Soluble CD26 is inversely Associated with Disease Severity in Patients with Chronic Eosinophilic Pneumonia

Backgrounds: CD26, a multifunctional T cell surface glycoprotein, is a type II transmembrane protein containing only six amino acid residues in its cytoplasmic region. In addition to its membrane form, CD26 exists in plasma in a soluble form (sCD26), which is thought to be the extracellular domain of the molecule cleaved from the cell surface. Recent studies indicated CD26 have an important role in the pathogenesis of asthma, known as Th2 like disease. The function of CD26 in the esosinophlic lung disease is not well understood.Methods: Serum sCD26 was determined by enzyme-linked Immunosorbent assay in patients with acute eosinophilic pneumonia, chronic eosinophilic pneumonia (CEP), and sarcoidosis, and in healthy volunteers, to establish its value for discriminating between disease entities and as marker of disease activity.Results: Soluble CD26 was signifi cantly reduced in CEP and was related to disease severity. In particular, sCD26 was inversely correlated with arterial oxygen tension in CEP.Conclusion: Serum levels of sCD26 might appear to be useful as a new marker of CEP disease activity

日本海沿岸における地域波浪特性の相互比較

This study examines the long-term wave data observed along the coastline of the Sea of Japan. The focus was mainly placed on the wave climate at Wajima Port, which is located on the outer coast of the Noto Peninsula in Ishikawa Prefecture. The wave characteristics at Wajima were first compared with those at Kanazawa, which is located relatively close (90 km) to Wajima. The wave climate at Wajima and Kanazawa indicated similar features in terms of wave height and period. The influence of Noto Peninsula was substantial only in terms of the incoming wave direction. While neither a statistically significant trend nor jump was found for the long-term variation of annual wave height at these sites, an increasing trend and an abrupt jump around 1990 have been detected in the long-term variation of wave periods at Kanazawa. The wave periods in July have significantly increased at both Wajima and Kanazawa. The wave properties were then compared with those at Rumoi and Hamada Port, which are respectively located 830 km and 510 km away from Wajima. Over a long stretch of the Sea of Japan coast covering Rumoi, Wajima, Kanazawa, and Hamada, wave climate indicated similar and significant seasonal changes. The difference in the properties of significant waves around these four sites was about 10 %. Significant wave height and period correlated very well with second order polynomials at each site. In contrast, wave directions along the coastline indicated significant differences. At Rumoi and Hamada, neither significant trends nor jumps in long-term annual wave periods were detected. The statistical test revealed that the long-term increasing trends and abrupt jumps of wave period in summer were intrinsic to the waves at Wajima and Kanazawa, located in the central coastal areas adjacent to the Sea of Japan

石川県加越海岸における波浪特性および関連する地形変化指標の季節変動

This study investigates the seasonal variability of wave characteristics and related morphological indices on the Kaetsu Coast in Ishikawa, Japan based on long-term wave data observed at Kanazawa Port from I 971 to 2012. First, the seasonal variations of wave energy flux are investigated in combination with the directional distribution. Most of the incoming wave energy is concentrated in the winter season, in which high waves from the WNW, NW, and NNW direction frequently impact the coastline. Second, the characteristics of wave breaking in the near shore area, and breaker height and depth, are examined. Re­lated morphological indices such as the closure depth and the Sunamura index are also estimated. The seasonal variations of these properties indicate common patterns, in which the values are highest in winter, medium in spring and autumn, and lowest in summer. The cumulative probability of breaker depths varies significantly from season to season. The estimated closure depth also indicates distinct seasonal changes. These results indicate that the cross-shore width of significant morphological change is substantially var­iable according to the time. The estimations of the Sunamura indices suggest that the shoreline is advanced during the summer, while shoreline recessions generally occur in other seasons. The transitions from shoreline recessions to shoreline advances are deduced to occur in March. and from advances to reces­sions in September. Third, an analysis ofinfragravity waves is conducted. The patterns of the daily as well as monthly variations of infragravity wave heights are similar to that of wind waves. A strong linear cor­relation exists between the heights of infragravity waves and wind waves

Aging and CMV Infection Affect Pre-existing SARS-CoV-2-Reactive CD8⁺ T Cells in Unexposed Individuals

加齢やサイトメガロウイルス感染が新型コロナウイルス反応性キラーT細胞に与える影響. 京都大学プレスリリース. 2021-08-23.Severe COVID-19 symptoms in the elderly are consistent with a weaker immune system. 京都大学プレスリリース. 2021-08-23.Age is a major risk factor for COVID-19 severity, and T cells play a central role in anti-SARS-CoV-2 immunity. Because SARS-CoV-2-cross-reactive T cells have been detected in unexposed individuals, we investigated the age-related differences in pre-existing SARS-CoV-2-reactive T cells. SARS-CoV-2-reactive CD4⁺ T cells from young and elderly individuals were mainly detected in the central memory fraction and exhibited similar functionalities and numbers. Naïve-phenotype SARS-CoV-2-reactive CD8⁺ T cell populations decreased markedly in the elderly, while those with terminally differentiated and senescent phenotypes increased. Furthermore, senescent SARS-CoV-2-reactive CD8⁺ T cell populations were higher in cytomegalovirus seropositive young individuals compared to seronegative ones. Our findings suggest that age-related differences in pre-existing SARS-CoV-2-reactive CD8+ T cells may explain the poor outcomes in elderly patients and that cytomegalovirus infection is a potential factor affecting CD8⁺ T cell immunity against SARS-CoV-2. Thus, this study provides insights for developing effective therapeutic and vaccination strategies for the elderly

Effect of controlled ventilation on diaphragm

Background : Since diaphragm passivity induces oxidative stress that leads to rapid atrophy of diaphragm, we investigated the effect of controlled ventilation on diaphragm thickness during assist-control ventilation (ACV). Methods : Previously, we measured end-expiratory diaphragm thickness (Tdiee) of patients mechanically ventilated for more than 48 hours on days 1, 3, 5 and 7 after the start of ventilation. We retrospectively investigated the proportion of controlled ventilation during the initial 48-hour ACV (CV48%). Patients were classified according to CV48% : Low group, less than 25% ; High group, higher than 25%. Results : Of 56 patients under pressure-control ACV, Tdiee increased more than 10% in 6 patients (11%), unchanged in 8 patients (14%) and decreased more than 10% in 42 patients (75%). During the first week of ventilation, Tdiee decreased in both groups : Low (difference, -7.4% ; 95% confidence interval [CI], -10.1% to -4.6% ; p < 0.001) and High group (difference, -5.2% ; 95% CI, -8.5% to -2.0% ; p = 0.049). Maximum Tdiee variation from baseline did not differ between Low (-15.8% ; interquartile range [IQR], -22.3 to -1.5) and High group (-16.7% ; IQR, -22.6 to -11.1, p = 0.676). Conclusions : During ACV, maximum variation in Tdiee was not associated with proportion of controlled ventilation higher than 25%

Monitoring of muscle mass in critically ill patients : comparison of ultrasound and two bioelectrical impedance analysis devices

Background: Skeletal muscle atrophy commonly occurs in critically ill patients, and decreased muscle mass is associated with worse clinical outcomes. Muscle mass can be assessed using various tools, including ultrasound and bioelectrical impedance analysis (BIA). However, the effectiveness of muscle mass monitoring is unclear in critically ill patients. This study was conducted to compare ultrasound and BIA for the monitoring of muscle mass in critically ill patients. Methods: We recruited adult patients who were expected to undergo mechanical ventilation for > 48 h and to remain in the intensive care unit (ICU) for > 5 days. On days 1, 3, 5, 7, and 10, muscle mass was evaluated using an ultrasound and two BIA devices (Bioscan: Malton International, England; Physion: Nippon Shooter, Japan). The influence of fluid balance was also evaluated between each measurement day. Results: We analyzed 93 images in 21 patients. The age of the patients was 69 (interquartile range, IQR, 59–74) years, with 16 men and 5 women. The length of ICU stay was 11 days (IQR, 9–25 days). The muscle mass, monitored by ultrasound, decreased progressively by 9.2% (95% confidence interval (CI), 5.9–12.5%), 12.7% (95% CI, 9.3–16.1%), 18.2% (95% CI, 14.7–21.6%), and 21.8% (95% CI, 17.9–25.7%) on days 3, 5, 7, and 10 (p < 0.01), respectively, with no influence of fluid balance (r = 0.04, p = 0.74). The muscle mass did not decrease significantly in both the BIA devices (Bioscan, p = 0.14; Physion, p = 0.60), and an influence of fluid balance was observed (Bioscan, r = 0.37, p < 0.01; Physion, r = 0.51, p < 0.01). The muscle mass assessment at one point between ultrasound and BIA was moderately correlated (Bioscan, r = 0.51, p < 0.01; Physion, r = 0.37, p < 0.01), but the change of muscle mass in the same patient did not correlate between these two devices (Bioscan, r = − 0.05, p = 0.69; Physion, r = 0.23, p = 0.07). Conclusions: Ultrasound is suitable for sequential monitoring of muscle atrophy in critically ill patients. Monitoring by BIA should be carefully interpreted owing to the influence of fluid change

免疫不全患者に対するHFNC

Background : Non-invasive positive pressure ventilation （NPPV） is highly recommended for immunocompromised patients with acute respiratory failure. In this population it remains uncertain, however, whether high flow nasal canula（HFNC）is as beneficial as NPPV. Methods : We retrospectively studied immunocompromised patients with acute respiratory failure admitted to our ICU from ２０１１ to ２０１８. The background and clinical outcomes of patients initially treated with HFNC and NPPV were compared. Results : Upon admission, １２ patients were treated with HFNC and １０ with NPPV. While the length of ICU stay was significantly shorter in HFNC group （HFNC４．６days vs. NPPV１３．８days, p=０．０２）, no intergroup difference was seen in ICU mortality （１６．７％ vs.３０．０％, p=０．４６）or intubation rate（３３．３％ vs.５０．０％, p=０．４３）. Conclusions : For immunocompromised patients with acute respiratory failure, HFNC may be an alternative to NPPV. Further prospective investigation is warranted

Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review

INTRODUCTION: Severe sepsis and septic shock are common problems in the intensive care unit and carry a high mortality. Endotoxin, one of the principal components on the outer membrane of gram-negative bacteria, is considered important to their pathogenesis. Polymyxin B bound and immobilized to polystyrene fibers (PMX-F) is a medical device that aims to remove circulating endotoxin by adsorption, theoretically preventing the progression of the biological cascade of sepsis. We performed a systematic review to describe the effect in septic patients of direct hemoperfusion with PMX-F on outcomes of blood pressure, use of vasoactive drugs, oxygenation, and mortality reported in published studies. METHODS: We searched PubMed, the Cochrane Collaboration Database, and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Prospective and retrospective observational studies, pre- and post-intervention design, and randomized controlled trials were included. Three authors reviewed all citations. We identified a total of 28 publications - 9 randomized controlled trials, 7 non-randomized parallel studies, and 12 pre-post design studies - that reported at least one of the specified outcome measures (pooled sample size, 1,425 patients: 978 PMX-F and 447 conventional medical therapy). RESULTS: Overall, mean arterial pressure (MAP) increased by 19 mm Hg (95% confidence interval [CI], 15 to 22 mm Hg; p < 0.001), representing a 26% mean increase in MAP (range, 14% to 42%), whereas dopamine/dobutamine dose decreased by 1.8 microg/kg per minute (95% CI, 0.4 to 3.3 microg/kg per minute; p = 0.01) after PMX-F. There was significant intertrial heterogeneity for these outcomes (p < 0.001), which became non-significant when analysis was stratified for baseline MAP. The mean arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio increased by 32 units (95% CI, 23 to 41 units; p < 0.001). PMX-F therapy was associated with significantly lower mortality risk (risk ratio, 0.53; 95% CI, 0.43 to 0.65). The trials assessed had suboptimal method quality. CONCLUSION: Based on this critical review of the published literature, direct hemoperfusion with PMX-F appears to have favorable effects on MAP, dopamine use, PaO2/FiO2 ratio, and mortality. However, publication bias and lack of blinding need to be considered. These findings support the need for further rigorous study of this therapy