Serum immunoglobulin G antibody titer to Fusobacterium nucleatum is associated with unfavorable outcome after stroke

Stroke can be a cause of death, while in non-fatal cases it is a common cause of various disabilities resulting from associated brain damage. However, whether a specific periodontal pathogen is associated with increased risk of unfavorable outcome after stroke remains unknown. We examined risk factors for unfavorable outcome following stroke occurrence, including serum antibody titers to periodontal pathogens. The enrolled cohort included 534 patients who had experienced an acute stroke, who were divided into favorable (n = 337) and unfavorable (n = 197) outcome groups according to modified ranking scale (mRS) score determined at 3 months after onset (favorable = score 0 or 1; unfavorable = score 2-6). The associations of risk factors with unfavorable outcome, including serum titers of IgG antibodies to 16 periodontal pathogens, were examined. Logistic regression analysis showed that the initial National Institutes of Health stroke scale score [odds ratio (OR) = 1·24, 95% confidence interval (CI) = 1·18-1·31, P < 0·001] and C-reactive protein (OR = 1·29, 95% CI = 1·10-1·51, P = 0·002) were independently associated with unfavorable outcome after stroke. Following adjustment with those, detection of the antibody for Fusobacterium nucleatum ATCC 10953 in serum remained an independent predictor of unfavorable outcome (OR = 3·12, 95% CI = 1·55-6·29, P = 0·002). Determination of the antibody titer to F. nucleatum ATCC 10953 in serum may be useful as a predictor of unfavorable outcome after stroke.

Study of factors related to the reflection abilities of dental trainees

INTRODUCTION

This study analysed the internal and external factors related to the reflection abilities of dental trainees.

PARTICIPANTS AND METHODS

We created transcripts from oral presentations by the dental trainees of Hiroshima University Hospital (n = 35, 2012-2013) at a significant event analysis conference. The reflection depths were compared between the trainees of the university hospital and external clinical combination groups. We determined and statistically analysed the reflection depths.

RESULTS

At the end of training, a Mann-Whitney U-test revealed a significant difference in the median reflection depths of the groups (U = 66, W = 342 and P = 0.007). The results of multiple regression analysis indicated a significant relation between the reflection depth and external training completion (P = 0.024). There were no relations with other factors, including gender and academic background.

CONCLUSION

Experiences in external clinics create a close connection between the staff and trainees because communities of practice can cause deeper reflections. We need to create small groups in large-scale organisations such as university hospitals. This construct can be adapted not only for Japanese dental trainees but also for global dental and other medical trainees.

Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope

A prospective clinical study was conducted to evaluate the safety, feasibility, and efficacy of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with direct metallic stent placement using a prototype forward-viewing echoendoscope. The indication for EUS - CDS in this study was lower biliary obstruction only, and not failed endoscopic biliary drainage, because the aim was to evaluate EUS - CDS for first-line biliary drainage therapy. The technical and functional success rates were 94 % (17 /18) and 94 % (16 /17), respectively. Early complications (focal peritonitis) were encountered in two patients (11 %). No patients developed late complications. EUS - CDS with direct metallic stent placement using a forward-viewing echoendoscope was generally feasible and effective for malignant distal biliary tract obstruction. The forward-viewing echoendoscope was useful, especially for deploying the metallic stent.

(1-->3)-beta-D-glucanemia in deep mycosis

Factor G, a coagulation proenzyme of the Japanese horseshoe crab (Tachypleus tridentatus), is extremely sensitive to (1→3)-β-D-glucan, which is a characteristic cell-wall constituent of fungi. Using this factor and by a digestion study with (1→3)-β-D-glucan, we showed that blood from patients with deep m ycosis contains the glucan. It was detected in 39 out of 41 fungal febrile episodes (sensitivity 90%), but in none of the 59 nonfungal febrile episodes (specificity 100%).

[Efficacy of antero-lateral thoracotomy with partial sternotomy for type B aortic dissection after ascending aortic replacement]

The patient was a 41-year-old man. He had undergone ascending aortic replacement due to type A acute aortic dissection 3 years before. He was diagnosed with de novo type B aortic dissection, and therefore given conservative treatment. Extension of the false lumen was detected in the discending aorta (56 mm in diameter). Computed tomography (CT) showed that discending aortic dissection had 4 lumens and their entries were not clear. Under selective cerebral extracorporeal circulation, we performed ascending-arch-descending aortic replacement using antero-lateral thoracotomy with partial sternotomy (ALPS method). He was discharged on the postoperative day 16. In conclusion, ALPS method guarantees wider surgical field and is useful for diffuse thoracic aortic disease, especially for aortic dissection with obscure entry which needs broad aortic replacement.

[Tumor thrombectomy for endometrial stromal sarcoma extending into the inferior vena cava and the right atrium from the uterus]

We report an extremely rare case of endometrial stromal sarcoma (ESS) extending into the inferior vena cava and the right atrium. A 65-year-old woman was admitted to our hospital due to lower-extremity edema. The chest-abdominal computed tomography (CT) showed tumor thrombus invading the inferior vena cava and right atrium with multiple lung metastasis. To prevent sudden death from pulmonary embolism, she underwent surgical removal the tumor thrombus with the use of cardiopulmonary bypass and deep hypothermic circulatory arrest. The pathological diagnosis of the tumor thrombus was low-grade ESS originating from the uterus. After thrombectomy, she underwent chemotherapy with carboplatin and paclitaxel. Surgical resection and chemotherapy to low-grade ESS achieved favourable prognosis.

In silico assessment of gene function involved in cysteine biosynthesis in Arabidopsis: expression analysis of multiple isoforms of serine acetyltransferase

In plants, the inorganic sulfur is first fixed into cysteine by the cysteine biosynthetic pathway. This biosynthetic pathway of cysteine involves several enzymatic reactions. In Arabidopsis thaliana, multiple isoforms seem to participate in each enzymatic step for cysteine biosynthesis. To obtain more insights on the specific role of each isoform involved in the cysteine biosynthesis, in silico analysis of these isoforms using Arabidopsis expressed sequence tags (EST) database was carried out. This EST database analysis revealed distinct population distribution of ESTs among multiple isoforms, suggesting that each isoform has its particular expression pattern, presumably associated with its specific role in cysteine biosynthesis. As another in silico analysis, co-expression analysis of genes involved in sulfur metabolism in Arabidopsis was performed using a public transcriptome database of DNA microarrays. This co-expression analysis also suggested specific function and co-regulation of some isoform genes for cysteine biosynthesis by consideration on the clustering of co-expressed genes. From the results of sensitivity to feedback regulation, subcellular localization and expression of mRNA analyses, each serine acetyltransferase (SATase) isoform seems to have its specific role for cysteine biosynthesis. Similar expression patterns were observed between the experimental results of expression data for SATase isoforms and the in silico results of "digital northern" analysis using EST database.

Polyclonal nature of diffuse proliferation of interstitial cells of Cajal in patients with familial and multiple gastrointestinal stromal tumours

BACKGROUND

Diffuse proliferation of interstitial cells of Cajal (ICCs) in the myenteric plexus layer of the intestine has been described in patients with familial and multiple gastrointestinal stromal tumours (GISTs). However, it is not fully understood whether proliferation is polyclonal or monoclonal.

AIMS

To evaluate the clonal nature of diffuse ICC proliferation in familial and multiple GIST cases, we carried out clonal analysis using inactivation at the human androgen receptor (HUMARA) locus.

MATERIALS AND METHODS

Diffuse ICC proliferation tissues from three female patients were microdissected using a laser capture microdissection (LCM) system. Normal intestinal mucosal tissues were also microdissected for polyclonal controls and GIST tissues for monoclonal controls from the same patients, and genomic DNA was extracted. After digestion by restriction enzyme HhaI, the HUMARA locus was amplified by a fluorescent polymerase chain reaction (PCR) procedure and the PCR products were analysed.

RESULTS

One case was uninformative because it was homozygous at the HUMARA locus. In the two other cases, PCR products from the diffuse ICC proliferation showed two alleles as well as those from normal intestinal mucosal tissues, indicating that ICC proliferation was polyclonal. In contrast, PCR products from associated GIST tissues showed only one allele, indicating that GISTs were monoclonal.

CONCLUSION

The results suggested that diffuse ICC proliferation in familial and multiple GIST cases was non-neoplastic hyperplasia.

Aortic valve replacement for aortic stenosis with a small mechanical prosthetic valve

BACKGROUND

Although aortic valve replacement (AVR) is the only effective treatment for patients with aortic stenosis (AS), it is recognized that the use of small prosthetic valves due to a small aortic root often affects postoperative course after AVR. The aim of this study was to determine whether the use of small prosthetic valves was a risk factor of AVR for AS.

METHODS

We compared various perioperative factors and operative outcomes between patients with a small mechanical prosthetic valve (small group) and patients with a large mechanical prosthetic valve (large group).

RESULTS

Early mortality was 0% in each group and the 5-year mortality was 25% in the small group and 10% in the large group. There were no significant differences in perioperative factors between the two groups. The small group patients were significantly older and smaller compared to the large group patients. The valve size was significantly correlated with age and BSA.

CONCLUSIONS

The use of small mechanical prostheses was not a risk factor of AVR for AS when it was proportionate to the BSA even for elderly patients. AVR using a small mechanical prosthetic valve may be performed with good results in the short- and long-term.

Safety and advantage of perioperative autologous blood transfusion in hepatic resection for hepatocellular carcinoma

BACKGROUND

The safety and advantages of perioperative autologous blood transfusion (ABT) were evaluated on hepatectomy for hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

Blood samples were obtained and stored from 30 patients with HCC. HCC cells were investigated by the presence of AFPmRNA using RT-PCR after storage. We also reviewed postoperative liver function and the long-term outcomes of 138 patients who underwent hepatectomy receiving ABT compared with patients receiving homologous blood transfusion (HBT) and patients without blood transfusion.

RESULTS

AFPmRNA was not detected in all samples stored for more than 14 days. Postoperative ALT, AST and total bilirubin in the HBT group were significantly higher than those of other groups. Patients in the HBT group had significantly lower survival rates than patients in the ABT group.

CONCLUSION

ABT was safe after storage and it had advantages compared with HBT with regard to postoperative liver function and survival rate after the hepatectomy for HCC.

Non-culture based diagnostic tests for mycotic infections

Non-culture methods being developed and evaluated for mycotic infections include polymerase chain reaction (PCR), galactomannan (GM) antigenemia, Western blot (WB) to detect antibodies, and detection of the fungal metabolites D-arabinitol and (1,3)-beta-D-glucan. Sample preparation for PCR from blood specimens depends on fractionation of peripheral blood, its pre-incubation in blood culture broth, or a total DNA method, which does not rely on fractionation, or pre-incubation. Targets for PCR of fungi in the 18S or ITS2 subunits of the ribosomal RNA genes facilitated the design of Aspergillus and Candida genus and species probes. Amplicons were identified using PCR-enzyme linked immunosorbent assay (ELISA) or reverse line-blot formats. A pilot study indicated that PCR tests on blood specimens were positive at least once in patients with confirmed invasive aspergillosis (IA). When serum-PCR and serum-GM tests were compared in IA patients, antigenemia was more often positive. PCR detected Aspergillus DNA in bronchoalveolar lavage specimens from patients at risk even when cultures were negative. D-Arabinitol can be detected as a marker of candidiasis with gas chromatography-mass spectrometry or enzyme dependent-fluorometry. Each method can differentiate the microbial D- and host L-enantiomers. (1,3)-beta-D-Glucan is produced by most genera of pathogenic fungi and can be detected in plasma by the 'G-test'. In patients with febrile neutropenia the efficacy of azole therapy correlated with plasma (1,3)-beta-D-glucan concentrations of > or = 10 pg ml(-1). The diagnosis of early acute pulmonary histoplasmosis can be improved by a WB test utilizing deglycosylated M antigen, a 94-kDa glycoprotein. The identity of M antigen as a catalase was deduced from the sequence of the cloned gene. PCR identification of Histoplasma capsulatum cultures was accomplished with primer pairs selected from H and M antigen gene sequences.

Safety and utility of autologous blood transfusion for resection of metastatic liver tumor

BACKGROUND/AIMS

The purpose of this study was to evaluate the safety and efficacy of predeposit autologous blood transfusion for resection of hepatic metastases.

METHODOLOGY

We examined stored blood from 25 patients with advanced colorectal or gastric cancer for carcinoembryonic antigen mRNA using reverse-transcriptase-polymerase chain reaction assay to detect cancer cell in the autologous blood. We also retrospectively evaluated no transfusion (A, n = 44), autologous transfusion (B, n = 15), and homologous transfusion groups (C, n = 26) for perioperative liver function and long-term outcome after undergoing resection of liver metastases.

RESULTS

In 5 of 25 patients, carcinoembryonic antigen mRNA was detected immediately after blood donation and after 7 days of storage, but not after 14-21 days of storage. The cumulative 5-year survival rates for groups A, B, and C were not different. However, disease-free survival with colorectal liver metastases was significantly higher in group A than in group C (P = 0.019). Total bilirubin concentrations in group C on the first postoperative day were also significantly higher than group A (P = 0.025).

CONCLUSIONS

Stored autologous blood may contain cancer cells, but these decrease or disappear after storage for more than 7 days. For hepatic resection of metastases, transfusion avoidance yields the optimal outcome.

[A case of free-floating ball thrombus in left atrium with mitral stenosis]

We report a rare case of free-floating ball thrombus in the left atrium with mitral stenosis. The patient was 71-year-old woman who admitted to the local hospital for transient ischemic attack. Electrocardiography showed atrial fibrillation and an echocardiogram examination revealed free-floating ball thrombus in the left atrium with mitral stenosis. She was transferred to our hospital for emergency open heart operation. After removal of the ball thrombus, mitral valve replacement and modified MAZE procedure were successfully performed. The size of the ball thrombus was 40 x 30 x 33 mm and weighed 20 g. Postoperative course was uneventful.

Transient QT interval prolongation with inverted T waves indicates myocardial salvage on dual radionuclide single-photon emission computed tomography in acute anterior myocardial infarction

In patients with acute myocardial infarction (AMI), transient QT interval prolongation with a prominent negative T wave is frequently observed in cases of early spontaneous reperfusion and often indicates a good prognosis. Additionally, in nuclear cardiac imaging, technetium-99m/thallium-201 overlap on dual single-photon emission computed tomography (dual SPECT) in AMI patients indicates the presence of viable myocardium and early recanalization. To elucidate the clinical significance of this transient QT interval prolongation, 34 patients (64 +/- 8 years) admitted within 24h of the onset of anterior AMI were enrolled and classified into 2 groups according to the presence (group A, n=24) or absence (group B, n=10) of scintigraphic overlap on simultaneous dual SPECT imaging. The maximal QTc interval was 0.59 +/- 0.06 s in group A and 0.52 +/- 0.06 s in group B (p<0.01). The peak creatine kinase was lower in group A (2650 +/- 2160 IU/L) than in group B (3490 +/- 2060 IU/L). The left ventricular ejection fraction (LVEF) at discharge was 62 +/- 11% in group A and 49 +/- 14% in group B (p<0.01). The scintigraphic overlap group had a smaller infarct and better LVEF, which suggests that the QT interval prolongation that appears transiently in the acute phase of AMI indicates scintigraphically the presence of salvaged myocardium.