Isolation and characterization of Leptospira interrogans from two patients with leptospirosis in Western Province, Sri Lanka

Leptospirosis is an endemic infectious disease causing considerable morbidity and mortality in Sri Lanka; however, reports on the isolation of Leptospira from infected patients in Sri Lanka have been largely unavailable since the 1970s. Two isolates were obtained and characterized from 100 blood cultures from leptospirosis-suspected patients. Phylogenic analysis of partial flaB gene sequences identified the isolates as Leptospira interrogans. The patient serum samples from which Leptospira was isolated reacted with the Leptospira serogroups Sejroe and Canicola at a titre of 1 : 200. Exposure to domestic sewage and gutters filled with muddy water was suspected to be the source of infection in these two culture-positive patients. This study reports the successful isolation of pathogenic Leptospira from two patients in Western Province, Sri Lanka.

Improved retransplant outcomes: early evidence of the share35 impact

BACKGROUND

Share 35 prioritizes offers of deceased donor livers to regional candidates with Model for End-Stage Liver Disease (MELD) ≥35 over local candidates with lower MELD scores. Analysis of Share35 has shown that overall 1- or 2-year post-transplant (LTx) outcomes have been unchanged while waitlist mortality has been reduced. However, these studies exclude retransplant (reLTx) recipients. This study aims to investigate the outcomes of liver retransplants in evaluating the impact of the Share35 policy.

METHODS

A retrospective analysis of data from the United Network for Organ Sharing database over the period June 2011-June 2015 was performed.

RESULTS

A total of 19,748 LTx and 312 reLTx recipients were identified. Of the LTx recipients, 9626 (48.7%) underwent transplant pre-Share 35 and 10,122 (51.3%) post-Share 35. 123 (39.4%) reLTx recipients underwent retransplantation pre-Share 35 and 189 (60.6%) post-Share 35. ReLTx recipients experienced improved 2-year graft survival post-Share 35 compared to pre-Share 35 (67% vs. 21.1%). Patient survival also improved at 2-years for reLTx recipients post-Share 35 compared to pre-Share 35 (69.2% vs. 33.1%). Transplant post-Share 35 was protective for both 2-year graft (HR = 0.669, CI = 0.454-0.985, p = 0.04) and patient (HR = 0.659, CI = 0.44-0.987, p = 0.003) survival.

CONCLUSION

Share35 is associated with improved outcomes after retransplantation.

Improvements in Outcomes for Ethnic Minorities During the Share 35 Era Are Not Due to Decreased Rates of Early Graft Loss

OBJECTIVES

Our aim was to investigate the effects of the Share 35 policy on outcomes in ethnic minorities and recipients who experienced early graft failure.

MATERIALS AND METHODS

We analyzed donor and recipient data from the United Network for Organ Sharing database before (June 6, 2011 to June 18, 2013) and after (June 18, 2013 to June 30, 2015) implementation of Share 35. Graft and patient survival outcomes were compared.

RESULTS

There were significant differences in 1- and 2-year graft and patient survival rates between ethnicities pre-Share 35 (P = .03, P < .001, P = .01, P < .001, respectively). There were no significant differences in 1- and 2-year graft and patient survival between ethnicities post-Share 35 (P = .268, P = .09, P = .343, P = .087, respectively). There were no differences in early graft failure rates pre- and post-Share 35 at 7 days (2.1% vs 2.0; P = .71) and 30 days (4.0% vs 3.8%; P = .47) after transplant, with a decreased early graft failure rate shown at 90 days after transplant (6.8% vs 5.8%; P = .003). When analyzed separately, the low Model for End-Stage Liver Disease (score of < 35) and the high Model for End-Stage Liver Disease recipients (score of ≥ 35) both exhibited reduced early graft failure rates post-Share 35 (6.1% vs 5.3% and 10.8% vs 7.8%, respectively; P < .05).

CONCLUIONS

Share 35 was associated with a short-term reduction in ethnic disparities. Most ethnic groups experienced improved survival in the Share 35 era. Share 35 was not associated with an increase in early graft failure and is an efficacious policy with regard to short-term outcomes.

Towards a threshold climate for emergency lower respiratory hospital admissions

Identification of 'cut-points' or thresholds of climate factors would play a crucial role in alerting risks of climate change and providing guidance to policymakers. This study investigated a 'Climate Threshold' for emergency hospital admissions of chronic lower respiratory diseases by using a distributed lag non-linear model (DLNM). We analysed a unique longitudinal dataset (10 years, 2000-2009) on emergency hospital admissions, climate, and pollution factors for the Greater London. Our study extends existing work on this topic by considering non-linearity, lag effects between climate factors and disease exposure within the DLNM model considering B-spline as smoothing technique. The final model also considered natural cubic splines of time since exposure and 'day of the week' as confounding factors. The results of DLNM indicated a significant improvement in model fitting compared to a typical GLM model. The final model identified the thresholds of several climate factors including: high temperature (≥27°C), low relative humidity (≤ 40%), high Pm10 level (≥70-µg/m³), low wind speed (≤ 2 knots) and high rainfall (≥30mm). Beyond the threshold values, a significantly higher number of emergency admissions due to lower respiratory problems would be expected within the following 2-3 days after the climate shift in the Greater London. The approach will be useful to initiate 'region and disease specific' climate mitigation plans. It will help identify spatial hot spots and the most sensitive areas and population due to climate change, and will eventually lead towards a diversified health warning system tailored to specific climate zones and populations.

Highly sensitive fluorescence detection of metastatic lymph nodes of gastric cancer with photo-oxidation of protoporphyrin IX

BACKGROUND

The establishment of a precise and rapid method to detect metastatic lymph nodes (LNs) is essential to perform less invasive surgery with reduced gastrectomy along with reduced lymph node dissection. We herein describe a novel imaging strategy to detect 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) fluorescence in excised LNs specifically with reduced effects of tissue autofluorescence based on photo-oxidation of PpIX. We applied the method in a clinical setting, and evaluated its feasibility.

METHODS

To reduce the unfavorable effect of autofluorescence, we focused on photo-oxidation of PpIX: Following light irradiation, PpIX changes into another substance, photo-protoporphyrin, via an oxidative process, which has a different spectral peak, at 675 nm, whereas PpIX has its spectral peak at 635 nm. Based on the unique spectral alteration, fluorescence spectral imaging before and after light irradiation and subsequent originally-developed image processing was performed. Following in vitro study, we applied this method to a total of 662 excised LNs obtained from 30 gastric cancer patients administered 5-ALA preoperatively.

RESULTS

Specific visualization of PpIX was achieved in in vitro study. The method allowed highly sensitive detection of metastatic LNs, with sensitivity of 91.9% and specificity of 90.8% in the in vivo clinical trial. Receiver operating characteristic analysis indicated high diagnostic accuracy, with the area under the curve of 0.926.

CONCLUSIONS

We established a highly sensitive and specific 5-ALA-induced fluorescence imaging method applicable in clinical settings. The novel method has a potential to become a useful tool for intraoperative rapid diagnosis of LN metastasis.

Redesigning Organ Allocation Boundaries for Liver Transplantation in the United States

Geographic disparities in access to and outcomes in transplantation have been a persistent problem widely discussed by transplant researchers and the transplant community. One of the alleged causes of disparities in the United States is administratively determined organ allocation boundaries that limit organ sharing across regions. This paper applies mathematical programming to construct alternative liver allocation boundaries that achieve more geographic equity in access to transplants than the current system. The performance of the optimal boundaries were evaluated and compared to that of current allocation system using discrete event simulation.

Growth rates of abdominal aortic aneurysms in Japanese patients observed in one institute

AIM

The aim of this paper was to investigate the growth rate of abdominal aortic aneurysms (AAA) in Japanese patients.

METHODS

We retrospectively studied patients conservatively followed with infrarenal AAA in terms of AAA diameter measured using computed tomography (CT) in our hospital between 1999 and 2009. The AAA surgery criterion in our institute was a diameter ≥ 5.0 cm or a growth rate ≥5 mm/year. We estimated operation-free ratios by initial AAA diameter and changes in AAA growth rates. Patients with an initial AAA diameter < 5.0 cm were divided into 2 groups. Patients with AAA that met the criteria for surgery were classified into the expansion group, and those remaining into the non-expansion group. Their AAA growth rates were compared.

RESULTS

The group consisted of 124 patients (average age, 73.7±8.6 years (range 54-92)) who had at least 2 recorded AAA measurements. The average follow-up period was 3.0±2.2 years (range 0.3-10.2). There were no cases of rupture during follow-up. Twenty-six patients (21.0%) underwent surgery (open replacement [N.=20]; endovascular abdominal aneurysm repair [N.=6]). The growth rate determined from the initially measured diameter was significantly faster in AAAs measuring 5.0-5.4 cm than in AAAs measuring 4.5-4.9 cm (P=0.01). More than 90% of patients with an initial AAA diameter <5.0 cm were observed conservatively for 2 years or more. However, more than half of the patients with an initial AAA diameter ≥4.0 cm needed surgery within 5 years. The growth rates of AAAs for each size during growth were significantly faster when the AAA diameter was 4.5-4.9 cm than when it was 4.0-4.4 cm (P=0.006), and when the AAA diameter was 5.0-5.4 cm than when it was 4.5-4.9 cm (P = 0.009). The expansion and non-expansion groups consisted of 38 (34.2%) and 73 (75.8%) patients, respectively. The AAA growth rate in the expansion group was significantly faster than that in the non-expansion group (3.4±2.2 mm/year vs. 1.4±1.3 mm/year, P=0.0001).

CONCLUSION

It may be considered that the appropriate indication for AAA repair is defined by a diameter of 5.0 cm for Japanese patients. Patients with AAA that is growing continuously by ≥3 mm/year and who have low operative risk may undergo surgery even if their AAA is <5.0 cm.

Cadmium and other metal levels in autopsy samples from a cadmium-polluted area and non-polluted control areas in Japan

This study was initiated to examine accumulation of cadmium (Cd) and other metals in kidney and liver in autopsy samples and to compare the levels between those in an area with heavy Cd exposure and those in no-polluted areas in Japan. Data on Cd and other metals in kidney (cortex and medulla) and liver in 95 cases (87 women and eight men; the exposed) in a Cd-polluted area and 43 cases (21 women and 22 men; the controls) in non-polluted areas were cited from 15 previous publications to be summarized together with six unpublished cases. Cd levels in kidney cortex and medulla were significantly lower in the exposed (31.5 and 23.8 μg/g wet tissue as GM, respectively) than in the controls (82.7 and 36.4 μg/g, respectively), whereas Cd levels in liver was higher in the exposed (60.2 μg/g) than in the controls (8.1 μg/g). Exposed women had lower Cd in the cortex (29.9 μg/g) and medulla (22.7 μg/g) than exposed men (55.4 and 38.1 μg/g, respectively) as well as in cortex of control women (92.9 μg/g). Comparison with worldwide data other than Japan for non-exposed populations [19.1, 9.3, and 1.3 μg/g in cortex, medulla, and liver, respectively, as the inverse variance-weighted averages (IVWA) of GM values for each of 22 reports] suggests that the levels for the non-exposed Japanese (123.3, 33.5, and 3.9 μg/g as IVWA) tended to be higher than the levels in other countries, possibly reflecting high dietary Cd intake in the past.

Lab coats versus business suits

Purpose

This paper seeks to examine whether the primary factors motivating the career plans of high‐achieving Indian adolescents vary between academic specializations. Particular attention is to be paid to differences between science and business students.

Design/methodology/approach

The study surveyed approximately 2,700 secondary school students in South India regarding their academic and career plans and their perceptions of business compared with science. Survey results were analyzed using both descriptive techniques and multinomial logistic regression.

Findings

Students perceive business to be comparable with, but not superior to, science and engineering. The proportion of students choosing business over science increased among males and in some more economically developed cities. Engineering students were most likely to cite parents as a major influence, while business students more often pointed to salary and career prospects.

Research limitations/implications

The study's scope was limited to South India. Greater geographic coverage could broaden the generalizability of the results.

Practical implications

The increasing desirability of formal business education can give rise to a stronger entrepreneurial base and greater business development in India. Furthermore, improved management skills in the Indian workforce can attract higher value‐added offshore work from multinational corporations.

Originality/value

The existing literature contains little empirical research directly comparing business students with their peers in science and engineering, with no such study previously conducted in India. The results shed light on what attracts students to each track and can inform policy aimed at encouraging further enrollment in specific fields.

Lack of correlation between cadmium level in local brown rice and renal failure mortality among the residents: a nation-wide analysis in Japan

OBJECTIVES

Cadmium is a ubiquitous hazardous element with nephro-toxicity after long-term exposure. The present study was initiated to examine possible effects of dietary cadmium (Cd) intake on health of local residents across Japan. For this purpose, Cd in locally harvested brown rice (Cd-BR) was taken as the parameter of Cd exposure, and two measures of mortality, i.e., standardized mortality ratio (SMR) and age-adjusted renal insufficiency mortality rate (AARIMR) were employed as parameters of over-all health effects including effects on kidney.

METHODS

Japan consists of 47 prefectures. Data on Cd in 37,250 brown rice samples harvested in 1997-1998 in the 47 prefectures were made available from the Ministry of Agriculture, Forestry and Fisheries, Japan. SMR and AARIMR data (for the year 2000) by two genders in the 47 prefectures were cited from publications of the Ministry of Health, Labour and Welfare, Japan. Possible correlation of Cd in brown rice (Cd-BR) with SMR and AARIMR was examined by Poisson regression analysis.

RESULTS

The geometric mean (GM) Cd-BR for Japan as a whole was 0.040 mg/kg with a geometric standard deviation (GSD) of 2.72. Prefectural GM values varied from a low of <0.01 mg/kg to a high of 0.089 mg/kg. Nevertheless, SMR (in a range of 89.9-119.5 for men and 87.1-111.7 for women) did not correlate with Cd-BR significantly. AARIMR (in a range of 5.3-11.9 and 3.2-8.4 for men and women, respectively) tended to decrease as a function of increasing Cd-BR both in men and women, although the correlation was insignificant in both genders.

CONCLUSIONS

No evidence was obtained in the present analysis to suggest that either mortality as a whole or the mortality due to renal failure is affected by dietary intake of Cd in rice.

Distance matters in choice of mental health program: policy implications for reducing racial disparities in public mental health care

The purpose of this study is to examine the influence of race, geographic distance and quality on the choice of community mental health programs. The study population was comprised of adult Medicaid recipients who received outpatient treatment for serious mental illness in FY 2001. A discrete choice model was employed to examine the likelihood of choosing one program over another. Quality was measured based on follow-up after hospital discharge and continuity of care in outpatient services. Maps showing the relationship between race and the quality of care were prepared to visually confirm the results of the statistical analysis. African American and Hispanic clients were less likely to travel further for treatment, while no significant difference was found between the Caucasian and other race groups. Caucasian subjects were more likely to choose programs with a higher quality of care compared to Hispanic or African American clients. Higher income clients were, on average, traveling longer and receiving better quality of care after controlling for race. The results suggested that clients living in higher income White neighborhoods are more likely to travel longer distances for mental health treatment. Special attention must be paid to improve the quality of care in lower income minority neighborhoods to insure equity of treatment in publicly funded programs.

Clinical comparison of two different types of bifurcated graft for postoperative baPWV and ABI

AIM

A newly-designed bifurcated graft with the distal end larger than the conventional type has been developed. The purpose of this study was to evaluate the early results of graft replacement using this new graft, and to compare whether the new graft is more advantageous than the conventional graft in terms of peripheral blood flow and arterial stiffness.

METHODS

Records of 36 patients who underwent bifurcated graft replacement for infrarenal abdominal aortic aneurysm (AAA), from May 2003 to September 2006 were reviewed after excluding peripheral arterial disease (ABI > 0.9). Subjects were divided into two groups: group C (N.=20), with implantation of the conventional type and group N (N.=16), with implantation of the new type. We investigated changes in brachial-ankle pulse wave velocity (baPWV) and ankle-brachial pressure index (ABI), measurements being performed preoperatively and postoperatively.

RESULTS

baPWV in the postoperative group as a whole was significantly higher than in the preoperative group (P<0.05), while ABI in the postoperative group was lower than in the preoperative group (P<0.05). In group C, baPWV increased (P<0.05) and ABI decreased (P<0.05) after bifurcated graft replacement, whereas in group N, there were no significant differences in changes of baPWV and ABI.

CONCLUSIONS

This study shows that the new graft reduces the development of arterial stiffness postoperatively compared with the conventional type. These results may predict the new type graft decrease in the risk of morbidity and mortality caused by atherosclerotic disease.

Current progress and challenges in ocular surface reconstruction using cultivated epithelial sheet transplantation

The cultivated epithelial transplantation is a new surgical modality for treating a variety of severe ocular surface disorders. This type of tissue-engineered epithelial sheet provides a rapid epithelial coverage on the corneal surface that reduces inflammation and postoperative complications. Although cultivated corneal epithelial transplantation is an effective surgical strategy, autologous transplantation is limited to unilateral cases. Autologous cultivated oral mucosal epithelial transplantation (COMET) enables surgeons to reconstruct the ocular surface using autologous, non-ocular surface cells, and has opened a new pathway for treating severe, bilateral ocular surface disorders.