Methods used to assess the severity of acromioclavicular joint separations in Japan: a survey

Background

In acromioclavicular joint (ACJ) separations, patient characteristics determine the indications for surgery. However, in Japan, classification methods used to assess the severity of ACJ separations differ between institutions, and even within a classification method, different interpretations can lead to different assessments of severity. Therefore, in this study, we conducted an email survey of Japan Shoulder Society (JSS) members regarding their assessment methods for ACJ separation severity.

Methods

A questionnaire about methods for assessing the severity of ACJ separations was emailed to JSS members (1655) including 59 JSS councilors. The survey focused on diagnostic imaging methods, classifications of severity assessments, and methods of assessing severity.

Results

In total, 183 responses were received. All respondents used an anteroposterior view of the ACJ. Severity assessments were classified by the Tossy classification (57 respondents), Rockwood classification (141 respondents), and other classifications (7 respondents) including duplication. Of the 141 respondents using the Rockwood classification, 119 diagnosed type III as ACJ dislocation when the inferior clavicle border translated above the superior acromial border, whereas 56 used the coracoclavicular distance. However, to diagnose type V, 118 respondents used the coracoclavicular distance whereas 38 used palpation. To diagnose type IV, 57 respondents considered all cases in which the clavicle translated posterior to the acromion, even when vertical ACJ dislocation occurred simultaneously. However, 88 respondents did so in the presence of posterior clavicle displacement and ACJ subluxation.

Conclusion

The Rockwood classification is commonly used for severity assessments in Japan; however, there is some disagreement regarding the assessment for the diagnosis of type IV. Methods to diagnose both superior and posterior translation of the clavicle need further debate.

Characteristics and predictive value for graft fibrosis of the complement-binding capacity of donor-specific human leukocyte antigen antibodies after pediatric liver transplantation

BACKGROUND

Donor-specific HLA antibodies (DSAs) have detrimental effects on short- and long-term outcomes after organ transplantation. Despite evidence that the complement-binding capacity of DSAs has predictive power in kidney transplantation, its clinical impact during long-term follow-up after LT remains unclear. In this study, we assessed the complement-binding capacities of DSAs and their association with histological findings.

METHODS

In total, 72 patients who underwent pediatric LT at our institution between July 1991 and October 2013 were retrospectively reviewed. A subgroup analysis of histological findings was performed for 37 subjects who underwent liver graft biopsy. Patients were divided into two groups based on the degree of graft fibrosis, and clinical characteristics were assessed.

RESULTS

All anti-class I DSAs were C1q-negative. Anti-DR and anti-DQ DSAs were identified in 34% and 41% of patients, respectively; however, only three of 25 patients with anti-DR DSAs exhibited a positive C1q-binding assay, whereas, 25 of 29 anti-DQ DSAs showed C1q-binding capacity. MFI values for DSA were significantly higher for patients with C1q-binding capacity than for those without (P < .0001). Complement-binding anti-DR DSA was relatively rare in both groups. Regarding anti-DQ DSA, there were no differences between fibrosis and non-fibrosis groups, irrespective of complement-binding capacity.

CONCLUSIONS

The association between anti-DR DSA and liver fibrosis, which was supported in this cohort, was not strengthened but rather impaired when accounting for complement-binding capacity due to low positive detection. Further studies of the association between complement-binding anti-DQ DSA and histological findings in LT are needed.

Patient care experience with utilization of isolation precautions: systematic literature review and meta-analysis

BACKGROUND

Use of isolation precautions (IP) may represent a trade-off between reduced transmission of infectious pathogens and reduced patient satisfaction with their care.

OBJECTIVE

To perform a systematic literature review and meta-analysis to identify if and how IPs impact patients' care experiences.

DATA SOURCES

Medline, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsychInfo, HSRProj and Cochrane Library databases.

STUDY ELIGIBILITY CRITERIA

Interventional and observational studies published January 1990 to May 2019 were eligible for inclusion.

PARTICIPANTS

Patients admitted to an acute-care facility.

INTERVENTIONS

IPs versus no IPs.

METHODS

Six reviewers screened titles, abstracts and full text. Experience of care reported by patients using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was assessed as the outcome for the meta-analysis. Pooled odds ratios were calculated using the random-effects model. Heterogeneity was assessed using the I² value.

RESULTS

After screening 7073 titles and abstracts, 15 independent studies were included in the review. Pooling of unadjusted estimates from the HCAHPS survey demonstrated that IP patients were less likely to give top scores on questions pertaining to respect, communication, receiving assistance and cleanliness compared to the no-IP patients. Patients under IP with longer length of stay appeared to have more negative experiences with the care received during their stay compared to no IP.

CONCLUSIONS

Patients under IP were more likely to be dissatisfied with several aspects of patient care compared to patients not under IP. It is crucial to educate patients and healthcare workers in order to balance successful implementation of IP and patient care experiences, particularly in healthcare settings where it may be beneficial.

Isotope Effect on Energy Confinement Time and Thermal Transport in Neutral-Beam-Heated Stellarator-Heliotron Plasmas

The isotope effect on energy confinement time and thermal transport has been investigated for plasmas confined by a stellarator-heliotron magnetic field. This is the first detailed assessment of an isotope effect in a stellarator heliotron. Hydrogen and deuterium plasmas heated by neutral beam injection on the Large Helical Device have exhibited no significant dependence on the isotope mass in thermal energy confinement time, which is not consistent with the simple gyro-Bohm model. A comparison of thermal diffusivity for dimensionally similar hydrogen and deuterium plasmas in terms of the gyroradius, collisionality, and thermal pressure has clearly shown robust confinement improvement in deuterium to compensate for the unfavorable mass dependence predicted by the gyro-Bohm model.

Post-discharge oral antimicrobial use among hospitalized patients across an integrated national healthcare network

OBJECTIVES

Antimicrobial stewardship programmes have focused on reducing inappropriate inpatient antimicrobial prescribing, but several small studies have found a large portion of antimicrobial exposure occurs immediately after hospital discharge. In this study, we describe the prescribing of oral antimicrobials at hospital discharge across an integrated national healthcare system. At the hospital level, we also compare total inpatient antimicrobial use and post-discharge oral antimicrobial use.

METHODS

This retrospective cross-sectional study used national administrative data to identify all acute-care admissions during 2014-2016 within the Veterans Health Administration (VHA). We evaluated inpatient days of therapy (DOT) and post-discharge DOT, defined as oral outpatient antimicrobials dispensed at the time of hospital discharge. At the hospital level, inpatient DOT/100 admissions were compared with post-discharge DOT/100 admissions using Spearman's rank-order correlation.

RESULTS

There were 1 681 701 acute-care admissions across 122 hospitals, and 335 369 (19.9%) were prescribed an oral antimicrobial at discharge. Fluoroquinolones (38.3%) were the most common post-discharge antimicrobial. At the hospital level, median inpatient antimicrobial use was 331.3 (interquartile range (IQR) 284.9-367.9) DOT/100 admissions and median post-discharge use was 209.5 (IQR 181.5-239.6) DOT/100 admissions. Thirty-nine per cent of the total duration of antimicrobial exposure occurred after discharge. At the hospital-level, the metrics of inpatient DOT/100 admissions and post-discharge DOT/100 admissions were weakly positively correlated with rho=0.44 (p < 0.001).

CONCLUSIONS

A large proportion of antimicrobial exposure among hospitalized patients occurred immediately following discharge. Antimicrobial-prescribing at hospital discharge provides an opportunity for antimicrobial stewardship. Hospital-level stewardship metrics need to include both inpatient and post-discharge antimicrobial-prescribing to provide a comprehensive assessment of hospital-associated antimicrobial use.

The motion and distribution of the gas in the central 300 pc of the galaxy as revealed by spectra of H3. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2019;377:20180400. [PMID: 31378174 DOI: 10.1098/rsta.2018.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Spectroscopy of absorption lines of H₃⁺ in the central molecular zone (CMZ) of the Galaxy show that a previously largely unknown component of the interstellar medium there, warm (T∼200 K) and diffuse (n ≲ 10² cm^-3) gas, makes up a large fraction of the volume of the CMZ, and that this gas is moving radially outward from the centre. These discoveries upend the generally accepted understanding that the interstellar environment of the CMZ comprises almost entirely an ultra-hot plasma and dense molecular clouds. The radial momentum associated with the diffuse gas in the CMZ exceeds that of the ejecta of thousands of core-collapse supernovae and implies some extraordinary past activity in the centre, possibly associated with the supermassive black hole, Sgr A*. We speculate that within approximately 10⁶ years, gravity could halt the expansion of the diffuse gas and that contraction towards the centre could then commence. This article is part of a discussion meeting issue 'Advances in hydrogen molecular ions: H₃⁺, H₅⁺ and beyond'.

Effect of rice bran fermented with Saccharomyces cerevisiae and Lactobacillus plantarum on gut microbiome of mice fed high-sucrose diet

To clarify the effect of rice bran (RB) and fermented RB (FRB) in a high-sucrose and low-dietary fibre diet on the gut microbiome, the in vitro bile acid-lowering capacity and caecal microbiota of ICR mice fed with 20% RB or FRB diets for two weeks were determined. The caecal microbiome was analysed by 16S rRNA gene amplicon sequencing. The in vitro bile acid-lowering capacity was high for FRB. In mouse experiments, triacylglycerol and total cholesterol were generally lower with FRB, although the faecal frequency was highest in mice fed with RB. The Shannon-Wiener and Simpson's indices for alpha-diversity in the microbiome of mice fed with RB and FRB, were higher than mice fed the control diet. At the phylum level in the caecal microbiome, Firmicutes and Bacteroidetes were high with FRB and RB, respectively. At the operational taxonomic unit level, some bacterial groups related to diabetes and gut toxicity, such as Lachnospiraceae and Enterorhabdus mucosicola, were high for RB but not for FRB diets. These results suggest that FRB, rather than RB, intake improve the intestinal environment and blood lipid condition.

Pyogenic Spondylitis: Clinical Features, Diagnosis and Treatment

Although pyogenic spondylitis is an infrequent infection, its incidence is increasing because of the growing number of elderly people and immunocompromised patients. Diagnosis is often difficult and appropriate imaging, blood cultures and/or biopsy are essential in making an early diagnosis. Most of the cases can be treated non-operatively. Surgical treatment is indicated in patients with spinal cord or cauda equine compression with progressive neurological deficits and/or patients who have failed conservative treatment. Early and accurate diagnosis of pyogenic spondylitis is important for timely and effective management, in order to reduce the occurrence of spinal deformity and dysfunction.

Strategy towards tailored donor tissue-specific pancreatic islet isolation

BACKGROUND

Optimizing the collagenase G (ColG):collagenase H (ColH) ratio is a key strategy for achieving tailored donor-tissue specific islet isolation. Collagen V (Col V) and collagen III (Col III) are crucial target matrices of ColG and ColH, respectively. We herein investigated the relevance between the expression of target matrices in pancreatic tissues and influence of ColG:ColH ratio on islet isolation outcome.

METHODS

Islet isolation was performed in Lewis and SD rats using different ColG:ColH ratios (5:1, 1:1 and 1:5; n = 7/group). The composition of Col III and Col V was examined using immunohistochemical staining, real-time polymerase chain reaction (PCR), Western blotting and mass spectrometry. Chain types in collagen I (Col I) were also assessed using mass spectrometry.

RESULTS

No beneficial effects were observed by increasing the ColG amount, irrespective of the rat strain. In contrast, the islet yield in Lewis rats was considerably increased by high amounts of ColH but decreased in SD rats, suggesting that Lewis pancreas contains more Col III than SD pancreas. Neither immunohistochemical nor real-time PCR showed correlation with isolation outcome. However, Western blotting revealed that Lewis contained considerably higher amount of Col III than SD (p = 0.10). Likewise, Col-I(α1)/Col-III(α1) and Col-I(α2)/Col-III(α1) were significantly lower in Lewis than in SD rats (p = 0.007, respectively). Furthermore, the isolation outcome was considerably correlated with the composition of homotrimeric Col I.

CONCLUSIONS

The Col III expression and the composition of homotrimeric Col I in pancreatic tissues determined using mass analyses appeared useful for optimizing the ColG:ColH ratio in islet isolation.

A Simple and Useful Predictive Assay for Evaluating the Quality of Isolated Hepatocytes for Hepatocyte Transplantation

No optimal assay for assessing isolated hepatocytes before hepatocyte transplantation (HTx) has been established, therefore reliable and rapid assays are warranted. Isolated rat hepatocytes were dipped in a water bath (necrosis model), and were also cultured with Okadaic acid (apoptosis model) or vehicle, followed by cellular assessment including trypan blue exclusion (TBE) viability, ADP /ATP ratio, plating efficiency (PE), DNA quantity and ammonia elimination. Hepatocytes were transplanted into the liver of analbuminemic rats, subsequently engraftment was assessed by serum albumin and the histology of transplanted grafts. In the necrosis model, the ADP/ATP ratio was strongly and negatively correlated with the TBE (R² = 0.559, P < 0.001). In the apoptosis model, the ADP/ATP ratio assay, PE, DNA quantification and an ammonia elimination test clearly distinguished the groups (P < 0.001, respectively). The ADP/ATP ratio, PE and DNA quantity were well-correlated and the ammonia elimination was slightly correlated with the transplant outcome. TBE could not distinguish the groups and was not correlated with the outcome. The ADP/ATP ratio assay predicted the transplant outcome. PE and DNA quantification may improve the accuracy of the retrospective (evaluations require several days) quality assessment of hepatocytes. The ADP/ATP ratio assay, alone or with a short-term metabolic assay could improve the efficiency of HTx.

Molecular characterization of multi-drug resistant Escherichia coli isolates from tropical environments in Southeast Asia

The emergence of antibiotic resistance among multidrug-resistant (MDR) microbes is of growing concern, and threatens public health globally. A total of 129 Escherichia coli isolates were recovered from lowland aqueous environments near hospitals and medical service centers in the vicinity of Kuala Lumpur, Malaysia. Among the eleven antibacterial agents tested, the isolates were highly resistant to trimethoprim-sulfamethoxazole (83.7%) and nalidixic acid (71.3%) and moderately resistant to ampicillin and chloramphenicol (66.7%), tetracycline (65.1%), fosfomycin (57.4%), cefotaxime (57.4%), and ciprofloxacin (57.4%), while low resistance levels were found with aminoglycosides (kanamycin, 22.5%; gentamicin, 21.7%). The presence of relevant resistance determinants was evaluated, and the genotypic resistance determinants were as follows: sulfonamides (sulI, sulII, and sulIII), trimethoprim (dfrA1 and dfrA5), quinolones (qnrS), β-lactams (ampC and blaCTX-M), chloramphenicol (cmlA1 and cat2), tetracycline (tetA and tetM), fosfomycin (fosA and fosA3), and aminoglycosides (aphA1 and aacC2). Our data suggest that multidrug-resistant E. coli strains are ubiquitous in the aquatic systems of tropical countries and indicate that hospital wastewater may contribute to this phenomenon.

Pediatric Living-Donor Liver Transplant Recipients without Transition After Reaching Adulthood

Background

Transition to adult care can trigger certain problems for pediatric liver transplant recipients. At our institution, the same transplant team performs both adult and pediatric liver transplantation and post-transplant care; thus, pediatric liver transplant recipients do not have to be transferred. However, it is unclear whether this system affects the recipient’s outcome during the transition period. Therefore, we retrospectively assessed pediatric liver transplant recipients who reached adulthood at our institution.

Material/Methods

This was a single-center, retrospective study involving consecutive pediatric living-donor liver transplant recipients who reached the age of 18 by October 2017. A total of 36 recipients, 20 females and 16 males, were included in the study.

Results

The 5- and 10-year patient survival after reaching the age of 18 was 100% and 93%, respectively. All of the 3 patients who died had been suffering from secondary biliary cirrhosis due to biliary stricture. In 5 patients (13.9%), biliary stricture became symptomatic or recurred after reaching the age of 18 years. Late-onset acute rejection and chronic rejection developed in 2 (5.6%) and 4 patients (11.1%), respectively. Only 4 (11.1%) patients were obviously noncompliant. We found no significant association between compliance and rejection or survival. Among the patients who are 18 years old and older, 5 (13.9%) had a psychiatric diagnosis.

Conclusions

Pediatric liver transplant recipients who underwent transplant surgery and received post-transplant care at our institution have good long-term outcomes. This suggests that having the same team perform both adult and pediatric transplantation and post-transplant care is beneficial for young adult recipients.

Correlation Between Splenectomy and Portal Vein Complications in Living Donor Liver Transplantation

OBJECTIVES

In adults undergoing living donor liver transplantation (LDLT), the transplanted livers are partial grafts, and the portal venous pressure is higher than that observed with whole liver grafts. In patients undergoing LDLT concomitant with splenomegaly, portal venous flow is often diverted to collateral vessels, leading to a high risk of portal vein thrombosis. In such cases, occlusion of the collateral veins is important; however, complete occlusion of all collaterals without blocking the blood flow through the splenic artery causes portal hypertension and liver failure. We aimed to examine the effect of performing a splenectomy concomitant with LDLT to reduce portal vein complications.

METHODS

Between 1991 and 2017, we performed 170 LDLT operations, including 83 in adults. For this cohort study, adult cases were divided into 2 groups. Group I was those who underwent LDLT without splenectomy (n = 60); Group II was those who underwent LDLT with splenectomy for the reduction of portal hypertension (n = 23). We investigated the incident rates of complications, including blood loss, lethal portal vein thrombosis (intrahepatic thrombosis), acute rejection, and so on. We also investigated the survival rates in both groups.

RESULTS

The incident rate of lethal portal vein thrombosis in Group II was significantly lower than that observed in Group I (4.4% vs 21.7%, respectively, P = .0363). There were no statistically significant differences observed between the groups with respect to blood loss, survival rates, and other such parameters.

CONCLUSION

LDLT concomitant with splenectomy might effectively reduce the occurrence of portal vein complications in adults.

Effect of Middle Hepatic Vein Tributaries Preserving Technique Until Just Before Graft Retrieval on Donors' Surgical Outcomes in Living Donor Liver Transplantation

BACKGROUND

The technique of preserving the major tributaries of the middle hepatic vein (MHV) (V5 and V8) until just before graft retrieval is beneficial to minimize congestion time of the graft. However, it remains unclear whether this technique exerts a burden on donors in terms of operative time, blood loss, and postoperative hepatic dysfunction. In this study we investigated adverse effects of the MHV tributaries preserving technique until immediately before graft retrieval on donors' surgical outcomes.

METHODS

Data from 71 donors who underwent right hepatectomy without MHV for a liver transplantation at our hospital from January 2002 to August 2016 were retrospectively reviewed. Donors were divided into 3 groups as follows: group 1 (n = 12), no MHV tributary reconstruction; group 2 (n = 33), single MHV tributary reconstruction; group 3 (n = 26), 2 or 3 MHV tributaries reconstruction. Donor operation time, blood loss, proportion of the remnant liver, maximum postoperative total bilirubin, aspartate aminotransferase, alanine transaminase, minimum platelets, prothrombin time, albumin level, number of days in hospital from surgery to discharge, and surgical complications were compared.

RESULTS

Compared with groups 2 and 3, group 1 exhibited shorter average operational time and less average blood loss, but the difference was not significant. Comparisons of all other factors indicated no significant differences.

CONCLUSION

The technique of preserving the major tributaries of the MHV until just immediately before graft retrieval does not appear to impose an apparent burden on donors.

Effect of neutron and γ -ray on charge-coupled device for vacuum/extreme ultraviolet spectroscopy in deuterium discharges of large helical device

A charge-coupled device (CCD) is widely used as a detector of vacuum spectrometers in fusion devices. Recently, a deuterium plasma experiment has been initiated in a Large Helical Device (LHD). Totally 3.7 × 10¹⁸ neutrons have been yielded with energies of 2.45 MeV (D-D) and 14.1 MeV (D-T) during the deuterium experiment over four months. Meanwhile, γ-rays are radiated from plasma facing components and laboratory structural materials in a wide energy range, i.e., 0.01-12.0 MeV, through the neutron capture. It is well known that these neutrons and γ-rays bring serious problems to the CCD system. Then, several CCDs of vacuum ultraviolet/extreme ultraviolet/X-ray spectrometers installed at different locations on LHD for measurements of spectra and spatial profiles of impurity emission lines are examined to study the effect of neutrons and γ-rays. An additional CCD placed in a special shielding box made of 10 cm thick polyethylene contained 10% boron and 1.5 cm thick lead is also used for the detailed analysis. As a result, it is found that the CCD has no damage in the present neutron yield of LHD, while the background noise integrated for all pixels of CCD largely increases, i.e., 1-3 × 10⁸ counts/s. The data analysis of CCD in the shielding box shows that the background noise caused by the γ-ray is smaller than that caused by the neutron, i.e., 41% from γ-rays and 59% from neutrons. It is also found that the noise can be partly removed by an accumulation of CCD frames or software programming.