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Convolution representation manifests itself as an important tool in the reduction of partial differential equations. In this study, we consider the convolution representation of traveling pulses in reaction-diffusion systems. Under the adiabatic approximation of inhibitor, a two-component reaction-diffusion system is reduced to a one-component reaction-diffusion equation with a convolution term. To find the traveling speed in a reaction-diffusion system with a global coupling term, the stability of the standing pulse and the relation between traveling speed and bifurcation parameter are examined. Additionally, we consider the traveling pulses in the kernel-based Turing model. The stability of the spatially homogeneous state and most unstable wave number are examined. The practical utilities of the convolution representation of reaction-diffusion systems are discussed.

We consider pulse dynamics in a bistable reaction-diffusion system with chemotaxis. We derive the ordinary differential equation of interfaces by applying the multiple scales method to the reaction-diffusion system for examining the effect of the chemotaxis on pulse dynamics in one dimension. The stability of the standing pulse is considered by two different methods, and the applicability of the methods is demonstrated. The chemotaxis influences the Hopf and drift bifurcations and the collision of two traveling pulses. It also enlarges the bifurcation point and enhances the repulsive force between pulses so that the parameter region of the elastic collision becomes large. Although the ordinary differential equation of interfaces can describe the elastic collision, it cannot describe the pair annihilation of pulses caused by the collision. The conditions for the reliable calculation of pulse collision are discussed.

BACKGROUND: MicroRNA-150 (miR-150) plays a protective role in heart failure (HF). Long noncoding RNA (ncRNA), Myocardial Infarction-Associated Transcript (MIAT) regulates miR-150 function in vitro by direct interaction. Concurrent with miR-150 downregulation, MIAT is upregulated in failing hearts, and gain-of-function single nucleotide polymorphisms in MIAT are associated with increased risk of MI in humans. Despite the correlative relationship between MIAT and miR-150 in HF, their in vivo functional relationship has never been established, and molecular mechanisms by which these two ncRNAs regulate cardiac protection remain elusive. METHODS: We use MIAT knockout (KO), homeobox a4 (Hoxa4) KO, MIAT transgenic (TG) and miR-150 TG mice. We also develop double transgenic (DTG) mice overexpressing MIAT and miR-150. We then employ a mouse model of MI followed by cardiac functional, structural and mechanistic studies by echocardiography, immunohistochemistry, transcriptome profiling, Western blotting and quantitative real-time RT-PCR. Moreover, we perform expression analyses in hearts from patients with HF. Lastly, we investigate cardiac fibroblast (CF) activation using primary adult human CFs and in vitro assays to define the conserved MIAT/miR-150/HOXA4 axis. RESULTS: Using novel mouse models, we demonstrate that genetic overexpression of MIAT worsens cardiac remodeling, while genetic deletion of MIAT protects hearts against MI. Importantly, miR-150 overexpression attenuates the detrimental post-MI effects caused by MIAT. Genome-wide transcriptomic analysis of MIAT null mouse hearts identifies Hoxa4 as a novel downstream target of the MIAT/miR-150 axis. Hoxa4 is upregulated in CFs isolated from ischemic myocardium and subjected to hypoxia/reoxygenation. HOXA4 is also upregulated in patients with HF. Moreover, Hoxa4 deficiency in mice protects the heart from MI. Lastly, protective actions of CF miR-150 are partially attributed to the direct and functional repression of pro-fibrotic Hoxa4. CONCLUSIONS: Our findings delineate a pivotal functional interaction among MIAT, miR-150 and Hoxa4 as a novel regulatory mechanism pertinent to ischemic HF.

The best thromboprophylaxis for pregnant women with congenital antithrombin deficiency (CAD) is controversial.To clarify the effectiveness of a protocol for venous thromboembolism (VTE) prevention in pregnant women with CAD.Women at high risk of VTE were administered antithrombin concentrate and heparin after conception, whereas those at low risk of VTE were administered heparin alone until delivery. All women received antithrombin concentrate at delivery except for one who was diagnosed with CAD.Ten women had CAD, including one in the high-risk group and nine in the low-risk group. No women had VTE at delivery as per the protocol for VTE prevention. Almost all women had increased antithrombin activity before delivery followed by maintenance at ≥ 70% due to antithrombin concentrate administration. VTE prophylaxis during and after delivery was successful in all women with CAD. However, one woman in the low-risk group did not receive heparin and developed VTE induced by severe hyperemesis at 9 gestational weeks, before the diagnosis of CAD. Women in the high-risk group received antithrombin concentrate after delivery but had increased D-dimer levels at postpartum.Our protocol to prevent VTE in pregnant women with CAD is safe and effective.

Aims/Introduction We investigated the association between gestational diabetes mellitus (GDM) and perinatal outcomes stratified by pre-pregnancy body mass index (BMI) and/or gestational weight gain (GWG). Materials and Methods Data from the national birth cohort in the Japan Environment and Children's Study from 2011 to 2014 (n = 85,228) were used. Japan uses the GDM guidelines of the International Association of Diabetes and Pregnancy Study Groups. The odds ratios (ORs) of perinatal outcomes were compared between women with and those without GDM. Results The OR (95% confidence interval) of having a small for gestational age infant in the GDM group with a pre-pregnancy BMI of >= 25.0 kg/m(2) and insufficient GWG (7.25 kg) was 2.04 (1.56-2.67). The OR of hypertensive disorders of pregnancy was higher in women with a BMI >= 18.5 kg/m(2) in the GDM group than in the non-GDM group. Conclusions Large for gestational age and hypertensive disorders of pregnancy were associated with pre-pregnancy BMI and GWG in either normal weight or overweight/obese women, and the relationship was strengthened when GDM was present. Women with GDM and a BMI of >= 25.0 kg/m(2) are at risk of having small for gestational age and large for gestational age infants depending on GWG.

The β1-adrenergic receptor (β1AR) is found primarily in hearts (mainly in cardiomyocytes [CMs]) and β-arrestin-mediated β1AR signaling elicits cardioprotection through CM survival. We showed that microRNA-150 (miR-150) is upregulated by β-arrestin-mediated β1AR signaling and that CM miR-150 inhibits maladaptive remodeling post-myocardial infarction. Here, we investigate whether miR-150 rescues cardiac dysfunction in mice bearing CM-specific abrogation of β-arrestin-mediated β1AR signaling. Using CM-specific transgenic (TG) mice expressing a mutant β1AR (G protein-coupled receptor kinase [GRK]–β1AR that exhibits impairment in β-arrestin-mediated β1AR signaling), we first generate a novel double TG mouse line overexpressing miR-150. We demonstrate that miR-150 is sufficient to improve cardiac dysfunction in CM-specific GRK–β1AR TG mice following chronic catecholamine stimulation. Our genome-wide circular RNA, long noncoding RNA (lncRNA), and mRNA profiling analyses unveil a subset of cardiac ncRNAs and genes as heretofore unrecognized mechanisms for beneficial actions of β1AR/β-arrestin signaling or miR-150. We further show that lncRNA Gm41664 and GDAP1L1 are direct novel upstream and downstream regulators of miR-150. Lastly, CM protective actions of miR-150 are attributed to repressing pro-apoptotic GDAP1L1 and are mitigated by pro-apoptotic Gm41664. Our findings support the idea that miR-150 contributes significantly to β1AR/β-arrestin-mediated cardioprotection by regulating unique ncRNA and gene signatures in CMs.

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Suppression of convection flows (solute transportation) and of impurity incorporation into crystals seem to be the main reasons why the quality of protein crystals improves under microgravity, although their precise mechanisms have not been completely discovered yet. We tried to clarify effects of suppression of convection flows on crystallization processes by in-situ observation of straight steps on parallelogram-shaped spiral growth hillocks on the {110} faces of highly purified glucose isomerase (GI) crystals under microgravity conditions and on the ground. Lateral growth rates Vlateral of a spiral hillock on the {110} face of a glucose isomerase crystal in situ under microgravity and step velocities Vstep of the same configuration on the ground had similar maximum values. This similarity indicates the convection flow has a small, if any, influence on the growth rates of protein crystals, contrary to conventional expectations. From Vstep of the straight step in a particular direction, we calculated the vibrational frequency of a GI tetramer at a kink site of a step as (1182±3) s^(-1) with the assumption of zero activation energy of kink incorporation processes.

Noncoding RNAs (ncRNAs) play fundamental roles in cardiac development and cardiovascular diseases (CVDs), which are a major cause of morbidity and mortality. With advances in RNA sequencing technology, the focus of recent research has transitioned from studies of specific candidates to whole transcriptome analyses. Thanks to these types of studies, new ncRNAs have been identified for their implication in cardiac development and CVDs. In this review, we briefly describe the classification of ncRNAs into microRNAs, long ncRNAs, and circular RNAs. We then discuss their critical roles in cardiac development and CVDs by citing the most up-to-date research articles. More specifically, we summarize the roles of ncRNAs in the formation of the heart tube and cardiac morphogenesis, cardiac mesoderm specification, and embryonic cardiomyocytes and cardiac progenitor cells. We also highlight ncRNAs that have recently emerged as key regulators in CVDs by focusing on six of them. We believe that this review concisely addresses perhaps not all but certainly the major aspects of current progress in ncRNA research in cardiac development and CVDs. Thus, this review would be beneficial for readers to obtain a recent picture of key ncRNAs and their mechanisms of action in cardiac development and CVDs.

Background. Total anomalous pulmonary venous connection (TAPVC) is a critical congenital heart disease for which emergency surgery is required after birth. In cases of no intervention, TAPVC is associated with a high mortality rate in the first year of life. Although foetal echocardiographic techniques for diagnosing TAPVC have improved, TAPVC remains one of the most difficult congenital heart diseases to diagnose via foetal echocardiography. Here, we report a case of TAPVC with pulmonary venous obstruction (PVO), which was diagnosed via foetal echocardiography. Case Presentation. On foetal echocardiography at 32 weeks’ gestation, a large atrial septal defect, enlarged superior vena cava, and continuous flow pattern in the vertical vein from the common chamber were observed in the foetus. Paediatric cardiologists and cardiac surgeons, neonatologists, and obstetricians planned to perform a caesarean section and emergency heart surgery. The male infant was born at 37 weeks’ gestation via caesarean section, and postnatal echocardiography revealed PVO at the confluence of the superior vena cava and common chamber. Similarly, chest computed tomography confirmed the foetal diagnosis. The postnatal diagnoses were TAPVC type Ib, PVO, atrial septal defect, and patent ductus arteriosus. Surgical repair of the TAPVC was initiated within the first 3 hours of life. Screening brain echocardiography and head computed tomography revealed intracranial haemorrhage and hydrocephalus. Therefore, the patient underwent emergency bilateral external drainage on day 13. On day 48, a ventriculoperitoneal shunt was inserted owing to progressive brain ventricular dilatation. The patient was discharged home on postoperative day 68. Conclusions. Although the prognosis of TAPVC with PVO remains poor, continuous observation through foetal echocardiography and early interdepartmental collaboration can result in good outcomes.

We report an unusual case of acute myocardial infarction in a high school girl. The patient was 17 years of age and had multiple coronary risk factors, including marked obesity with a body mass index (BMI) of 42.7 kg/m2, dyslipidemia and glucose intolerance. She had been an on and off smoker since she was 13 years of age. Due to the recent Westernization of the lifestyle, the prevalence of metabolic syndrome in the young generation has been increasing in Japan. Cardiovascular disease based on lifestyle-related diseases may become more common in young people.

Background: MicroRNA-150 (miR-150) plays a protective role in heart failure (HF). Long noncoding RNA, myocardial infarction–associated transcript (MIAT) regulates miR-150 function in vitro by direct interaction. Concurrent with miR-150 downregulation, MIAT is upregulated in failing hearts, and gain-of-function single-nucleotide polymorphisms in MIAT are associated with increased risk of myocardial infarction (MI) in humans. Despite the correlative relationship between MIAT and miR-150 in HF, their in vivo functional relationship has never been established, and molecular mechanisms by which these 2 noncoding RNAs regulate cardiac protection remain elusive. Methods: We use MIAT KO (knockout), Hoxa4 (homeobox a4) KO, MIAT TG (transgenic), and miR-150 TG mice. We also develop DTG (double TG) mice overexpressing MIAT and miR-150. We then use a mouse model of MI followed by cardiac functional, structural, and mechanistic studies by echocardiography, immunohistochemistry, transcriptome profiling, Western blotting, and quantitative real-time reverse transcription-polymerase chain reaction. Moreover, we perform expression analyses in hearts from patients with HF. Lastly, we investigate cardiac fibroblast activation using primary adult human cardiac fibroblasts and in vitro assays to define the conserved MIAT/miR-150/HOXA4 axis. Results: Using novel mouse models, we demonstrate that genetic overexpression of MIAT worsens cardiac remodeling, while genetic deletion of MIAT protects hearts against MI. Importantly, miR-150 overexpression attenuates the detrimental post-MI effects caused by MIAT. Genome-wide transcriptomic analysis of MIAT null mouse hearts identifies Hoxa4 as a novel downstream target of the MIAT/miR-150 axis. Hoxa4 is upregulated in cardiac fibroblasts isolated from ischemic myocardium and subjected to hypoxia/reoxygenation. HOXA4 is also upregulated in patients with HF. Moreover, Hoxa4 deficiency in mice protects the heart from MI. Lastly, protective actions of cardiac fibroblast miR-150 are partially attributed to the direct and functional repression of profibrotic Hoxa4 . Conclusions: Our findings delineate a pivotal functional interaction among MIAT, miR-150, and Hoxa4 as a novel regulatory mechanism pertinent to ischemic HF.

Aim In Hokkaido, Japan, the number of people suffering from coronavirus disease 2019 (COVID‐19) is rapidly increased, and by the end of February 2020, there were already 70 confirmed cases of the disease. We investigated the safety of urgently initiated maternal telemedicine in preventing the spread of the coronavirus infection. Methods This retrospective, single‐institution study examined maternal telemedicine at the department of obstetrics of the Hokkaido University Hospital from March 4 to April 2, 2020. The physicians remotely examined the pregnant women from their homes using a visual communication system which kept communication confidential, performed prenatal checkup and administered medical care according to their various blood pressures, weights and cardiotocograms. Results Forty‐four pregnant women received a total of 67 telemedicine interventions. Thirty‐two pregnant women (73%) had complications, and 22 were primiparas (50%). Telemedicine interventions were provided 19 times at less than 26 weeks of gestation, 43 times between 26 and 36 weeks of gestation and 5 times after 37 weeks of gestation. There was one case with an abnormality diagnosed during the remote prenatal checkups, and the patient was hospitalized on the same day. However, there were no abnormal findings observed in mothers and children during the other 66 remote prenatal checkups and medical care. Conclusion Maternal telemedicine can be safely conducted in pregnant women who are at risk of having an underlying disorder or fetal abnormality 1 month following the start of the attempt. It should be considered as a form of maternal medical care to prevent the spread of COVID‐19.

To investigate the relationship between serum total protein (TP) levels and maternal/neonatal outcomes among pregnant women with preeclampsia.TP was measured at preeclampsia diagnosis and delivery in 94 women with singleton pregnancies and preeclampsia as hypertension with proteinuria who delivered at ≥ 22 gestational weeks (GWs). As a control group, measurements were also made in 188 women with singleton pregnancies without hypertension and/or proteinuria.The relationship between serum TP levels and maternal outcomes.Serum TP levels showed a significantly negative relationship with urine protein-to-creatinine (P/C) ratio at preeclampsia diagnosis and delivery. Serum TP levels at delivery in the preeclampsia group (53 ± 7 g/L) were lower than in the control group (61 ± 4 g/L, P 0.0001). In each group, there was no relationship between the daily decrease in TP and the daily increase maternal body weight. However, there was a positive relationship between the daily increase in P/C ratio and the daily increase in maternal body weight in the preeclampsia group (P = 0.0021). Severe hypoproteinemia at preeclampsia diagnosis was a predictor of abruptio placentae (TP 49 g/L; odds ratio, 21.3) and peripartum cardiomyopathy (TP 45 g/L; odds ratio, 43.5). Furthermore, women with severe hypoproteinemia at delivery had higher morbidity due to pulmonary edema (TP 55 g/L; odds ratio, 26.4) and central serous chorioretinopathy (TP 42 g/L; odds ratio, 264).Serum TP levels and proteinuria severity at preeclampsia diagnosis and delivery showed a positive relationship and predicted poor maternal outcome.

The β3-adrenergic receptor (β3AR) is related to myocardial fatty acid metabolism and its expression has been implicated in heart failure. In this study, we investigated the role of β3AR in sepsis-related myocardial dysfunction using lipopolysaccharide (LPS)-induced endotoxemia as a model of cardiac dysfunction. We placed mice into three treatment groups and treated each with intraperitoneal injections of the β3AR agonist CL316243 (CL group), the β3AR antagonist SR59230A (SR group), or normal saline (NS group). Survival rates were significantly improved in the SR group compared with the other treatment groups. Echocardiography analyses revealed cardiac dysfunction within 6–12 h of LPS injections, but the outcome was significantly better for the SR group. Myocardial ATP was preserved in the SR group but was decreased in the CL-treated mice. Additionally, quantitative PCR analysis revealed that expression levels of genes associated with fatty acid oxidation and glucose metabolism were significantly higher in the SR group. Furthermore, the expression levels of mitochondrial membrane protein complexes were preserved in the SR group. Electron microscope studies showed significant accumulation of lipid droplets in the CL group. Moreover, inducible nitric oxide synthase (iNOS) protein expression and nitric oxide were significantly reduced in the SR group. The in vitro study demonstrated that β3AR has an independent iNOS pathway that does not go through the nuclear factor-κB pathway. These results suggest that blockading β3AR improves impaired energy metabolism in myocardial tissues by suppressing iNOS expression and recovers cardiac function in animals with endotoxin-induced heart failure. NEW & NOTEWORTHY Nitric oxide production through stimulation of β3-adrenergic receptor (β3AR) may improve cardiac function in cases of chronic heart failure. We demonstrated that the blockade of β3AR improved mortality and cardiac function in endotoxin-induced heart failure. We also determined that LPS-induced inducible nitric oxide synthase has a pathway that is independent of nuclear factor-κB, which worsened cardiac metabolism and mortality in the acute phase of sepsis. Treatment with the β3AR antagonist had a favorable effect. Thus, the blockade of β3AR could offer a novel treatment for sepsis-related heart failure.

The present study aimed to determine the relationship between the severity of proteinuria and maternal/neonatal outcomes among women with preeclampsia.Proteinuria severity was measured at preeclampsia diagnosis and at delivery in 94 women with preeclampsia (among 2904 women with singleton pregnancies, who delivered after 22 gestational weeks). Preeclampsia was defined as hypertension with proteinuria.Protein:creatinine (P/C) ratio to worse the maternal outcome was 4.8 among women with preeclampsia.The frequencies of HELLP syndrome and maternal pulmonary edema in women with a P/C ratio ≥5.0 (35.5% and 35.5%, respectively) were significantly higher than those in women with a P/C ratio5.0 (12.7%, P = 0.014 and 6.4%, P 0.001, respectively). The best P/C ratio cutoff value to determine early-onset preeclampsia and early preterm birth (EPB) was 4.1 (P 0.001 and P 0.001, respectively). The best P/C ratio cutoff values to determine the interval between the preeclampsia diagnosis and delivery7 days and the need to undergo cesarean section were 1.8 and 1.5, respectively. The best P/C ratio cutoff value to determine maternal pulmonary edema and central serous chorioretinopathy (CSC) was 4.8 (P = 0.020 and P = 0.014, respectively). Finally, the best P/C ratio cutoff values to determine EPB and maternal CSC in women with preeclampsia were 4.1 (odds ratio, 10.9; 95% confidence interval; 4.08 to 29.2, P 0.0001) and 4.8 (odds ratio, 17.6; 95% confidence interval; 0.898 to 344, P = 0.0008), respectively, according to the multivariate analysis.A higher P/C ratio at delivery in women with preeclampsia might cause EPB and CSC.

Cardiovascular diseases (CVDs) represent the foremost cause of mortality in the United States and worldwide. It is estimated that CVDs account for approximately 17.8 million deaths each year. Despite the advances made in understanding cellular mechanisms and gene mutations governing the pathophysiology of CVDs, they remain a significant cause of mortality and morbidity. A major segment of mammalian genomes encodes for genes that are not further translated into proteins. The roles of the majority of such noncoding ribonucleic acids (RNAs) have been puzzling for a long time. However, it is becoming increasingly clear that noncoding RNAs (ncRNAs) are dynamically expressed in different cell types and have a comprehensive selection of regulatory roles at almost every step involved in DNAs, RNAs and proteins. Indeed, ncRNAs regulate gene expression through epigenetic interactions, through direct binding to target sequences, or by acting as competing endogenous RNAs. The profusion of ncRNAs in the cardiovascular system suggests that they may modulate complex regulatory networks that govern cardiac physiology and pathology. In this review, we summarize various functions of ncRNAs and highlight the recent literature on interactions between ncRNAs with an emphasis on cardiovascular disease regulation. Furthermore, as the broad-spectrum of ncRNAs potentially establishes new avenues for therapeutic development targeting CVDs, we discuss the innovative prospects of ncRNAs as therapeutic targets for CVDs.

The incidence of chromosomal abnormalities in twin pregnancies is not well-studied. In this retrospective study, we investigated the frequency of chromosomal abnormalities in twin pregnancies and compared the incidence of chromosomal abnormalities in dichorionic diamniotic (DD) and monochorionic diamniotic (MD) twins. We used data from 57 clinical facilities across Japan. Twin pregnancies of more than 12 weeks of gestation managed between January 2016 and December 2018 were included in the study. A total of 2899 and 1908 cases of DD and MD twins, respectively, were reported, and the incidence of chromosomal abnormalities in one or both fetuses was 0.9% (25/2899) and 0.2% (4/1908) in each group (p = 0.004). In this study, the most common chromosomal abnormality was trisomy 21 (51.7% [15/29]), followed by trisomy 18 (13.8% [4/29]) and trisomy 13 (6.9% [2/29]). The incidence of trisomy 21 in MD twins was lower than that in DD twins (0.05% vs. 0.5%, p = 0.007). Trisomy 21 was less common in MD twins, even when compared with the expected incidence in singletons (0.05% vs. 0.3%, RR 0.15 [95% CI 0.04–0.68]). The risk of chromosomal abnormality decreases in twin pregnancies, especially in MD twins.

The blanket modules of first wall need bear tremendous heat flux due to the very high temperature of plasma in the nuclear fusion reactor. Therefore, it is significant to clarify the knowledge of transient heat transfer process for helium gas flowing in the tubes installed in the blanket modules. In this research, the transient heat transfer process of turbulent forced convection for helium gas flowing in a horizontal minichannel was experimentally investigated. The test tube made of platinum with the inner diameter of 1.8 mm, the wall thickness of 0.1 mm and the effective length of 90 mm was heated by a direct current from power source. The heat generation rate of the test tube, Q̇, was raised with an exponential function, Q̇ = Q0 exp(t/τ), where Q0 is the initial heat generation rate, t is time, and τ is e-folding time of heat generation rate. The heat generation rates of the test tube were controlled and measured by a heat input control system. The flow rates were adjusted by the bypass of gas loop and measured by the turbine flow meter. The experiment was conducted under the e-folding time of heat generation rate ranged from 40 ms to 15 s. Based on experimental data, it is obvious that the heat flux and temperature difference between surface temperature of test tube and bulk temperature of helium gas increased with the exponentially increasing of heat generation rate. At the same flow velocity, the heat transfer coefficients approached constant values when the e-folding time is longer than about 1 s (quasi-steady state), but increased with a decrease of e-folding time when the e-folding time is smaller than about 1 s (transient state). The heat transfer coefficients increased with the increase in flow velocities but showed less dependent on flow velocities at shorter e-folding time. Furthermore, the Nusselt number under quasi-steady and transient condition was affected by the Reynolds number and the Fourier number.

Aim We aimed to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of noninvasive prenatal testing (NIPT) in high-risk pregnant women. Methods Pregnant women who underwent GeneTech NIPT, the most commonly used NIPT in Japan, between January 2015 and March 2019, at Japan NIPT Consortium medical sites were recruited for this study. The exclusion criteria were as follows: pregnant women with missing survey items, multiple pregnancy/vanishing twins, chromosomal abnormalities in the fetus other than the NIPT target disease, and nonreportable NIPT results. Sensitivity and specificity were calculated from the obtained data, and maternal age-specific PPV and NPV were estimated. Results Of the 45 504 cases, 44 263 cases fulfilling the study criteria were included. The mean maternal age and gestational weeks at the time of procedure were 38.5 years and 13.1 weeks, respectively. Sensitivities were 99.78% (95% confidence interval [95% CI]: 98.78-99.96), 99.12% (95% CI: 96.83-99.76), and 100% (95% CI: 88.30-100) for trisomies 21, 18, and 13, respectively. Specificities were more than 99.9% for trisomies 21, 18, and 13, respectively. Maternal age-specific PPVs were more than 93%, 77%, and 43% at the age of 35 years for trisomies 21, 18, and 13, respectively. Conclusion The GeneTech NIPT data showed high sensitivity and specificity in the detection of fetal trisomies 21, 18, and 13 in high-risk pregnant women, and maternal age-specific PPVs were obtained. These results could provide more accurate and improved information regarding NIPT for genetic counseling in Japan.

OBJECTIVE To examine whether laboratory parameters can predict the onset of recurrent hypertensive disorders of pregnancy (HDP). METHODS A retrospective study of 257 women with consecutive deliveries at a hospital in Sapporo, Japan, between 2009 and 2017. Women were divided into four groups according to whether or not they had HDP in the first and second peripartum periods (HDP-HPD, HDP-Non, Non-HDP, Non-Non). HDP was defined as gestational hypertension and/or proteinuria. Laboratory parameters measured on the day of or 1 day before delivery were compared between peripartum-1 and peripartum-2. RESULTS Frequency of HDP in peripartum-2 was higher among the 24 (9.3%) women with HPD in peripartum-1 (6/24, 25.0%) than among the 233 (90.7%) women without (3/233, 1.3%) (P

Introduction Vertebral fractures associated with ankylosing spinal disorders pose significant diagnostic and therapeutic challenges. Notably, the ankylosed spine remains in ankylosis after fracture treatment, and the underlying susceptibility to further fractures still remains. Nevertheless, information is scarce in the literature concerning patients with ankylosing spinal disorders who have multiple episodes of vertebral fractures. Case report Case 1 involves an 83-year-old male patient with diffuse idiopathic skeletal hyperostosis (ankylosis from C2 to L4) who had three episodes of vertebral fractures. The first episode involved a C5-C6 extension-type fracture, which was treated with posterior segmental screw instrumentation. Five years later, the patient sustained a three-column fracture at the L1 vertebra following another fall. The fracture was managed with percutaneous segmental screw instrumentation. One year and two months postoperatively, the patient fell again and had a refracture of the healed L1 fracture. The patient was treated with a hard brace, and the fracture healed. Case 2 involves a 76-year-old female patient with ankylosing spondylitis (ankylosis from C7 to L2) who had two episodes. At the first episode, she suffered paraplegia due to a T8 vertebra fracture. The patient was treated with laminectomy and posterior segmental screw instrumentation. The patient recovered well and had all the hardware removed at 10 months postoperatively. Five years later, she had another fall and suffered a three-column fracture at L1. The patient underwent percutaneous segmental screw instrumentation. The patient required revision surgery with L1 laminectomy and L1 right pediclectomy for persistent right inguinal pain. At one-year follow-up, the patient recovered well, and the fracture healed. Conclusions The abovementioned cases show that an age older than 75 years and a long spinal ankylosis from the cervical spine to the lumbar spine may serve as risk factors for the repetition of vertebral fractures associated with ankylosed spinal disorders.

AIM This study aimed to examine how the number of patients diagnosed with pre-eclampsia increased according to the Japanese classification of hypertensive disorders of pregnancy (HDP) that was revised in 2018. The effect of new classification on perinatal outcomes was also analyzed. METHODS We enrolled 181 women with HDP who delivered at Hokkaido University Hospital between February 2011 and December 2017. All women were reclassified on the basis of the new classification, in which proteinuria was not required to diagnose pre-eclampsia in patients with maternal organ damage. The number and reasons of reclassification and the admission rate to the neonatal intensive care unit (NICU) and gestational age (GA) at the onset of HDP and at delivery were analyzed. RESULTS In this cohort, 17 (9.4%) of 181 women with HDP were reclassified. Low platelet count (41.2%) and uteroplacental dysfunction (41.2%) were the two main causes for reclassification. GA at the onset of HDP (33.6 [29.9-36.1] weeks vs 37.4 [35.7-38.4] weeks; P

Aim: This study was performed to evaluate maternal changes in laboratory characteristics after fetoscopic laser photocoagulation (FLP) for twin-to-twin transfusion syndrome (TTTS). Methods: A retrospective review was conducted among 30 women with monochorionic diamniotic twin pregnancy with TTTS who underwent FLP at 16–26 weeks of gestation. Maternal laboratory parameters were measured before and after FLP. Results: The pre-FLP mean hemoglobin level (10.0 g/dL), hematocrit level (30.0%), platelet count (229 × 109/mL), fibrinogen level (461 mg/dL), and antithrombin activity (96.8%) decreased after FLP (8.5 g/dL, 25.5%, 204 × 109/mL, 403 mg/dL, and 83.6%, respectively) and returned to normal spontaneously within 2 weeks (9.6 g/dL, 29.4%, 293 × 109/mL, 460 mg/dL, and 102.4%, respectively). The D-dimer level before FLP (2.41 μg/mL) increased after FLP (4.28 μg/mL), and the elevated level was maintained for 2 weeks (3.24 μg/mL). The symptomatic venous thromboembolism (VTE) was not detected after FLP in any of the 30 patients. However, one woman had pulmonary embolism after subsequent cesarean section. Conclusion: Changes in maternal anemia and coagulation/fibrinolysis after FLP for TTTS returned to normal spontaneously within 2 weeks. Maternal elevation of D-dimer level after FLP might be a warning indicator of VTE.

MicroRNA-150 (miR-150) is downregulated in patients with multiple cardiovascular diseases and in diverse mouse models of heart failure (HF). miR-150 is significantly associated with HF severity and outcome in humans. We previously reported that miR-150 is activated by β-blocker carvedilol (Carv) and plays a protective role in the heart using a systemic miR-150 KO mouse model. However, mechanisms that regulate cell-specific miR-150 expression and function in HF are unknown. Here, we demonstrate that potentially novel conditional cardiomyocyte-specific (CM-specific) miR-150 KO (miR-150 cKO) in mice worsens maladaptive cardiac remodeling after myocardial infarction (MI). Genome-wide transcriptomic analysis in miR-150 cKO mouse hearts identifies small proline-rich protein 1a (Sprr1a) as a potentially novel target of miR-150. Our studies further reveal that Sprr1a expression is upregulated in CMs isolated from ischemic myocardium and subjected to simulated ischemia/reperfusion, while its expression is downregulated in hearts and CMs by Carv. We also show that left ventricular SPRR1A is upregulated in patients with HF and that Sprr1a knockdown in mice prevents maladaptive post-MI remodeling. Lastly, protective roles of CM miR-150 are, in part, attributed to the direct and functional repression of proapoptotic Sprr1a. Our findings suggest a crucial role for the miR-150/SPRR1A axis in regulating CM function post-MI.

Background Currently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of 9/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of 9/L. We evaluated the effect of mild thrombocytopenia: platelet count 9/L and ≥ 100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. Methods A total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥ 150 × 109/L; mild thrombocytopenia, 9/L and ≥ 100 × 109/L; and severe thrombocytopenia, 9/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Estimated relative risk was calculated with a Poisson regression analysis with a robust error. Results Platelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The estimated relative risks of severe thrombocytopenia were 4.46 [95 % confidence interval, 2.59–7.68] for maternal organ damage except for thrombocytopenia, 1.61 [1.06–2.45] for preterm delivery Conclusions Mild thrombocytopenia was not associated with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

Cardiovascular diseases (CVDs) represent the foremost cause of mortality in the United States and worldwide. It is estimated that CVDs account for approximately 17.8 million deaths each year. Despite the advances made in understanding cellular mechanisms and gene mutations governing the pathophysiology of CVDs, they remain a significant cause of mortality and morbidity. A major segment of mammalian genomes encodes for genes that are not further translated into proteins. The roles of the majority of such noncoding ribonucleic acids (RNAs) have been puzzling for a long time. However, it is becoming increasingly clear that noncoding RNAs (ncRNAs) are dynamically expressed in different cell types and have a comprehensive selection of regulatory roles at almost every step involved in DNAs, RNAs and proteins. Indeed, ncRNAs regulate gene expression through epigenetic interactions, through direct binding to target sequences, or by acting as competing endogenous RNAs. The profusion of ncRNAs in the cardiovascular system suggests that they may modulate complex regulatory networks that govern cardiac physiology and pathology. In this review, we summarize various functions of ncRNAs and highlight the recent literature on interactions between ncRNAs with an emphasis on cardiovascular disease regulation. Furthermore, as the broad-spectrum of ncRNAs potentially establishes new avenues for therapeutic development targeting CVDs, we discuss the innovative prospects of ncRNAs as therapeutic targets for CVDs.

Aim To clarify whether maternal characteristics or laboratory parameters could help predict the onset of recurrent gestational diabetes mellitus (GDM). Methods We enrolled 615 women with consecutive singleton deliveries at or after 28 GW from two perinatal medical centers between 2011 and 2019 and divided them into four groups according to whether they had GDM in the first and second pregnancies. The outcome of this study was to clarify the incidence and the predictors of recurrent GDM. Results We found that among 72 women (11.7%) who had GDM during their first pregnancy, the rate of recurrent GDM was 47.2%. The 34 women (5.5%) with recurrent GDM gained significantly less weight in the first and second pregnancies and lost less weight between the first delivery and the second conception compared with those women without GDM in both pregnancies. Of women with GDM during the first pregnancy, 21 scored 2 or 3 (multiple) positive points on a 75-g oral glucose tolerance test (OGTT) during their first pregnancies; the GDM recurrence rate among these women (66.7%) was significantly higher than that among the 51 women who scored 1 positive point (39.2%; p = 0.0411). During the first pregnancy, insulin administration therapy was significantly more frequent in women with recurrent GDM than in women without recurrent GDM (23.5% vs. 5.3%, p = 0.0396, respectively). Conclusion A predictor of recurrent GDM onset was a score of 2 or 3 positive points on the OGTT during the first pregnancy.

BackgroundCurrently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of 9/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of 9/L. We evaluated the effect of mild thrombocytopenia: platelet count 9/L and ≥100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. MethodsA total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥150 × 109/L; mild thrombocytopenia, 9/L and ≥100 × 109/L; and severe thrombocytopenia, 9/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Adjusted relative risk were calculated with a Poisson regression analysis with a robust error. ResultsPlatelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The adjusted risk ratios of severe thrombocytopenia were 2.11 [95% confidence interval, 1.61–2.77] for maternal organ damage except thrombocytopenia, 1.24 [1.01–1.53] for preterm delivery ConclusionsMild thrombocytopenia was not related with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

Objective Maternal characteristics and neonatal outcomes associated with cell-free DNA (cfDNA) results were analysed retrospectively to assess the details of false-positive and false-negative results after initial blood sampling in non-invasive prenatal testing (NIPT). Study design A multicentre retrospective study was performed for women undergoing NIPT who received discordant cfDNA results between April 2013 and March 2018. The NIPT data obtained using massive parallel sequencing were studied in terms of maternal background, fetal fraction, z-scores, invasive procedure results and neonatal outcomes after birth. Results Of the 56,545 women who participated in this study, 54 false-positive (0.095 %) and three false-negative (0.006 %) cases were found. Seven of the 54 false-positive cases (13.0 %) had vanishing twin on ultrasonography. Among the 18 false-positive cases of trisomy 18, confined placental mosaicism (CPM) was confirmed in three cases (16.7 %), while CPM was present in one of the three false-negative cases of trisomy 21. Conclusion These data suggest that the incidence of women with false-positive or false-negative results is relatively low, that such false results can often be explained, and that vanishing twin and CPM are potential causes of NIPT failure. Genetic counselling with regard to false results is important for clients prior to undergoing NIPT.

Pregnant women with diabetes mellitus (DM) are at high risk for hypertensive disorder of pregnancy (HDP). Women with poor control DM sometimes have heavy-for-dates infants. However, women with HDP sometimes have light-for-dates infants. We aim to clarify the relationship between glycemic control and fetal growth in women with DM and/or subsequent HDP. Of 7893 women gave singleton birth at or after 22 gestational weeks, we enrolled 154 women with type 1 DM (T1DM) or type 2 DM (T2DM) whose infants did not have fetal abnormalities. Among women with T1DM or T2DM, characteristics of the three groups (with HDP, without HDP, and with chronic hypertension [CH]) were compared. No women with T1DM had CH, but 19 (17.4%) of 109 with T2DM did. HDP incidence was similar between women with T1DM (22.2%) and T2DM without CH (16.7%). Among women with T1DM, the incidences of fetal growth restriction (FGR) with and without HDP were similar. However, among women with T2DM without CH, this incidence was significantly higher among those with HDP (33.3%) than among those without HDP (5.3%), was significantly more common with HbA1c levels at first trimester. 7.2% (33.3%) than with those < 7.2% (5.6%), and significantly more numerous without pre-pregnancy therapies for DM (23.3%) than with them (3.3%). Among women with T2DM and HDP, those with FGR had smaller placenta SDs and higher insulin dosages at delivery than those without light-for-dates. In multivariate analysis, the presence of diabetic nephropathy was a predictor of T1DM and HDP (P = 0.0105), whereas HbA1c levels >= 7.2% before pregnancy was a predictor of T2DM and HDP (P = 0.0009). Insulin dosage > 50U/day at delivery (P = 0.0297) and the presence of HDP (P = 0.0116) independently predicted T2DM, HDP, and FGR development. Insufficient pre-pregnancy treatment of DM increased the risk of HDP.

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We consider the motion of a spot under the influence of chemotaxis. We propose a two-component reaction diffusion system with a global coupling term and a Keller-Segel type chemotaxis term. For the system, we derive the equation of motion of the spot and the time evolution equation of the tensors. We show the existence of an upper limit for the velocity and a critical intensity for the chemotaxis, over which there is no circular motion. The chemotaxis suppresses the range of velocity for the circular motion. This braking effect on velocity originates from the refractory period behind the rear interface of the spot and the negative chemotactic velocity. The physical interpretation of the results and its plausibility are discussed.

In this study, we propose a spread-spectrum watermarking model using a parity-check code for simultaneous restorations of the message and image. In our model, in addition to the stego image, the pa...

Three kinds of bis(aromatic fluoride) compounds, 3,5-bis(4-fluorobenzoyl)biphenyl (1), 3,5-bis(4-fluorobenzoyl)-1,1′:4′,1″-terphenyl (2), and 3,5-bis(4-fluorobenzoyl)-1,1′:4′,1″:4″,1′′′-quaterphenyl (3), were synthesized by cross-coupling of the corresponding triflates with phenylboronic acid. Linear poly(ether ketone)s (1x, 2x, and 3x) having phenyl, biphenyl, and terphenyl side groups, respectively, were prepared by the polycondensation of the bis(aromatic fluoride) compounds with bisphenol A (a) and 4,4′-dihydroxybiphenyl (b) in N-methyl-2-pyrrolidone. The obtained poly(ether ketone)s were characterized by X-ray diffraction, differential scanning calorimetry, and thermogravimetry. The structure–property relationships of these poly(ether ketone)s were examined and compared with those of poly(ether ketone)s (4x) having no side group, which were prepared from 3,5-bis(4-fluorobenzoyl)benzene (4). The properties of the poly(ether ketone)s, solubilities, and thermal properties were compared and discussed based on the length of the side groups.

We present two unrelated Japanese pedigrees with achondrogenesis type 1b (ACG1B), characterized by prenatally lethal fetal hydrops and severe micromelia. The affected members in these pedigrees carried a common homozygous missense point mutation in solute carrier family 26 member 2 (SLC26A2), a gene associated with ACG1B (NM_000112:c.1987G>A). This loss-of-function point mutation causes substitution of glycine 663 with arginine in a highly conserved loop domain of SLC26A2. Interestingly, only a few cases of this mutation have been registered in Japanese genomic databases, and there are no reports of this mutation in any major genomic databases outside Japan. Furthermore, we confirmed the presence of a homozygous stretch of approximately 75 kb surrounding the pathogenic variant. Our findings suggest that this missense point mutation in SLC26A2, which is likely the cause of the ACG1B phenotypes in these unrelated fetuses, is distributed exclusively in Japan.

OBJECTIVE Beginning in 2008, the Centers for Medicare and Medicaid Service (CMS) determined that certain hospital-acquired adverse events such as surgical site infection (SSI) following spine surgery should never occur. The following year, they expanded the ruling to include deep vein thrombosis (DVT) and pulmonary embolism (PE) following total joint arthroplasty. Due to their ruling that “never events” are not the payers' responsibility, CMS insists that the costs of managing these complications be borne by hospitals and health care providers, rather than billings to health care payers for additional care required in their management. Data comparing the expected costs of such adverse events in patients undergoing spine and orthopedic surgery have not previously been reported. METHODS The California State Inpatient Database (CA-SID) from 2008 to 2009 was used for the analysis. All patients with primary procedure codes indicating anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), lumbar laminectomy (LL), total knee replacement (TKR), and total hip replacement (THR) were analyzed. Patients with diagnostic and/or treatment codes for DVT, PE, and SSI were separated from patients without these complication codes. Patients with more than 1 primary procedure code or more than 1 complication code were excluded. Median charges for treatment from primary surgery through 3 months postoperatively were calculated. RESULTS The incidence of the examined adverse events was lowest for ACDF (0.6% DVT, 0.1% PE, and 0.03% SSI) and highest for TKA (1.3% DVT, 0.3% PE, 0.6% SSI). Median inpatient charges for uncomplicated LL was $51,817, compared with $73,432 for ACDF, $143,601 for PLIF, $74,459 for THR, and $70,116 for TKR. Charges for patients with DVT ranged from $108,387 for TKR (1.5 times greater than index) to $313,536 for ACDF (4.3 times greater than index). Charges for patients with PE ranged from $127,958 for TKR (1.8 times greater than index) to $246,637 for PLIF (1.7 times greater than index). Charges for patients with SSI ranged from $168,964 for TKR (2.4 times greater than index) to $385,753 for PLIF (2.7 times greater than index). CONCLUSIONS Although incidence rates are low, adverse events of spinal procedures substantially increase the cost of care. Charges for patients experiencing DVT, PE, and SSI increased in this study by factors ranging from 1.8 to 4.3 times those for patients without such complications across 5 common spinal and orthopedic procedures. Cost projections by health care providers will need to incorporate expected costs of added care for patients experiencing such complications, assuming that the cost burden of such events continues to shift from payers to providers.

STUDY DESIGN Retrospective case series. OBJECTIVE To determine the clinical and radiographic outcomes of patients undergoing minimally invasive lateral lumbar interbody fusion (LLIF) with a minimum 2-year follow-up. SUMMARY OF BACKGROUND DATA Minimally invasive LLIF is performed through a lateral, retroperitoneal, transpsoas approach. This procedure is characterized by the use of a tubular retractor to minimize tissue damage and real-time neuromonitoring to ensure safe passage through the psoas muscle. To date, advantages of minimal invasive LLIF, compared with open procedures, has been limited to early postoperative outcomes and complications, with the longest mean follow-up duration of 22 months. METHODS A total of 118 patients who underwent minimally invasive LLIF with a minimum of 2 years follow-up were included in this study. Clinical outcomes were determined by using Visual Analog Score for the degree of pain (trunk or lower extremity), and Oswestry Disability Index and Short Form-12 scoring methods for patient function. Radiographic evaluations included (i) disk height; (ii) segmental coronal angulation; (iii) segmental lordotic angulation; (iv) Cobb angle; (v) cage subsidence; and (vi) fusion status. Data were statistically tested using either paired Students t test or Wilcoxon matched-pair test. Significance level was set at P

Because of their osteoconductive properties, structural bone allografts retain a theoretic advantage in biologic performance compared with artificial interbody fusion devices and endoprostheses. Current regulations have addressed the risks of disease transmission and tissue contamination, but comparatively few guidelines exist regarding donor eligibility and bone processing issues with a potential effect on the mechanical integrity of structural allograft bone. The lack of guidelines appears to have led to variation among allograft providers in terms of processing and donor screening regarding issues with recognized mechanical effects. Given the relative lack of data on which to base reasonable screening standards, a basic biomechanical evaluation was performed on one source of structural bone allograft, the femoral ring. Of the tested parameters, the minimum and maximum cortical wall thicknesses of femoral ring allograft were most strongly correlated with the axial compressive load to failure of the graft, suggesting that cortical wall thickness may be a useful screening tool for compressive resistance expected from fresh cortical bone allograft. Development of further biomechanical and clinical data to direct standard development appears warranted.

This paper explains the strategy of our company (Tokyo Electric Power, TEPCO) regarding means of long-term heat removal from the primary containment vessel (PCV) of Units 6 and 7 (ABWR) of the Kashiwazaki-Kariwa Nuclear Power Station in a severe accident. If the PCV continues in a high-temperature state for a long time, the strength of the PCV concrete will decline, and the risk of being affected by an earthquake will increase. Therefore, it is crucial for safety to cool the PCV and reduce its temperature to the maximum working temperature or lower. TEPCO provides a means of cooling the reactor pressure vessel (RPV) and PCV called the alternative coolant circulation system (ACCS). This system uses the heat exchanger of the residual heat removal (RHR) system, the make up water condensate (MUWC) pump, and alternative heat exchanger vehicles. By using these measures, it is possible reduce temperature in the PCV over the long term to the maximum working temperature (design value) or less, even in severe accident scenarios such as a large LOCA + ECCS function failures + SBO (station blackout). This function has quite high reliability, but in a scenario where these measures cannot be used, expectations are placed on the filtered vent (FV). However, due to FV characteristics, it is impossible to reduce to below the saturation temperature of 100°C at atmospheric pressure using FV alone, and it will be necessary in the medium/long-term to cool the PCV while also restoring the cooling equipment. Therefore, the following restoration operation of PCV cooling and its dose evaluation were studied. (1) RPV heat removal by restoring the RHR system (2) RPV and PCV heat removal using a portable pump employing a portable heat exchanger (3) RPV and PCV heat removal using the suppression pool water clean up system (SPCU) employing portable heat exchangers (4) RPV heat removal using the clean up water system (CUW) By clarifying beforehand issues such as feasibility of these systems, the on-site environment for restoration measures, and the necessary gear/systems, the authors were able to secure means of long-term cooling of the PCV, and further enhance PCV reliability.

Dedifferentiated chondrosarcoma remains a significant therapeutic challenge. Studies performed to date have not identified efficacious chemotherapy regimens for this disease.We sought to (1) evaluate the disease-specific survival at 2 and 5 years of patients with dedifferentiated chondrosarcoma; (2) assess the prognostic variables (both patient- and treatment-related), including the use of chemotherapy with ifosfamide, that relate to survivorship; and (3) assess specific toxicities associated with ifosfamide use.Data from 41 patients with dedifferentiated chondrosarcoma diagnosed and treated at the University of Texas MD Anderson Cancer Center from 1986 to 2010 were analyzed for demographics, treatments, oncologic outcomes, and prognostic variables. There were 14 women and 27 men. The mean age at diagnosis was 58 years (range, 26-86 years). Seven patients presented with metastasis. Surgical resection alone was performed in 11 patients; resection and chemotherapy in 26 patients; resection and radiotherapy in two patients; and resection, chemotherapy, and radiotherapy in two patients. Ifosfamide-based regimens were used for 16 patients. In general, ifosfamide was used when the tumor was located in the trunk or if cisplatin was discontinued as a result of toxicity. Minimum followup was 8 months (median, 68 months; range, 8-281 months). Survival was estimated using Kaplan-Meier plots and analyzed by using the Cox proportional hazards model.Disease-specific survival rates at 2 and 5 years were 33% and 15%, respectively. Multivariate analysis revealed that treatment without ifosfamide-based chemotherapy was the only independent negative prognostic factor for disease-specific survival (hazard ratio, 0.4; 95% confidence interval, 0.17-0.92; p = 0.03). Ifosfamide was discontinued in a patient as a result of renal dysfunction and was decreased in dose in another patient who developed encephalopathy.In this small retrospective study, it appeared that ifosfamide-based adjuvant chemotherapy combined with surgical resection offered a treatment advantage compared with patients who did not receive the drug in patients with dedifferentiated chondrosarcoma, although disease-specific survival for patients who have this rare tumor remains dismal.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

We describe our experience with stent-graft placement in a patient with a clinically diagnosed syphilitic aortic aneurysm.The patient was a 43-year-old man with syphilitic and human immunodeficiency virus (HIV) co-infection. Computed tomography (CT) revealed an aortic aneurysm with 89 mm in maximum size which was located at distal aortic arch and was considered syphilis derived saccular aneurysm. The aneurysm was judged at high risk of rupture from its shape. We decided to perform stent-graft implantation. Before surgery, the patient was given antibacterial and anti-HIV agents. Hand-made fenestrated stent graft by Tokyo Medical University was implanted. The graft was placed from the ascending aorta to Th 9 level in the descending aorta. The aneurysm completely disappeared during follow-up, with no flare-up of syphilitic infection up to 2 years after surgery.The number of patients with syphilis and human immunodeficiency virus co-infection is now increasing. Stent-graft implantation may be an effective treatment in such immunocompromised patients.

Aim The aim of this study was to underscore problems associated with the dipstick test and determination of protein concentration alone in spot-urine (P-test) compared with spot-urine protein-to-creatinine ratio (P/Cr test) and to determine whether urine collection for 24-h test was complete. Material and Methods Dipstick and P/Cr tests were performed simultaneously in 357 random spot-urine specimens from 145 pregnant women, including 35 with pre-eclampsia. Positive results were defined as ≥1+ on dipstick test, protein concentration ≥30 mg/dL on P-test, and P/Cr ratio ≥ 0.27 (mg/mg) on P/Cr test. Sixty-four 24-h urine tests (quantification of protein in urine collected during 24 h) were performed in 27 of the 145 women. We assumed that P/Cr ratio ≥ 0.27 predicted significant proteinuria (urinary protein ≥ 0.3 g/day). The 24-h urine collection was considered incomplete when urinary creatinine excretion was 25.0 mg/kg/day. Results Forty-four percent (69/156) of specimens with a positive test result on dipstick test contained protein