Effect of rice-cooking water to the daily arsenic intake in Bangladesh: results of field surveys and rice-cooking experiments

The effect of rice-cooking water to the daily arsenic intake of Bangladeshi people was investigated. At the first field survey, uncooked rice and cooked rice of 29 families were collected. Their arsenic concentrations were 0.22+/-0.11 and 0.26+/-0.15 mg/kg dry wt, respectively. In 15 families, arsenic concentration in rice increased after cooking. Good correlation (R(2)=0.89) was observed between arsenic in rice-cooking water and the difference of arsenic concentration in rice by cooking. In the second survey, we collected one-day duplicated food of 18 families. As a result, we estimated that six of 18 families likely used the arsenic contaminated water for cooking rice even they drank less arsenic-contaminated water for drinking purpose. We also conducted rice-cooking experiments in the laboratory, changing arsenic concentration in rice-cooking water. Clear linear relationships were obtained between the arsenic in rice-cooking water and the difference of arsenic concentration in rice by cooking. Factors that affect arsenic concentration in cooked rice are suggested as follows: (1) arsenic concentration in uncooked rice, (2) that in rice-cooking water, (3) difference in water content of rice before and after cooking, and (4) types of rice, especially, the difference between parboiled and non-parboiled rice.

Antithrombin effect on coagulation and fibrinolytic profiles after living donor liver transplantation: a pilot study

Early after liver transplantation, patients are in a hypercoagulable state because of an imbalance between coagulation and fibrinolysis because of the slow recovery of depleted anticoagulant proteins. Antithrombin (AT) is used in anticoagulant protocols to prevent thrombosis. The subjects of the present study were 17 men and eight women that underwent living donor liver transplantation. The initial 15 cases were administered AT concentrate (1500 U/day) on postoperative days (POD) 1 through 3 (AT group) and the following 10 consecutive cases were not administered AT (control). AT, thrombin-AT complex, plasmin-alpha2 plasmin inhibitor complex, thrombomodulin, fibrin degradation product D-dimer (FDP-DD) level, prothrombin time international normalized ratio, activated partial thromboplastin time, and platelet counts were measured. In the AT group, AT activity was maintained at levels >80% for 5 days after transplantation. In the control group, AT activity did not return to normal during the first 2 weeks after the operation. FDP-DD levels were significantly higher in the control group than in the AT group (P < 0.05). Six patients in the control group and three patients in the AT group required transfusions with platelet concentrate (P < 0.05). AT supplementation might reduce FDP-DD levels and prevent decreased platelet counts in the early stages after liver transplantation.

[An adult case of double aortic arch]

Reports of surgical treatment are rare in adults with double aortic arch. We present such a case of a 15-year-old male who presented with dysphagia and dyspnea. Diagnosis was made by magnetic resonance imaging (MRI), showing a dominant right arch. The patient underwent divisions of left aortic arch and ligamentum arteriosum, and further dissections around esophagus and trachea. After the operation, both dysphagia and dyspnea were disappeared completely. By reviewing literatures in adult cases, cautions in surgical procedure were discussed in this article.

Pseudomonas aeruginosa infection after living-donor liver transplantation in adults

OBJECTIVES

Pseudomonas aeruginosa infection is a major cause of bacterial infection after deceased-donor liver transplantation. The incidence and risk factors of P. aeruginosa infection after living-donor liver transplantation (LDLT), however, are not known.

METHODS

We retrospectively reviewed the data from 170 adult patients who underwent LDLT at the University of Tokyo Hospital. The microbiologic and medical records of the patients from admission to 3 months after LDLT were reviewed. Uni- and multivariate analyses were performed to identify the independent risk factors for postoperative P. aeruginosa infection.

RESULT

Preoperative P. aeruginosa carriage was identified in 15 (9%) patients. Only 2 of the 15 patients later presented with postoperative P. aeruginosa infection. Postoperative P. aeruginosa infection occurred in 27 (16%) of 170 patients by median postoperative day 38. Among those 27 patients, surgical site infections were recorded in 8 (30%) and intra-abdominal infections in 14 (52%). In 5 of the 27 (19%) patients, P. aeruginosa isolates were multiple antimicrobial resistant. Postoperative bile leakage independently predicted postoperative P. aeruginosa infection.

CONCLUSION

P. aeruginosa infections were frequently detected after LDLT, including those by multiple antimicrobial-resistant isolates. Postoperative bile leakage predisposed patients to P. aeruginosa infection. Surveillance culture should be checked periodically after LDLT to ensure that appropriate antimicrobials can be administered for postoperative infection.

Heparin-induced thrombocytopenia after liver transplantation

BACKGROUND

Unfractionated heparin sodium (UFH) or low-molecular weight heparin (LMWH) is used in anticoagulant protocols at several institutions to prevent thrombosis after liver transplantation. Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated reaction to heparin, resulting in platelet count decreases of more than 50%. The frequencies of HIT after liver transplantation and platelet factor 4/heparin-reactive antibody (HIT antibody) positivity in liver transplantation patients, however, are unknown.

PATIENTS AND METHODS

The 32 men and 20 women underwent living donor liver transplantation. We started LMWH (25 IU/kg/h) on postoperative day (POD) 1, switching to UFH (5000 U/d) on POD 2 or 3. The dose of UFH was changed according to the activated clotting time level. HIT antibody levels were measured the day before surgery and on POD 7 and 14. Platelet count was measured daily for 3 weeks.

RESULTS

The average platelet counts preoperatively, and on POD 7, 14, and 21 were 65, 88, 149, and 169 x 10(9)/L, respectively. Two patients developed hepatic artery thrombosis on POD 11 and 19, respectively, although they were HIT antibody-negative and their platelet counts were stable. In 2 other patients, the platelet count decreased suddenly from 107 x 10(9)/L on POD 4 to 65 x 10(9)/L on POD 6 and from 76 x 10(9)/L on POD 7 to 33 x 10(9)/L on POD 9, respectively. The heparin-induced platelet aggregation test was negative in these patients. The percentage of HIT antibody-positive patients was 0.5% preoperatively, 5.6% on POD 7, and 5.6% on POD 14. None of the subjects/patients developed UFH-related HIT.

CONCLUSIONS

In our series, the occurrence of HIT after liver transplantation was uncommon.

Finite element 3D reconstruction of the pulmonary acinus imaged by synchrotron X-ray tomography

The alveolated structure of the pulmonary acinus plays a vital role in gas exchange function. Three-dimensional (3D) analysis of the parenchymal region is fundamental to understanding this structure-function relationship, but only a limited number of attempts have been conducted in the past because of technical limitations. In this study, we developed a new image processing methodology based on finite element (FE) analysis for accurate 3D structural reconstruction of the gas exchange regions of the lung. Stereologically well characterized rat lung samples (Pediatr Res 53: 72-80, 2003) were imaged using high-resolution synchrotron radiation-based X-ray tomographic microscopy. A stack of 1,024 images (each slice: 1024 x 1024 pixels) with resolution of 1.4 mum(3) per voxel were generated. For the development of FE algorithm, regions of interest (ROI), containing approximately 7.5 million voxels, were further extracted as a working subunit. 3D FEs were created overlaying the voxel map using a grid-based hexahedral algorithm. A proper threshold value for appropriate segmentation was iteratively determined to match the calculated volume density of tissue to the stereologically determined value (Pediatr Res 53: 72-80, 2003). The resulting 3D FEs are ready to be used for 3D structural analysis as well as for subsequent FE computational analyses like fluid dynamics and skeletonization.

[Effect of sivelestat sodium on acute lung injury after acute aortic dissection]

Acute lung injury is a frequent and serious complication in patients with acute aortic dissection (AAD). Elevated neutrophil elastase has been reported to be one of the major determinants occurring in AAD. On admission, we administered sivelestat sodium hydrate, a neutrophil elastase inhibitor, to 11 patients with AAD who were medically treated to prevent lung injury. We compared their clinical course with that of 12 patients of control group in which sivelestat was not used prophylacticaly. Although there were 5 patients (42%) who suffered from respiratory failure and needed mechanical ventilation in the control group, no one needed intubation in the sivelestat group. Our study suggested that sivelestat sodium hydrate could be effective in preventing intubation due to respiratory failure. Further prospective study is necessary to evaluate prophylactic administration of sivelestat sodium hydrate in AAD.

Impact of live donor age (>or=50) on liver transplantation

BACKGROUND

The question of whether donor age negatively impacts recipient outcome in adult-to-adult living donor liver transplantation (LDLT) is rarely discussed. The aim of this study was to evaluate the impact of older donor age (50 years or older) on recipient outcomes in adult-to-adult LDLT.

METHODS

LDLT data were retrospectively evaluated from our 299 LDLT cases in 297 recipients, which were divided into 2 groups: a younger group (group Y, donor age<50, n=237) and an older group (Group O, donor age>or=50, n=62). Clinical parameters of both recipients and donors were comparable between groups.

RESULTS

There was no difference between the groups in patient survival or postoperative complications of either donors or recipients. In recipients, graft regeneration was significantly impaired in Group O. Graft function, including protein synthesis and cholestasis, was comparable between the 2 groups.

CONCLUSION

Although the regeneration capacity of aged grafts was impaired, the function of grafts from older donors was comparable to that of those from younger donors. There was no difference in the clinical outcomes between the groups.

Mutagenic fate of insecticide fenitrothion in the environment-mutagenicity increases both by anaerobic biodegradation and photodegradation

In the present study, our objectives were (1) using the Ames assay, to evaluate the change in mutagenicity of a fenitrothion-containing solution during aerobic biodegradation, anaerobic biodegradation, and photodegradation, and (2) to identify possible mutagenic transformed products (TPs) that contributed substantially to any increase in mutagenicity. Mutagenicity of the fenitrothion-containing solution did not increase during aerobic biodegradation with any of the tested bacterial strains. In contrast, the mutagenicity increased for strain YG1029 during anaerobic biodegradation because of the generation of a strongly mutagenic TP, amino-fenitrothion. During photodegradation, mutagenicities increased slightly for YG1021 and YG1024, possibly owing to the production of a previously unreported mutagenic TP.

Blood eosinophilia after living donor liver transplantation for hepatitis C virus-related cirrhosis

BACKGROUND

Differentiating between acute cellular rejection (ACR) and recurrent hepatitis C virus after liver transplantation in hepatitis C virus-positive patients is difficult, but vital for preventing graft loss.

METHODS

The blood eosinophil counts 3 days before or on the day of biopsy were retrospectively reviewed to evaluate their value for predicting ACR in 91 biopsy samples from 45 patients.

RESULTS

Eosinophil counts on the day of biopsy were significantly higher in the ACR group (n = 20) than in the non-ACR (n = 71) group, although the difference was negligible 3 days before the biopsy. A relative eosinophil count of 2% or an absolute eosinophil count of 200 cells/mm(3) predicted ACR with a specificity of 94% or 96%, respectively.

CONCLUSIONS

Blood eosinophil count on the day of biopsy can be helpful in the diagnosis of ACR in patients who underwent living donor liver transplantation for hepatitis C virus-related cirrhosis.

Factors influencing postoperative speech function of tongue cancer patients following reconstruction with fasciocutaneous/myocutaneous flaps—a multicenter study

This study investigated postoperative speech function in tongue cancer patients following reconstruction with fasciocutaneous/myocutaneous flaps, to clarify the factor(s) influencing outcome. Eighty-one patients, enrolled from 11 Japanese institutions, were classified into three groups by the site of resection: lateral (N=51), anterior (N=17) and combined (N=13). The lateral group was divided into three subgroups and the anterior group into two subgroups by the size of resection. Mandibulectomy had been performed in 43 patients and radiation therapy in 24 patients. Reconstruction was accomplished by radial forearm flap (N=50), rectus abdominis myocutaneous flap (N=18), pectoralis major myocutaneous flap (N=11), latissimus dorsi myocutaneous flap (N=1) or scapula flap (N=1). Speech function was evaluated with two objective tests and three self-reporting questionnaires. The influence of tongue mobility, age at operation and examination, time interval to examination, and type of flap reconstruction on the functional results was also investigated. Better results were obtained with lateral type resections, smaller excisions, greater tongue mobility, younger patients and longer interval to examination. Mandibulectomy and radiation therapy were negative factors. Type of flap reconstruction had no effect on functional outcome. A treatment method with less functional interference should be developed, particularly for patients anticipated to be in poor functional state postoperatively.

Methicillin-resistant Staphylococcus aureus infection after living-donor liver transplantation in adults

BACKGROUND

Methicillin-resistant Staphylococcus aureus (MRSA) infection frequently complicates the postoperative course in deceased-donor liver transplantation. The incidence and risk factors of MRSA infection after Living-donor Liver transplantation (LDLT), however, are unclear.

METHODS

We retrospectively reviewed the data from 242 adult patients who underwent LDLT at the University of Tokyo Hospital. The microbiologic and medical records of the patients from admission to 3 months after LDLT were reviewed. Uni- and multivariate analyses were performed to identify the independent risk factors for postoperative MRSA infection.

RESULTS

Postoperative MRSA infection occurred in 25 of 242 patients by median postoperative day 23. Preoperative MRSA colonization, preoperative use of antimicrobials, operation time (> or =16 h), and postoperative apheresis independently predicted postoperative MRSA infection.

CONCLUSION

Surveillance culture should be checked periodically after admission to identify patients at high risk for MRSA infection and to administer appropriate antimicrobials for perioperative infection. Postoperative apheresis, suggesting postoperative liver dysfunction, predisposed patients to MRSA infection.

Genetic analysis of multifocal superficial urothelial cancers by array-based comparative genomic hybridisation

The purpose of this study was to investigate the accumulation of genetic alterations during metachronous and/or synchronous development of multifocal low-grade superficial urothelial tumours in the same patient, by using array-based comparative genomic hybridisation (array-CGH) and FGFR mutation analysis. We analysed 24 tumours (pTa-1 G1-2) from five patients. We had previously identified a clonal relationship among the tumours of each patient by microsatellite analysis. This time, unsupervised hierarchical cluster analysis revealed that the tumours from each patient were clustered together independently of the tumours from the other patients. All of the tumours from a single patient showed a set of 2–7 identical regional or whole-arm chromosomal changes. In addition, several individual alterations were also found. Cladistic diagrams revealed that the accumulation of genetic alterations could not be explained by a linear model, and the existence of a hypothetical precursor cell was assumed in four patients. In some cases, FGFR mutation seemed to occur later during multifocal tumour development. Taken together, these findings suggest that low-grade superficial urothelial tumours accumulate minor genetic alterations during multifocal development, although these tumours are genetically stable.

Direct observation of the bandwidth-disorder induced variation of charge/orbital ordering structure in RE(0.5)(Ca(1-y)Sr(y))(1.5)MnO(4)

Changes in the charge/orbital ordering (CO/OO) structure with the bandwidth of the e(g) band and quenched disorder were investigated in doped manganites RE(0.5)(Ca(1-y)Sr(y))(1.5)MnO(4)(RE = Pr,Eu) with a single-layer perovskite structure. A systematic study of the modulation structure associated with the CO/OO phase demonstrated that the long-range commensurate structure changes to a short-range incommensurate structure with increasing Sr content through the enhancement of the bandwidth and quenched disorder in these systems. At the same time, the transition temperature of CO/OO (T(CO/OO)) decreases. Changes in structure and T(CO/OO) with different A-site combinations reveal that the CO/OO phase is strongly suppressed by the widening of the e(g) band and the stronger quenched disorder in these layered manganites.

Polymorphisms of norepinephrine transporter and adrenergic receptor alpha1D are associated with the response to beta-blockers in dilated cardiomyopathy

Recent clinical trials have clearly demonstrated that the administration with beta-blockers decreases the mortality in the patients with chronic heart failure (CHF). However, significant heterogeneity exists in the effectiveness of beta-blockers among individual cases. We focused on 39 polymorphisms in 16 genes related to adrenergic system and investigated their association with the response to beta-blockers among 80 patients with CHF owing to idiopathic dilated cardiomyopathy. The polymorphisms of NET T-182C (P=0.019), ADRA1D T1848A (P=0.023) and ADRA1D A1905G (P=0.029) were associated with the improvement of left ventricular fractional shortening (LVFS) by beta-blockers. Furthermore, combined genotype analysis of NET T-182C and ADRA1D T1848A revealed a significant difference in LVFS improvement among genotype groups (P=0.011). These results suggest that NET (T-182C) and ADRA1D (T1848A and A1905G) polymorphisms are predictive markers of the response to beta-blockers. Genotyping of these polymorphisms may provide clinical insights into an individual difference in the response to the beta-blocker therapy in CHF.