Community-Acquired Severe Clostridium difficile Enteritis Complicated by Metabolic Acidosis and Acute Kidney Injury.

Clostridium difficile (CD) is known to be pathogenic when the balance of intestinal microbiota is disrupted by the administration of broad-spectrum antimicrobial agents. Therefore, CD enteritis is often suspected in cases of hospital-onset diarrhea. There has been a rise in the incidence of community-acquired CD enteritis in recent years in the United States. In this report, we present a case of a 57 year-old-man who was admitted to the emergency department with abdominal distension and dyspnea. The patient suffered from acute renal failure and metabolic acidosis from enteritis. He required mechanical ventilation and continuous renal replacement therapy (CRRT) in the ICU. Analysis of the patient's stool sample on admission revealed the presence of CD antigens, and the prompt administration of metronidazole led to swift improvement. No studies have investigated the actual incidence of community-acquired CD enteritis infection in Japan. Since 20% of community-acquired CD enteritis cases have been reported as severe, all cases of community-acquired enteritis should raise concerns for CD enteritis. CD antigen/toxin in the stool should then be determined promptly before administering antibiotics.

Castration Induces Down-Regulation of A-Type K+ Channel in Rat Vas Deferens Smooth Muscle.

A-type K+ channels contribute to regulating the propagation and frequency of action potentials in smooth muscle cells (SMCs). The present study (i) identified the molecular components of A-type K+ channels in rat vas deferens SMs (VDSMs) and (ii) showed the long-term, genomic effects of testosterone on their expression in VDSMs. Transcripts of the A-type K+ channel α subunit, Kv4.3L and its regulatory ß subunits, KChIP3, NCS1, and DPP6-S were predominantly expressed in rat VDSMs over the other related subtypes (Kv4.2, KChIP1, KChIP2, KChIP4, and DPP10). A-type K+ current (IA) density in VDSM cells (VDSMCs) was decreased by castration without changes in IA kinetics, and decreased IA density was compensated for by an oral treatment with 17α-methyltestosterone (MET). Correspondingly, in the VDSMs of castrated rats, Kv4.3L and KChIP3 were down-regulated at both the transcript and protein expression levels. Changes in Kv4.3L and KChIP3 expression levels were compensated for by the treatment with MET. These results suggest that testosterone level changes in testosterone disorders and growth processes control the functional expression of A-type K+ channels in VDSMCs.

Successful Treatment of a Case of Necrotizing Fasciitis due to Vibrio vulnificus in a Cold Climate in Japan.

Vibrio vulnificus infection often occurs in warm regions, frequently leading to necrotizing fasciitis, sepsis, and death. We herein report a rare case presenting in a cold climate region in northern Japan, Aomori district, of a V. vulnificus infection complicated by necrotizing fasciitis and septic shock. The patient's prior history of injury and typical clinical course were helpful clues to the diagnosis of V. vulnificus infection, and early initiation of antimicrobial treatment saved his life. V. vulnificus infection should be considered even in cold regions, particularly if patients have risk factors.

Acotiamide hydrochloride (Z-338) enhances gastric motility and emptying by inhibiting acetylcholinesterase activity in rats.

In clinical trials, acotiamide hydrochloride (acotiamide: Z-338) has been reported to be useful in the treatment of functional dyspepsia. Here, we investigated the effects of acotiamide on gastric contraction and emptying activities in rats in comparison with itopride hydrochloride (itopride) and mosapride citrate (mosapride). We also examined in vitro the compound's inhibitory effect on acetylcholinesterase (AChE) activity derived from rat stomach. In in vivo studies, acotiamide (30 and 100mg/kg s.c.) and itopride (100mg/kg s.c.) markedly enhanced normal gastric antral motility in rats. In gastric motility dysfunction models, acotiamide (100mg/kg s.c.) and itopride (100mg/kg s.c.) improved both gastric antral hypomotility and the delayed gastric emptying induced by clonidine, an α(2)-adrenoceptor agonist. In contrast, mosapride (10mg/kg s.c.) had no effect on these models. Like the AChE inhibitors itopride (30 mg/kg s.c.) and neostigmine (10 µg/kg s.c.), acotiamide (10mg/kg s.c.) also clearly enhanced gastric body contractions induced by electrical stimulation of the vagus, which were abolished by atropine and hexamethonium, whereas mosapride (3 and 10mg/kg s.c.) did not. In in vitro studies, acotiamide concentration-dependently inhibited rat stomach-derived AChE activity (IC(50)=2.3 µmol/l). In addition, stomach tissue concentrations of acotiamide after administration at 10mg/kg s.c. were sufficient to produce inhibition of AChE activity in rat stomach. These results suggest that acotiamide stimulates gastric motility and improves gastric motility dysfunction in rats by inhibiting AChE activity, and may suggest a role for acotiamide in improving gastric motility dysfunction in patients with functional dyspepsia.

Production of human ß-actin and a mutant using a bacterial expression system with a cold shock vector.

Actin is the most abundant protein in the cytoplasm of most eukaryotic cells and is involved in a variety of cellular functions. It has been difficult to produce actin in bacterial expression systems in good yields. In this study, we developed a new simple method for the production of recombinant actin in Escherichia coli cells. Human ß-actin was successfully expressed using a cold shock vector, pCold, in the bacterial expression system. The expressed ß-actin (hexahistidine-tagged) was separated with a Ni-chelating resin, followed by a polymerization/depolymerization cycle or column chromatography with the Ni-chelating resin. The purified recombinant ß-actin showed a normal polymerization ability compared with ß-actin purified from human platelets. We produced a recombinant mutant actin with a Gly-168Arg mutation in the system and confirmed that it exhibited an impaired polymerization ability. The system developed in this study will provide a useful method for the production of actin isoforms and their mutants.

Diagnosis of gastric cancer with MDCT using the water-filling method and multiplanar reconstruction: CT-histologic correlation.

OBJECTIVE: The purpose of this study was to assess the utility of MDCT with a thin-sliced multiplanar reconstruction (MPR) technique and water-filling method for the diagnosis of gastric cancers. MATERIALS AND METHODS: Sixty-five patients with gastric cancers were preoperatively examined with MDCT using the water-filling method. The abdomen was dynamically scanned at 30 and 80 sec after the start of contrast medium administration. MPR images were reconstructed with a slice width of 1.25 mm and a slice interval of 1 mm. The detection rate and accuracy of T staging for gastric cancer were evaluated on MPR images and compared with 5-mm-slice axial images. In addition, MDCT images were correlated with pathologic findings. RESULTS: The detection rate of all gastric cancers using the MPR technique was 65%. The detection rate of advanced gastric cancers was 96.2% (25 of 26), whereas that of early gastric cancers was 41.2% (14 of 34). There was a statistically significant difference (p < 0.05) in the detection rate of early gastric cancers between MPR and 5-mm-slice axial images. The MDCT appearances of gastric cancers were well correlated with pathologic findings such as mucinous component or differences in infiltration of cancer cells. The overall accuracy of CT staging was 85%. MPR images were superior to axial images for the evaluation of the z-axis extent of tumor. CONCLUSION: MDCT with the water-filling method has advantages in acceptable evaluation of depth invasion of gastric carcinomas and in visualization of histologic changes in the tumors. MPR images may be a useful guide for the evaluation of the z-axis extent of tumor.