Thin anterior uterine wall with incomplete uterine rupture in a primigravida detected by palpation and ultrasound: a case report

<p>Abstract</p> <p>Introduction</p> <p>Uterine rupture is an obstetric complication associated with significant maternal and fetal morbidity and mortality. This disorder usually occurs with a scarred uterus, especially in a uterus with prior Cesarean section. Uterine sacculation or diverticulum may also lead to a thin uterine wall during pregnancy.</p> <p>Case presentation</p> <p>A 27-year-old Japanese primigravid woman was admitted to our hospital due to weak, irregular uterine contractions in her 38^thweek of gestation. She had no past history of uterine surgery or known diseases. A hard mass was palpable in her abdomen. An ultrasound revealed that the anterior uterine wall was thin and bulging, with a fetal minor part beneath it which corresponded to the palpated mass. A Cesarean section was performed which revealed a thin anterior uterine wall with incomplete uterine rupture. The woman and baby were healthy.</p> <p>Conclusions</p> <p>Although extremely rare, an unscarred primigravid uterus can undergo incomplete rupture even without discernable risk factors or labor pains. Abdominal palpation and ultrasound may be useful in detecting this condition.</p

Noise simulation system for determining imaging conditions in digital radiography

Reduction of exposure dose and improvement in image quality can be expected to result from advances in the performance of imaging detectors. We propose a computerized method for determining optimized imaging conditions by use of simulated images. This study was performed to develop a prototype system for image noise and to ensure consistency between the resulting images and actual images. An RQA5 X-ray spectrum was used for determination of input-output characteristics of a flat-panel detector (FPD). The number of incident quantum to the detector per pixel (counts/pixel) was calculated according to the pixel size of the detector and the quantum number in RQA5 determined in IEC6220-1. The relationship among tube current-time product (mAs), exposure dose (C/kg) at the detector surface, the number of incident quanta (counts/pixel), and pixel values measured on the images was addressed, and a conversion function was then created. The images obtained by the FPD was converted into a map of incident quantum numbers and input into random-value generator to simulate image noise. In addition, graphic user interface was developed to observe images with changing image noise and exposure dose levels, which have trade-off relationship. Simulation images provided at different noise levels were compared with actual images obtained by the FPD system. The results indicated that image noise was simulated properly both in objective and subjective evaluation. The present system could allow us to determine necessary dose from image quality and also to estimate image quality from any exposure dose. © 2012 Copyright Society of Photo-Optical Instrumentation Engineers (SPIE)

Review of a simple noise simulation technique in digital radiography

Reduction of exposure dose and improvement in image quality can be expected to result from advances in the performance of imaging detectors. A number of researchers have reported on methods for simulating reduced dose images. The simplest method provides reduced dose images by adding white Gaussian noise with a certain standard deviation to the original image. Our aim in this study was to develop and validate a system with a graphic user interface for simulating reduced dose images by a simple method. Here, we describe a technical approach with the use of a flat-panel detector system, and we validated the simulation performance in reducing the dose objectively and subjectively. In addition, the technical limitations and possible solutions to the simple method are suggested based on the validation results presented in this paper. © 2012 Japanese Society of Radiological Technology and Japan Society of Medical Physics.発行後1年より全文公開

Simulation system for understanding the lag effect in fluoroscopic images

Real-time tumor tracking in external radiotherapy can be achieved by diagnostic (kV) X-ray imaging with a dynamic flat-panel detector (FPD). It is crucial to understand the effects of image lag for real-time tumor tracking. Our purpose in this study was to develop a lag simulation system based on the image lag properties of an FPD system. Image lag properties were measured on flat-field images both in direct- and indirect-conversion dynamic FPDs. A moving target with image lag was simulated based on the lag properties in all combinations of FPD types, imaging rates, exposure doses, and target speeds, and then compared with actual moving targets for investigation of the reproducibility of image lag. Image lag was simulated successfully and agreed well with the actual lag as well as with the predicted effect. In the indirect-conversion FPD, a higher dose caused greater image lag on images. In contrast, there were no significant differences among dose levels in a direct-conversion FPD. There were no relationships between target speed and amount of image blurring in either type of FPD. The maximum contour blurring and the rate of increase in pixel value due to image lag were 1.1 mm and 10.0 %, respectively, in all combinations of imaging parameters examined in this study. Blurred boundaries and changes in pixel value due to image lag were estimated under various imaging conditions with use of the simulation system. Our system would be helpful for a better understanding of the effects of image lag in fluoroscopic images. © 2012 Japanese Society of Radiological Technology and Japan Society of Medical Physics

Intestinal adhesion due to previous uterine surgery as a risk factor for delayed diagnosis of uterine rupture: a case report

<p>Abstract</p> <p>Introduction</p> <p>Uterine rupture is a life-threatening condition both to mothers and fetuses. Its early diagnosis and treatment may save their lives. Previous myomectomy is a high risk factor for uterine rupture. Intestinal adhesion due to previous myomectomy may also prevent early diagnosis of uterine rupture.</p> <p>Case presentation</p> <p>A 38-year-old primiparous non-laboring Japanese woman with a history of myomectomy was admitted in her 34^thweek due to lower abdominal pain. Although the pain was slight and her vital signs were stable, computed tomography revealed massive fluid collection in her abdominal cavity, which led us to perform a laparotomy. Uterine rupture had occurred at the site of the previous myomectomy; however, the small intestine was adhered tightly to the rupture, thus masking it. The baby was delivered through a low uterine segment transverse incision. The ruptured uterine wall was reconstructed.</p> <p>Conclusion</p> <p>Intestinal adhesion due to a prior myomectomy occluded a uterine rupture, possibly masking its symptoms and signs, which may have prevented early diagnosis.</p

Evaluation of olfactory impairment using a simple test kit “The Odor Stick Identification test for the Japanese” (OSIT-J) in neurodegenerative diseases

Purpose: Olfactory deficit has been studied in aging, amnestic mild cognitive impairment (aMCI), Alzheimer’s disease (AD). Parkinson\u27s disease (PD), dementia with Lewy bodies (DLB) and idiopathic REM-sleep behavior disorder (iRBD). Our aim was to investigate the usefulness of a simple test kit “The Odor Stick Identification test for the Japanese ”(OSIT-J) in clinical practice.Methods: A total of 240 patients were enrolled in this study, including 44 cognitively normal subjects (NS), 31 patients with aMCI, 70 patients with mild AD (AD-mild), 28 patients with DLB, 31 patients with PD and 36 patients with iRBD. The OSIT-J consists of 12 types of odor sticks. The subjects were asked to select an odor from a list of 4 odors that were rubbed on the medicine wraping paper for each odor stick. The maximum score was 12.Results: The mean odor identification (OI) score decreased in the order of aMCI, iRBD, AD-mild, PD and DLB (NS: aMCI, P<0.05, NS: AD-mild, DLB, PD and iRBD, P<0.001, aMCI: DLB, P<0.001, aMCI: PD, P<0.01 (Kruskal-Wallis, Dunn’s test). The sensitivity and specificity in differentiating each disease from NS at a cutoff value of 8 was 96.8% and 79.5%, respectively, in PD, and 96.4% and 79.5% in DLB. An ageing effect was observed in NSs ( r=-0.453 (p<0.01)).Conclusions: Olfactory deficit is a non-specific phenomenon. However, it is important to be aware of the underlying diseases or future development of diseases. The OSIT-J, which is a simple test, is useful for detecting OI abnormalities in daily clinical practice

Inhibitory effects of RAGE-aptamer on development of monocrotaline-induced pulmonary arterial hypertension in rats

Background: The receptor for advanced glycation end products (RAGE), a transmembrane receptor belonging to the immunoglobulin superfamily, is overexpressed in pulmonary artery smooth muscle cells (PASMCs) in patients with pulmonary arterial hypertension (PAH) and is implicated in the etiology of PAH. Recently, we reported that RAGE-aptamer, a short and single-stranded DNA directed against RAGE, inhibited an inappropriate increase in cultured PASMCs in PAH. The aim of this study was to determine the efficacy of RAGEaptamer in monocrotaline-induced PAH in rats. Methods and Results: Rats were assigned to either an untreated control group, a group that received continuous subcutaneous administration of RAGE-aptamer immediately after monocrotaline injection, or a group that received control-aptamer immediately after monocrotaline injection. All rats survived 21 days after injection of monocrotaline and control-aptamer or RAGE-aptamer. Injection of monocrotaline with continuous subcutaneous delivery of control-aptamer resulted in higher right ventricular systolic pressure compared with controls. This increase was attenuated by continuous subcutaneous delivery of RAGE-aptamer. The proportion of small pulmonary arteries with full muscularization was greater in the monocrotaline and control-aptamer group than in the control group. Continuous subcutaneous delivery of RAGE-aptamer significantly reduced the percentage of small pulmonary arteries with full muscularization Conclusions: Continuous subcutaneous delivery of RAGE-aptamer suppresses development of monocrotaline-induced PAH in rats. Inhibition of RAGE ameliorates muscularization of 3 small pulmonary arteries. Treatment with RAGE-aptamer might be a new therapeutic option for PAH

Oxygen-evolving photosystem II structures during S1–S2–S3 transitions

Photosystem II (PSII) catalyses the oxidation of water through a four-step cycle of Si states (i = 0–4) at the Mn4CaO5 cluster1,2,3, during which an extra oxygen (O6) is incorporated at the S3 state to form a possible dioxygen4,5,6,7. Structural changes of the metal cluster and its environment during the S-state transitions have been studied on the microsecond timescale. Here we use pump-probe serial femtosecond crystallography to reveal the structural dynamics of PSII from nanoseconds to milliseconds after illumination with one flash (1F) or two flashes (2F). YZ, a tyrosine residue that connects the reaction centre P680 and the Mn4CaO5 cluster, showed structural changes on a nanosecond timescale, as did its surrounding amino acid residues and water molecules, reflecting the fast transfer of electrons and protons after flash illumination. Notably, one water molecule emerged in the vicinity of Glu189 of the D1 subunit of PSII (D1-E189), and was bound to the Ca2+ ion on a sub-microsecond timescale after 2F illumination. This water molecule disappeared later with the concomitant increase of O6, suggesting that it is the origin of O6. We also observed concerted movements of water molecules in the O1, O4 and Cl-1 channels and their surrounding amino acid residues to complete the sequence of electron transfer, proton release and substrate water delivery. These results provide crucial insights into the structural dynamics of PSII during S-state transitions as well as O–O bond formation

Genome-wide meta-analysis identifies multiple novel loci associated with serum uric acid levels in Japanese individuals

Gout is a common arthritis caused by elevated serum uric acid (SUA) levels. Here we investigated loci influencing SUA in a genome-wide meta-analysis with 121,745 Japanese subjects. We identified 8948 variants at 36 genomic loci (P<5 × 10–8) including eight novel loci. Of these, missense variants of SESN2 and PNPLA3 were predicted to be damaging to the function of these proteins; another five loci—TMEM18, TM4SF4, MXD3-LMAN2, PSORS1C1-PSORS1C2, and HNF4A—are related to cell metabolism, proliferation, or oxidative stress; and the remaining locus, LINC01578, is unknown. We also identified 132 correlated genes whose expression levels are associated with SUA-increasing alleles. These genes are enriched for the UniProt transport term, suggesting the importance of transport-related genes in SUA regulation. Furthermore, trans-ethnic meta-analysis across our own meta-analysis and the Global Urate Genetics Consortium has revealed 15 more novel loci associated with SUA. Our findings provide insight into the pathogenesis, treatment, and prevention of hyperuricemia/gout

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target