Anti-demineralization effect of desensitizer containing copolymer and sodium fluoride on root dentin - a transverse microradiographic study

Objective: To evaluate anti-demineralization effects of dentin desensitizer containing sodium fluoride and methacrylate-co-p-styrene sulfonic acid (MS polymer) on root dentin using transverse microradiography (TMR).

Material and methods: Twenty-four dentin specimens were divided into four groups: MSO (no fluoride), MSF (3000 ppm F), FJL (9000 ppm F), and Control. In MSO and MSF, each desensitizer was rubbed into the dentin surfaces for 10 s then left for 20 s. In FJL, paste containing 9000 ppm F was applied onto the surface for 30 s. All specimens, including the Controls, were rinsed with deionized water, dried and an area of their surface exposed to pH 5.0 acidic solution, refreshed every 24 h, for 4 days. Sections 300-µm-thick were assessed by TMR. Mineral profiles and integrated mineral loss (IML) of lesions were analyzed by dedicated software. IML was analyzed with one-way ANOVA and Tukey’s test.

Results: MSF and FJL specimens showed high mineral volume % at the surface and in lesions, and significantly lower IML than the other groups (p < .05).

Conclusion: Dentin desensitizer containing 3000 ppm fluoride and MS polymer has the same anti-demineralization effect as does a fluoride paste containing 9000 ppm F.

Programmed death-1 ligands and tumor infiltrating T lymphocytes in primary and lymph node metastasis of esophageal cancer patients

Neoadjuvant chemotherapy (NAC) is administered to many patients with esophageal squamous cell carcinoma (ESCC) prior to surgery, but it is also true that some of these patients demonstrated no response to the therapy following surgery. In addition, the prognosis of advanced case such as ESCC patients with lymph node metastasis has remained relatively low. Programmed death ligand-1 (PD-L1) in conjunction with tumor-infiltrating lymphocytes (TILs) has been studied as a potential mechanism of "immune escape" in several human malignancies. Therefore, in this study, we studied PD-L1 status in carcinoma cells and forkhead box protein 3 (FOXP3) and CD8 status among TILs in the residual tumors of primary and metastatic sites following NAC. We also studied the association of these factors with the clinicopathological findings in 44 patients with ESCC harboring lymph node metastasis. There was discordance in the pathological response to chemotherapy between the primary tumor and lymph node metastasis, and histologically identified resistance to NAC in lymph node metastases tended to be correlated with an adverse clinical outcome (P = 0.0765) than resistance in the primary tumor. Both univariate and multivariate analyses for disease-specific survival (DSS) revealed that the PD-L1 status of carcinoma cells in metastatic lymph nodes and a higher FOXP3/CD8 ratio in the primary tumor were both significantly correlated with an eventual adverse clinical outcome of the patients (P = 0.0178, P = 0.0463, respectively). These results all indicated that the PD-L1 status of carcinoma cells in metastatic lymph nodes and the FOXP3/CD8 ratio in primary tumors could predict eventual clinical outcomes in ESCC patients with NAC.

Observation of Ξ(1620)^{0} and Evidence for Ξ(1690)^{0} in Ξ_{c}^{+}→Ξ^{-}π^{+}π^{+} Decays

We report the first observation of the double strange baryon Ξ(1620)^{0} in its decay to Ξ^{-}π^{+} via Ξ_{c}^{+}→Ξ^{-}π^{+}π^{+} decays based on a 980  fb^{-1} data sample collected with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The mass and width are measured to be 1610.4±6.0(stat)_{-4.2}^{+6.1} (syst)  MeV/c^{2} and 59.9±4.8(stat)_{-7.1}^{+2.8}(syst)  MeV, respectively. We obtain 4.0σ evidence of the Ξ(1690)^{0} with the same data sample. These results shed light on the structure of hyperon resonances with strangeness S=-2.

Long-Term Treatment with Thrombomodulin Improves Functional Outcomes after Cerebral Ischemia Even if Administration is Delayed

Our previous study indicated that recombinant human soluble thrombomodulin (rhsTM) could attenuate brain damage when administered as a bolus in the cerebral ischaemic early phase. Then, we considered that treatment with rhsTM may show therapeutic effects even when administered in the ischaemic delayed phase, because rhsTM has an action of inhibiting high-mobility group box 1 (HMGB1) as a late mediator of lethal systemic inflammation. This study was performed to investigate the effects of delayed treatment with rhsTM on ischaemic brain damage induced by high HMGB1 level in mice subjected to 4-hour middle cerebral artery occlusion (MCAO). One day after MCAO, rhsTM was administered intraperitoneally at a dose of 1 or 5 mg/kg once a day for 7 days. Neurological score, motor coordination and HMGB1 levels were measured 1, 3 and 7 days after MCAO. The presence of activated microglia was evaluated 7 days after MCAO. Systemic HMGB1 levels increased 1 to 7 days after MCAO and were higher at 7 days compared with day 1. At the same time, survival rate decreased, and activated microglia increased in the infarct area. Treatment with rhsTM improved neurological score, motor coordination, survival and prevented brain damage. Moreover, rhsTM decreased both HMGB1 level and number of activated M1 microglia. The results of this study indicated that rhsTM improved functional outcomes via inhibition of HMGB1 up-regulation and M1 microglial activation in the cerebral ischaemic delayed phase. rhsTM may become a new therapeutic agent with a wide therapeutic time window in patients with cerebral ischaemia.

A new species of the genus Elasmopus from Miyako Island, Japan (Crustacea: Amphipoda: Maeridae)

A new species of the maerid amphipod, Elasmopus nkjaf, from Miyako Island, Ryukyu Islands, Japan, is named and described. Additionally, nucleotide sequences of nuclear 28S ribosomal RNA and histone H3 as well as mitochondrial cytochrome c oxidase subunit I and 16S ribosomal RNA from its holotype and paratype were determined. Elasmopus nkjaf sp. nov. belongs to the rapax-group, and distinguished from the other rapax-group species by long setae on ventral margin of epimeral plate 3, gland cone of peduncular article 2 of antenna 2 not reaching to end of peduncular article 3, propodus of gnathopod 1 facially setose, length of propodus of male gnathopod 2 shorter than 3 times as long as length of carpus, medial face of propodus of male gnathopod 2 shallowly hollowed, posterior margin of epimeral plate 3 without denticles. A key to the species of Elasmopus species occurring Japanese and adjacent waters is provided.

Thoracoscopic Esophagectomy for a Patient With Perforated Esophageal Epiphrenic Diverticulum After Kidney Transplantation: A Case Report

A 58-year-old man who underwent cadaveric kidney transplantation twice presented to hospital with a perforated epiphrenic diverticulum. Computed tomography revealed epiphrenic diverticulitis and right pleural effusion. Upper gastrointestinal fibroscopy showed an epiphrenic diverticulum full of food residue. He was transferred to our hospital, where we performed percutaneous endoscopic gastrostomy under general anesthesia in the supine position before thoracoscopy. Thoracoscopic esophagectomy was performed in the semi-prone position under 6-10 mmHg artificial pneumothorax via the right thoracic cavity. We performed subtotal esophagectomy to remove sources of infection because the esophageal wall surrounding the diverticulum was too thick to close or to perform diverticulectomy. A cervical esophagostomy was constructed after the thoracic procedure. The patient was managed with continuous hemodiafiltration and administered immunosuppressants and steroids to preserve the transplanted kidney. Continuous hemodiafiltration was stopped on postoperative day (POD) 4. The patient was discharged from the intensive care unit on POD 10 and transferred to the original hospital on POD 24 for rehabilitation. The second operative stage was performed on POD 157 at our hospital. We performed gastric tube reconstruction via the ante-sternal route and anastomosed the tube to the cervical esophagus. The postoperative course was uneventful; the patient was transferred to the original hospital on POD 15 after the second operation. Minimally invasive surgery was sufficient to treat perforated epiphrenic diverticulum while preserving the transplanted kidney. We recommend completely removing the source of infection and reducing surgical invasiveness to preserve the transplanted kidney in cases of esophageal perforation following kidney transplantation.

Rediscovered syntypes of Procrangonyx japonicus, with nomenclatural consideration of some crangonyctoidean subterranean amphipods (Crustacea: Amphipoda: Allocrangonyctidae, Niphargidae, Pseudocrangonyctidae)

Two missing syntypes of the Japanese subterranean amphipod Procrangonyx japonicus (Uéno, 1930), the type species of Procrangonyx Schellenberg, 1934, were rediscovered in the collections of the Kyoto University Museum. The morphology of uropod 3, which has been considered the principal diagnostic character of the genus, is redescribed on the basis of one of the syntypes, and the nomenclatural history of the generic names Procrangonyx and Eocrangonyx Schellenberg, 1937 (corrected from 1936) for some Far-Eastern subterranean amphipod species is reviewed. Owing to confusion between the terms "type fixation" and "type designation"-the latter being just one means of accomplishing the former-the view that Procrangonyx is unavailable and invalid has prevailed in recent literature. Procrangonyx was indeed proposed after 1930 with no type species "designation", but under Articles 67.2.1 and 68.3 of the International Code of Zoological Nomenclature, Eucrangonyx japonicus Uéno, 1930 was "fixed" as its type species by monotypy in the original publication. Since a diagnosis of the genus was also provided in the same work, Procrangonyx is available under Article 13.3 of the Code. However, because endopodal segmentation of uropod 3 proves to be variable in P. japonicus, doubt is thrown on the taxonomic distinctness of Procrangonyx vis à vis Pseudocrangonyx Akatsuka Komai, 1922. Additionally, the publication dates of Allocrangonyx Schellenberg, 1937 and Niphargus foreli speziae Schellenberg, 1937 are corrected from 1936.

236. The Impact of Earlier Intervention by an Antimicrobial Stewardship Team on Appropriate Antimicrobial Therapy for Specific Antimicrobial Agents

Background

The optimal timing of intervention to obtain significant effects with regard to reducing the consumption of antimicrobial agents or antimicrobial-resistant bacteria in facilities that lack the manpower to maintain an antimicrobial stewardship team (AST) is not well-known.

Methods

An observational retrospective study was performed at Fukuoka University Hospital between April 1, 2013 and March 31, 2016 to evaluate the optimal timing of intervention on appropriate antimicrobial therapy for specific antimicrobial agents, including broad-spectrum antimicrobial agents (piperacillin–tazobactam, carbapenems, fluoroquinolones) and anti-MRSA (vancomycin, teicoplanin, daptomycin, and linezolid) agents. In period 1, interventions were performed for patients using specific antimicrobial agents for >14 days. In period 2, interventions were performed for patients using anti-MRSA agents, and in period 3, interventions were performed for patients using any specific antimicrobial agents, regardless of the days of use, on a weekly basis. The effects on antimicrobial use, the antimicrobial-resistant bacteria, and the clinical outcomes among the three periods were compared.

Results

The AUDs of piperacillin–tazobactam and carbapenems decreased significantly (10.8 → 9.2 and 15.7 → 14.2; period 2 vs. period 3, P < 0.05). The rates of piperacillin–tazobactam, meropenem and levofloxacin resistance in Pseudomonas aeruginosa isolates decreased from 13.8%, 16.2%, 11.9% in period 1 to 10.4%, 8.7%, 6.5% in period 3, respectively. The annual costs of these antimicrobials decreased according to the period: period 1, US$ 1,080,000; period 2, US$ 944,000; and period 3, US$ 763,000 (period 3 vs. period 1, P <0.01). No recurrence was observed within 7 days after intervention and the mortality rate and length of stay did not change to a statistically significant extent in any of the study periods.

Conclusion

When interventions were performed once a week by an ASP team, accelerating the timing of intervention from patients with >14 days of use to all patients treated with the specific antimicrobial agents was significantly more effective for reducing the consumption of antimicrobials leading to reduction of the related costs and antimicrobial-resistant P. aeruginosa without compromising the patient outcomes.

Disclosures

T. Takata, Taisho Toyama Pharmaceutical Co. Ltd.: Speaker’s Bureau, Speaker honorarium

Evaluating the ontogenetic external morphology of an ectoparasitic Torix tukubana (Hirudinida: Glossiphoniidae), with records of its new host amphibian species

Torix is a leech genus containing freshwater proboscidate species, and several members of this taxon are ectoparasites specific to amphibians. Torix tukubana inhabits mountain streams in Japan, and only two frog species are known to be hosts. We collected this leech from two other amphibians, Onychodactylus japonicus (Japanese clawed salamander) and Rana ornativentris (montane brown frog), for the first time. This finding suggests that the host specificity of T. tukubana is low. The immature individuals of T. tukubana were also collected and identified based on DNA data. This is the first juvenile record of this species confirmed by its DNA barcode sequences. Several morphological characters known from large individuals and used as diagnostic characteristics in taxonomic keys were not observed in the juveniles, suggesting that these are ontogenetic traits.

Combination of serum squamous cell carcinoma antigens 1 and 2 as potential diagnostic marker for sinonasal squamous cell carcinoma and inverted papilloma

BACKGROUND

Differentiating inverted papilloma from squamous cell carcinoma (SCC) is sometimes difficult. We evaluated the clinical usefulness of serum SCCA1 and SCCA2 in the management of patients with inverted papilloma or SCC.

METHODS

Serum and tissue samples for the analysis of SCCA1, SCCA2, and SCC antigen were taken from 18 patients with sinonasal inverted papilloma and 23 cases with sinonasal SCC. The SCCA1, SCCA2, and SCC antigen levels were determined.

RESULTS

The serum SCCA1 concentration was significantly higher in the inverted papilloma group than in the SCC group, whereas the serum SCCA2 level was significantly higher in the SCC group than in the inverted papilloma group.

CONCLUSION

Patients with sinonasal inverted papilloma predominantly express SCCA1 protein, whereas those with SCC predominantly express SCCA2. This suggests that combined measurements of both serum SCCA1 and SCCA2 concentrations can be very useful for distinguishing sinonasal inverted papilloma from SCC.

Reassessment of the Groundwater Amphipod Paramoera relicta Synonymizes the Genus Relictomoera with Paramoera (Crustacea: Amphipoda: Pontogeneiidae)

The systematic status of the stygobitic amphipod, Paramoera relicta Uéno, 1971, was revisited based on morphological examination of the paratypes, and molecular phylogenetic analyses using a newly collected specimen from its type locality. The paratypes clearly showed that this species does not possess the "sinusoid" antennal sinus in the head, which was erroneously described in the original description of this species; P. relicta is unquestionably classified within the genus Paramoera Miers, 1875 . Molecular phylogenetic trees obtained with nuclear histone H3 and mitochondrial 16S rRNA demonstrated that P. relicta clearly belongs to the clade consisting of Paramoera species. Since the genus Relictomoera Barnard and Karaman, 1982 was erected according to the "sinusoid" characteristic of its type species P. relicta, this genus is no longer valid, and should be treated as a junior subjective synonym of Paramoera. One of the paratypes of P. relicta is herein designated as a neotype for the species to clarify its taxonomic status and emend the morphological characteristics of this pontogeneiid amphipod.

The impact of earlier intervention by an antimicrobial stewardship team for specific antimicrobials in a single weekly intervention

OBJECTIVE

The objective of this study was to evaluate the effects of earlier intervention by an antimicrobial stewardship team (AST) on antimicrobial use, antimicrobial resistance rates, and the clinical outcomes, without changing the weekly intervention schedule.

METHODS

A retrospective study was conducted at Fukuoka University Hospital between April 2013 and March 2016. The effects were compared among three study periods (SP): SP1 (patients receiving anti-methicillin-resistant Staphylococcus aureus agents and carbapenems for ≥14 days), SP2 (patients receiving specific antimicrobials for ≥14 days), and SP3 (patients receiving specific antimicrobials regardless of the duration of treatment).

RESULTS

The timing of AST intervention was shortened from an average of 15.5days after administration in SP1 to 4.2 days in SP3. The antimicrobial use density (AUD) of carbapenems and piperacillin-tazobactam decreased significantly (SP2 vs. SP3, p<0.05), and the costs of specific antimicrobials decreased (SP1, US$ 1080000; SP2, US$ 944000; SP3, US$ 763000). The rates of carbapenem resistance among Pseudomonas aeruginosa isolates showed a significant reduction from 16.2% in SP2 to 8.7% in SP3 (p<0.05). The mortality rate and length of stay did not change during the study period.

CONCLUSIONS

Earlier intervention by an AST could contribute to the proper use of antimicrobials without adversely affecting patient outcomes.

The clinical value of serum squamous cell carcinoma antigens 1 and 2 in head and neck squamous cell carcinoma

OBJECTIVE

The usefulness of pretreatment measurement of SCC antigen in patients with head and neck SCC is still controversial. Our aim of this study was to evaluate the clinical usefulness of serum SCC antigen, SCCA1 and SCCA2 in the management of patients with head and neck SCC.

METHODS

Serum samples for the analysis of SCCA1, SCCA2 and SCC antigen were taken from head and neck SCC patients before treatment. Serum SCC antigen was assayed with a solid phase immunoradiometric assay. The SCCA1 and SCCA2 protein level was determined by a sandwich ELISA.

RESULTS

Fifty-two of 96 cases (54%) showed evaluated serum SCC antigen levels above the upper limit. The serum SCCA2 level was significantly higher in the head and neck SCC patients than in control group, whereas there were no significant differences in the serum SCCA1 level between head and neck SCC patients and control group. 72% of head and neck SCC patients demonstrated SCCA2 levels higher than 0.15, whereas 68% of the control subjects had SCCA2 levels less than 0.15.

CONCLUSION

The serum SCCA2 levels were increased during the progression of cancer and might be a useful tool for the management of head and neck SCC.