July 2021. For the 236 patients prescribed desmopressin formulations, mean prescription duration was 114 days. Among the total cases, 90 (38.1%) cases were prescribed only once, mean PDC was 0.60, and the number of high‐adherence patients (PDC ≥ 0.80) was 108 (45.8%). Desmopressin prescription doses were fixed in 216 patients and adjusted in 20 patients. Multivariate analysis identified prescription dose adjustment for desmopressin as significantly associated with high PDC. Conclusion: Desmopressin showed a 38% dropout rate after the first dose. However, high medication continuation and high medication adherence rates (PDC) could be maintained with prescription adjustments. Careful patient monitoring and appropriate adjustment of the desmopressin dosage appear to be important factors in improving nocturia. [ABSTRACT FROM AUTHOR]

Featured Application: The present study found a significant relationship between the prevalence of skin symptom exacerbations and the concentration of particulate matter 2.5 and its ionic components. A few studies have evaluated this topic, so the present study may be an important stepping stone for future research. (1) Background: To date, little research has epidemiologically examined whether the concentration of particulate matter (PM) 2.5 and its ionic components is related to the prevalence of skin symptom exacerbations. Therefore, this study aimed to clarify this association in patients with allergic diseases. (2) Methods: From 1 February to 31 May 2020, we evaluated the daily prevalence of skin symptoms in outpatients with allergic diseases being treated at Fukuoka National Hospital, Fukuoka, Japan, and measured the concentration of PM2.5 and its ionic components. (3) Results: Univariate analysis showed a statistically significant association between skin symptoms and the concentration of PM2.5 and the ionic components SO42−, NH4+, K+, and Mg2+; multivariate analysis showed a statistically significant association between the daily prevalence of skin symptom and the concentration of the ionic components SO42− or Mg2+. (4) Conclusions: Our findings indicate that the concentration of some PM2.5 ionic components may affect skin symptom in patients with allergic diseases. [ABSTRACT FROM AUTHOR]

To estimate the connectivity of a road network, it is crucial to evaluate the correlation of hazard intensities among individual bridge locations since the probability of multiple bridges being damaged simultaneously depends on the degree of this correlation. However, research on connectivity assessment of bridge networks considering spatial correlations associated with flood intensities is scarce in the literature. When quantifying the spatial correlation of flood intensities, modeling based on the stream distance rather than the Euclidean distance is required, taking into account that river flow is restricted only within the stream network. To achieve this purpose, a novel methodology is proposed to evaluate the spatial correlation of a stream network based on a geostatistical linear model and stream network covariance models. In addition, this study considers the spatial correlation of seismic hazard intensity. With the proposed method, it is possible to identify which bridges play an important role in ensuring the connectivity of the road network under multiple hazards, i.e. flood and seismic. As an illustrative example, the proposed method is applied to a hypothetical bridge network in Kumamoto Prefecture, Japan. The results demonstrate that improved network connectivity can be achieved by implementing a relevant retrofitting strategy for important bridges. [ABSTRACT FROM AUTHOR]

Objectives: Patients following renal transplantation (RTX) may experience nocturia exacerbation due to polyuria and reduced bladder capacity, thereby impacting the specific quality of life (QOL) associated with nocturia. The present study aims to investigate factors associated with the deterioration of nocturia‐specific QOL in RTX patients. Methods: The study cohort comprised 59 consecutive patients who had undergone successful RTX. Nocturia‐related QOL questionnaires (N‐QOL) were employed to evaluate the specific QOL related to nocturia. The Bother/Concern and Sleep/Energy domains of the N‐QOL were also assessed. The primary outcome measure was to explore factors related to the aggravation of nocturia‐specific QOL in patients post‐RTX. Results: The mean nocturia frequency post‐RTX was 1.3 ± 1.0. Univariate and multivariate analyses revealed a significant reduction in the Bother/Concern domain score associated with increased nocturia (p =.042). Aging significantly decreased the total N‐QOL score and the Sleep/Energy domain score (p =.001 and.0002, respectively). Prolonged duration after RTX significantly reduced the scores of both the Sleep/Energy domain and the Bother/Concern domain (p =.018 and.037, respectively). However, the duration of dialysis prior to RTX was not significantly associated with the total score or subdomains of N‐QOL. Conclusions: Nocturia‐specific QOL affected not only the nocturia itself, but also aging and the prolonged duration after RTX. Thus, comprehensive approaches to the RTX patients were needed to improve the Nocturia‐specific QOL in RTX patients. [ABSTRACT FROM AUTHOR]

Runx2 (runt related transcription factor 2) is an essential transcription factor for osteoblast proliferation and differentiation. Uridine diphosphate (UDP)-N-acetylgalactosamine (GalNAc): polypeptide GalNAc-transferase 3 (Galnt3) prevents proteolytic processing of fibroblast growth factor 23 (Fgf23), which is a hormone that regulates the serum level of phosphorus. Runx2 and Galnt3 were expressed in osteoblasts and osteocytes, and Fgf23 expression was restricted to osteocytes in bone. Overexpression and knock-down of Runx2 upregulated and downregulated, respectively, the expressions of Galnt3 and Fgf23, and Runx2 directly regulated the transcriptional activity of Galnt3 in reporter assays. The expressions of Galnt3 and Fgf23 in osteoblast-specific Runx2 knockout (Runx2fl/flCre) mice were about half those in Runx2fl/fl mice. However, the serum levels of phosphorus and intact Fgf23 in Runx2fl/flCre mice were similar to those in Runx2fl/fl mice. The trabecular bone volume was increased during aging in both male and female Galnt3−/− mice, but the osteoid was reduced. The markers for bone formation and resorption in Galnt3−/− mice were similar to the control in both sexes. Galnt3−/− mice exhibited hyperphosphatemia and hypercalcemia, and the intact Fgf23 was about 40% that of wild-type mice. These findings indicated that Runx2 regulates the expressions of Galnt3 and Fgf23 and that Galnt3 decelerates the mineralization of osteoid by stabilizing Fgf23. [ABSTRACT FROM AUTHOR]

The relationship between exposure to polycyclic aromatic hydrocarbons and nasal symptoms currently remains unclear. Therefore, we herein examine this relationship in 51 adults living in Ishikawa prefecture, Japan, and conducted a 2 month follow-up survey on these participants. All participants were asked to record daily nasal symptoms in an allergy diary during the study period between 1 April to 31 May 2020. We collected air pollutant samples during the study period and determined the concentrations of PAHs and total suspended particulates by high-performance liquid chromatography. Sulfur dioxide and nitrogen dioxide concentrations were obtained through the Atmospheric Environmental Regional Observation System. We used generalized estimating equations to analyze the association between pollutant and nasal symptoms. After adjustment for confounding factors, the B values of fluoranthene, pyrene, and Benzo[k]fluoranthene were 2.389 (p = 0.026), 3.744 (p = 0.022) and 9.604 (p = 0.041), respectively, with a one-day lag. In contrast, the B value of indeno[1,2,3-cd]pyrene was −6.664 (p = 0.013) with no lag. Collectively, these results suggest ambient PAHs such as Flt, Pyr, and BkF were associated with nasal symptoms in adults. Further studies are needed to elucidate the mechanisms contributing to the relationships between specific PAHs and nasal symptoms. [ABSTRACT FROM AUTHOR]

Ambient polycyclic aromatic hydrocarbons' (PAHs) specific components are likely involved in respiratory disease development and exacerbation in children and adults. Airborne PAH exposure's effects on cough symptoms in children and adults with chronic coughs in Kanazawa and Fukuoka, Japan, were investigated in this longitudinal study. A total of 98 patients with chronic coughs were enrolled and followed up between 1 April and 31 May 2020. The enrolled patients were non-smoking adults and children aged 3–83 years. Cough diaries were used to record and collect daily cough symptoms. High-performance liquid chromatography coupled with a fluorescence detector was used to determine the particulate PAH content in daily total suspended particles collected on quartz fiber filters. Ambient concentrations of fine particulate matter, nitrogen dioxide, and sulfur dioxide were obtained from local monitoring sites. Generalized estimated equations were used to estimate the association between daily PAHs and cough symptoms. Among nine PAHs measured, benz[a]anthracene (BaA) was significantly associated with cough symptoms for both lag4 and lag5 PAH exposure. These findings suggest that airborne specific PAHs, especially BaA, affect cough symptoms in children and adults with chronic cough. Further studies are needed to develop effective measures to prevent respiratory diseases against specific PAHs. [ABSTRACT FROM AUTHOR]

Featured Application: Few studies have examined the efficacy of masks in preventing the effects of ionic components of air pollution on health. The results of this study should serve as a base for future research. Mask wearing can protect health care workers. However, its efficacy in avoiding the health effects of air pollution is not well studied. Recently, we evaluated the relationship between air pollution and health status or peak expiratory flow rate (PEFR). At the beginning of that study, about 20% of people were wearing masks. However, in the same period one year later, most people were wearing masks because of the COVID-19 pandemic. Therefore, in this study, we examined the relationship between mask wearing, concentration of ionic components of PM2.5, respiratory symptoms, and PEFR. Seventy-two patients in Fukuoka City with asthma and allergic diseases measured PEFR daily and recorded respiratory symptoms and mask wearing in a diary. We measured the ionic components of PM2.5 in Fukuoka City and examined the relationships between patient measurements, mask wearing, and air pollution. Univariate analysis showed that, in 2020, but not in 2021, some ionic components of PM2.5, i.e., Cl−, NO3−, Na+, and Mg2+, were significantly correlated with the frequency of cough and nasal symptoms and a decrease in PEFR. Some ionic components of PM2.5 may increase the frequency of respiratory symptoms and decrease PEFR in patients with allergic diseases; however, this tendency is not seen when masks are used. The use of masks may be one of the factors that attenuate the effects of PM2.5 ionic components. [ABSTRACT FROM AUTHOR]

Featured Application: Few studies have evaluated the relationship between the concentration of ionic components in PM2.5 and clinical symptoms or peak expiratory flow rate. The present study is an important stepping stone for future research. (1) Background: Few studies have evaluated the association between the ionic components of PM2.5 and respiratory symptoms or peak expiratory flow rate (PEFR). The aim of this study was to clarify these associations. (2) Methods: Patients with allergic diseases treated at Fukuoka Hospital recorded their morning and evening PEFR and respiratory symptoms in a diary. We measured PM2.5 and its ionic components in Fukuoka City and examined the relationship with PEFR and respiratory symptoms by univariate and multivariate analysis. (3) Results: Among the ionic components of PM2.5, Cl−, NO3−, Na+, K+, and Mg2+ were significantly correlated with the frequency of coughing and nasal symptoms. In univariate analysis, the concentrations of each of the above ions was significantly associated with a decrease in PEFR and the concentrations of each was associated with at least one respiratory symptom or PEFR. Multivariate analysis of items significantly correlated with PEFR indicated that the concentration of ionic components may predict changes in PEFR. (4) Conclusions: In patients with allergic diseases, some ionic components of PM2.5 may increase the frequency of respiratory symptoms and decrease PEFR, so further study and caution are required in daily clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to clarify the relationships of intraoperative surgical position with the incidence of postoperative rhabdomyolysis and with postoperative renal function to safely perform robot‐assisted radical prostatectomy. Methods: The participants in the present study were 276 consecutive patients who underwent robot‐assisted radical prostatectomy at our institutions between 2013 and 2020; 130 cases were performed in the opened legs position and 146 cases in the lithotomy position with a steep 23°–25° head‐down position. Rhabdomyolysis was defined as creatine kinase values greater than 1000 IU/L. Propensity score matching including age, body mass index, the presence of comorbidities, preoperative creatine kinase, preoperative estimated glomerular filtration rate, and prostate‐specific antigen was performed, resulting in a matched cohort of 146 patients (opened legs position group n = 73; lithotomy position group n = 73). Results: After propensity score matching, creatine kinase values on the first day after surgery were significantly lower in the opened legs position group than in the lithotomy position group (opened legs position group: lithotomy position group = 246.9 ± 114.9 IU/L: 558.2 ± 114.9 IU/L, P = 0.034). There were significantly fewer patients diagnosed with postoperative rhabdomyolysis in the opened legs position group (opened legs position group: lithotomy position group = 0% (0/73): 9.6% (7/73), P < 0.001). In addition, fluid replacement volume was significantly less in the opened legs position group (opened legs position group: lithotomy position group = 5747 ± 180 mL: 6349 ± 0176 mL, P = 0.018). Conclusions: To prevent rhabdomyolysis after surgery, robot‐assisted radical prostatectomy should be performed in the opened legs position. [ABSTRACT FROM AUTHOR]

Seismic isolation is an effective technology for mitigating the seismic damage to bridges. However, rupture and large cracks of laminated rubber bearings, including lead rubber bearings, have occurred at several bridges during recent earthquakes. Preventing the rupture of seismic isolators by considering uncertainties and variations in the mechanical properties due to ageing deterioration can improve the ductility capacity of the bridge systems when subjected to extreme ground motions. This study presents a time-dependent seismic reliability assessment methodology for isolated bridges that considers long-term ageing deterioration of lead rubber bearings. The effects of capacity hierarchy between the isolator and the column, as well as the ageing deterioration of isolators on the seismic reliability and the predominant ultimate failure mode were clarified. It was found that the effect of ageing deterioration of lead rubber bearings on seismic reliability is relatively smaller than that of the difference in seismic hazards at different sites. Furthermore, the seismic safety of isolated bridges can be significantly improved by setting an adequate capacity hierarchy between the isolator and the column, as it can prevent the rupture of the isolator under extreme ground motions considering the ageing deterioration of the isolator. [ABSTRACT FROM AUTHOR]

Background: Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known. Objective: To identify clinical factors in children with asthma associated with low or declining lung function during the treatment. Methods: We enrolled children with asthma who had been treated throughout three age periods, i.e., 6–9, 10–12, and 13–15 years old, at seven specialized hospitals in Japan. Clinical information and lung function measurements were retrieved from the electronic chart systems. To characterize the lung function trajectories during each age period, we evaluated the forced expiratory volume 1 (FEV1) with % predicted values and individual changes by the slope (S) from linear regression. We defined four trajectory patterns: normal (Group N) and low (Group L), showing %FEV1 ≥80% or <80% throughout all three periods; upward (Group U) and downward (Group D), showing S ≥ 0 or S < 0%. Logistic regression analysis was performed to compare factors associated with the unfavorable (D/L) versus favorable (N/U) groups. Results: Among 273 eligible patients, 197 (72%) were classified into Group N (n = 150)/U (n = 47), while 76 (28%) were in Group D (n = 66)/L (n = 10). A history of poor asthma control, long-acting beta2 agonist use, and a lower height Z-score during 13–15 years were associated with an unfavorable outcome (Group D/L). Conversely, inhaled corticosteroid (ICS) use during 10–12 years and high-dose ICS use during 13–15 years were associated with a favorable outcome (Group N/U). Conclusion: We identified several factors that are associated with unfavorable lung function changes in pediatric asthma. Attention should be paid to the possible relationship between yearly changes in lung function and poor asthma control, use of ICS (and its dose) and use of LABA. [ABSTRACT FROM AUTHOR]

To clarify different effects of Asian dust (AD), long-range transported from Asian continent, on total suspended particles (TSP) and polycyclic aromatic hydrocarbons (PAHs) in Japan, TSP were simultaneously collected during AD periods (from 1 March to 31 May 2020 and 2021) in Fukuoka and Kanazawa. During AD days, decided by Light Detection and Ranging and Japan Meteorological Agency, TSP concentrations increased significantly (p < 0.001) at two sampling sites. PAH concentrations increased in Kanazawa (p < 0.001) but not in Fukuoka on AD days. Correlation coefficients (r) between daily TSP and total PAHs concentrations were weak in Kanazawa: 0.521 (non-AD) and 0.526 (AD) (p < 0.01), and in Fukuoka: 0.321 (non-AD) and 0.059 (AD). However, correlation between seasonal (average monthly) TSP and total PAH concentrations were stronger: 0.680 (Kanazawa) and 0.751 (Fukuoka). The reasons might be that seasonal variations of TSP and total PAHs in two cities depend equally on planetary scale westerly, while daily TSP and total PAHs variations in each city varied by different transportation distances from AD and PAHs sources in the Asian continent to Japan. Different local sources and meteorological conditions were considered. These results are important for elucidating the causes of chronic and acute respiratory diseases. [ABSTRACT FROM AUTHOR]

The relationship between exercise-induced bronchoconstriction (EIB) and exertional dyspnea in children and adolescents is yet to be fully established. This study examined whether indicators of fractional exhaled nitric oxide (FeNO), forced expiratory volume in 1 s (FEV1) percent predicted at baseline, and dyspnea are useful for predicting children and adolescents with EIB. We enrolled 184 children and adolescents diagnosed with asthma (mean age 11.2 years); participants were divided into two groups according to age (12 years) and were subjected to a 6-min exercise challenge test. Lung function tests and modified Borg scale scores were used to examine perceptions of dyspnea at 0, 5 and 15 min after exercise. Among children, the maximum percentage drop in FEV1 after exercise correlated significantly with FeNO (adjusted β = 2.3, P < 0.001) and with the perception of dyspnea at 5 min after exercise (adjusted β = 1.9, P < 0.001). Among adolescents, the maximum percentage drop in FEV1 correlated with FeNO (adjusted β = 2.7, P = 0.007) and with lung function (FEV1, percent predicted; adjusted β = −0.28, P = 0.006). Children with EIB had significantly stronger dyspnea after exercise than did children without EIB. Adolescents even without EIB may experience more exertional dyspnea than children without EIB. Overall, our findings indicated that EIB was associated with FeNO and exertional dyspnea in asthmatic children. By contrast, EIB was associated with FEV1 percent predicted at baseline and FeNO but not with exertional dyspnea in asthmatic adolescents. [ABSTRACT FROM AUTHOR]

Background: Clarification of the risk factors for coronavirus disease 2019 (COVID-19) severity is strongly warranted for global health. Recent studies have indicated that elevated body mass index (BMI) is associated with unfavorable progression of COVID-19. This is assumed to be due to excessive deposition of visceral adipose tissue (VAT); however, the evidence investigating the association between intra-abdominal fat and COVID-19 prognosis is sparse. We therefore investigated whether measuring the amount of intra-abdominal fat is useful to predict the prognosis of COVID-19.Methods: The present study enrolled 53 consecutive cases of COVID-19 patients aged ≥ 20 years with chest computed tomography (CT) scans. The VAT area, total adipose tissue (TAT) area, and VAT/TAT ratio were estimated using axial CT images at the level of the upper pole of the right kidney. Severe COVID-19 was defined as death or acute respiratory failure demanding oxygen at ≥ 6 L per minute, a high-flow nasal cannula, or mechanical ventilation. The association of VAT/TAT with the incidence of progression to a severe state was estimated as a hazard ratio (HR) using Cox regression analysis. To compare the prediction ability for COVID-19 disease progression between BMI and VAT/TAT, the area under the receiver operating characteristic curve (AUC) of each was assessed.Results: A total of 15 cases (28.3% of the whole study subjects) progressed to severe stages. The incidence of developing severe COVID-19 increased significantly with VAT/TAT (HR per 1% increase = 1.040 (95% CI 1.008-1.074), P = 0.01). After adjustment for potential confounders, the positive association of VAT/TAT with COVID-19 aggravation remained significant (multivariable-adjusted HR = 1.055 (95% CI 1.000-1.112) per 1% increase, P = 0.049). The predictive ability of VAT/TAT for COVID-19 becoming severe was significantly better than that of BMI (AUC of 0.73 for VAT/TAT and 0.50 for BMI; P = 0.0495 for the difference).Conclusions: A higher ratio of VAT/TAT was an independent risk factor for disease progression among COVID-19 patients. VAT/TAT was superior to BMI in predicting COVID-19 morbidity. COVID-19 patients with high VAT/TAT levels should be carefully observed as high-risk individuals for morbidity and mortality. [ABSTRACT FROM AUTHOR]

A nerve‐sparing procedure during robot‐assisted radical prostatectomy has been considered one of the most important techniques for preserving postoperative genitourinary function. The reason is that adequate nerve‐sparing procedures could preserve both erectile function and lower urinary tract function after surgery. When a nerve‐sparing procedure is carried out, the cavernous nerves themselves cannot be visualized, despite the magnified viewing field during robot‐assisted radical prostatectomy. Thus, nerve‐sparing procedures have been considered challenging operations, even now. However, because not all surgeons have carried out a sufficient number of nerve‐sparing procedures, the development of new nerve‐sparing procedures or new methods for mapping the cavernous nerves is required. Recently, various new operative techniques, for example, Retzius‐sparing robot‐assisted radical prostatectomy, transvesical robot‐assisted radical prostatectomy and retrograde release of neurovascular bundle technique during robot‐assisted radical prostatectomy, have been developed. In addition, new surgical devices, for example, biological/bioengineering solutions for cavernous nerve protection and devices for identifying the cavernous nerves during radical prostatectomy, have developed to preserve the cavernous nerves. In contrast, limitations or problems in preserving cavernous nerves and postoperative erectile function have become apparent. In particular, the recovery rate of erectile function, the positive surgical margin rate at the site of nerve‐sparing and the indications for nerve sparing have become obvious with the accumulation of much evidence. Furthermore, predictive factors for postoperative erectile function after nerve‐sparing procedures have also been clarified. In this article, the importance of a comprehensive approach for early recovery of erectile function in the robot‐assisted radical prostatectomy era is discussed. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative margin assessment can reduce positive margins in patients undergoing breast-conserving surgery. However, reports on intraoperative margin assessment have described only the use of either imprint cytology or frozen section. This study was designed to elucidate the effect of intraoperative margin assessment using imprint cytology followed by frozen section. Methods: Overall, 522 patients were enrolled. First, the entire surgical margin was subjected to imprint cytology. Frozen section was performed only in cases with "positive" or "suspicious" imprint cytology results. An additional intraoperative excision was performed in patients with frozen section-positive lesion sites. All margins were evaluated using postoperative permanent sections after excision. Results: Among 522 patients, 136 (26.1%) were imprint cytology-positive, and 386 (73.9%) were imprint cytology-negative. Among the 386 imprint cytology-negative patients not subjected to frozen section, 11 (2.1%) were permanent sections-positive (imprint cytology-false-negative). In 47 of the 136 imprint cytology-positive patients, additional intraoperative excision was unnecessary due to the frozen section-negative diagnosis. Moreover, these patients could avoid reoperation, because they were permanent section-negative. The false-positive rate of imprint cytology alone was 13.4%, but adding frozen section to imprint cytology decreased the overall false-positive rate to 2.5%. After undergoing excision, four patients still had positive margins. The overall positive margin rate in the final pathology based on permanent sections was 2.9% (15/522). Conclusions: Imprint cytology followed by frozen section led to a markedly decreased positive margin rate. This is considered the best method for intraoperative margin assessment, as it can overcome the limitations of cytology and histology performed individually. [ABSTRACT FROM AUTHOR]

Background: Despite evidence for the protective effects of early regular exposure to peanut and egg proteins against allergies, the optimal timing of cow's milk (CM) protein exposure is unknown. Objective: We aimed to determine when during the first year of life CM‐based formula consumption becomes associated with lower CM allergy (CMA) risk. Methods: We used the data set of the Japan Environment and Children's Study (JECS), a nationwide birth cohort involving over 100 000 mother‐child pairs. CMA was defined as an allergic reaction to a CM product in an individual not consuming CM products at the time of evaluation, combined with physician‐diagnosed food allergy. For each exposure, we identified when formula milk was commenced, and its consumption status during 0‐3, 3‐6 and 6‐12 months old. Results: The prevalence of CMA was 0.23% and 1.03% at 6 and 12 months old, respectively. Multivariable regression analyses revealed that introducing regular consumption of formula within the first 3 months of age was associated with lower risk of CMA at 12 months. Regular consumption at 3‐6 months was strongly associated with a reduction in 12‐month CMA (adjusted relative risks [95% confidence intervals]: 0.22 [0.12‐0.35]), whereas no association was observed at 0‐3 months (1.07 [0.90‐1.27]). Conclusion and Clinical Relevance: Regular exposure to formula milk at age 3 months or older is associated with lower CMA at 12 months old, suggesting that the effect of very early CM exposure on CMA may disappear if the exposure is brief. At present, however, the results of this observational study should not be used for formula recommendation and randomized controlled trials are required to confirm this association. [ABSTRACT FROM AUTHOR]

Pseudocirrhosis is a rare hepatic complication of chemotherapy, which is morphological changes in hepatic contour that closely mimic cirrhosis. Like in classic cirrhosis, portal hypertension is common in patients with this condition. The mechanism of pseudocirrhosis is unknown to date. We report three cases of pseudocirrhosis arising in the setting of regression of breast cancer liver metastases. All the cases underwent systemic chemotherapy, and all had remarkable responses. Their hormone receptor statuses were all positive and Her2/neu statuses were all negative. They were all treated with cytotoxic chemotherapeutic agent and also hormone therapy. This report suggests clinicians should have pseudocirrhosis in mind when hormone therapy and cytotoxic chemotherapy are jointly administered. [ABSTRACT FROM AUTHOR]

An 83-year-old woman underwent mastectomy for breast cancer of the right breast in 2008. In addition to hormone therapy and irradiation, zoledronate was started for bone metastasis 6 months postoperatively. Five years after the operation, the patient developed osteonecrosis of the jaw, and underwent sequestrectomy because of uncontrollable pain in the mandible. The patient visited our hospital for a 1-week history of fever and right facial swelling with pain, and was diagnosed with right mandibular cellulitis. Despite antibiotic therapy, the patient fell into shock. Follow-up computed tomography showed gas formation extending down to the posterior mediastinum, which was compatible with descending necrotizing mediastinitis (DNM). The patient succumbed to septicemia on the third hospital day. The mortality rate of DNM greatly increases in patients with advanced cancer because clinicians cannot perform radical treatment due to the impaired general condition and limited life expectancy. DNM advances by the hour; therefore, repeated computed tomography is essential when antibiotic therapy does not improve the patient's condition. Attention must be paid to detect signs of DNM in such patients. To the best of our knowledge, this is the first report in English regarding DNM caused by bisphosphonate-induced osteonecrosis of the jaw. [ABSTRACT FROM AUTHOR]

Post-prostatectomy urinary incontinence (PPI) is a crucial issue that requires physician intervention even in the heyday of robotic surgery. Editorial Comment from Dr Haga et al. to Minimal residual membranous urethral length and membranous urethral length predict poor recovery from incontinence after robot-assisted radical prostatectomy and after open radical prostatectomy On the contrary, recently, there has been a shift in focus to overactive bladder (OAB) symptoms after radical prostatectomy in the era of RARP in order to overcome PPI. [Extracted from the article]

An earthquake of JMA magnitude 6.5 (first event) hit Kumamoto Prefecture, Japan, at 21:26 JST, April 14, 2016. Subsequently, an earthquake of JMA magnitude 7.3 (second event) hit Kumamoto and Oita Prefectures at 01:46 JST, April 16, 2016. An out-of-service Kyushu Shinkansen train carrying no passengers traveling on elevated bridges was derailed by the first event. This was the third derailment caused by an earthquake in the history of the Japanese Shinkansen, after one caused by the 2004 Mid-Niigata Prefecture Earthquake and another triggered by the 2011 Tohoku Earthquake. To analyze the mechanism of this third derailment, it is crucial to evaluate the strong ground motion at the derailment site with high accuracy. For this study, temporary earthquake observations were first carried out at a location near the bridge site; these observations were conducted because although the JMA Kumamoto Station site and the derailment site are closely located, the ground response characteristics at these sites differ. Next, empirical site amplification and phase effects were evaluated based on the obtained observation records. Finally, seismic waveforms during the first event at the bridge site of interest were estimated based on the site-effect substitution method. The resulting estimated acceleration and velocity waveforms for the derailment site include much larger amplitudes than the waveforms recorded at the JMA Kumamoto and MLIT Kumamoto station sites. The reliability of these estimates is confirmed by the finding that the same methods reproduce strong ground motions at the MLIT Kumamoto Station site accurately. These estimated ground motions will be useful for reasonable safety assessment of anti-derailment devices on elevated railway bridges. [ABSTRACT FROM AUTHOR]

In contrast, myosteatosis evaluated by CT might indicate the decline in muscle quality. Myosteatosis, which refers to fatty infiltration of skeletal muscle, has attracted considerable attention in the past decade.1 Myosteatosis can be evaluated by imaging modalities, such as computed tomography (CT), magnetic resonance imaging and quantitative ultrasound.2 It has typically been reported in association with metabolic disorders characterized by insulin resistance, dysglycemia, type 2 diabetes mellitus and visceral chronic inflammation.1 Additionally, research regarding the association between myosteatosis and reduced survival in urological cancer has also been published more recently.3 A recent study by Yamashita I et al i . was carried out from completely different perspectives.4 Interestingly, they investigated the relationship between myosteatosis/sarcopenia evaluated by CT and post-prostatectomy urinary incontinence (PPI) after robot-assisted radical prostatectomy.4 The authors concluded that myosteatosis was significantly associated with prolongation of PPI, although sarcopenia was not. Myosteatosis as a novel predictor of urinary incontinence after robot-assisted radical prostatectomy. [Extracted from the article]

Background: Roux-en-Y reconstruction after distal gastrectomy can result in delayed gastric emptying, called Roux stasis syndrome (RSS). The cause of RSS has not been completely identified. This study retrospectively investigated the development of RSS. Methods: Between April 2008 and March 2014, we performed 138 procedures with distal gastrectomy using Roux-en-Y reconstruction. The development of RSS was analyzed and examined for correlations with the length of the operation, amount of blood loss, and surgical procedure. Results: RSS was observed in 16 of the 138 patients. There were no relationships between the length of the operation or amount of blood loss and the development of RSS according to the Mann-Whitney U test. There were also no significant differences in the development of RSS between the patients treated with laparotomy and laparoscopic surgery, end-to-side, side-to-side, or end-to-end anastomosis or isoperistaltic or antiperistaltic anastomosis, as determined using the chi-square test. However, the development of RSS tended to lower in the patients who underwent laparoscopic surgery, side-to-side anastomosis, and isoperistaltic anastomosis. In addition, there was a significant difference between the patients who received antecolic and retrocolic reconstruction ( p = 0.005). Conclusions: Our findings suggest that antecolic reconstruction correlates with a lower likelihood of developing RSS. [ABSTRACT FROM AUTHOR]

Robot-assisted radical prostatectomy (RARP) is considered to be extremely important in terms of maintenance of postoperative health-related quality of life (QOL) in patients who undergo this procedure, because of its potential for resulting in a good prognosis. Editorial Comment to Importance of considering interest in sex when evaluating satisfaction after robot-assisted radical prostatectomy First, in the high-interest in sex group, sexual trouble was prolonged after RARP in dissatisfied patients regardless of improvement in sexual function to the same degree as in satisfied patients. [Extracted from the article]

Acute pancreatitis reportedly occurs in about 15 % of cases of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs), with two-thirds of BD-IPMNs being located in the head or uncinate process of the pancreas. However, the surgical indications and optimal treatment methods for BD-IPMNs have not been established. A 59-year-old Japanese male with epigastralgia was admitted to our hospital. A multidetector row computed tomography (MDCT) scan disclosed grade I acute pancreatitis. Magnetic resonance cholangiopancreatography disclosed a 1.5-cm BD-IPMN in the uncinate process. Two months after discharge, the epigastralgia recurred, and MDCT again revealed grade I pancreatitis. Due to the repeated episodes of pancreatitis, we performed ductal branch-oriented pancreatic resection. To detect the inferior branch of the Wirsung duct and avoid the development of a pancreatic fistula, we injected indigo carmine into the tumor which confirmed ligation of the inferior branch. Histopathologically, the tumor proved to be an adenoma. The postoperative course was uneventful in both the short- and long-term follow-up and, to date, there has been no recurrence of pancreatitis, or diabetes mellitus during the 6 years since pancreatectomy. This procedure is one of the methods that can be used for the successful resection of a BD-IPMN in the uncinate process that caused recurrent acute pancreatitis. [ABSTRACT FROM AUTHOR]

The human ZFAT gene was originally identified as a susceptibility gene for autoimmune thyroid disease. Mouse Zfat is a critical transcriptional regulator for primitive hematopoiesis and required for peripheral T cell homeostasis. However, its physiological roles in T cell development remain poorly understood. Here, we generated Zfatf/f-LckCre mice and demonstrated that T cell-specific Zfat-deletion in Zfatf/f-LckCre mice resulted in a reduction in the number of CD4+CD8+double-positive (DP) cells, CD4+single positive cells and CD8+single positive cells. Indeed, in Zfatf/f-LckCre DP cells, positive selection was severely impaired. Defects of positive selection in Zfat-deficient thymocytes were not restored in the presence of the exogenous TCR by using TCR-transgenic mice. Furthermore, Zfat-deficient DP cells showed a loss of CD3ζ phosphorylation in response to T cell antigen receptor (TCR)-stimulation concomitant with dysregulation of extracellular signal-related kinase (ERK) and early growth response protein (Egr) activities. These results demonstrate that Zfat is required for proper regulation of the TCR-proximal signalings, and is a crucial molecule for positive selection through ERK and Egr activities, thus suggesting that a full understanding of the precise molecular mechanisms of Zfat will provide deeper insight into T cell development and immune regulation. [ABSTRACT FROM AUTHOR]

Abstract: Tespa1 has been recently reported to be a critical molecule in T-cell development, however, the precise molecular mechanisms of Tespa1 remain elusive. Here, we demonstrate that Tespa1 shows amino-acid sequence homology to KRAS-induced actin-interacting protein (KRAP), an inositol 1,4,5-trisphosphate receptor (IP3R) binding protein, and that Tespa1 physically associates with IP3R in T and B lymphocytes. Two-consecutive phenylalanine residues (Phe185/Phe186) in Tespa1, which are conserved between Tespa1 and KRAP, are indispensable for the association between Tespa1 and IP3R. These findings suggest that Tespa1 plays critical roles in the immune system through the regulation of the IP3R. [Copyright &y& Elsevier]

In the seismic design of reinforced concrete (RC) bridge structures, there should be no brittle failures, such as shear failures, in the components, and a plastic hinge should be formed at the bottom of the bridge pier. These are important concepts in capacity design to guarantee the safety of bridges subjected to severe earthquakes. These concepts can maximise post-event operability and minimise the cost of repairing bridges after a severe earthquake. In this article, a reliability-based methodology to carry out capacity design with partial factors is proposed and applied to the seismic design of RC bridge structures. This ensures that (i) all of the components undergo the desired ductile failure mode, (ii) the damage due to an earthquake is induced only at the bottom of the bridge pier and (iii) the probability of failure is at most equal to a specified value. [ABSTRACT FROM PUBLISHER]

Tespa1 has been recently reported to be a critical molecule in T‐cell development, however, the precise molecular mechanisms of Tespa1 remain elusive. Here, we demonstrate that Tespa1 shows amino‐acid sequence homology to KRAS‐induced actin‐interacting protein (KRAP), an inositol 1,4,5‐trisphosphate receptor (IP3R) binding protein, and that Tespa1 physically associates with IP3R in T and B lymphocytes. Two‐consecutive phenylalanine residues (Phe185/Phe186) in Tespa1, which are conserved between Tespa1 and KRAP, are indispensable for the association between Tespa1 and IP3R. These findings suggest that Tespa1 plays critical roles in the immune system through the regulation of the IP3R. [ABSTRACT FROM AUTHOR]

Background: We previously established a three-dimensional (3-D) colonic crypt model using HKe3 cells which are human colorectal cancer (CRC) HCT116 cells with a disruption in oncogenic KRAS, and revealed the crucial roles of oncogenic KRAS both in inhibition of apoptosis and in disruption of cell polarity; however, the molecular mechanism of KRAS-induced these 3-D specific biological changes remains to be elucidated. Results: Among the genes that were upregulated by oncogenic KRAS in this model, we focused on the phosphodiesterase 4B (PDE4B) of which expression levels were found to be higher in clinical tumor samples from CRC patients in comparison to those from healthy control in the public datasets of gene expression analysis. PDE4B2 was specifically overexpressed among other PDE4 isoforms, and re-expression of oncogenic KRAS in HKe3 cells resulted in PDE4B overexpression. Furthermore, the inhibition of PDE4 catalytic activity using rolipram reverted the disorganization of HCT116 cells into the normal physiologic state of the epithelial cell polarity by inducing the apical assembly of ZO-1 (a tight junction marker) and E-cadherin (an adherens junction marker) and by increasing the activity of caspase-3 (an apoptosis marker) in luminal cavities. Notably, rolipram reduced the AKT phosphorylation, which is known to be associated with the disruption of luminal cavity formation and CRC development. Similar results were also obtained using PDE4B2-shRNAs. In addition, increased expression of PDE4B mRNA was found to be correlated with relapsed CRC in a public datasets of gene expression analysis. Conclusions: These results collectively suggested that PDE4B is upregulated by oncogenic KRAS, and also that the inhibition of PDE4 catalytic activity can induce both epithelial cell polarity and luminal apoptosis in CRC, thus highlighting the utility of our 3-D culture (3 DC) model for the KRAS-induced development of CRC in 3-D microenvironment. Indeed, using this model, we found that PDE4B is a promising candidate for a therapeutic target as well as prognostic molecular marker in CRC. Further elucidation of the signaling network of PDE4B2 in 3 DC would provide a better understanding of CRC in vivo. [ABSTRACT FROM AUTHOR]

Over the last two decades, the probabilistic assessment of reinforced concrete (RC) structures under seismic hazard has been developed rapidly. However, little attention has been devoted to the assessment of the seismic reliability of corroded structures. For the life-cycle assessment of RC structures in a marine environment and earthquake-prone regions, the effect of corrosion due to airborne chlorides on the seismic capacity needs to be taken into consideration. Also, the effect of the type of corrosive environment on the seismic capacity of RC structures has to be quantified. In this paper, the evaluation of the displacement ductility capacity based on the buckling model of longitudinal rebars in corroded RC bridge piers is established, and a novel computational procedure to integrate the probabilistic hazard associated with airborne chlorides into life-cycle seismic reliability assessment of these piers is proposed. The seismic demand depends on the results of seismic hazard assessment, whereas the deterioration of seismic capacity depends on the hazard associated with airborne chlorides. In an illustrative example, an RC bridge pier was modeled as single degree of freedom (SDOF). The longitudinal rebars buckling of this pier was considered as the sole limit state when estimating its failure probability. The findings show that the life-cycle reliability of RC bridge piers depends on both the seismic and airborne chloride hazards, and that the cumulative-time failure probabilities of RC bridge piers located in seismic zones can be dramatically affected by the effect of airborne chlorides. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We investigated the effects of a short-term dietary zinc deficiency on bone metabolism. Zinc deficiency increased the mRNA expression of zinc uptake transporters such as Zip1, Zip13, and Zip14 in bone. However, zinc deficiency might not maintain zinc storage in bone, resulting in a decrease in bone formation through downregulation of the expression levels of osteoblastogenesis-related genes. [ABSTRACT FROM AUTHOR]

The article presents a scientific research on the effects of lowering food intake by high phosphorus (P) diet on parathyroid hormone (PTH) actions, bone turnover markers, and kidney mineral concentration in rats. Results of the study showed that high P intake causes secondary hyperparathyroidism. It decreases urinary excretion of cyclic adenosine monophosphate and elevates serum concentration and urinary excretion of C-terminal telopeptide of type I collagen and kidney mineral concentrations.

To determine the parathyroid hormone (PTH) action on kidney and bone by high phosphorus (P) diet, this study investigated PTH/PTH-related peptide (PTHrP) receptor mRNA expression in 6-week-old parathyroidectomized (PTX) rats received constant amount of PTH. To maintain serum PTH levels equally to sham operated rats, PTX rats were constantly exposed to rPTH (1–34) and fed a control diet (0.3% P) and a high P diet (1.2% P) for 7 days, respectively. There were no significant differences in serum PTH (1–34) concentration in rats fed the control diet. In sham groups, serum PTH concentrations, both (1–84) and (1–34) fragments, were increased in rats fed the high P diet than in rats fed the control diet. Urinary excretions of P and C-terminal telopeptides of type I collagen were significantly increased in both PTX and sham rats by the high P diet. PTH/PTHrP receptor mRNA expression in kidney and femur was not changed in both PTX and sham rats by the high P diet. In conclusion, high P diet did not change PTH action in PTX rats and increased urinary excretion of P and bone resorption regardless of PTH action. [ABSTRACT FROM AUTHOR]

This study investigated the gender differences in the kidney function of magnesium (Mg)-deficient rats. Male and female rats were fed a control diet or a Mg-deficient diet for 21 d. Mg-deficient diet had no significant effect on kidney calcium (Ca) or phosphorus (P) concentration in male rats, while Ca and P concentrations in female rats were significantly higher in Mg-deficient rats than in the control rats. With regard to indicators of kidney function, no significant differences in creatinine clearance and serum urea nitrogen concentration were observed among the groups. Serum albumin concentrations were significantly lower in rats fed the Mg-deficient diet than in rats fed the control diet. In both sexes, urinary albumin excretion was significantly higher in rats fed the Mg-deficient diet than in rats fed the control diet. Gender differences had no significant influence on creatinine clearance, serum urea nitrogen concentration, serum albumin concentration and urinary albumin excretion. These results suggest that gender differences have no effect on kidney function in Mg-deficient rats under the condition used. [ABSTRACT FROM AUTHOR]

Determines whether the parathyroid hormone (PTH) dominantly regulated the effects of high phosphorus intakes on urinary excretion of phosphorus and bone metabolism in rats. Indication that a high phosphorus diet increases urinary phosphorus excretion while promoting bone resorption regardless of PTH-dependent regulation.

Neurilemmoma of the breast is rarely seen, although it is common at intracranial or peripheral sites. There have been only 14 cases described in the literature. We present the fifteenth case of a 64-year-old woman with neurilemmoma of the breast, the first to be diagnosed by fine needle aspiration cytology. Fibroadenoma must be distinguished from this tumor. Complete removal is the treatment of choice, considering the possibility of local recurrence and malignant change. [ABSTRACT FROM AUTHOR]

The development of nephrocalcinosis in rats fed a high phosphorus diet, and the effectiveness of the Chinese traditional medicine, Wulingsan, and its components (Poria, Alismatis Rhizoma, Atractylodis Rhizoma, Cinnamomi Ramus, Polyporus) in suppressing the development of calcinosis were studied. The rats were fed a high phosphorus diet (1.5% P) supplemented with Wulingsan or its individual components (0.5 g/kg body weight) as separate experimental groups for a 2-week period. Upon histological observation by light microscopy and electron microscopy, signs of nephrocalcinosis were observed in almost all areas of the kidney. Calculi, consisting mainly of needle-shaped crystals of hydroxyapatite, were observed in the proximal tubules, in the collecting ductal lumina, and in the mitochondria of the proximal tubular cells and the interstitial cells. X-ray microanalysis revealed that the calculi were composed of hydroxyapatite (Ca and P). In the group fed the diet supplemented with Wulingsan, the severity of calcinosis in the corticomedullary junction was only slight. In all groups fed individual components of Wulingsan, the severity of calcinosis was almost the same as that in the group fed the high phosphorus diet (1.5% P). Wulingsan suppressed the development of calcinosis in rats fed the high phosphorus diet supplemented with this Chinese medicine, whereas its individual components alone had no effect. The process of calcinosis and the mechanism responsible for the activity of this Chinese medicine in the suppression of calcinosis are discussed. [ABSTRACT FROM AUTHOR]

The thread cells in the slime gland of Japanese hagfishes, Paramyxine atami and Eptatretus burgeri were studied by light and electron microscopy. The mature thread cells are large elements (180×80 μ) filled with an intricately coiled thread, approximately 2 μ in diameter. The protein nature of the thread has been confirmed by histochemical examination. In the initial stage of growth, the thread consists of a bundle of distinctly parallel filaments approximately 90-120 Å in diameter and a centrally located tubular component approximately 230-260 Å in diameter which occurs singly or occasionally as a double and triple structure. The developing thread displays thin filaments, approximately 30-60 Å in diameter. The thin filaments are composed of fine fibrous structures, subfilaments, approximately 10-30 Å in diameter. On the outer surface of the thread a coating is apparent, giving it a fluffy appearance. Polysomal clusters consisting of five or six ribosomes are predominant. Fine fibrous structures are also found among the threads. They seem to have a spatial relationship with the polysomes and resemble the subfilament constituents of the thin filaments. From these results, it may be suggested that the fine fibrous structures synthesized by polysomes, twist together and coalesce into a thread. The problem of the polysome size and the molecular weight of the fibrous protein synthesized is discussed. [ABSTRACT FROM AUTHOR]