Optical Coherence Tomography for the Assessment of Coronary Plaque Vulnerability

Optical coherence tomography (OCT) is a high-resolution imaging technology, which can provide detailed observation of the vulnerable coronary atherosclerotic plaques in clinical settings. The current understanding of the major cause of acute coronary syndrome is that it results from plaque rupture of a vulnerable plaque. OCT can provide detailed observation of the vulnerable coronary plaque. The main findings of vulnerable plaque by OCT are considered to be a lipid-rich plaque, a thin-cap fibroatheroma, microchannel structure, spotty calcification, macrophage infiltration, and cholesterol crystal. These features observed by OCT can provide cardiologists to consider pathological mechanisms of coronary atherosclerosis and suitable medical and interventional treatments for vulnerable patients. In this review, we will discuss the characteristics of OCT assessment for coronary atherosclerosis and the clinical impacts of OCT imaging for the treatment of coronary artery disease

Comparative Analysis on Traumatic Brain Injury Risk Due to Primary and Secondary Impacts in a Pedestrian Sideswipe Accident

A series of pedestrian sideswipe impacts were computationally reconstructed; a fast-walking pedestrian was collided laterally with the side of a moving vehicle at 25 or 40 km/h, which resulted in rotating the pedestrian’s body axially. Potential severity of traumatic brain injury (TBI) was assessed using linear and rotational acceleration pulses applied to the head and by measuring intracranial brain tissue deformation. We found that TBI risk due to secondary head strike with the ground can be much greater than that due to primary head strike with the vehicle. Further, an ‘effective’ head mass, meff, was computed based upon the impulse and vertical velocity change involved in the secondary head strike, which mostly exceeded the mass of the adult head-form impactor (4.5 kg) commonly used for a current regulatory impact test for pedestrian safety assessment. Our results demonstrated that an SUV is more aggressive than a sedan due to the differences in frontal shape. Additionally, it was highlighted that a striking vehicle velocity should be lower than 25 km/h at the moment of impact to exclude the potential risk of sustaining TBI, which would be mitigated by actively controlling meff, because meff is closely associated with a rotational acceleration pulse applied to the head involved in the final event of ground contact

Systemic Lymphadenectomy Cannot Be Recommended for Low-Risk Corpus Cancer

Objective. The objective of this study is to ascertain whether omission of lymphadenectomy could be possible when uterine corpus cancer is considered low-risk based on intraoperative pathologic indicators. Patient and Methods. Between 1998 and 2007, a total of 83 patients with low risk corpus cancer (endometrioid type, grade 1 or 2, myometrial invasion ≦50%, and no intraoperative evidence of macroscopic extrauterine spread, including pelvic and paraaortic lymph node swelling and adnexal metastasis) underwent the total abdominal hysterectomy and bilateral salpingo-oophorectomy without lymphadenectomy. A retrospective review of the medical records was performed, and the disease-free survival (DFS), overall survival (OS), peri- and postoperative morbidities and complications were evaluated. Results. The 5-year DFS rates and the 5-year OS rates were 97.6% and 98.8%, respectively. No patient presented postoperative leg lymphedema and deep venous thrombosis. Conclusion. Omission of lymphadenectomy did not worsen the DFS or OS. The present findings suggest that systemic lymphadenectomy could be omitted in low-risk endometrial carcinoma

High Expression of Pitx-2 in the ICAT-deficient Metanephros Leads to Developmental Arrest

ICAT (Inhibitor of β-catenin and T cell factor) inhibits the interaction between β-catenin and TCF/LEF transcription factor and serves as a negative regulator of Wnt signaling. In a subset of ICAT knockout mice, significant delay in the ureteric bud branching and renal agenesis are observed. In order to examine the process of this developmental defect, molecular changes were analyzed in fetal ICAT–/– kidneys with a focus on Wnt-signaling associated factors. The protein level of active β-catenin was elevated in ICAT–/– kidneys. DNA microarray and immunohistochemical analyses revealed that the expression of a Wnt target gene Pitx-2 was enhanced in ICAT–/– kidneys. There was no genotypic difference in the expression level of another Wnt target gene, c-Ret. These results suggest that the enhancement of Pitx-2 expression induced by activated Wnt signaling leads to delays in ureteric bud branching and subsequent renal agenesis. In the ICAT–/– kidneys which developed to E18.5 without any apparent defect, renal glomeruli, convoluted tubules and collecting ducts were decreased in density and showed abnormal structure. ICAT may be required for various developmental stages during renal development

A case of IgG4-related tubulointerstitial nephritis concurrent with Henoch-Schönlein purpura nephritis

We describe a 72-year-old man, who had been suffered from Henoch-Schönlein purpura (HSP) several times, presented with hematoproteinuria with granular cast, and general lymphadenopathy. The immunological examination of the serum showed polyclonal hypergammagloburinemia with high value of IgG4. The renal biopsy revealed interstitial inflammatory cell infiltration, including infiltration of lymphocytes and plasma cells, and segmental glomerulonephritis. Direct immunofluorescence microscopy revealed apparent positive staining with anti-human IgA, and anti-human IgG in glomeruli, anti-human IgG4 antibody staining showed many positive plasma cells in the interstitium. The patient was diagnosed with HSP nephritis that was complicated by IgG4-related nephropathy. As a result of the treatment with 30mg prednisolone, the swelling of the LNs decreased, but the patient continued to have persistent hematoproteinuria

"Valuing Variable Annuities" (in Japanese)

In this paper we propose a framework to evaluate variable annuities. We show that the invested capital to a variable annuity can be decomposed into: (i) the reserve money in the account, (ii) options, (iii) fees paid to the mutual fund companies, and (iv) margin accruing to the insurance company. The first two components comprise value to the insured, and the last two accrue to the supply side companies. This view provides a convenient method to double-check the computation of various components of value. We also show that death benefit option attached to the most popular variable annuities is a portfolio of European put options of differing maturities. Assuming that investment value follows a geometric Brownian motion, this component can be valued applying the Black-Scholes formula and using the "death rates statistics" published by the Ministry of Heath, Labour and Welfare. Options on the income benefit are also valued using the Black-Scholes formula.@Stepped-up death benefit is a form of look-back options, which we value using a trinomial lattice. We value some typical products assuming that a person purchases them at age 40 and at age 50. We then examine how various value components would change in response to the volatilities of the investment products, the length of the contract and so on.

Development of an intravital imaging system for the synovial tissue reveals the dynamics of CTLA-4 Ig in vivo

There have been many attempts to visualize the inflamed joints using multiphoton microscopy. However, due to the hypervascular and multilayered structure of the inflamed synovium, intravital imaging of the deep synovial tissue has been difficult. Here, we established original intravital imaging systems to visualize synovial tissue and pathological osteoclasts at the pannus–bone interface using multiphoton microscopy. Combined with fluorescence-labeling of CTLA-4 Ig, a biological agent used for the treatment of rheumatoid arthritis, we identified that CTLA-4 Ig was distributed predominantly within the inflamed synovium and bound to CX3CR1+ macrophages and CD140a+ fibroblasts 6 h after injection, but not to mature osteoclasts. Intravital imaging of blood and lymphatic vessels in the inflamed synovium further showed that extravasated CTLA-4 Ig was immediately drained through lymphatic vessels under acute arthritic conditions, but the drainage activity was retarded under chronic conditions. These results indicate that this intravital synovial imaging system can serve as a platform for exploring the dynamics of immune cells, osteoclasts, and biological agents within the synovial microenvironment in vivo.Hasegawa T., Kikuta J., Sudo T., et al. Development of an intravital imaging system for the synovial tissue reveals the dynamics of CTLA-4 Ig in vivo. Scientific Reports 10, 13480 (2020); https://doi.org/10.1038/s41598-020-70488-y