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Objective: Primary aldosteronism (PA) is a major cause of secondary hypertension and is associated with chronic renal injury. The glomerular filtration rate (GFR) in PA rapidly decreases after the removal of glomerular hyperfiltration due to aldosterone excess by adrenalectomy (ADX) or mineralocorticoid receptor antagonist (MRA) treatment and is stable in the long term. However, the effects of these treatments on the long‐term renal function of PA patients with chronic kidney disease (CKD) is not well understood. Design and Patients: In this single‐center, retrospective study, acute and chronic changes in the estimated GFR (eGFR) were examined in 107 patients with PA, including 49 patients with post‐treatment CKD defined as eGFR < 60 ml/min/1.73 m2. Results: The reduction in eGFR observed 1 month after ADX in the CKD group (N = 31) was −20.1 ± 8.2 ml/min/1.73 m2. Multivariate analysis showed that pre‐treatment eGFR and plasma aldosterone concentration were independent predictive factors of the acute reduction in eGFR after ADX. The reduction of eGFR observed 1 month after MRA administration in the post‐treatment CKD group (N = 18) was −9.2 ± 5.9 ml/min/1.73 m2. Multivariate analysis showed that the duration of hypertension and pre‐treatment eGFR were independent predictive factors of the acute reduction in eGFR after ADX administration. In 20 patients with CKD (N = 12 ADX and N = 8 MRA) followed for more than 5 years post‐treatment, there was no further significant decline in eGFR over a follow‐up period of 7 (6, 8) years nor any difference between the two treatment modalities. Conclusions: Our study suggests that treatment of PA in stage 3 CKD is safe and useful in preventing renal injury. [ABSTRACT FROM AUTHOR]

Phaeochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumours with a hereditary background in over one‐third of patients. Mutations in succinate dehydrogenase (SDH) genes increase the risk for PPGLs and several other tumours. Mutations in subunit B (SDHB) in particular are a risk factor for metastatic disease, further highlighting the importance of identifying SDHx mutations for patient management. Genetic variants of unknown significance, where implications for the patient and family members are unclear, are a problem for interpretation. For such cases, reliable methods for evaluating protein functionality are required. Immunohistochemistry for SDHB (SDHB‐IHC) is the method of choice but does not assess functionality at the enzymatic level. Liquid chromatography–mass spectrometry‐based measurements of metabolite precursors and products of enzymatic reactions provide an alternative method. Here, we compare SDHB‐IHC with metabolite profiling in 189 tumours from 187 PPGL patients. Besides evaluating succinate:fumarate ratios (SFRs), machine learning algorithms were developed to establish predictive models for interpreting metabolite data. Metabolite profiling showed higher diagnostic specificity compared to SDHB‐IHC (99.2% versus 92.5%, p = 0.021), whereas sensitivity was comparable. Application of machine learning algorithms to metabolite profiles improved predictive ability over that of the SFR, in particular for hard‐to‐interpret cases of head and neck paragangliomas (AUC 0.9821 versus 0.9613, p = 0.044). Importantly, the combination of metabolite profiling with SDHB‐IHC has complementary utility, as SDHB‐IHC correctly classified all but one of the false negatives from metabolite profiling strategies, while metabolite profiling correctly classified all but one of the false negatives/positives from SDHB‐IHC. From 186 tumours with confirmed status of SDHx variant pathogenicity, the combination of the two methods resulted in 185 correct predictions, highlighting the benefits of both strategies for patient management. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

Abstract: Aims/Introduction: To investigate whether the ratio of visceral fat area (VFA) to subcutaneous fat area (SFA; V/S ratio) could be predictive of cardiovascular disease (CVD) as compared with VFA or SFA in patients with diabetes. Materials and Methods: A total of 682 patients with type 2 diabetes (mean age 64 ± 13 years; 41% women) were enrolled. VFA (cm2) and SFA (cm2) were assessed by a dual bioelectrical impedance analyzer. The patients were divided into four groups according to the quartiles of the V/S ratio. The study end‐point was the first occurrence or recurrence of CVD. Results: Over a median follow up of 2.5 years, 21 patients reached the end‐point. The number of patients who reached the end‐point was increased along with the increasing of the V/S ratio quartiles. The V/S ratio was significantly associated with incident or recurrent CVD (hazard ratio [HR] 1.82, 95% CI: 1.09–3.04, P = 0.021) after adjusting for estimated glomerular filtration rate (HR 0.98, 95% CI: 0.96–1.00), brain‐type natriuretic peptide (HR 1.00, 95% CI: 1.00–1.01), use of antiplatelet agents (HR 4.26, 95% CI: 1.63–11.13), coefficient of variation of R‐R intervals (HR 0.85, 95% CI: 0.69–1.10) and glycated hemoglobin (HR 1.37, 95% CI: 1.05–1.79). The addition of the V/S ratio to age, estimated glomerular filtration rate, brain‐type natriuretic peptide, antiplatelet agents and glycated hemoglobin significantly improved classification performance for CVD using net reclassification improvement (0.60, 95% CI: 0.21–1.00) and the integrated discrimination improvement (0.02, 95% CI: 0.00–0.05). Conclusions: The V/S ratio measured by dual bioelectrical impedance analyzer is an independent predictor of CVD in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Activation of dipeptidyl peptidase 4 has been reported to be associated with impairment of insulin signalling in skeletal muscle, presumably leading to loss of muscle function. This study was aimed to investigate whether the use of dipeptidyl peptidase 4 inhibitors (DPP4i) could attenuate the progressive loss of muscle mass in patients with type 2 diabetes.Methods: A total 105 patients with type 2 diabetes (mean age 62 ± 12 years; 39% female) were studied in this retrospective observational study. To reduce the bias due to confounding variables, propensity-score matching analysis was performed. Change in skeletal muscle index measured by the whole body dual-energy X-ray absorptiometry at 1-year follow-up was evaluated. One-year changes in visceral and subcutaneous fat area and liver attenuation index were also determined by abdominal computed tomography.Results: Overall, 37 of 105 (35.2%) patients were treated with DPP4i. The estimated change in skeletal muscle index in patients with DPP4i was significantly higher than that in patients without (0.05 ± 0.06 vs -0.10 ± 0.04 kg, P = .046). In a propensity-matched population (N = 48), the same finding was observed (0.04 ± 0.03 in DPP4i versus -0.12 ± 0.03 kg in non-DPP4i, P = .033). There were no significant differences in changes of visceral and subcutaneous fat area and liver attenuation index between patients with DPP4i and those without.Conclusions: Our data suggest the potential of DPP4i to prevent the progressive loss of muscle mass with ageing in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims/Introduction To investigate the impact of increased visceral adiposity with normal weight ( OB[−] VA[+]) on the prevalence of non-alcoholic fatty liver disease in patients with type 2 diabetes. Materials and Methods This was a cross-sectional study of 140 Japanese patients with type 2 diabetes (mean age 65 ± 11 year; 44.6% women). Visceral fat area ( VFA; cm2) and liver attenuation index ( LAI) were assessed by abdominal computed tomography. The patients were divided into four groups by VFA and body mass index ( BMI; kg/m2) as follows: BMI <25 kg/m2 and VFA <100 cm2 ( OB[−] VA[−]), BMI ≥25 kg/m2 and VFA <100 cm2 ( OB[+] VA[−]), BMI <25 kg/m2 and VFA ≥100 cm2 ( OB[−] VA[+]), and BMI ≥25 kg/m2 and VFA ≥100 cm2 ( OB[+] VA[+]). Multivariate linear regression and logistic regression analysis were carried out to determine the impact of OB(−) VA(+) on LAI. Results In the present study, 25.0% were OB(−) VA(+) patients, where the LAI levels were lower (1.09 ± 0.22) than those in OB(−) VA(−) patients (1.23 ± 0.15), and were equivalent to those in OB(+) VA(+) patients (1.03 ± 0.26). In multivariate linear regression analysis, OB(−) VA(+) was independently associated with LAI (standardized β−0.212, P = 0.014). In multivariate logistic regression analysis, OB(−) VA(+) was a significant predictor of LAI <0.9 (odds ratio 5.88, 95% confidence interval 1.03−33.52, P = 0.046). Conclusions The present study provides evidence that increased visceral adiposity with normal weight is a strong predictor for the prevalence of non-alcoholic fatty liver disease in Japanese patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

We present a case of a 62-year-old diabetic woman with acute pyelonephritis and spondylitis caused by Salmonella typhi. She was admitted to Tokyo Medical Dental University Hospital, Tokyo, Japan, because of unconsciousness and was diagnosed with sepsis by retrograde pyelonephritis as a result of Salmonella typhi. Antibiotics treatment was immediately started; however, she subsequently developed lumbar spondylitis, and long-term conservative treatment with antibiotics and a fixing device were required. This is the first report of a diabetic patient who developed retrograde urinary tract infection with Salmonella typhi, followed by sepsis and spondylitis. The infection could be a result of diabetic neuropathy, presenting neurogenic bladder and hydronephrosis. The patient was successfully treated with antibiotics and became asymptomatic with normal inflammatory marker levels, and no clinical sign of recurrence was observed in the kidney and spine at 4 months. [ABSTRACT FROM AUTHOR]

Transforming growth factor- β (TGF- β) has been demonstrated to inhibit myogenesis in myoblasts. Here we report that transcriptional upregulation of p21WAF1/Cip1 and muscle creatinine kinase (MCK) genes in C2C12 cells, which are associated with growth arrest at the G1 phase and representative cell-lineage-specific expression during myogenesis, was inhibited by TGF- β treatment. C2C12 cells expressed TWIST2, but not TWIST1, which was downregulated in myogenic differentiation in response to low-serum cultures. We further found that TGF- β prevented differentiation-associated downregulation of TWIST2 transcription, resulting in maintaining TWIST2 mRNA expression as high as that in growing C2C12 cells. Ectopic TWIST2 suppressed the p21 and MCK promoters activated by the exogenous addition of E2A and MyoD and this inhibitory effect of TWIST2 was cancelled by the introduction of short hairpin RNA (shRNA) against TWIST2. On the other hand, TWIST2 shRNA failed to recover endogenous promoter activities from TGF- β-mediated repression. The results clearly indicate that TGF- β inhibits G1 arrest and maintains TWIST2 expression in C2C12 cells. Our data however suggest that the TGF- β signaling pathway may not involve TWIST2 to inhibit p21 and MCK expression. [ABSTRACT FROM AUTHOR]

Sulfatide, which binds to influenza A viruses and prevents the viral infection, was found to inhibit the sialidase activities of influenza A viruses in a pH-dependent manner. The kinetic parameters of the effect of sulfatide on the sialidase activities of human influenza A viruses using fluorometric assay indicated that sulfatide was a powerful and non-competitive type inhibitor in low-pH conditions. [Copyright &y& Elsevier]

Since the Schottky barrier height at the metal/p-ZnSe and p-GaN interfaces is very high, and heavy p-type doping is difficult, it is extremely difficult to obtain low-resistance ohmic contact material for p-ZnSe and p-GaN. However, a key to the development of low-resistance ohmic contact material is to find an element that forms an intermediate semiconductor layer to reduce the Schottky barrier or to increase the doping concentration. © 1999 Scripta Technica, Electron Comm Jpn Pt 2, 82(10): 43–47, 1999 [ABSTRACT FROM AUTHOR]

AbstractA case of mucinous cholangiocarcinoma (CC), a rare histological type of CC, featuring unusual images is reported. The patient was hospitalized because of acute development of jaundice and fever. Computed tomography demonstrated multiple cystic lesions in the liver and a band-like low density area parallel to the intrahepatic portal vein, a so-called ‘periportal collar’. Endoscopic cholangiography revealed a stricture of the hepatic duct with slight upstream dilatation. Cytology of the bile juice and fine-needle aspiration of the cystic lesion in the liver disclosed mucinous carcinoma. The patient died of multiorgan failure 3 weeks after admission. The autopsied liver showed that multiple mucus lakes were lined with adenocarcinoma cells and signet ring cells were floating in the mucus lakes. The cancer cells had spread along the portal tract and invaded into the hepatic parenchyma. © 1999 Blackwell Science Asia Pty Ltd. [ABSTRACT FROM AUTHOR]

The article discusses the shoelace technique combined with vacuum-assisted closure device in leg fasciotomy.