Preoperative difficulty factors in delayed laparoscopic cholecystectomy: Tokyo Guidelines 2018 surgical difficulty score analysis.

INTRODUCTION: Tokyo Guidelines 2018 (TG18) recommend early laparoscopic cholecystectomy (LC) for low-risk acute cholecystitis (AC); however, some patients undergo delayed LC (DLC) after conservative treatment. DLC, influenced by chronic inflammation, is a difficult procedure. Previous studies on LC difficulty lacked objective measures. Recently, TG18 introduced a novel 25 findings difficulty score, which objectively assesses intraoperative factors. The purpose of this study was to use the difficulty score proposed in TG18 to identify and investigate the predictors of preoperative high-difficulty cases of DLC for AC. METHODS: We retrospectively reviewed 100 patients with DLC after conservative AC treatment. The surgical difficulty of DLC was evaluated using a difficulty score. Based on previous studies, the highest scores in each category were categorized as grades A-C. RESULTS: The severity of AC was mild in 51 patients and moderate in 49. Surgical outcomes revealed a distribution of difficulty scores, with grade C indicating high difficulty, showing significant differences in operative time, blood loss, achieving a critical view of safety, bailout procedures, and postoperative hospital stay compared with grades A and B. Regarding the preoperative risk factors, multivariate analysis identified age >61 years (p = .008), body mass index >27.0 kg/m2 (p = .007), and gallbladder wall thickness >6.2 mm (p = .001) as independent risk factors for grade C in DLC. CONCLUSION: The difficulty score proposed in TG18 provides an objective framework for evaluating surgical difficulty, allowing for more accurate risk assessments and improved preoperative planning in DLC for AC.

[Two Cases of Stage â £ Colorectal Cancer with Long-Term Survival following Single-Agent Chemotherapy with Capecitabine-A Case Reports].

We experienced 2 cases of Stage Ⅳ colorectal cancer obtained long-term survival by chemotherapy with only capecitabine. Case 1: Seventy-one-years-old male was performed open sigmoid colectomy, D2 dissection for sigmoid colon cancer. Pathological diagnosis was pT4aN2aM0, pStage Ⅲc. Capecitabine plus oxaliplatin(CAPOX)was performed as adjuvant chemotherapy for 6 months consequently. Two-years after operation, peritoneal dissemination was found, and CAPOX plus bevacizumab(BEV)was started. Due to appearance of renal disfunction and proteinuria, only capecitabine was continued. Since then, 60 months have been passed without disease progression. Case 2: Seventy-six-years-old female was diagnosed as ascending colon cancer with multiple lung metastases. She had initially given systematic chemotherapy with CAPOX plus BEV. Grade 2 adverse effect(numbness and diarrhea)appeared, then the chemotherapy was discontinued. Seven months later, bowel obstruction due to tumor growth was appeared, and open right-hemi colectomy, with D3 dissection was performed for relief of symptoms. Pathological diagnosis was pT3N1bM1a, pStage Ⅳa. With her request, chemotherapy was performed with only capecitabine. Although lung metastasis was slowly progressed, for 72 months she has maintained good general condition since the chemotherapy with only capecitabine was started.

Phylogeny and a new species of Polylobatispora.

During surveys conducted on freshwater fungi from Vietnam, a new aquatic anamorphic fungus was isolated from decaying leaves in Vietnam. The fungus produced phialidic, swollen conidiophore and conidiogenous cells with one-celled conidia with four very tiny lobes. Based on its conidial development and other morphological characteristics, we confirmed that this is a novel fungus and described it as P. ambigua sp. nov. Phylogenetic analyses of P. ambigua based on the LSU nrDNA sequences showed that this fungus clusters in a single clade with the two known Polylobatispora spp. with 97% bootstrap value which is sister with Pseudoprobiscisporaceae. The Polylobatispora clade is nested in the Attracrosporales, Sordariomycetes. Furthermore, in this study two known species of Polylobatispora (P. deltoidea and P. quinquecornuta) were also isolated and illustrated.

Human gnathostomiasis: a neglected food-borne zoonosis.

BACKGROUND: Human gnathostomiasis is a food-borne zoonosis. Its etiological agents are the third-stage larvae of Gnathostoma spp. Human gnathostomiasis is often reported in developing countries, but it is also an emerging disease in developed countries in non-endemic areas. The recent surge in cases of human gnathostomiasis is mainly due to the increasing consumption of raw freshwater fish, amphibians, and reptiles. METHODS: This article reviews the literature on Gnathostoma spp. and the disease that these parasites cause in humans. We review the literature on the life cycle and pathogenesis of these parasites, the clinical features, epidemiology, diagnosis, treatment, control, and new molecular findings on human gnathostomiasis, and social-ecological factors related to the transmission of this disease. CONCLUSIONS: The information presented provides an impetus for studying the parasite biology and host immunity. It is urgently needed to develop a quick and sensitive diagnosis and to develop an effective regimen for the management and control of human gnathostomiasis.

Aerobic degradation of cis-dichloroethene by the marine bacterium Marinobacter salsuginis strain 5N-3.

An aerobic bacterium, designated strain 5N-3 (NBRC 113055), that degrades cis-dichloroethene (cDCE) was isolated from a sea sediment in Japan. Strain 5N-3 was able to degrade a certain amount of cDCE in the presence of pyruvate without the action of inducers. In the presence of inducers, such as phenol and benzene, the strain completely removed cDCE. By the application of 16S ribosomal RNA (16S rRNA) gene sequencing and average nucleotide identity analyses, the strain 5N-3 was identified as Marinobacter salsuginis. On the other hand, identified species of Marinobacter are not known to degrade cDCE at all. A draft genome sequence analysis of the strain 5N-3 suggested that the dmp-homologous operon (operon for phenol degradation) may be contributing to the aerobic degradation of cDCE. This is the first report on an aerobic marine bacterium that has been found to degrade cDCE.

[Clinical Experience with 13 Cases of Primary Small Bowel Adenocarcinoma].

Between 2003 and 2017, 13 patients with primary small bowel adenocarcinoma(SBA)were treated at our hospital. Tumors developed in the duodenum in 6 patients and in the jejunum in 7 patients. The median age of the patients was 62 (range: 31-83)years and male/female ratio was 10/3. Initial symptoms were obstruction in 5 patients, bleeding in 3 patients, and abdominal pain in 1 patient. The median diameter of tumor was 50(range: 23-100)mm. Concerning surgical margin, R0 resection was in 8 patients, R1 resection in 3 patients, and R2 resection in 2 patients. The number of patients with stage 0 disease was 1, stage Ⅱ was 2, stage Ⅲ was 6, and stage Ⅳ was 4. Chemotherapy was provided to 8 patients. The median survival time was 31.6(range: 1-118)months and 5-year survival rate were 26.9%. Four patients survived longer than 4 years without recurrence. Although there is no treatment established for SBA, it was thought that proactive resection and chemotherapy can be anticipated in these patients to bring about an improved survival.

[A Case of Adenocarcinoma Arising from Ectopic Gastric Mucosa in Meckel's Diverticulum with Abdominal Wall Abscess].

A 47-year-old woman visited a neighboring hospital because of lower abdominal pain and high fever. She was diagnosed with acute pyelonephritis and administered(oral)antibiotics. However, there was no sign of improvement. She was referred to our hospital for closer examination. Computed tomography revealed an 8 cm abdominal wall abscess spreading from the prevesical space to the rectus abdominis. Incisional drainage was performed under local anesthesia. She developed rectus abdominis muscle diastasis, and a laparotomy was performed 2 months later. Intraoperative findings showed that her Meckel's diverticulum was continuous with the abdominal wall abscess. Diagnosed with Meckel's diverticulitis with abdominal wall abscess, the patient underwent surgery(excision)for these. Histopathological findings showed adenocarcinoma cells in the abscess tissue and were continuous with gastric pyloric gland-like tissue in Meckel's diverticulum. Based on these findings, the patient was diagnosed with adenocarcinoma arising from ectopic gastric mucosa in the Meckel's diverticulum. The patient received postoperative adjuvant chemotherapy for a year. The patient is currently alive and has not experienced recurrence for 2 years since surgery. It is difficult to diagnose carcinoma of Meckel's diverticulum preoperatively due to late onset of symptoms. The diagnosis is often made at the advanced stage, when the prognosis is poor. This case is rare due to the incidental finding of an abdominal abscess and the absence of recurrence 2 years after surgery.

A case of hepatic anisakiasis caused by Pseudoterranova decipiens mimicking metastatic liver cancer.

BACKGROUND: Anisakid nematodes (Anisakis spp. or Pseudoterranova spp.) usually infect gastric or intestinal walls, while they rarely infect in extra-gastrointestinal sites of human body. Generally, Anisakis spp. larvae are highly infected in fish intermediate hosts, whereas Pseudoterranova spp. larvae are very rarely infected. To the best of our knowledge, there have been no reports which have documented cases of hepatic anisakiasis caused by Pseudoterranova spp. This report describes the first documented case of hepatic anisakiasis due to infection with Pseudoterranova decipiens and clinical features of the hepatic anisakiasis through literature review. CASE PRESENTATION: The case was a 28-year-old man with prior history of malignancy who was found to have a hepatic mass mimicking metastatic liver tumor. A new low density area of 20 mm in diameter in liver segment 7 was found on follow-up CT. With suspicious diagnosis of metastatic liver cancer, laparoscopic partial hepatectomy was performed. A pathological examination revealed no evidence of malignancy, but showed necrotic granuloma with eosinophil infiltration and the presence of a larva with Y-shaped lateral cords, which are specific to anisakid larvae. The type of larva was identified as Pseudoterranova decipiens sensu lato using PCR of DNA purified from a fixed granuloma embedded in paraffin. CONCLUSION: The present report is the first to discuss the case of a patient with hepatic anisakiasis caused by Pseudoterranova decipiens. Hepatic anisakiasis is a potential differential diagnosis for hepatic tumors and genetic identification with the PCR method was reliable for obtaining final diagnosis even when the larvae body in the resected specimen collapses with time.

Virgisporangium myanmarense sp. nov., a novel motile actinomycete isolated from an anthill soil in Myanmar.

An actinomycete strain, designated MM04-1133T, was isolated from an anthill soil sample collected in Bagan, Myanmar. To establish the taxonomic status of this strain, the isolate was subjected to a polyphasic approach. Strain MM04-1133T was Gram-staining positive, aerobic, motile and formed long and narrow sporangia directly above the surface of the substrate mycelium. Whole-cell hydrolysates of the strain contained 3-OH-diaminopimelic acid, arabinose, glucose, galactose, mannose, rhamnose and xylose. The predominant menaquinones were MK-10(H6) and MK-10(H8). The major cellular fatty acids were iso-C16:0 and anteiso-C17:0. The diagnostic phospholipid was phosphatidylethanolamine. The G+C content of the DNA was 69.1 mol%. Phylogenetic analysis based on 16S rRNA gene sequence revealed that strain MM04-1133T clustered within the genus Virgisporangium, with the sequence exhibiting highest similarity (98.5% identity) with Virgisporangium ochraceum NBRC 16418T. The strain grew in the presence of 0-1% (w/v) NaCl, at pH 5-8 and at 20-40 °C, with optimal growth at 30-37 °C. Based on phylogenetic analysis and chemotaxonomic and phenotypic data, we propose classifying this isolate as a novel species of the genus Virgisporangium, to be designated as Virgisporangium myanmarense sp. nov. The type strain is MM04-1133T (=NBRC 112733T=VTCC 910008T).

Complete mitochondrial genomes of Gnathostoma nipponicum and Gnathostoma sp., and their comparison with other Gnathostoma species.

Gnathostomiasis is a foodborne zoonotic parasitosis caused by Gnathostoma nematodes. It has caused significant public problems worldwide, but its molecular biology is limited. The purpose of this study was to decode the complete mitochondrial (mt) genomes of Gnathostoma nipponicum and Gnathostoma sp., and compare their mt sequences with other Gnathostoma species. The complete mt genome sequences were amplified by long-range PCR and determined by subsequent primer walking. The complete mt genomes of G. nipponicum and Gnathostoma sp. were 14,093bp and 14,391bp, respectively. Both of the two mt genomes contain 12 protein-coding genes (PCGs), 2 ribosomal RNA genes and 22 transfer RNA genes. The gene order and transcription direction are the same as G. spinigerum and G. doloresi. The sequence difference across the entire mt genomes varied from 14.4% to 18.2% between G. nipponicum, Gnathostoma sp., G. spinigerum and G. doloresi of Japan and China isolates. Phylogenetic analyses by Bayesian inference (BI) using concatenated amino acid sequences of 12 PCGs showed that G. nipponicum and Gnathostoma sp. are two distinctive species of Gnathostoma, and G. nipponicum are more closely related to Gnathostoma sp. than to G. spinigerum. The mtDNA datasets provide abundant resources of novel markers, which can be used for the studies of molecular epidemiology and diagnosis of Gnathostoma spp.

The complete mitochondrial genomes of Gnathostoma doloresi from China and Japan.

Gnathostoma doloresi is one of the neglected pathogens causing gnathostomiasis. Although this zoonotic parasite leads to significant socioeconomic concerns globally, little is known of its genetics and systematics. In the present study, we sequenced and characterized the complete mitochondrial (mt) genomes of G. doloresi isolates from China and Japan. The lengths of the mt genomes of the G. doloresi China and Japan isolates are 13,809 and 13,812 bp, respectively. Both mt genomes encode 36 genes, including 12 protein-coding genes (PCGs), 2 ribosomal RNA genes, and 22 transfer RNA genes. The gene order, transcription direction, and genome content are identical with its congener G. spinigerum. Phylogenetic analyses based on concatenated amino acid sequences of 12 PCGs by Bayesian inference (BI) indicated that G. doloresi are closely related to G. spinigerum. Our data provide an invaluable resource for studying the molecular epidemiology, phylogenetics, and population genetics of Gnathostoma spp. and should have implications for further studies of the diagnosis, prevention, and control of gnathostomiasis in humans and animals.

Two Japanese siblings affected with Chikungunya fever with different clinical courses: Imported infections from the Cook Islands.

Two Japanese siblings visited the Cook Islands on business and stayed for 2 months. The sister developed a high fever, arthralgia, erythema and leg edema on the day after returning to Japan. The brother also developed neck and joint pain on the day following the sister's onset. Subsequently, his erythematous lesions spread over his whole body. Chikungunya virus was detected from the sister's blood and urine by specific reverse transcription polymerase chain reaction, but not in the brother's samples. Retrospectively, his history of Chikungunya fever was confirmed by the presence of the anti-Chikungunya virus immunoglobulin (Ig)M and IgG antibodies using the specific enzyme-linked immunoassay. In Japan, no autochthonous case of Chikungunya fever was reported previously. We should give attention to the imported infectious diseases for epidemic prevention. This report warns about the danger of the imported infectious diseases, and also suggests that covering the topic of infectious disease in the world is critical to doctors as well as travelers.

Improvement in early diagnosis of Japanese spotted fever by using a novel Rick PCR system.

Rickettsia diseases, including Japanese spotted fever (JSF), are serious infections. Delayed diagnosis occasionally results in life-threatening liver disorders and disseminated intravascular coagulation (DIC). Because of the shortness of the latent period, serological diagnosis is not preferable for early diagnosis of JSF. Until now, a polymerase chain reaction (PCR)-based diagnosis method has been used for early diagnosis, and the sensitivity reaches as high as 90% using skin biopsy samples as we previously reported. On the other hand, the sensitivity of the same PCR method using blood samples is limited at less than 50%. In the present study, using peripheral blood samples, we developed a novel diagnostic method for JSF using a Rick PCR system with original PCR primers, showing improved sensitivity compared with the conventional nested PCR. It may constitute a preferable diagnostic tool for early and sensitive diagnosis of Rickettsia infection.

[A Case of Sigmoid Colon Cancer with Synchronous Liver Metastasis, Treated with Laparoscopic Liver Resection after SOX plus BV Chemotherapy].

We performed laparoscopic liver resection in a patient with synchronous liver metastasis from advanced sigmoid colon cancer after induction with S-1 plus oxaliplatin (SOX) plus bevacizumab (BV) chemotherapy. A 61-year-old woman underwent laparoscopy-assisted sigmoidectomy for locally advanced sigmoid colon cancer with synchronous liver metastasis. SOX plus BV chemotherapy was initiated. After 3 courses, the liver tumor was downsized, and metastasectomy was performed laparoscopically with R0 resection. The postoperative course was uneventful and the patient was discharged on the 11th postoperative day. She has been free from recurrence. Induction with SOX plus BV chemotherapy is considered to be not only effective, but also beneficial for maintaining the quality of life (QOL) in patients with advanced colorectal cancer.

Streptomyces catbensis sp. nov., isolated from soil.

Strain VN07A0015(T) was isolated from soil collected on Cat Ba Island, Vietnam. The taxonomic position of strain VN07A0015(T) was near Streptomyces aomiensis M24DS4(T) (98.5% 16S rRNA gene sequence similarity) and Streptomyces scabrisporus NBRC 100760(T) (95.6%), and it clustered within them; however, this cluster was distant from the type strains of other species of the genus Streptomyces. The aerial mycelia of strain VN07A0015(T) were greyish and formed imperfect spiral spore chains (retinaculiaperti type) with smooth-surfaced spores. The morphological features of strain VN07A0015(T) were different from those of the type strains of S. aomiensis and S. scabrisporus. The chemotaxonomic characteristics of strain VN07A0015(T) were typical for all members of the genus Streptomyces, which possessed ll-type diaminopimelic acid, menaquinone MK-9(H6, H8) and the major fatty acids iso-C(16 : 0) and iso-C(15 : 0). DNA-DNA relatedness between strain VN07A0015(T) and S. aomiensis NBRC 106164(T) was less than 30%. In addition, some physiological and biochemical traits differed from those of S. aomiensis. Therefore, we propose that strain VN07A0015(T) be classified in the genus Streptomyces as a representative of Streptomyces catbensis sp. nov. (type strain VN07A0015(T) = VTCC-A-1889(T) = NBRC 107860(T)).

New species of the genus Metschnikowia isolated from flowers in Indonesia, Metschnikowia cibodasensis sp. nov.

A novel species, Metschnikowia cibodasensis, is proposed to accommodate eight strains (ID03- 0093(T), ID03-0094, ID03-0095, ID03-0096, ID03-0097, ID03-0098, ID03-0099, and ID03-0109) isolated from flowers of Saurauia pendula, Berberis nepalensis, and Brunfelsia americana in Cibodas Botanical Garden, West Java, Indonesia. The type strain of M. cibodasensis is ID03- 0093(T) (= NBRC 101693(T) =UICC Y-335(T) = BTCC-Y25(T)). The common features of M. cibodasensis are a spherical to ellipsoidopedunculate shaped ascus, which contains one or two needleshaped ascospores, and lyse at maturity. Asci generally develop directly from vegetative cells but sometimes from chlamydospores. The neighbor-joining tree based on the D1/D2 domain of nuclear large subunit (nLSU) ribosomal DNA sequences strongly supports that M. cibodasensis (eight strains) and its closest teleomorphic species, M. reukaufii, are different species by a 100% bootstrap value. The type strain of M. cibodasensis, ID03-0093(T), differed from M. reukaufii NBRC 1679(T) by six nt (five substitutions and one deletion) in their D1/D2 region of nLSU rDNA, and by 18 nt (five deletions, four insertions, and nine substitutions) in their internal transcribed spacer regions of rDNA, respectively. Four strains representative of M. cibodasensis (ID03-0093(T), ID03-0095, ID03-0096, and ID03-0099) showed a mol% G+C content of 44.05 ± 0.25%, whereas that of M. reukaufii NBRC 1679(T) was 41.3%. The low value of DNADNA homology (5-16%) in four strains of M. cibodasensis and M. reukaufii NBRC 1679(T) strongly supported that these strains represent a distinct species.

Rare case of disseminated cysticercosis and taeniasis in a Japanese traveler after returning from India.

We report disseminated cysticercosis concurrent with taeniasis in a 31-year-old male Japanese, who had visited India three times and stayed for 1 month each time during the previous 1 year. The patient presented increasing numbers of subcutaneous nodules and expelled proglottids, although numerous cysts were also found in the brain in imaging findings, though no neurological symptoms were observed. Histopathological and serological findings strongly indicated cysticercosis. We found taeniid eggs in his stool by microscopic examination and revealed them as the Indian haplotype of Taenia solium by mitochondrial DNA analysis. We concluded that disseminated cysticercosis was caused by the secondary autoinfection with eggs released from the tapeworm carrier himself. After confirming the absence of adult worms in the intestine by copro-polymerase chain reaction, the patient was successfully treated with albendazole at a dose of 15 mg/kg/day for 28 days. Subcutaneous and intracranial lesions had completely disappeared by the end of the treatment period.

Population genetic structuring in Opisthorchis viverrini over various spatial scales in Thailand and Lao PDR.

Khon Kaen Province in northeast Thailand is known as a hot spot for opisthorchiasis in Southeast Asia. Preliminary allozyme and mitochondrial DNA haplotype data from within one endemic district in this Province (Ban Phai), indicated substantial genetic variability within Opisthorchis viverrini. Here, we used microsatellite DNA analyses to examine the genetic diversity and population structure of O. viverrini from four geographically close localities in Khon Kaen Province. Genotyping based on 12 microsatellite loci yielded a mean number of alleles per locus that ranged from 2.83 to 3.7 with an expected heterozygosity in Hardy-Weinberg equilibrium of 0.44-0.56. Assessment of population structure by pairwise F(ST) analysis showed inter-population differentiation (P<0.05) which indicates population substructuring between these localities. Unique alleles were found in three of four localities with the highest number observed per locality being three. Our results highlight the existence of genetic diversity and population substructuring in O. viverrini over a small spatial scale which is similar to that found at a larger scale. This provides the basis for the investigation of the role of parasite genetic diversity and differentiation in transmission dynamics and control of O. viverrini.

The production of ß-glucosidases by Fusarium proliferatum NBRC109045 isolated from Vietnamese forest.

Fusarium proliferatum NBRC109045 is a filamentous fungus isolated from Vietnamese forest due to high production of ß-glucosidases. Production of the enzyme was studied on varied carbon source based mediums. The highest activity was obtained in medium containing 1% corn stover + 1% wheat bran (3.31 ± 0.14 U/ml). It is interesting to note that glucose (0.69 ± 0.02 U/ml) gave higher activity and just followed by cellobiose among the di- and mono-saccharides, which is generally regarded as a universal repressor of hydrolases. We improved the zymogram method to prove that in response to various carbon sources, F. proliferatum could express various ß-glucosidases. One of the ß-glucosidases produced by F. proliferatum growing in corn stover + wheat bran based medium was partially purified and proved to have high catalytic ability.