Abstract To assess the role of IL-6/IL-18 in the pathogenesis of systemic juvenile idiopathic arthritis (s-JIA) and to investigate the clinical significance of serum IL-18 levels for predicting ...macrophage activation syndrome (MAS) development, we measured the serum IL-6/IL-18 levels in 76 s-JIA patients, including 15 with MAS, and compared them with the clinical features. We identified 2 distinct subsets on the basis of serum IL-6/IL-18 levels. The IL-18-dominant subset had more patients who developed MAS. Serum IL-18 levels during active phase in patients with MAS were significantly higher than those without MAS. The cutoff value of serum IL-18 levels for predicting MAS development was 47750 pg/ml. The patients with IL-18 dominant subset at their disease onset were significantly more likely to develop MAS after TCZ therapy started. IL-18 might have a key role in the pathogenesis of MAS. Serum IL-18 levels > 47750 pg/ml might be useful to predict MAS development.
Background: Regular assessment of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) is essential for detecting glucocorticoid-induced osteoporosis in juvenile-onset autoimmune ...diseases. Z-score is used to standardize osteoporosis assessment in children and is evaluated with only one of three devices in Japan. The purpose of this study was to determine how many Japanese medical facilities for pediatric rheumatic diseases were unable to use Z-scores to evaluate osteoporosis. Methods: Electronic questionnaires were distributed between 2017 and 2019 to hospitals belonging to the Pediatric Rheumatology Association of Japan and to university hospitals and public children's hospitals that provide medical care for pediatric rheumatic diseases. The questionnaire inquired about the location of DXA measurement, manufacturer (Hologic, GE healthcare, Hitachi), and measurement site, and the answers were collected using Google Forms. Statcel 4 was used for analysis. Results: Overall, 120 facilities responded to the survey, of which 117 had DXA. In the remaining three facilities, DXA was not installed in two and was out of order in one. Bone loss in childhood was evaluated using a Z-score calculated from age-based reference values; however, 30% of hospitals without HOLOGIC DXA could not evaluate osteoporosis by Z-score in Japanese childhood. The characteristics of the hospitals enrolled in this study did not bias the selection of Hologic DXA. Conclusions: Neighboring institutions should consider sharing access to Hologic DXA equipment, to ensure use of uniform reference values. GE BMD reference values should be established for Japanese children.
Forest fragmentation can increase dry deposition of atmospheric ammonia (NH3) volatilized from agricultural areas, and consequently increase spatial variability of Nr deposition within the forest ...(“elevated reactive nitrogen (Nr) deposition”). However, little is known about this effect and its impact on forest production in a deciduous broad-leaved forest in Asian countries. Here, we performed the field observations of atmospheric concentration and deposition of inorganic Nr gases and particles in a Japanese fragmented forest from May 2018 to April 2019. Leaf traits and growth of Japanese oak tree and understory vegetation were also measured. Atmospheric concentration and deposition of dissolved inorganic Nr (DIN) to tree canopies were measured via filter sampling and throughfall methods, respectively. Canopy retention/exchange was also estimated as a part of dry deposition using the canopy budget model. The results demonstrated that annual dry deposition of NH3 to tree canopies (4.4 kgN ha−1 y−1) was dominant in the annual total DIN deposition (7.1 kgN ha−1 y−1) at the forest edge, including the elevated Nr deposition of approximately 2 kgN ha−1 y−1. Additionally, agricultural activities such as fertilization in the area surrounding the forest likely enhanced the potential of canopy retention of NH4+, readily absorbed by tree canopy. The growth rates of tree and understory vegetation (dwarf bamboo) were higher at the edge than that at the interior, emphasizing a need for further investigation to quantify the effect of low Nr deposition (<3–5 kgN ha−1 y−1) on forest production, along with the conventional experimental studies under a high Nr deposition.
•Field observations were conducted in a Japanese cool-temperate fragmented forest.•Canopy retention was estimated using the canopy budget model.•The edge effect of NH3 dry deposition was about 2 kgN ha−1 y−1.•Agricultural activities surrounding the forest enhanced the NH3 canopy retention.•Growth rates of tree and dwarf bamboo may be enhanced due to the edge effect.
Cryopyrin-associated periodic fever syndrome (CAPS) is a highly debilitating disorder, which is characterized by unregulated interleukin-1β production driven by autosomal dominantly inherited ...mutations in the
NLRP3
gene. Patients with CAPS often present with early-onset episodes of fever and rash. These patients also present with variable systemic signs and symptoms, such as arthritis, sensorineural hearing loss, chronic aseptic meningitis, and skeletal abnormalities, but minimal gastrointestinal symptoms. Recently, effective therapies for CAPS targeted against interleukin-1 have become available. We report a case of a young Japanese woman with CAPS who developed inflammatory bowel disease during canakinumab therapy. The patient had colostomy after intestinal perforation and changed canakinumab to infliximab. To the best of our knowledge, this is the first report of a case of inflammatory bowel disease secondary to CAPS complicated by gastrointestinal symptoms and arthritis which canakinumab could not control. Patients with CAPS who have symptoms that cannot be controlled by canakinumab should be considered for possible co-morbidities.
Heavy traumatic brain injury (TBI) may lead to the manifestation of either syndrome of inappropriate secretion of antidiuretic hormones (SIADH) or central diabetes insipidus (CDI). We present a case ...of TBI where SIADH transformed into CDI within a remarkably short timeframe. A previously healthy 4-yr-old boy was admitted to our hospital with hyponatremia and elevated urinary sodium level on the day following a traumatic head injury. Within 150 min after initiating SIADH treatment, a significant increase in urine volume and a decrease in urinary sodium levels were observed. Therefore, the treatment plan was modified to include desmopressin. By the 5th day of admission, the urine volume gradually stabilized and normalized without the need for further desmopressin treatment. Mild TBI can give rise to various conditions that may undergo rapid changes. Closely monitoring serum and urine electrolytes, along with urine volume, is imperative for the administration of appropriate and timely treatment.
Objectives: With the development of services to improve the daily lives of older adults and the use of Internet of Things technology in healthcare in Japan, there is a growing need to address health ...literacy, especially among older adults living alone. The current study aims to fill this research gap by assessing the current state of health literacy in this population, and potentially providing guidance for future support strategies.Methods: In this study, 22 older female participants in long-term care preventive services were assessed for health literacy, cognitive function, and activities of daily living using the Household Composition and Basic Demographic Information, the Health Literacy Scale, the Japanese version of the Montreal Cognitive Assessment, and the Occupational Self-Assessment-Short Form.Results: The household composition was 13 older adults living alone and nine living with others. Older adults living alone had significantly lower functional health literacy than those living with others, which affected their ability to understand and apply health information. Difficulties reading health materials were also prevalent in this group, suggesting that visual impairment or a lack of assistive devices may affect their understanding of health information. Considering these specific needs through tailored strategies is essential for helping older adults to adapt to an increasingly digital society.Conclusions: Understanding the current state of functional health literacy among older adults living alone in the community is essential for developing strategies to improve their well-being, prevent isolation, and enable them to make informed decisions about their health.
This study aimed to determine the influence of tocilizumab (TCZ) in modifying the clinical and laboratory features of macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic ...arthritis (s-JIA). Furthermore, we assessed the performance of the 2016 MAS classification criteria for patients with s-JIA-associated MAS while treated with TCZ.
A panel of 15 pediatric rheumatologists conducted a combination of expert consensus and analysis of real patient data. Clinical and laboratory features of s-JIA-associated MAS in 12 TCZ-treated patients and 18 untreated patients were evaluated. Possible MAS was defined as having characteristic laboratory features but lack of clinical features of MAS, or atypical MAS, or early treatment that prevented full-blown MAS.
Clinically, the TCZ-treated patients with s-JIA-associated MAS were less likely febrile and had significantly lower ferritin, triglyceride, and CRP levels than the untreated patients with s-JIA-associated MAS. Other laboratory features of MAS including lower platelet counts and lower fibrinogen were more pronounced in TCZ-treated patients. The TCZ-treated patients with s-JIA-associated MAS were less likely to be classified as MAS based on the MAS classification criteria (25% vs 83.3%, p < 0.01). This is ascribed to the absence of fever or insufficient ferritin elevation, compared with the untreated patients.
TCZ could modify the clinical and laboratory features of s-JIA-associated MAS. When evaluating the s-JIA patients while treated with TCZ, it is not applicable to use MAS classification criteria. Care must be taken to not underdiagnose MAS based on the MAS classification criteria.
Purpose The aim of this study was to examine the relationships between oral and mental/physical functions of community-dwelling older adults. Participants and Methods We conducted a mail ...questionnaire survey of 1,940 community-dwelling persons aged 65 years or older. Using a basic checklist, we investigated oral function, motor function, low nutrition, depressive tendencies, cognitive function, and confinement, and compared the results between the groups with and without impaired oral function. Results We found that motor function, low nutrition, and cognitive function were associated with oral function. Conclusion We found a relationship between oral function and psychosomatic function in the elderly. The results suggest that a decline in psychosomatic function may be caused by a decline in oral function.
Abstract Background Osteoporosis can lead to spontaneous fractures in adults with cerebral palsy (CP). Undercarboxylated osteocalcin (ucOC) is a useful marker for vitamin K insufficiency in ...osteoporosis. The primary objective of this study was to determine the effect of vitamin K2 on bone mineral density (BMD) in adults with CP and vitamin K insufficiency. Methods Sixteen adults, median age of 56 years, with CP and osteoporosis in whom the serum ucOC concentration exceeded 4.5 ng/mL were included. All patients received 45 mg of vitamin K2 per day. BMD was measured and presented as a percentage of the young adult mean (%YAM). Serum levels of ucOC and BMD were measured at baseline and after 6 and 12 months. Results Serum levels of ucOC decreased from 7.8 ng/mL (range, 4.9–32) at baseline to 3.9 ng/mL (range, 1.9–6.8) after 6 months ( P = 0.001). BMD increased from 59%YAM (range, 45–67) at baseline to 68%YAM (range, 50–79) after 12 months ( P = 0.003). Conclusions Vitamin K2 had a positive effect on BMD in osteoporotic adults with CP and high serum concentrations of ucOC, and might be useful as a first line treatment for osteoporotic adults with CP and vitamin K insufficiency.
To examine the hypothesis that the soil microbial community in a nitrogen (N) limited forest responds to moderately elevated N deposition (< 10 kg ha
−1
yr
−1
), correlations between N deposition and ...soil microbial properties were analyzed in a cool temperate forest surrounded by normally fertilized pasture grasslands in northern Japan. Three experimental plots were established in forest edges adjacent to the grasslands, and the other three plots were in forest interiors at least 700 m away from the grasslands. N deposition in each plot was measured from May to November 2018. In August 2018, we collected litter and surface soil samples from all plots to measure net N mineralization and nitrification rates as indicators of microbial activity, and microbial biomass and various gene abundances (i.e., bacterial 16S rRNA gene, fungal ITS region, and bacterial and archaeal amoA genes) as indicators of microbial abundance. N deposition in forest edges was 1.4-fold greater than that in forest interiors, whereas maximum N deposition was 3.7 kg ha
−1
. N deposition was significantly correlated with net N mineralization and nitrification rates and 16S rRNA and bacterial amoA gene abundances. Microbial community structures analyzed for bacterial 16S rRNA gene and fungal ITS region amplicons were different between litter and soil samples but were similar between the forest edge and interior, although this analysis was made only for single pair of the two plots in the forest edge and interior. N deposition was also correlated with the soil C/N ratio and nitrate and ammonium contents. Thus, it was suggested that some soil microbial activities and abundances in an N limited forest likely responded to moderately elevated N deposition. These findings provide primary information on soil microbial response to moderately elevated N deposition.
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