Clinical characteristics of peristomal pyoderma gangrenosum: A Single Center Retrospective Observational Study.

Peristomal pyoderma gangrenosum (PPG), a variant of pyoderma gangrenosum, occurs adjacent to intestinal or urinary stomas and are typically seen in patients with active inflammatory bowel diseases (IBD). The present study evaluated 14 cases of PPG among 537 patients that had undergone ostomy surgery at Asahikawa Medical University Hospital from January 2017 to December 2021. The incidence of PPG among ostomy cases was calculated as 1.01 per 100-person-years. The median period from ostomy surgery to PPG onset was 192.5 days (36-1224 days). Significant differences in gender and ostomy subtype were observed in patients with PPG compared to all patients that had undergone ostomy surgery. IBD prevalence was comparable between groups. Topical corticosteroids or tacrolimus were sufficient for controlling PPG lesions in all cases other than one case controlled with oral prednisolone administered for a separate condition. Clinicians should be aware of recent developments in IBD therapies that may modify the risk of developing PPG. The present study results add to current knowledge of the pathogenesis of PPG.

Hypotension and Bradycardia Caused by the Inadvertent Ingestion of Rhododendron japonicum.

A 61-year-old man was transferred to our hospital with the complaints of dizziness, severe nausea and abdominal discomfort after consuming approximately 50 g of the flowers of Rhododendron japonicum. On admission, hypotension and sinus bradycardia were evident. Symptoms including hypotension and bradycardia completely recovered within 12 hours following normal saline infusion and intravenous atropine. The ingestion of certain types of Rhododendron species can cause intoxication, referred to as "mad honey poisoning", due to the action of grayanotoxins. This is the first local case of acute intoxication caused by Rhododendron japonicum.

Sex-specific temporal trends in the incidence and prevalence of hospitalized patients with preserved versus reduced left ventricular ejection fraction heart failure: A Japanese community-wide study.

BACKGROUND: Sex specific temporal trends in the incidence and prevalence of hospitalization for heart failure (HF), particularly in conjunction with reduced and preserved left ventricular ejection fraction (EF) remain unclear, especially in Asian general populations. METHODS: We conducted a community based HF registration study over a 10 year period in an aging cohort of the Japanese general population. RESULTS: A total of 2598 cases of hospitalized HF were registered during the survey period. Of these 1413 cases (55%) were initial admissions for HF (incident case). The study period was divided into five 2-year terms (T1, 2003-2004; T2, 2005-2006; T3, 2007-2008; T4, 2009-2010; T5, 2011-2012), and data were compared among the terms. Age adjusted incidence of HF (per 105 person-year) remained stable in men, but decreased significantly by 25% in women (from 104 at T1 to 79 at T5; p for trend < 0.05). Among incident cases who underwent echocardiography (≈ 90%), the proportion of HF with preserved EF increased in men (from 32% at T1 to 43% at T5; p for trend < 0.05), and was relatively high and remained stable throughout the study period in women (from 52% at T1 to 58% at T5; p for trend; NS). CONCLUSION: Although the incidence of HF has declined especially in women between 2003 and 2012 in the study population, the proportion of HF with preserved EF has increased over time. These trends suggest a future prevalence of HF with preserved EF rather than HF with reduced EF in aging Asian populations.

Comparison of the incidence of acute decompensated heart failure before and after the major tsunami in Northeast Japan.

On March 11, 2011, a huge tsunami attacked the northeastern coast of Japan after a magnitude 9 earthquake. No reports have investigated the impact of tsunamis on the incidence of cardiovascular disease, especially heart failure (HF). We investigated the number and clinical characteristics of hospitalized patients with acute decompensated HF (ADHF) in the east coast of Iwate hit by the tsunami (tsunami area) for a 12-week period around the disaster. For comparison with previous years, numbers of ADHF were surveyed in the corresponding area in 2009 and 2010. In addition, to elucidate the impact of the tsunami, a similar study was performed in a remote area where the tsunami had minimal effect (control area). After the disaster, the number of patients with ADHF in the tsunami area was significantly increased compared to the predisaster period (relative risk 1.97, 95% confidence interval 1.50 to 2.59). The peak was found 3 to 4 weeks after the disaster. In contrast, in the control area, no significant change in ADHF events was observed (relative risk 1.29, 95% confidence interval 0.94 to 1.78). There was a significant correlation between changes in the number of ADHF admissions and percent tsunami flood area (r = 0.73, p <0.001) or the number of shelter evacuees (r = 0.83, p <0.001). In conclusion, these findings suggest that large and sudden changes in daily life and the trauma associated with a devastating tsunami have a significant impact on the incidence of ADHF.

Termination of the structural confusion between plipastatin A1 and fengycin IX.

Plipastatin A1 and fengycin IX were experimentally proven to be identical compounds, while these had been considered as diastereomers due to the permutation of the enantiomeric pair of Tyr in most papers. The (1)H NMR spectrum changed to become quite similar to that of plipastatin A1, when the sample which provided resembled spectrum of fengycin IX was treated with KOAc followed by LH-20 gel filtration. Our structural investigations disclosed that the structures of these molecules should be settled into that of plipastatin A1 by Umezawa (L-Tyr4 and D-Tyr10).

Absolute stereochemistry of altersolanol A and alterporriols.

The absolute stereochemistry of altersolanol A (1) was established by observing a positive exciton couplet in the circular dichroism (CD) spectrum of the C3,C4-O-bis(2-naphthoyl) derivative 10 and by chemical correlations with known compound 8. Before the discussion, the relative stereochemistry of 1 was confirmed by X-ray crystallographic analysis. The shielding effect at C7'-OMe group by C1-O-benzoylation established the relative stereochemical relationship between the C8-C8' axial bonding and the C1-C4/C1'-C4' polyol moieties of alterporriols E (3), an atropisomer of the C8-C8' dimer of 1. As 3 could be obtained by dimerization of 1 in vitro, the absolute configuration of its central chirality elements (C1-C4) must be identical to those of 1. Spectral comparison between the experimental and theoretical CD spectra supported the above conclusion. Axial stereochemistry of novel C4-O-deoxy dimeric derivatives, alterporriols F (4) and G (5), were also revealed by comparison of their CD spectra to those of 2 and 3.

Absolute stereochemistry of novel isochromanone derivatives from Leptosphaeria sp. KTC 727.

A novel isochromanone, (S)-8-hydroxy-6-methoxy-4,5-dimethyl-3-methylene-isochromen-1-one (1), known 2 and previously reported metabolites from Leptosphaeria sp. KTC 727 (JCM 13076 = MAFF 239586) were isolated from the same source by culturing for a relatively long period. The results of the present study disclose their structures involving the absolute stereochemistry. The planar structures of these molecules were established by ESIMS and NMR spectral analyses. The absolute configuration of 1 was established by comparing its electronic circular dichroism (ECD) spectrum with that of structurally-related known compound 3. The relative stereochemistry of 2 was revealed by a combination of nuclear Overhauser effect (NOE) experiments and thermodynamic discussions. Successful transformation of 1 to 2 led us to assign the configuration of 2 after comparing their ECD spectra. These compounds exhibited weak antifungal activities against Cochliobolus miyabeanus.

Stereochemical investigations of isochromenones and isobenzofuranones isolated from Leptosphaeria sp. KTC 727.

Two new metabolites, (R)-3,4-dihydro-4,6,8-trihydroxy-4,5-dimethyl-3-methyleneisochromen-1-one (1) and (R)-7-hydroxy-3-((S)-1-hydroxyethyl)-5-methoxy-3,4-dimethylisobenzofuran-1(3H)-one (2), were isolated along with two structurally known related compounds (3 and 4) from the culture broth of Leptosphaeria sp. KTC 727 (JCM 13076 = MAFF 239586). These structures were disclosed mainly with (1)H and (13)C NMR spectroscopic analyses. The relative configuration of 2 was established by NOE studies. The absolute configuration of this molecule was determined by a combination of the modified Mosher's method and CD spectra after derivatizations. The theoretical CD profiles also supported these assignments. Structural correlations enabled us to establish the absolute configurations of metabolites 1, 3, and 4, in which configurations of the latter two had not been established. Compound 2 exhibited the strongest antifungal activity among them, inhibiting the hyphal growth of Cochliobolus miyabeanus at about 0.5 µg/mL.

Novel neofusapyrones isolated from Verticillium dahliae as potent antifungal substances.

Novel fusapyrone analogs, deoxyneofusapyrone and 7-desmethyldeoxyneofusapyrone were isolated from a pathogenic fungus, Verticillium dahliae, which causes Verticillium wilt disease in Helianthus annuus. Spectral analyses revealed that these are 2-pyrone type analogs of deoxyfusapyrone and its 7-desmethyl derivative, respectively. Biological assay disclosed that 10microg of deoxyneofusapyrone inhibited the growth of MRSA clinical isolate 87-7927.

Characteristics of acute congestive heart failure with normal ejection fraction and less elevated B-type natriuretic peptide.

BACKGROUND: Heterogeneity in B-type natriuretic peptide (BNP) levels, especially among individuals with acute heart failure with normal left ventricular ejection fraction (HFNEF), can cause confusion in interpreting results. We investigated the characteristics of cases of acute HFNEF with only modestly elevated BNP. METHODS: One hundred forty-two patients with acute or acute exacerbation of chronic HFNEF were divided into two groups by BNP level: BNP < 100 pg/ml (NB group, n = 45) and BNP > or = 100 pg/ml (B group, n = 97). We compared clinical findings, echocardiography results, and neurohormonal factors between these two groups. RESULTS: In the NB group, a history of open-heart surgery (OHS) was more frequent (71% vs. 22%, p < 0.0001) and hypertension was less frequent (p = 0.0005). Left atrial diameter (LAd) was higher (p = 0.0026), while interventricular septal thickness, posterior wall thickness, relative wall thickness, left ventricular mass index were lower (p = 0.0005, p = 0.0225, p = 0.0114, p = 0.0051, respectively) in the NB group. In patients with HFNEF, a history of OHS remained an independent predictor of BNP level (< 100 pg/ml) after adjustment for hypertension, age, LAd, and interventricular septal thickness (odds ratio 3.6, p = 0.0252). CONCLUSION: We found associations between acute HFNEF with less elevated BNP and a history of OHS. In a patient suspected of HFNEF, a history of OHS is considered diagnostic evidence of presence of diastolic heart failure when plasma levels of BNP are less elevated.