Bacteraemia and obstructive pyelonephritis caused by Bifidobacterium breve in an elderly woman: a case report and literature review

Bifidobacterium spp. are non-spore-forming Gram-positive anaerobes that are indigenous to the human gastrointestinal tract and vagina. They are believed to be non-pathogenic organisms for humans and thus are widely used as probiotics. An 83-year-old woman taking cephalexin for 4 days was diagnosed with obstructive pyelonephritis. Y-branched Gram-positive rods were found in both anaerobic and aerobic blood culture bottles, and in an anaerobic urine culture. Bifidobacterium breve was finally identified. Ceftriaxone and metronidazole were administered to the patient, and she was discharged after intermittent catheterization for dysuria. Urinary tract infection caused by Bifidobacterium spp. is believed to be rare, but it can develop in patients with underlying urological conditions. Recognition of the characteristic morphology and conducting anaerobic urine culture may help in identifying more cases of Bifidobacterium urinary tract infections.

Advantage of POLARx over ARCTIC FRONT ADVANCE PRO during pulmonary vein isolation for paroxysmal atrial fibrillation

Introduction

The electrical pulmonary vein (PV) isolation has been established as a curative therapy for paroxysmal atrial fibrillation (AF). Arctic Front™cryoballoon has been used worldwide for AF cryoablation. Recently, a new cryoballoon, POLARxTM CRYOABLATION system have been introduced, of which material of the balloon is softer and the N2O gas flow rate is higher.

Purpose

The aim was to investigate the procedural parameter and efficacy of POLARx comparing with Arctic Front.

Methods

This retrospective single center study included 101 consecutive patients who underwent paroxysmal AF ablation using cryoballoon at Keio University hospital from April 2021 to March 2022. The procedural data including the cryoballoon temperature and the number and duration of cryoablation were compared between POLARx (POLARx group) and ARCTIC FRONT ADVANCE PRO (AFA group). After the cryoablation, we added the radiofrequency application in order to maximize the isolated area when the voltage was remained inside PV (Figure 1). The necessities of the additional radiofrequency applications were also compared.

Results

In the present study, 64 patients in AFA group and 37 patients in POLARx group were analyzed. POLARx group included younger population and less females (62.8±9.9 vs 67.5±9.4 year of age, P=0.02; 13.5 vs 32.8%, P=0.04). There was no significant difference in comorbidities and examination data such as left atrium diameter or brain natriuretic peptide level. The minimal cryoballoon temperatures reached in POLARx group were lower than AFA group (−59.3±6.2 vs −47.7±7.5°C, P<0.01). No difference was found in the total number and duration of cryoablation and the time to isolate PV (6.1±2.1 vs 5.9±1.6, P=0.69; 790.2±256.1 vs 776.1±235.0 sec, P=0.69; 41.8±21.3 vs 47.1±29.6 sec, P=0.44, respectively). With regard to individual PVs, the total number and duration were tended to be larger at right superior PV in POLARx group (1.9±1.1 vs 1.4±0.7, P=0.01; 231.8±123.8 vs 193.2±83.0 sec, P=0.07), while there was no significant difference at the other PVs. The rate of successful PV isolation by a single cryo-application was not different between AFA and POLARx group (54.3 vs 61.4%, P=0.17). The additional radiofrequency applications were more frequent in AFA group (14.8 vs. 4.9%, P=0.003). There was a significant difference at right inferior PV (32.8 vs 8.1%, P=0.01), while not at left superior PV, left inferior PV and right superior PV (9.4 vs 2.9%, P=0.42; 9.4 vs 5.7%, P=0.71; 7.8 vs 2.7%, P=0.41). Phrenic nerve injury was occurred 1 case in both group and esophageal ulcer was occurred in 1 case in AFA group. No other complication including cardiac tamponade was occurred.

Conclusion

The total number and duration of cryoablation were not significantly different between AFA and POLARx group, except for right superior PV. There was an advantage in largely isolating right inferior PV in POLARx group comparing with AFA group.

Funding Acknowledgement

Type of funding sources: None.

Gli1+-PDL Cells Contribute to Alveolar Bone Homeostasis and Regeneration

The periodontal ligament (PDL) contains mesenchymal stem cells (MSCs) that can differentiate into osteoblasts, cementoblasts, and fibroblasts. Nevertheless, the distribution and characteristics of these cells remain uncertain. Gli1, an essential hedgehog signaling transcription factor, functions in undifferentiated cells during embryogenesis. Therefore, in the present study, the differentiation ability of Gli1⁺ cells was examined using Gli1-CreERT2/ROSA26-loxP-stop-loxP-tdTomato (iGli1/Tomato) mice. In 4-wk-old iGli1/Tomato mice, Gli1/Tomato⁺ cells were only slightly detected in the PDL, around endomucin-expressing blood vessels. These cells had proliferated over time, localizing in the PDL as well as on the bone and cementum surfaces at day 28. However, in 8-wk-old iGli1/Tomato mice, Gli1/Tomato⁺ cells were quiescent, as most cells were not immunoreactive for Ki-67. These cells in 8-wk-old mice exhibited high colony-forming unit fibroblast activity and were capable of osteogenic, chondrogenic, and adipogenic differentiation in vitro. In addition, after transplantation of teeth of iGli1/Tomato mice into the hypodermis of wild-type mice, Tomato fluorescence indicating the progeny of Gli1⁺ cells was detected in the osteoblasts and osteocytes of the regenerated bone. These results demonstrate that Gli1⁺ cells in the PDL were MSCs and could contribute to the alveolar bone regeneration.

Effects of dietary palmitoleic acid on vascular function in aorta of diabetic mice

BACKGROUND

Chronic hyperglycemia in diabetes causes atherosclerosis and progresses to diabetic macroangiopathy, and can lead to coronary heart disease, myocardial infarction and cerebrovascular disease. Palmitoleic acid (POA) is a product of endogenous lipogenesis and is present in fish and vegetable oil. In human and animal studies, POA is reported as a beneficial fatty acid related to insulin sensitivity and glucose tolerance. However, few studies have reported its effects on aortic function in diabetes. Here, we investigated the effects of POA administration on vascular function in KKAy mice, a model of type 2 diabetes.

METHODS

Male C57BL/6 J (control) and KKAy (experimental) mice at the age of 14 weeks were used in the present study. For each mouse strain, one group was fed with reference diet and a second group was fed POA-containing diet for 2 weeks. The vascular reactivities of prepared aortic rings were then measured in an organ bath to determine if POA administration changed vascular function in these mice.

RESULTS

KKAy mice treated with POA exhibited decreased plasma glucose levels compared with mice treated with reference diet. However, endothelium-dependent vasorelaxant responses to acetylcholine and protease-activated receptor 2 activating protein, which are attenuated in the aorta of KKAy mice compared to C57BL/6 J mice under a reference diet, were not affected by a 2-week POA treatment. In addition, assessment of vasoconstriction revealed that the phenylephrine-induced vasoconstrictive response was enhanced in KKAy mice compared to C57BL/6 J mice under a reference diet, but no effect was observed in KKAy mice fed a POA-containing diet. In contrast, there was an increase in vasoconstriction in C57BL/6 J mice fed the POA-containing diet compared to mice fed a reference diet. Furthermore, the vasoconstriction in aorta in both C57BL/6 J and KKAy mice fed a POA-containing diet were further enhanced under hyperglycemic conditions compared to normal glucose conditions in vitro. In the hyperinsulinemic, and hyperinsulinemic combined with hyperglycemic conditions, vasoconstriction was increased in KKAy mice fed with POA.

CONCLUSION

These results suggest that POA intake enhances vasoconstriction under hyperglycemic and hyperinsulinemic conditions, which are characteristics of type 2 diabetes, and may contribute to increased vascular complications in diabetes.

Investigation of association between the preoperative intra-articular anesthetic test and persistent pain after total knee arthroplasty

BACKGROUND

A better understanding of the etiology of persistent pain after total knee arthroplasty (TKA) is required to prevent unfavorable outcomes. The purpose of this study was to investigate the association of persistent pain after TKA, patient characteristics, and the remaining pain ratio per the preoperative intra-articular anesthetic test.

METHODS

This study included 89 patients who underwent TKA and underwent an intra-articular anesthetic test preoperatively. The remaining pain ratio out of 100 percent 30 min after intra-articular anesthetic injection and demographic data were also evaluated preoperatively. Numerical rating scale (NRS) scores for pain during movement (Q1), at rest (Q2), at first movement in the morning (Q3), and during climbing up and down stairs (Q4) were evaluated 1 year after TKA. Multiple linear regression analysis was performed to assess the impact of independent variables on the NRS score for questionnaire No.4. and the remaining pain ratio per the intra-articular anesthetic.

RESULTS

The mean remaining pain ratio per the preoperative intra-articular anesthetic test was 29.3%. The NRS score for Q4 was significantly higher than those for any of the other NRS questionnaires administered 1 year after TKA (Q1-Q4, Q2-Q4, P < 0.001; Q3-Q4, P < 0.05). The analysis found the weak correlation between the pain ratio of anesthetic test and the NRS score for Q4 after TKA (R = 0.28, P = 0.018). BMI and preoperative FTA were the major predictors of remaining pain ratio per the intra-articular anesthetic test (R = 0.40, P = 0.002).

CONCLUSION

This study revealed that the remaining pain ratio per the preoperative intra-articular anesthetic test was weakly correlated with persistent pain during climbing up and down stairs 1 year after TKA. In addition, BMI and preoperative FTA were associated with the remaining pain ratio per the preoperative intra-articular anesthetic test.

Lower grip strength and dynamic body balance in women with distal radial fractures

In this case-control study, we concluded that women with distal radial fractures who were surgically treated showed lower grip strength and dynamic body balancing than those of controls. These results suggest that measurements of grip strength and dynamic body balance may be useful screening tools to assess future fracture risk.

INTRODUCTION

Patients with distal radial fractures (DRFs) are at risk of future fragility fractures. However, their physical characteristics and tendencies for falls remain unclear. We aimed to compare the physical characteristics of women with and without distal radial fractures.

METHODS

We included 128 women with a DRF as their first fragility fracture (fracture group) who underwent surgical treatment. Concurrently, 128 age- and sex-matched participants without a history of fragility fractures were selected as controls (control group). The participants underwent assessments of grip strength and the body balancing ability test. Measurements were taken twice in the fracture group, at 2 weeks and 6 months postoperatively, and once in the control group. The body balancing ability test included the Functional Reach Test, Timed Up and Go test (TUG), 2-Step test (2ST), and Timed Uni-pedal Stance test. The participants also completed questionnaires about their health.

RESULTS

There were no significant differences (p > 0.05) in patient characteristics between the groups. The fracture group showed lower grip strength across all age groups. In the DRF group, prolonged TUG time was observed at 2 weeks postoperatively in all age groups and at 6 months in participants aged 55-74 years; the 2ST score was significantly lower in participants aged between 65 and 74 years.

CONCLUSIONS

Women with DRF demonstrated lower grip strength and dynamic body balancing ability. Lower grip strength and dynamic body balancing ability were identified as significant risk factors in women with DRF, suggesting that these may be useful screening tools to assess fracture risk.

Correction to: Lower grip strength and dynamic body balance in women with distal radial fractures

The article Lower grip strength and dynamic body balance in women with distal radial fractures, written by. K. Fujita, H. Kaburagi, A. Nimura, T. Miyamoto, Y. Wakabayashi, Y. Seki, H. Aoyama, H. Shimura, R. Kato, A. Okawa was originally published electronically on the publisher's internet portal.

Distal locking screw length for volar locking plate fixation of distal radius fractures: Postoperative stability of full-length unicortical versus shorter screws

We compared post-operative distal radius fracture (DRF) displacement after volar locking plate fixation using full-length unicortical and shorter-length distal locking screws. In this non-inferiority, retrospective cohort study, DRFs treated with volar locking plate fixation were evaluated on X-rays. In the full-length group, volar locking plate fixation was performed with full-length unicortical distal locking screws. In the shorter-length group, the distal locking screws were planned pre-operatively to be approximately 75% of the distal radius depth based on the lunate depth, and the same depth was drilled. Three radiographic parameters - ulnar variance, volar tilt, and radial inclination - were measured intra-operatively and at the final follow-up. The displacements were compared between the two groups. Each group contained 34 fractures. The mean ulnar variance between the two periods increased 1.1 mm in the full-length group and 1.3 mm in the shorter group (mean difference, 0.2 mm; 90% confidence interval, -0.3 to 0.6). The shorter group was not significantly inferior to the full-length one. Volar tilt increased 0.6° in the full-length group and -0.1° in the shorter group, while the radial inclination increased 0.1° in the full-length group and 0.2° in the shorter one. The differences in the increases were not significant. The post-operative DRF stability of 75%-length distal locking screws was not inferior to that of full-length unicortical screws. To prevent extensor pollicis longus tendon rupture, shorter distal locking screws and the same drilling depth may be preferable for volar locking plate fixation.

Clinical features and treatment of nonalcoholic fatty liver disease across the Asia Pacific region-the GO ASIA initiative

BACKGROUND

The Gut and Obesity Asia (GO ASIA) workgroup was formed to study the relationships between obesity and gastrointestinal diseases in the Asia Pacific region.

AIM

To study factors associated with nonalcoholic steatohepatitis (NASH) and advanced fibrosis, and medical treatment of biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients.

METHODS

Retrospective study of biopsy-proven NAFLD patients from centres in the GO ASIA Workgroup. Independent factors associated with NASH and with advanced fibrosis on binary logistic regression analyses in a training cohort were used for the development of their corresponding risk score, which were validated in a validation cohort.

RESULTS

We included 1008 patients from nine centres across eight countries (NASH 62.9%, advanced fibrosis 17.2%). Independent predictors of NASH were body mass index ≥30 kg/m² , diabetes mellitus, dyslipidaemia, alanine aminotransferase ≥88 U/L and aspartate aminotransferase ≥38 U/L, constituting the Asia Pacific NASH risk score. A high score has a positive predictive value of 80%-83% for NASH. Independent predictors of advanced fibrosis were age ≥55 years, diabetes mellitus and platelet count <150 × 10⁹ /L, constituting the Asia-Pacific NAFLD advanced fibrosis risk score. A low score has a negative predictive value of 95%-96% for advanced fibrosis. Only 1.7% of patients were referred for structured lifestyle program, 4.2% were on vitamin E, and 2.4% were on pioglitazone.

CONCLUSIONS

More severe liver disease can be suspected or ruled out based on factors identified in this study. Utilisation of structured lifestyle program, vitamin E and pioglitazone was limited despite this being a cohort of biopsy-proven NAFLD patients with majority of patients having NASH.

Evaluation of swallowing ability using swallowing sounds in maxillectomy patients

Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement.

Why chronically ill children face challenges in regular classrooms: perspectives from nursing teachers in Japan

BACKGROUND

Chronically ill children are increasingly expected to join their peers in regular classrooms. However, sometimes schools do not provide adequate assistance. This study explores nursing teachers' thoughts and experiences on integrating such students into regular classrooms in Japan.

METHODS

We analysed 79 essays written by nursing teachers collectively titled 'The challenges of having chronically ill children in regular classrooms'. We conducted a qualitative study using Kinoshita's Modified Grounded Theory Approach.

RESULTS

Nursing teachers identified three main obstacles: insufficient resources to support chronically ill students, parents not playing a supporting role in aiding them at school and a regular classroom not being suitable for them. However, collaborating with the children's medical staff proved successful at integrating them into regular classrooms.

CONCLUSIONS

Given these obstacles, it seems very difficult for nursing teachers to lead the way toward establishing cooperative support systems for the children. Instructions from medical staff could empower teachers to set up such systems.

Characterization and application of newly developed polymorphic microsatellite markers in the Ezo red fox (Vulpes vulpes schrencki)

The Ezo red fox (Vulpes vulpes schrencki), a subspecies endemic to Hokkaido island, Japan, is a known host species for the tapeworm Echinococcus multilocularis. To develop tools for molecular ecological studies, we isolated 28 microsatellite regions from the genome of Ezo red fox, and developed 18 polymorphic microsatellite markers. These markers were characterized using 7 individuals and 22 fecal samples of the Ezo red fox. The number of alleles for these markers ranged from 1 to 7, and the observed heterozygosity, estimated on the basis of the genotypes of 7 individuals, ranged from 0.29 to 1.00. All markers, except DvNok5, were in Hardy-Weinberg equilibrium (P > 0.05), and no linkage disequilibrium was detected among these loci, except between DvNok14 and DvNok28 (P = 0.01). Moreover, six microsatellite loci were successfully genotyped using feces-derived DNA from the Ezo red fox. The markers developed in our study might serve as a useful tool for molecular ecological studies of the Ezo red fox.

Judging hardness of an object from the sounds of tapping created by a white cane

The white cane plays a vital role in the independent mobility support of the visually impaired. Allowing the recognition of target attributes through the contact of a white cane is an important function. We have conducted research to obtain fundamental knowledge concerning the exploration methods used to perceive the hardness of an object through contact with a white cane. This research has allowed us to examine methods that enhance accuracy in the perception of objects as well as the materials and structures of a white cane. Previous research suggest considering the roles of both auditory and tactile information from the white cane in determining objects' hardness is necessary. This experimental study examined the ability of people to perceive the hardness of an object solely through the tapping sounds of a white cane (i.e., auditory information) using a method of magnitude estimation. Two types of sounds were used to estimate hardness: 1) the playback of recorded tapping sounds and 2) the sounds produced on-site by tapping. Three types of handgrips were used to create different sounds of tapping on an object with a cane. The participants of this experiment were five sighted university students wearing eye masks and two totally blind students who walk independently with a white cane. The results showed that both sighted university students and totally blind participants were able to accurately judge the hardness of an object solely by using auditory information from a white cane. For the blind participants, different handgrips significantly influenced the accuracy of their estimation of an object's hardness.

Are tyrosine residues involved in the photoconversion of the water-soluble chlorophyll-binding protein of Chenopodium album?

Non-photosynthetic and hydrophilic chlorophyll (Chl) proteins, called water-soluble Chl-binding proteins (WSCPs), are distributed in various species of Chenopodiaceae, Amaranthaceae, Polygonaceae and Brassicaceae. Based on their photoconvertibility, WSCPs are categorised into two classes: Class I (photoconvertible) and Class II (non-photoconvertible). Chenopodium album WSCP (CaWSCP; Class I) is able to convert the chlorin skeleton of Chl a into a bacteriochlorin-like skeleton under light in the presence of molecular oxygen. Potassium iodide (KI) is a strong inhibitor of the photoconversion. Because KI attacks tyrosine residues in proteins, tyrosine residues in CaWSCP are considered to be important amino acid residues for the photoconversion. Recently, we identified the gene encoding CaWSCP and found that the mature region of CaWSCP contained four tyrosine residues: Tyr13, Tyr14, Tyr87 and Tyr134. To gain insight into the effect of the tyrosine residues on the photoconversion, we constructed 15 mutant proteins (Y13A, Y14A, Y87A, Y134A, Y13-14A, Y13-87A, Y13-134A, Y14-87A, Y14-134A, Y87-134A, Y13-14-87A, Y13-14-134A, Y13-87-134A, Y14-87-134A and Y13-14-87-134A) using site-directed mutagenesis. Amazingly, all the mutant proteins retained not only chlorophyll-binding activity, but also photoconvertibility. Furthermore, we found that KI strongly inhibited the photoconversion of Y13-14-87-134A. These findings indicated that the four tyrosine residues are not essential for the photoconversion.

Disclosing haemophilia at school: strategies employed by mothers of children with haemophilia in Japan

INTRODUCTION

Most children with haemophilia in Japan study in mainstream schools. However, many mothers have difficulty deciding whether to inform teachers of their child's haemophilia because of the accompanying potential discrimination and prejudice, particularly after the press coverage on the HIV scandal in the 1980s.

AIMS

We therefore aim to explore and describe disclosure strategies of mothers of children with haemophilia.

METHODS

A qualitative study was conducted using the modified grounded theory approach to explore disclosure strategies of mothers of children with haemophilia. Semi-structured interviews were conducted with 19 selected mothers (12 children were HIV positive and 7 were HIV-negative).

RESULTS

In the pre-HIV/AIDS crisis period, the kind of strategy employed - full disclosure, conditional full disclosure and partial disclosure - depended on the extent of mothers' fears about mainstream schools refusing admission because of their child's haemophilia. After the HIV/AIDS crisis in the 1980s in Japan, the three categories of strategies employed by mothers of children with haemophilia were limited disclosure, non-disclosure and full disclosure. These depended on mothers' expectations of discrimination towards their child because of the social stigma around haemophilia and being HIV-positive.

CONCLUSION

For children with haemophilia to feel safe attending school, public schools must establish care management and anti-discrimination systems for children with chronic diseases, thus assuring parents of their children's welfare at school.