Effectiveness of patient and staff cohorting to reduce the risk of vancomycin-resistant enterococcus (VRE) acquisition: a retrospective cohort study during a VRE outbreak in Japan

BACKGROUND

Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting.

METHODS

Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared.

FINDINGS

Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when susceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62-10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61-35.40).

CONCLUSION

Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors.

[Long-Term Survival of a Patient with Hepatocellular Carcinoma after Surgical Resection of Metachronous Hilar Lymph Node Metastases]

The recurrence of hepatocellular carcinoma(HCC)is primarily due to intrahepatic metastases. Additionally, extrahepatic HCC metastases most commonly occurs in the lungs, lymph nodes, adrenal glands, and bones. Systemic chemotherapy is the standard treatment for extrahepatic metastases. Although several reports on surgical resection of lymph node metastases (LNM) in patients with HCC have been published, its clinical benefits remain controversial. We report a case in which surgical resection of LNM was performed in a patient with HCC. The patient was a 74-year-old woman diagnosed with HCC and non-B non-C chronic hepatitis, for which she underwent a laparoscopic partial hepatectomy. The pathological diagnosis was St-A, 1.6×1.4 cm, confluent multinodular type, pT1N0M0, fStage Ⅰ. Nine months later, 2 LNM on the liver hilum were detected and managed with sorafenib. Sorafenib was discontinued after 2 months due to the development of Grade 3 hand-foot syndrome. Since no new lesions were detected on follow-up, lymph node resection was performed. The patient remains disease-free 4.5 years postoperatively.

A case of intraductal papillary neoplasm of the bile duct accompanied by intraductal papillary mucinous neoplasm of the pancreas and hepatocellular carcinoma

A 73-year-old man with mixed-type intraductal papillary mucinous neoplasm of the pancreas body was followed up for 14 years. Based on imaging findings, the intraductal papillary mucinous neoplasm of the pancreas met the high-risk stigmata, and new hepatic masses were suspected to be intraductal papillary neoplasms of the bile duct. With a diagnosis of intraductal papillary mucinous neoplasm of the pancreas and intraductal papillary neoplasm of the bile duct, the patient had undergone left lateral hepatectomy and distal pancreatectomy. Based on pathology, the pancreatic specimen was diagnosed as a high-grade intraductal papillary mucinous neoplasm of the pancreas, and the hepatic specimen was diagnosed as an intraductal papillary neoplasm of the bile duct and hepatocellular carcinoma. The intraductal papillary neoplasms of the bile duct and hepatocellular carcinoma were adjacent to each other. Fifteen months after surgery, recurrence in the remnant pancreas was detected. The patient had undergone residual total pancreatectomy, with no recurrence thirty months after the second resection. This case demonstrates that second surgery for metachronous high-risk lesions in the remnant pancreas of patients with intraductal papillary mucinous neoplasm of the pancreas and intraductal papillary neoplasm of the bile duct may also be considered to improve survival.

Hepatocellular carcinoma recurrence in the extrahepatic bile duct wall: A case report

We should know that hepatocellular carcinoma can progress as if it replaces the bile duct wall itself.

[A Case of Complete Resection Using the Liver-First Approach after Systemic Chemotherapy in a Patient with Synchronous Colorectal Liver and Lung Metastases]

Conversion surgery for patients with initially unresectable colorectal liver metastases is increasingly being performed because of effective systemic chemotherapy. Additionally, many studies have reported the benefit of the liver-first approach for advanced liver metastasis. We report a case of an initially unresectable advanced colon cancer with multiple liver and lung metastases that was successfully treated with the liver-first approach following chemotherapy. The patient was a 36-year- old woman who was diagnosed with advanced rectal cancer, cT4aN2aM1b, cStage Ⅳb. After a temporary transverse colostomy, she was administered systemic chemotherapy for 9 months. The primary tumor and liver metastases showed partial response while the lung metastases showed complete response. Since it was considered that liver metastases were the main prognostic factors, we performed a right hemihepatectomy plus S3 partial hepatectomy, followed by laparoscopic high anterior resection. A partial pneumonectomy was also performed because of the regrowth of the lung metastases, and we succeeded in complete resection. The liver-first approach was a beneficial treatment option for this patient with unresectable colorectal liver metastases.

A case of laparoscopic anterior resection for rectal cancer with duplication of the inferior vena cava using preoperative 3D computed tomography angiography

We report the case of a patient with duplication of the inferior vena cava (DIVC) who underwent anterior laparoscopic resection for rectal cancer. A 66-year-old woman presented with abnormal lung shadows on a chest x-ray during a routine health checkup. She was diagnosed with rectal cancer and lung metastasis using colonoscopy and thoracoabdominal computed tomography (CT). In addition, a 3D CT angiography revealed double inferior vena cava, one on either side of the aorta. The preoperative diagnosis was rectal cancer cT3N0M1a(Lung) cStage IVA with DIVC, and a two-stage surgery was planned. The first stage was high anterior laparoscopic resection. This was safely performed because the pre-hypogastric nerve fascia was preserved and the left inferior vena cava was not visualized during the surgery. During the second stage of the surgery, video-assisted thoracoscopic left lower lobectomy was performed and no recurrence was observed for >6 months after the second surgery.

New isoflavone glucosides in yabumame (Amphicarpaea bracteata (L.) Fernald subsp. edgeworthii (Benth.) H.Ohashi var. japonica (Oliv.) H.Ohashi) and their effect on leukotriene B4 production in mast cells

Yabumame (Amphicarpaea bracteata (L.) Fernald subsp. edgeworthii (Benth.) H.Ohashi var. japonica (Oliv.) H.Ohashi) is a legume plant that the Ainu people eat as a traditional food, although the bioactive ingredients other than vitamins have not been studied. In this study, the structures of yabumame isoflavone glucosides were determined and their effect on leukotriene (LT) B₄, a chemical mediator of type I allergy, produced in mast cells, was investigated in vitro. Seven compounds were isolated from yabumame. Their structures were determined by spectroscopic and spectrometric analyses, which were genistein-7-O-β-D-glucoside (1), formononetin-7-O-(2″-O-β-D-glucosyl)-β-D-glucoside (2), formononetin-7-O-β-D-glucoside (3), biochanin A-7-O-(2″-O-β-D-glucosyl)-β-D-glucoside (4), formononetin-7-O-(6″-O-malonyl)-β-D-glucoside (5), biochanin A-7-O-(2″-O-β-D-glucosyl-6″-O-β-D-glucosyl)-β-D-glucoside (6), and biochanin A-7-O-(6″-O-malonyl)-β-D-glucoside (7). Compounds 2, 4, and 6 were determined as new compounds. Compound 3 showed statistically significant suppressive effect on LTB₄ production in mast cells, although the activity was not strong. On the other hand, biochanin A, an aglycone common to compounds 4, 6, and 7, strongly inhibited the LTB₄ production. The results suggest that some of yabumame isoflavone glucosides might contribute to mitigate type I allergy. Seven isoflavone glucosides including 3 new compounds were found in yabumame and their anti-allergic effect was evaluated.

Effects of the time-of-day (morning vs. afternoon) of implementing a combined physical and cognitive exercise program on cognitive functions and mood of older adults: A randomized controlled study

This study examined the effects of the time of conducting a combined physical and cognitive exercise program on cognitive functions and the mood of older adults. We randomly assigned 17 participants (8 men, 9 women, age 73,24±3,75) to the morning group (AM Group), 18 (8 men, 10 women, age 73,11±4,84) to the afternoon group (PM Group), and they completed a 12-week, dual-task exercise program in the morning or the afternoon, respectively. Moreover, the waiting-list control group consisted of 12 participants (6 men, 6 women, age 73,25±5,93). The cognitive functions and the mood of the participants were assessed before and after the program by using the Neurobehavioral Cognitive Status Examination, and the short version of the Profile of Mood States, respectively. As a result, the exercise program conducted in the afternoon had broader effects on cognitive functions (increased Repetition and Memory) than in the morning (increased Repetition), or the waiting-list control group (increased Judgment). Moreover, the program in the afternoon tended to reduce Anger-Hostility, and Fatigue. In conclusion, conducting the exercise program in the afternoon might be more effective for improving cognitive functions and the mood of older adults than in the morning. However, there was heterogeneity between the groups despite the randomization. Therefore, we suggest conducting a more rigorously controlled study using a larger sample to validate these findings.

Laparoscopic anatomical segment 3 segmentectomy for hepatocellular carcinoma accompanied by hypoplasia of the right hepatic lobe

We report a case of laparoscopic anatomical segment 3 segmentectomy for hepatocellular carcinoma (HCC) accompanied by hypoplasia of the right hepatic lobe. An 80-year-old man was admitted with a suspicion of HCC diagnosed by computed tomography during follow-up for thyroid cancer. Dynamic computed tomography showed 40-mm HCC in segment 3 and hypoplasia of the right hepatic lobe with the Chilaiditi sign. We performed laparoscopic anatomical segment 3 segmentectomy. There were no postoperative complications, and the patient was discharged 6 days postoperatively. This procedure can be performed safely and is technically feasible, but special attention should be paid to anatomical alterations to avoid fatal surgical complications.

Supramolecular chemistry of pillar[n]arenes functionalised by a copper(i)-catalysed alkyne-azide cycloaddition "click" reaction

Since we discovered pillar[n]arenes in 2008, many chemists have developed a strong interest in pillar[n]arene chemistry because of the many advantages associated with these materials, including their facile and high yielding synthesis, versatile functionality, planar chirality and unique host-guest properties. In this feature article, we discuss recent advances in the field of supramolecular chemistry based on the use of pillar[n]arenes as substrates for copper(i)-catalysed alkyne-azide cycloaddition (CuAAC) "click" chemistry. The CuAAC reaction provides facile access to 1,4-disubstituted triazoles by a reaction between alkyne and azido substrates in the presence of a Cu(i) catalyst. Pillar[n]arenes bearing alkyne or azido groups can therefore be used as substrates for this reaction. Herein, we discuss not only the synthesis of pillar[n]arenes bearing alkyne or azido groups but also the application of these functionalised systems to the CuAAC reaction to construct supramolecular assemblies. We also discuss the rational molecular design and synthesis of guest compounds using the CuAAC reaction because linear alkanes sandwiched between 1,2,3-triazole moieties are good guests for cyclic pentamer pillar[5]arenes.

Botanical origin of Mei-gui Hua in Chinese markets

The petals or buds of Rosa species have been used as an important Chinese crude drug called "Mei-gui Hua" and also an ingredient for herbal tea in China. The 15 flavonol glycosides in 34 commercially available "Mei-gui Hua" were quantitatively determined by UPLC, and the data were compared with those of known Rosa sp. belong to Cinnamomeae, Gallicanae, Caninae and Synstylae by principal component analysis for the estimation of original plants of these "Mei-gui Hua". Seven samples were classified into two groups (Types A and B) composed of species in Gallicae and Synstilae and 11 samples into a group (Type D) composed of species in Cinnamomeae. Six samples were plotted among Types B, C and D. However, nine samples were shown to form a new group (Type F), and the original plants of these samples were assumed to be more complex hybrids of Rosa species including other sections than Cinnamomeae, Gallicanae, Caninae and Synstylae. This method must be useful and convenient to estimate the origin of crude drug "Mei-gui Hua" commercially available in markets. The results of this study also demonstrated that "Mei-gui Hua" commercially available in Chinese market must be prepared from hybrids of various species of Rosa, and it is not reasonable to assign only R. rugosa as scientific name of the origin plants.

Effects of reduced-volume of sprint interval training and the time course of physiological and performance adaptations

This study sought to determine the time course of training adaptations to two different sprint interval training programmes with the same sprint: rest ratio (1:8) but different sprint duration. Nine participants (M: 7; F: 2) were assigned to 15-second training group (15TG) consisting of 4-6 × 15-second sprints interspersed with 2-minute recovery, whereas eight participants (M: 5; F: 3) were assigned to 30-second training group (30TG) consisting of 4-6 × 30 second sprints interspersed with 4-minute recovery. Both groups performed their respective training twice per week over 9 weeks and changes in peak oxygen uptake (V˙O2peak) and time to exhaustion (TTE) were assessed every 3 weeks. Additional eight healthy active adults (M: 6; F: 2) completed the performance assessments 9 weeks apart without performing training (control group, CON). Following 9 weeks of training, both groups improved V˙O2peak (15TG: 12.1%; 30TG: 12.8%, P<.05) and TTE (15TG: 16.2%; 30TG: 12.8%, P<.01) to a similar extent. However, while both groups showed the greatest gains in V˙O2peak at 3 weeks (15TG: 16.6%; 30TG: 17.0%, P<.001), those in TTE were greatest at 9 weeks. CON did not change any of performance variables following 9 weeks. This study demonstrated that while the changes in cardiorespiratory function plateau within several weeks with sprint interval training, endurance capacity (TTE) is more sensitive to such training over a longer time frame in moderately-trained individuals. Furthermore, a 50% reduction in sprint duration does not diminish overall training adaptations over 9 weeks.

Selective Play: Choosing Partners in an Uncertain World

The theoretical implications of introducing the “selective play” paradigm to experimental gaming research are discussed. In the traditional “forced play” environment, players are locked in a particular relationship and do not have options of leaving the current relationship and joining another. In the selective play environment players are given the options of leaving the current relationship andforming a new relationship. A previous computer tournament of prisoner's dilemma network (Hayashi, 1993) showed that out-for-tat (OFT) strategy performed very well in the selective play environment. OFT keeps cooperating with a partner until the partner defects; it deserts the partner and turns to someone else as soon as the partner defects. Results of a new computer tournament that introduced opportunity costs, however, point to the limits of the OFT's strength. OFT prematurely forms a commitment relationship with a cooperative partner and fails to utilize better opportunities. The best performer in the second tournament was the only one who was “trustful” and had a positive bias in calculating the expected payoff of interactions with a “stranger.”

Persistent Urinary Incontinence After Nephrectomy: A Case of Inverted-Y Ureteral Duplication with Ectopic Ureteral Insertion into the Vagina

Inverted-Y ureteral duplication is one of the rarest anomalies of ureteral branching. We encountered a 20-year-old female patient with persistent incontinence even after nephrectomy for ectopic ureteral insertion into the vagina. She had inverted-Y ureteral duplication between the bladder and vagina, and urine was being transported from the bladder to the vagina. To the best of our knowledge, this is a rare case of inverted-Y ureteral duplication with ectopic ureteral insertion into the vagina as well as the ureter into the bladder, which became apparent due to persistent urinary incontinence even after nephrectomy.

Successful control of an outbreak of GES-5 extended-spectrum β-lactamase-producing Pseudomonas aeruginosa in a long-term care facility in Japan

BACKGROUND

Little is known about multidrug-resistant Pseudomonas aeruginosa (MDRP) outbreaks in long-term care facilities (LTCFs).

AIM

To describe an MDRP outbreak in an LTCF and to clarify risk factors for MDRP acquisition.

METHODS

Patients who were positive for MDRP at an LTCF from January 2013 to January 2014 were analysed. A descriptive analysis, a case-control study, and a microbiological analysis were performed.

FINDINGS

A total of 23 MDRP cases were identified, 16 of which were confirmed in sputum samples. Healthcare workers were observed violating hand hygiene procedures when performing oral, wound, and genital care. Nasogastric tube and oxygen mask use was associated with MDRP acquisition in the respiratory tract, which might have been confounded by poor hand hygiene. Sharing unhygienic devices, such as portable oral suction devices for oral care, and washing bottles and ointments for wound and genital care with inadequate disinfection could explain the transmission of MDRP in some cases. Isolates from 11 patients were found to be indistinguishable or closely related by pulsed-field gel electrophoresis and harbouring the blaGES-5 gene. Subsequent enhanced infection control measures were supported by nearby hospitals and a local public health centre. No additional cases were identified for a year after the last case occurred in January 2014.

CONCLUSION

An outbreak of MDRP with an antimicrobial resistance gene, blaGES-5, occurred in a Japanese LTCF. It was successfully controlled by enhanced infection control measures, which neighbouring hospitals and a local public health centre supported.

[INTRAVESICAL MIGRATION OF A HEM-O-LOK CLIP AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: A CASE REPORT]

The Hem-o-lok clips (HOLC) is frequently used for hemostasis of the lateral pedicles in robot-assisted prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP). We report a rare post-operative complication, the migration of a HOLC into the bladder leading to calculus formation after RARP. A 54 year-old man underwent RARP with nerve- sparing procedure with HOLCs in the left neurovascular bundle. Three months later, he was referred to our hospital for pollakisuria and spontaneous hematuria. Abdominal ultrasonographic examination and computed tomography (CT) demonstrated a bladder stone that was 7 mm in diameter. On cystourethroscopy, he was noted to have a yellow-colored stone at 9 o'clock position of vesicourethral anastomosis. A cystolithotripsy for a bladder stone was performed until the surface of it was broken. A HOLC with a calculus was revealed and retrieved by stone forceps through the urethra. Since then, Intravesical migration of a HOLC has not been observed.

Flavonol glycosides in the petal of Rosa species as chemotaxonomic markers

Thirteen flavonol glycosides were isolated from the petals of Rosa species belonging to the section Gallicanae, and their structures were identified from their spectroscopic data. These flavonol glycosides, along with two flavonol glycosides isolated from Rosa rugosa, in the petals of 31 Rosa species belonging to sections Gallicanae, Cinnamomeae, Caninae, and Synstylae were quantitatively analyzed by UPLC. The results indicated that the species belonging to these sections could be classified into four types (Type A, B, C and D) based on the pattern of flavonol glycoside contents, whereas the R. rugosa flavonol glycosides were detected only in section Cinnamomeae. A principal components analysis (PCA) calculated from the 15 flavonol glycosides contained in these samples supported the presence of four types. The distribution of the species in Type D (a group of Cinnamomeae) was shown to reflect close interrelationships, but species in Type B (one group of Gallicanae) could be subdivided into two groups, one of which contained species in section Synstylae. Moreover, the flavonol glycosides were grouped by sugar moieties: a disaccharide composed of two hexoses (S1), a hexose (S2), including a hexose with galloyl group, a pentose (S3), and a disaccharide composed of a hexose and a pentose (S4). The ratios of the amounts of S1-S4 to total flavonol glycoside content indicated that differences among the four sections were more distinctive than the amounts of the 15 flavonol glycosides. The 31 samples were divided into Type B, composed of one type of Gallicanae and Synstylae, Type A+C, composed of another type of Gallicanae and Caninae, and Type D, composed of Cinnamomeae. The R. rugosa flavonol glycosides were shown to be important chemotaxonomic markers for the classification of species in Cinnamomeae, and this method of using flavonol glycosides as chemotaxonomic markers could be useful for the identification of Rosa species belonging to sections Gallicanae, Cinnamomeae, Caninae, and Synstylae.

Occurrence of piperidine alkaloids in Piper species collected in different areas

A simple and convenient method was established for simultaneous quantitative determination of piperine and piperlonguminine in dried fruits of Piper longum and allied plants. The average content of piperine in P. longum (18.26 mg/g, range 12.05-33.23 mg/g) was about one half that of P. nigrum (40.09 mg/g, range 29.57-54.23 mg/g), but the content of piperlonguminine in P. longum was in the range of 0.42-1.82 mg/g, and the average content of piperlonguminne (0.91 mg/g) was about seven times higher than that in P. nigrum (0.13 mg/g). A sample of P. longum from Vietnam and a sample of P. retrofractum collected in Ishigaki, Japan, showed high contents of piperine and piperlonguminine. On the other hand, a sample of P. betle collected in Taiwan showed low content of piperine, and piperlonguminine was not detected.

Pillar[5]- and pillar[6]arene-based supramolecular assemblies built by using their cavity-size-dependent host–guest interactions

We discuss various pillar[5]- and pillar[6]arene-based supramolecular assemblies built using their host–guest interactions.

Cognitive factors affecting free recall, cued recall, and recognition tasks in Alzheimer's disease

BACKGROUND/AIMS

Our aim was to identify cognitive factors affecting free recall, cued recall, and recognition tasks in patients with Alzheimer's disease (AD).

SUBJECTS

We recruited 349 consecutive AD patients who attended a memory clinic.

METHODS

Each patient was assessed using the Alzheimer's Disease Assessment Scale (ADAS) and the extended 3-word recall test. In this task, each patient was asked to freely recall 3 previously presented words. If patients could not recall 1 or more of the target words, the examiner cued their recall by providing the category of the target word and then provided a forced-choice recognition of the target word with 2 distracters. The patients were divided into groups according to the results of the free recall, cued recall, and recognition tasks. Multivariate logistic regression analysis for repeated measures was carried out to evaluate the net effects of cognitive factors on the free recall, cued recall, and recognition tasks after controlling for the effects of age and recent memory deficit.

RESULTS

Performance on the ADAS Orientation task was found to be related to performance on the free and cued recall tasks, performance on the ADAS Following Commands task was found to be related to performance on the cued recall task, and performance on the ADAS Ideational Praxis task was found to be related to performance on the free recall, cued recall, and recognition tasks.

CONCLUSION

The extended 3-word recall test reflects deficits in a wider range of memory and other cognitive processes, including memory retention after interference, divided attention, and executive functions, compared with word-list recall tasks. The characteristics of the extended 3-word recall test may be advantageous for evaluating patients' memory impairments in daily living.

Cryopreservation of the model alga Ectocarpus (Phaeophyceae)

The brown alga Ectocarpus has recently become the first fully sequenced multicellular alga and is an important biological model. Due to the large and growing number of Ectocarpus strains isolated and maintained by the research community, including increasing numbers of mutants, there is an urgent need for developing reliable, cost-effective long-term maintenance techniques. We report here that cryopreservation constitutes an attractive option in this respect, using a simple two-step protocol employing combined DMSO 10 percent (v/v) and sorbitol 9 percent (w/v) as cryoprotectants. This model organism appears to be remarkably robust and post-cryo recovery has been observed in all strains tested in this study. Cultures can be regenerated by the germination of cryopreserved zooids (spores), or the recovery of vegetative cells. In the latter case, dividing surviving cells may grow into the cell lumen of a neighbouring dead cell, eventually regenerating a phenotypically normal thalloidal structure.

SU-E-T-497: Study of Restricted Mass Stopping Power Ratio in Small Electron Tube Fields

PURPOSE

Electron tubes with small radii are useful to treat narrow regions which cannot accommodate normal electron applicators. In small electron fields, it is not trivial to estimate restricted mass stopping power ratio (MSR), which is needed to evaluate dose from ion chamber measurement. We studied MSRs in small electron tube fields using the Monte Carlo simulation.

METHODS

Electron tubes with radii, 3 and 2.5 cm, were used in this study. Nominal electron energies were 6 and 9 MeV. There were two types of tubes. One has a normal cut but the other has a 45-degree cut. For the normal cut tube, percent depth dose (PDD) in water was evaluated along the center of axis (CAX) of a beam. For the 45-degree cut tube, PDD was evaluated along the vertical line from the intersection of the CAX and the phantom surface with 45-degree gantry angle. The MSRs and mean electron energies were calculated using the Monte Carlo simulation.

RESULTS

We found good agreement between the measured and calculated PDDs. The changes of mean energies from those in the 10×10 cm² field at the depth of maximum dose (dmax) were very small for the normal cut electron tubes. For the 45-degree cut tubes, the changes of mean energies at dmax were less than 1 MeV. The MSRs in the normal cut tube fields were almost the same as those in the 10×10 cm² field at the corresponding depths. The MSRs for the 45-degree cut tubes deviated from those in the 10×10 cm² by about 1% (1.5 % at most).

CONCLUSIONS

We evaluated the mean energies and MSRs in small electron tube fields. The deviations of them from the values in the 10×10 cm² were small. The maximum difference of MSR was 1.5% in 45-degree cut tube fields. This work was supported by KAKENHI (23791449), Japan Society for the Promotion of Science, and Cancer Professional Training Plan, The Ministry of Education, Culture, Sports, Science and Technology, Japan.

Simultaneous determination of hydrolysable tannins in the petals of Rosa rugosa and allied plants

The petals of Rosa rugosa and allied plants for medicinal use contain abundant hydrolysable tannins, and they show remarkable biological activities. The activities are dependent on the structures of the hydrolysable tannins, so their contents and compositions are essential for evaluation of medicinal potency. Therefore, we optimized the simultaneous quantitative determination of the hydrolysable tannins using ultra-performance liquid chromatography. A column of ethylene bridged hybrid (BEH) phenyl (C(6) alkyl phenyl group as solid-phase modification) was shown to be most effective for the separation of hydrolysable tannins isolated from R. rugosa and related compounds when the column temperature was kept under 25 degrees C. The efficacy of the BEH phenyl column might be due to the interaction between solid phase and phenolic ester groups of hydrolysable tannins such as galloyl, hexahydroxydiphenoyl and valoneoyl groups. The relation between the retention times on the BEH phenyl column and the column temperature was demonstrated to depend on the structural characteristics of hydrolysable tannins.

Evaluation of unexpected positive results from a commercial ELISA for antibodies to PRRSV

Unexpected positive results from the widely used IDEXX ELISA for the detection of antibodies to porcine reproductive and respiratory syndrome virus (PRRSV) may confound investigations of the disease. Supplementing the ELISA with blocking agents and the use of IgG purified from serum samples had no effect on the unexpected positive results, suggesting that they were due to an antibody-antigen reaction. Simple competitive and blocking ELISAs were developed by modifying the IDEXX ELISA, and they and an indirect fluorescent antibody test (IFAT) were used to examine PRRSV antibodies in 33 antibody-negative, 88 antibody-positive and 73 unexpectedly positive sera. All the unexpectedly positive sera were negative by IFAT, and 89.0 per cent were negative by both the competitive and blocking ELISAs. The competitive ELISA (97.7 per cent) and the blocking ELISA (96.5 per cent) detected more positive sera than the IFAT (90.9 per cent). These results show that both ELISAs are capable of distinguishing positive and unexpectedly positive sera, and suggest that most of the unexpected positive signals are false-positives.

Effect of triterpenoids isolated from the floral spikes of Betula platyphylla var. japonica on P-glycoprotein function

One of the major causes of multidrug resistance (MDR) in cancer cells is over-expression of P-glycoprotein (P-gp). We studied the effects of 20 triterpenes isolated from the floral spikes of Betula platyphylla var. japonica ( B. platyphylla) on P-gp function based on our previous finding that some of them showed MDR reversing effects. We evaluated accumulations and effluxes of rhodamine 123 as a P-gp substrate with P-gp over-expressing KB-C2 cells. Among the 20 triterpenes, compounds 3, 4, 8, 9, 13, 15, and 20 increased rhodamine 123 accumulations in KB-C2 cells, and three ( 8, 13, and 20) of them also inhibited efflux of rhodamine 123 out of cells. In addition, compounds 13 and 20 showed a weak inhibitory activity of P-gp ATPase. These results suggested that MDR reversing effects of compounds 13 and 20 are partly involved in inhibition of P-gp ATPase.

Changes in evaluation of the pepsinogen test result following Helicobacter pylori eradication therapy in Japan

AIMS

The pepsinogen (PG) test result is used in Japan for screening for gastric cancer. In this study, we investigated the changes in evaluation of the PG test result following H. pylori eradication.

METHODS

The subjects were 120 consecutive H. pylori-positive patients with upper gastrointestinal symptoms. Subjects underwent endoscopy prior to, and at 2 months after the eradication therapy, at which time blood was taken for determination of changes in PG levels.

RESULTS

The overall eradication rate was 79.3% (per protocol). Following eradication therapy, the evaluation of PG test result converted from positive to negative in 80.4% (37/46) of cases of successful eradication, and in 0% (0/6) of cases of eradication failure.

CONCLUSIONS

These results suggest that the evaluation of PG test result should be used after the definitive confirmation of the success or failure of H. pylori eradication therapy.

Triterpenoids from the floral spikes of Betula platyphylla var. japonica and their reversing activity against multidrug-resistant cancer cells

Four new triterpenes, together with 16 known triterpenes, were isolated from the floral spikes of Betula platyphylla var. japonica in a search for compounds capable of reversing multidrug resistance in cancer cells. The structures of the new triterpenes were elucidated as 3,4-seco-olean-4(23),13(18)-dien-3-oic acid (1), 3,4-seco-urs-4(23),20(30)-dien-3-oic acid (2), 3-O-methylmalonylepiocotillol II (6), and 3-O-methylmalonylcabraleahydroxylactone (16) by spectroscopic examination. The cytotoxicity of the isolated triterpenes against human cancer cell lines as well as multidrug-resistant cancer cell lines was evaluated. Most of the isolated triterpenes showed very weak cellular toxicities. Although no discernible differences were found in the cytotoxicities for the tested compounds against sensitive and resistant cell lines, the cytotoxicities for several triterpenes against multidrug-resistant cancer cell lines (KB-C2 or K562/Adr) were enhanced in the presence of nontoxic concentrations of colchicine or doxorubicin. Compound 10 reversed the cytotoxicity of colchicine against KB-C2 cells at 8.1 microM and showed comparable potency to 5 microM verapamil.

Carotid artery calcification seen on panoramic dental radiographs in the Asian population in Japan

OBJECTIVES

To determine the frequency of carotid artery calcification (CAC) seen on panoramic dental radiographs, the relationship between the condition and a history of cerebral infarction (CI), and the history of the risk factors of CI in patients in Japan.

METHODS

A total of 2374 individuals whose panoramic radiographs were obtained at their first consultation were reviewed.

RESULT

CAC was found in 95 subjects (4.0%) and was found at a higher frequency in patients with a history of CI than in those without a history of CI. The modifiable risk factors (a history of hypertension, diabetes and hypercholesterolaemia) and CAC showed significant relationship in the chi(2) test for pairwise comparison. When age and gender were added and all of these risk factors were considered simultaneously in the multiple logistic regression analysis, age and history of hypercholesterolaemia remained statistically significant.

CONCLUSIONS

CAC may be seen on panoramic dental radiographs and is related to the patients' general history of CI, and the risk factors of CI in the Asian population in Japan.