[Infection Measures in Facilities Needing Close Contact such as Rehabilitation Treatment or Dementia Care].

The coronavirus disease (COVID-19) is currently raging worldwide. An outbreak in convalescent rehabilitation hospitals and geriatric facilities treating individuals with dementia resulted in a large number of deaths due to viral transmission through close contact in the first wave, leading to increased concerns regarding the same in the second wave. Because it is difficult to eradicate COVID-19, prevention and control of transmission is of utmost importance. In this article, we will discuss the course of the disease in facilities requiring close contact with patients, response of these facilities to infection and prevention of transmission, and an outline regarding the role of medical professionals in future social interactions.

Effect of continuous positive airway pressure on regional cerebral blood flow during wakefulness in obstructive sleep apnea.

BACKGROUND: The alteration of regional cerebral blood flow (rCBF) during wakefulness after the treatment for obstructive sleep apnea syndrome (OSA) using continuous positive airway pressure (CPAP) has not been elucidated. The aim of this study was to investigate rCBF characteristics and the effects of nasal CPAP in OSA patients. METHODS: Fifteen severe OSA patients (apnea-hypopnea index, 62.7 ± 22.4/h), when awake, underwent Technetium-99m ethyl cysteinate dimer single photon emission computed tomography before and after CPAP treatment, and the findings were compared to those of nine healthy controls matched for age and sex. RESULTS: Compared to controls, patients with OSA before CPAP treatment showed a significantly lower rCBF in the frontal lobe. After the treatment, no difference in rCBF was observed between the good CPAP compliance group and the controls. In the former group, there was a positive correlation between the 3% oxygen desaturation index on diagnostic polysomnogram and the increase of rCBF after CPAP treatment in the frontal lobe. CONCLUSIONS: When awake, patients with severe OSA were shown to have reversible decreases in rCBF, especially in the frontal lobe, and an appropriate CPAP treatment was thought to improve rCBF in this area. Our results support the importance of appropriate CPAP treatment for severe OSA patients.

Chronic intermittent hypoxia/reoxygenation facilitate amyloid-ß generation in mice.

Previous studies have shown a high prevalence of obstructive sleep apnea (OSA) among patients with Alzheimer's disease (AD). However, it is poorly assessed whether chronic intermittent hypoxia (CIH), which is a characteristic of OSA, affects the pathophysiology of AD. We aimed to investigate the direct effect of intermittent hypoxia (IH) in pathophysiology of AD in vivo and in vitro. In vivo, 15 male triple transgenic AD mice were exposed to either CIH or normoxia (5% O2 and 21% O2 every 10 min, 8 h/day for 4 weeks). Amyloid-ß (Aß) profile, cognitive brain function, and brain pathology were evaluated. In vitro, human neuroblastoma SH-SY5Y cells stably expressing wild-type amyloid-ß protein precursor were exposed to either IH (8 cycles of 1% O2 for 10 min followed by 21% O2 for 20 min) or normoxia. The Aß profile in the conditioned medium was analyzed. CIH significantly increased levels of Aß42 but not Aß40 in the brains of mice without the increase in hypoxia-inducible factor 1, alpha subunit (HIF-1α) expression. Furthermore, CIH significantly increased intracellular Aß in the brain cortex. There were no significant changes in cognitive function. IH significantly increased levels of Aß42 in the medium of SH-SY5Y cells without the increase in the HIF-1α expression. CIH directly and selectively increased levels of Aß42 in the AD model. Our results suggest that OSA would aggravate AD. Early detection and intervention of OSA in AD may help to alleviate the progression of the disease.

[Current understanding and perspectives of lymphangioleiomyomatosis].

Lymphangioleiomyomatosis (LAM) is a slowly progressive neoplastic disease characterized with proliferation of abnormal smooth muscle-like cells (LAM cells) in the lungs and along axial lymphatics. Proliferation of LAM cells are considered to be driven by dysregulated mTORC1 signaling, that is caused by mutations in either the TSC1 or TSC2 gene in LAM cells. The MILES trial has successfully demonstrated that sirolimus, a mTORC1 inhibitor, can stabilize pulmonary function in LAM, but its effect disappears once sirolimus is discontinued. Limited ability of sirolimus may be due to concomitant activation of autophagy in LAM cells when mTORC1 activity is suppressed by sirolimus. Recently animal models for LAM have been independently established by several groups, which may provide a platform for developing drugs interfering various steps in disease progression.

[Analysis of predominant bacterial species and clinical backgrounds in lung abscess patients].

We reviewed the clinicopathological characteristics of lung abscesses retrospectively. We analyzed 89 patients hospitalized from July 1984 to May 2009. Most were men (76/89). There were large proportions with alcohol consumption (29.2%) and dental caries or gingivitis (60.7%). Furthermore, those without other diseases accounted for only 13.5%. Predominant infectious species were clear in 43 cases (48.3%) including identification of bacteria. The identification rate of predominant bacteria improved from 38.5% to 56.0% after initiation of the introduction of expectoration culture, bronchoscopic specimen collection and gingival culture in 2003, facilitating clarification of the predominant bacteria. The Streptococcus anginosus group with predominant bacteria being slightly aerobic streptococci, anaerobic bacterium, and aerobic bacterium was detected in 10, 12, and 31 cases, respectively. The improvement in the identification rate of predominant bacteria was achieved by carrying out examination with close liaison with the staff of our inspection room. In selecting antimicrobials based on diagnostic significance, we should focus on positive identification of predominant bacteria, a factor which appears to have major clinical significance.

Breakthrough lung Scedosporium prolificans infection with multiple cavity lesions in a patient receiving voriconazole for probable invasive aspergillosis associated with monoclonal gammopathy of undetermined significance (MGUS).

Breakthrough non- Aspergillus mold infections among patients receiving the anti-mold azole antifungal agents like voriconazole or posaconazole have been increasingly reported. We report a case of lung Scedosporium prolificans infection with multiple cavities in a 58-year-old man with monoclonal gammopathy of undetermined significance (MGUS) during voriconazole treatment for probable invasive aspergillosis. Cultures of repeated sputum specimens yielded the same fungus until his death 83 days after diagnosis. S. prolificans should be considered in patients with breakthrough infections receiving voriconazole.