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HDR syndrome is an autosomal dominant disorder characterized by hypoparathyroidism (H), deafness (D), and renal dysplasia (R) caused by genetic variants of the GATA3 gene. We present the case of a 38-year-old Japanese man with HDR syndrome who exhibited hypoparathyroidism, sensorineural deafness, renal dysfunction, severe symptomatic hypocalcemia with Chvostek’s and Trousseau’s signs, and QT prolongation on electrocardiography. He had a family history of deafness and hypocalcemia. Genetic testing revealed a novel GATA3 gene variant at exon 2 (c.48delC), which induces a frameshift resulting in termination at codon 178, causing HDR syndrome. We summarized 45 Japanese cases of HDR syndrome with regard to the mode of onset (familial or sporadic) and the age at diagnosis. In addition, we summarized all previous cases of HDR syndrome with GATA3 gene variants. Mapping of previously reported genetic variants in HDR syndrome revealed that most missense variants were observed at exons 4 and 5 regions in the GATA3 gene. These two regions contain zinc finger domains, demonstrating their functional importance in GATA3 transcription. This review of literature provides a useful reference for diagnosing HDR syndrome and predicting the related future manifestations.

Deep placement of coated urea, lime nitrogen (Lime N), or urea with a nitrification inhibitor, 3,4-dimethylpyrazole phosphate (DMPP-U) did not inhibit N fixation activity, and it promoted soybean growth and seed yield. However, the effect of deep placement on the N budget including N leaching has not been evaluated. In this research, soybean plants were cultivated with a basal deep placement of urea, Lime N, or DMPP-U, and the control without deep placement of N fertilizer in lysimeters filled with Andosols. The nitrate was the principal N leachate and most of them leached until the flowering stage. The total amount of leached nitrate was the highest in urea deep placement, and it was reduced by the deep placement of Lime N or DMPP-U. In 2020, the total amount of nitrate in the leachate during the cultivation was 0.95, 1.83, and 2.78 ​g ​N m−2 in control, Lime N, and urea, respectively. The seed yield was higher in Lime N (424 ​g ​m−2) and urea (399 ​g ​m−2) than in the control (267 ​g ​m−2). The total amount of N accumulated in the shoots was higher in Lime N (32.1 ​g ​N m−2) than in the control (26.5 ​g ​N m−2) and urea (24.2 ​g ​N m−2) treatments. These results indicated that soybean plants with Lime N might assimilate more N both from N fertilizer and N2 fixation compared with control plants. Soil incubation test confirmed that the Lime N or DMPP-U retarded nitrification than urea.

We report the first case of airway obstruction due to toxin-producing Corynebacterium ulcerans, successfully managed with venovenous extracorporeal membrane oxygenation (V-V ECMO). A woman aged 73 years who was living with companion animals was intubated for pneumonia of unknown origin and treated with an empirical antimicrobial agent. Corynebacterium species were detected in the sputum and treated as commensal bacteria. Subsequently, the patient suddenly could not ventilate because of central airway obstruction caused by pseudomembrane formation. Therefore, V-V ECMO was initiated. Additional mass spectrometry identified the Corynebacterium species as C. ulcerans. After treatment with antitoxin, the patient was successfully weaned from V-V ECMO. Hence, in patients in contact with companion animals who present with respiratory failure and pseudomembrane formation, C. ulcerans pneumonia should be suspected and treated with antitoxin. C. ulcerans pneumonia may result in an inability to ventilate due to pseudomembrane formation. Therefore, treatment strategies including V-V ECMO should be considered in such cases.

The benefits of introducing a systematic lung-protective protocol for coronavirus disease 2019 (COVID-19) pneumonia requiring invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in terms of mortality, duration of ventilation, and length of ICU stay. In this single-centre, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, P = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, P = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, P = 0.06). The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed.

Background: The associations between the types/amounts of beverages consumed in daily life and measures of the glycemia status were investigated in a Japanese population-based cohort. Methods: Data from the baseline survey of the Japan Public Health Center-based Prospective Diabetes cohort were used. A cross-sectional analysis was performed in 3852 men and 6003 women who were evaluated under the fasting condition. The daily consumptions of coffee, green tea, oolong tea, black tea, soft drinks, fruit juices, or plain water were assessed using a self-reported questionnaire. Multivariable-adjusted linear regression analyses were performed using measures of the glycemia status (fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) ) as dependent variables and the types/amounts of beverages consumed as the independent variables, to calculate the differences according to the types/amounts of beverages consumed. Results: In the multivariable-adjusted models, coffee consumption of ≥240 mL/day was significantly associated with a change of the FPG level by −1.9 mg/dL in men (p = 0.013) and −1.4 mg/dL in women (p = 0.015), as compared to coffee consumption of 0 mL/day. No significant association of the FPG level was observed with any of the other types/amounts of beverages consumed. On the other hand, significant associations were found between the HbA1c levels and consumption of several types of beverages. Conclusions: High coffee consumption was associated with lower FPG levels in this Japanese population. Some unexpected associations of the HbA1c levels with the consumption of some types of beverages were observed, which need to be further investigated.

The waste sludge from food factories has rich nutrients and useful material for fertilizer or animal feed, but quick treatments and recycling of the waste sludge are difficult due to its higher water content. We have developed a rapid composting system to make sludge fertilizer using mix of waste sludge and shredded newspaper (Sludge Fertilizer Made by Paper Mixing Method, SF-PMM). The mixture was incubated in a box reactor, continuously aerated with warm air around 35°C, and changed to mature SF-PMM, in only two weeks. To search movement of N from the SF-PMM to plants, we developed a new method to label small amounts of SF-PMM with 15N-glycine. 50 L of wastewater from a food factory was incubated with 1 L of active sludge and 3 g of 15N-glycine (98 atom% 15N), and 175 g of labeled sludge was obtained in a day. This sludge was mixed with 25 g of newspaper chips, packed between two steel meshes, and placed at 20 cm depth in the reactor composting 200 kg of unlabeled sludge-paper mixture. Composting was restarted, and after about 7 days of reaction, 15N-labeled SF-PMM 7.03 atom% 15N was obtained. The surrounding unlabeled compost contained 4.0, 4.0, and 0.8% of N, P2O5, and K2O, respectively. C/N and pH were 10 and 7.4, respectively. Komatsuna (Brassica rapa var. perviridis) was cultivated in a pot with 50 and 100 mg N of SF-PMM, and healthy plants were obtained as in the Control experiments containing 50 mg N ammonium sulfate. No growth inhibition was observed in these experiments. Even in 100 mg SF-PMM, excellent growth of the roots was observed. About 56% of the N in the plant was shown to come from 15N-SF-PMM, and about 6% of the total15N in the 15N-SF-PMM was also shown to be incorporated into the plant.

The deep placement of urea fertilizer (DMU) containing 1% (W/W) of the nitrification inhibitor 3,4-dimethylpyrazole phosphate (DMPP) on soybean growth and seed yield was as effective as those of the coated urea (CU) and lime nitrogen (LN) in a field research. The average seed yields were high in LN (464 g·m−2) and DMU (461 g·m−2) and relatively low in CU (405 g·m−2), U (396 g·m−2), and Cont (373 g·m−2) treatments. The accumulations of dry matter and nitrogen in soybean shoots were higher in the plants with deep placement of CU, LN, and DMU than U and Cont. The daily nitrogen fixation activity and daily nitrogen absorption rate were calculated based on the relative ureide method. Both nitrogen fixation activity and nitrogen absorption rate were higher in DMU, CU, and LN compared with control treatment, suggesting that the deep placement of DMU did not repress nitrogen fixation. Soil incubation test was performed using the same field soil with DMU, U, LN, and urea with DMPP 1%, 2%, and 4%. DMU inhibits nitrification similar to the pattern of LN until 8 weeks. The increasing DMPP concentration did not markedly increase the nitrification inhibition. From these results, it was concluded that urea fertilizer with 1% DMPP is efficient for deep placement of N fertilizer for soybean cultivation due to its lower price compared with CU and LN.

Accumulation of epicardial adipose tissue (EAT) is considered to be a cardiovascular risk factor independent from visceral adiposity, obesity, hypertension and diabetes. We explored the parameters related to EAT accumulation, aiming to clarify the novel pathophysiological roles of EAT in subjects with type 2 diabetes (T2DM).We examined the laboratory values, including cystatinC, and surrogate markers used for evaluating atherosclerosis. EAT was measured as the sum of the adipose tissue area, obtained by plain computed tomography scans in 208 subjects with T2DM but no history of coronary artery disease.EAT correlated positively with age, body mass index (BMI), visceral fat area, leptin, cystatin C and C-peptide, while correlating negatively with adiponectin, estimated glomerular filteration rate (eGFR) and the liver-to-spleen ratio. Multiple linear regression analysis revealed serum cystatin C (β = 0.175), leptin (β = 0.536), BMI (β = 0.393) and age (β = 0.269) to be the only parameters showing independent statistically significant associations with EAT. When cystatin C was replaced with eGFR, eGFR showed no significant correlation with EAT. In reverse analysis, serum cystatin C was significantly associated with EAT after adjustment in multivariate analysis.EAT accumulation and elevated cystatin C have been independently regarded as risk factors influencing atherosclerosis. The strong association between EAT and cystatin C demonstrated herein indicates that EAT accumulation may play an important role in Cystatin C secretion, possibly contributing to cardiometabolic risk in T2DM patients.

ObjectiveThe aim of the present study was to test a hypothesis that a history of having a macrosomic infant (≥ 4000 g) is associated with the risk of diabetes.MethodsData on the Japan Public Health Center-based Prospective diabetes cohort were analyzed, which is a population-based cohort study on diabetes. The survey of diabetes was performed at baseline and at the 5-year follow-up. A history of having a macrosomic infant was assessed using a self-administered questionnaire. A cross-sectional analysis was performed among 12,153 women who participated in the 5-year survey of the cohort. Logistic regression was used to examine the relationship between a history of having a macrosomic infant and the presence of diabetes. A longitudinal analysis was also conducted among 7,300 women without diabetes who participated in the baseline survey. Logistic regression was used to investigate the relationship between a history of having a macrosomic infant and the incidence of diabetes between the baseline survey and the 5-year survey.ResultsIn the cross-sectional analysis, parous women with a positive history were more likely to have diabetes in relation to parous women without (OR = 1.44, 95% CI = 1.13-1.83). The longitudinal analysis showed a modest but non-significant increased risk of developing diabetes among women with a positive history (OR = 1.24, 95% CI = 0.80-1.94).ConclusionsAn increased risk of diabetes was implied among women with a history of having a macrosomic infant although the longitudinal analysis showed a non-significant increased risk.

OBJECTIVE: The effect of smoking cessation on the risk of diabetes has been reported previously. However, it is unknown whether the association is influenced by weight gain and other potential risk factors. METHODS: The Japan Public Health Center-Based Prospective Study established in 1990 for Cohort I and in 1993 for Cohort II provided data, and 25,875 men and 33,959 women were analyzed. The response rate to the baseline questionnaire was 80.9%, and 68.4% of the respondents participated both the 5- and 10-year follow-up surveys. Smoking cessation was noted during the initial five years and the development of diabetes was reported in the subsequent five years. RESULTS: An increased risk was observed among individuals who newly quit smoking compared with never smokers among men (odds ratio (OR)=1.42, 95% CI=1.03-1.94) and women (OR=2.84, CI=1.53-5.29). The risk of developing diabetes among male new quitters who gained 3 kg or more during the 5-year follow-up did not substantially differ from the risk among male never smokers with less than 3 kg of weight gain or no weight gain, while an increased risk was observed among male new quitters with less or no weight gain (OR=1.46, 95%CI 1.00-2.14). An insignificant increased risk was observed among male new quitters with a family history of diabetes compared with male never smokers with a family history of diabetes. The risk was more than twice as high for male new quitters who used to smoke 25 or more cigarettes per day compared with never smokers (OR=2.15, 95%CI: 1.34-3.47). DISCUSSION: An increased risk of diabetes was implied among individuals who quit smoking. However, the increased risk was not implied among those who gained weight over the 5-years of follow-up. Those who had major risk factors for diabetes or who smoked heavier had a higher risk.