Utility of urinary presepsin in the diagnosis of pyelonephritis: a cross-sectional study.

BACKGROUND: Presepsin is produced during the phagocytosis of bacteria by granulocytes. Presepsin increases at the site of infection; however, the significance of urinary presepsin in pyelonephritis is unknown. This study aimed to evaluate whether measuring urinary presepsin can distinguish between pyelonephritis and nonpyelonephritis. METHODS: A cross-sectional study of patients with suspected pyelonephritis was conducted. Urinary presepsin at admission was compared between the pyelonephritis and nonpyelonephritis groups using the Mann-Whitney test. The predictive accuracy of urinary presepsin for diagnosing pyelonephritis was evaluated by the area under the receiver operating characteristics (ROC) analysis curve. RESULTS: A total of 35 eligible participants were included in the pyelonephritis group and 25 in the nonpyelonephritis group. The median urinary presepsin level was 2232.0 (interquartile range [IQR], 1029.0-3907.0) pg/mL in the pyelonephritis group and 1348.0 (IQR, 614.5-2304.8) pg/mL in the nonpyelonephritis group. Urinary presepsin concentrations were significantly higher in the pyelonephritis group than in the nonpyelonephritis group (P = 0.023). ROC analysis of urinary presepsin revealed a cutoff value of 3650 pg/mL to distinguish between the pyelonephritis and nonpyelonephritis groups. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for the diagnosis of pyelonephritis were 0.40 (95% confidence interval [CI], 0.24-0.58), 0.96 (95% CI, 0.79-1.00), 0.93 (95% CI, 0.68-1.00), 0.52 (95% CI, 0.37-0.68), 9.60 (95% CI, 1.35-68.23), and 0.62 (95% CI, 0.47-0.83), respectively. CONCLUSIONS: The measurement of urinary presepsin is useful in differentiating pyelonephritis from other diseases.

Use of a 2-year continuing professional development programme to change Japanese physicians' attitudes to learning primary care: a qualitative study.

OBJECTIVE: To evaluate changes in the learning attitudes of primary care physicians. DESIGN: Qualitative study through one focus group interview with the programme's participants. Analysis of the focus group content using the Steps for Coding and Theorization method. SETTING: Japan. PARTICIPANTS: Eight primary care physicians who completed a 2-year continuing professional development (CPD) programme using a problem-based learning (PBL) approach, focused on acquiring the skills needed to practise as primary care physicians in the community. RESULTS: Participants described positive changes in their attitudes and behaviours as a result of the training programme. These changes were grouped into three main themes: 'changes in learning methods regarding medical practice', 'encounters with diverse perspectives and values, and confidence gained from those encounters', and 'showing one's attitude towards learning and its influence on others'. The experienced practitioners participating in this study reported that the programme helped them apply their skills more broadly; for example, searching the literature for psychosocial aspects of practice and engaging more comfortably with diverse perspectives. They reported the positive impact of their learning on their coworkers. CONCLUSION: A 2-year CPD programme using PBL can influence primary care physicians' attitudes and learning-related behaviours. Further research is needed to determine which specific aspects of the programme are the most effective and whether the changes in attitudes and behaviours described affect patient care.

How do case presentation teaching methods affect learning outcomes?--SNAPPS and the One-Minute preceptor.

BACKGROUND: Various techniques have been developed to enable preceptors to teach residents effectively in outpatient settings to promote active learning, including SNAPPS and the One-Minute Preceptor (OMP). This study aimed to ascertain the differences between SNAPPS and the OMP in case presentation content and learner evaluation when used to teach residents about case presentation. METHODS: From 2011 to 2013, participants were 71 junior clinical residents employed in two hospitals for clinical training. They were randomly allocated to two groups, one using SNAPPS and the other the OMP. From recorded discussions, the "differential diagnoses", "questions and uncertainties", "treatment plans", and "learning issues" were counted. Also, a self-evaluation form was distributed at the end of the study to evaluate the residents' satisfaction with the case presentation. RESULTS: Members of the SNAPPS group used significantly more meaning units related to questions and uncertainties compared with those of the OMP group (P < 0.001). Self-evaluation sheets revealed that members of the SNAPPS group had significantly higher positive responses than those of the OMP group in terms of the following evaluations: "It was easy to bring up questions and uncertainties" (P = 0.046), "It was easy to present the case efficiently" (P = 0.002), "It was easy to present the case in the sequence given" (P = 0.029), and "I was able to give an in-depth case presentation" (P = 0.005). CONCLUSIONS: SNAPPS may induce more meaning units related to questions and uncertainties and give more satisfaction to residents than the OMP.

Temporary cerebral revascularization using a radial artery in the hand-eyeshade posture: technical note.

Kamiyama introduced a unique method of temporary cerebral revascularization using a radial artery graft (RAG) in his technical review. We tried original method with Sugita frame, and pointed out some disadvantages that include to avoid taking instruments or hands in and out, stability of hands, and unrestricted usage of brain retractors during temporary bypass between radial artery and M2 potion of middle cerebral artery (RA-M2 bypass). To solve those disadvantages, especially for Sugita head frame users, we here present a modified Kamiyama's method of temporary cerebral revascularization with the forearm elevated over the face like as hand-eyeshade posture.

Simple transposition technique for microvascular decompression using an expanded polytetrafluoroethylene "belt": technical note.

Microvascular decompression (MVD) is a standard surgical procedure for treating vascular compression syndromes. There are two basic ways to perform MVD: interposition using a prosthesis and transposition. With the transposition technique, adhesions and granuloma around the decompression site are avoided, but the required operation is more complex than that for the interposition method. We describe a simple, quick MVD transposition procedure that uses a small "belt" cut from a sheet of 0.3-mm-thick expanded polytetrafluoroethylene membrane. The belt has a hole at the wide end and the other end tapered to a point. The belt is encircled around offending vessels by inserting the pointed end into the hole. The pointed end is then passed through a dural tunnel over the posterior wall of the petrous bone and is tied two or three times. This method avoids the risks involved in handling a surgical needle close to the cranial nerves and vessels.

Neuroimaging characteristics and growth pattern on magnetic resonance imaging in a 52-year-old man presenting with pituicytoma: a case report.

INTRODUCTION: Pituicytoma is a rare neoplasm of the neurohypophysis. To the best of our knowledge there have been no reports of pituicytoma in which long-term magnetic resonance imaging observation was performed. We calculated the doubling time of the tumor volume and described the growth pattern of a pituicytoma. CASE PRESENTATION: A 52-year-old Japanese man with a history of decreased libido was found to have a sellar and suprasellar mass. He underwent transsphenoidal surgery, but only a small specimen was obtained because of intraoperative bleeding. The tentative histological diagnosis was schwannoma. He noticed bitemporal hemianopsia 7 years later. A follow-up magnetic resonance imaging disclosed a tumor volume doubling time of 3830 days. Transcranial gross-total tumor resection was performed. The lesion consisted of elongated and plump tumor cells that were arranged in a fascicular or storiform pattern and were positive for S-100 protein and focally positive for glial fibrillary acidic protein. The final histological diagnosis was pituicytoma. CONCLUSION: Pituicytoma is a slow-growing tumor, but the growth rate may change during follow-up.

Treatment of an unruptured fusiform aneurysm of the internal carotid artery associated with Wegener's granulomatosis by endovascular balloon occlusion. Case report.

A 22-year-old woman developed an unruptured fusiform aneurysm of the internal carotid artery 7 months after being diagnosed with Wagener's granulomatosis. Intracranial aneurysmal formation is an extremely rare complication of Wegener's granulomatosis. This rare case of intracranial aneurysm was treated by endovascular balloon occlusion.

[A case of ruptured internal carotid artery "kissing aneurysms": case report and review of the literature].

OBJECTIVE: A rare case of ruptured kissing aneurysms on the right internal carotid-posterior communicating artery (ICPCA) and -anterior choroidal artery (ICAchA) is reported. CASE: A 47-year-old female was transferred to our hospital because of subarachnoid hemorrhage (SAH). Cerebral angiography revealed two aneurysms on the right ICPCA and ICAchA. Right frontotemporal craniotomy was performed to obliterate them on the day of admission. Despite the presence of angiographical cleavage, these two aneurysms were attached to each other tightly, and it was extremely difficult to dissect the space between them and premature rupture occurred. A Sugita long straight clip was inserted parallel to internal carotid artery to obliterate the body of ICAchA aneurysm and the neck of ICPCA aneurysm. Another straight clip was applied to the neck of the former aneurysm. Both PCA and AchA could be secured successfully. Postoperatively, although she developed symptomatic vasospasm on the 10th day, she discharged without any neurological deficits 40 days later. CONCLUSIONS: Because of the difficulty in dissection of aneurysms, the operation for kissing aneurysms has been recognized as hazardous and challenging since Jefferson. We emphasize that a clipping technique described above should be kept in mind as a safe value, though meticulous dissection of each aneurysmal neck followed by independent neck clipping is reasonable.

Differences in hepatitis C virus core protein processing among genotypes 1 and 2.

Two forms of hepatitis C virus (HCV) core protein, p23 and p21, are produced from a precursor polyprotein. Production of p21 by cleavage at the c-terminus of p23 is considered essential for viral assembly and replication. In the present experiment, an in vitro translation and transcription assays were used to examine cleavage of p21 from p23 among 19 clones isolated from patients with chronic hepatitis, including 10 infected with genotype 1, and nine infected with genotype 2. Significantly greater p21 to p23 ratios were observed among genotype 1 clones, compared to genotype 2 clones. A comparison of the amino acid sequences of these clones revealed greater production of p21 core protein among clones which contained alanine, rather than valine, at amino acid residue 189. An exploration of Hepatitis Virus Database revealed that efficient p21 production related alanine at amino acid position 189 was observed in most clones of genotype 1 and in rare clones of genotype 2. These data suggest that the efficiency of core protein production differs among genotypes depending on differences in the c-terminus amino acid sequences of their core region. This may explain differences in some of the clinical characteristics of various genotypes or clones.

Complete regression of esophageal cancer with concomitant liver metastasis achieved by concurrent chemoradiation therapy.

We report a patient with esophageal cancer with concomitant liver metastasis in whom complete response was achieved by chemoradiation therapy. A 66-year-old man was diagnosed as having stage IVB esophageal cancer with synchronous metastasis in the liver and cardiac lymph node, and concurrent chemoradiation therapy was started. The chemotherapy, consisting of 5-fluorouracil (300 mg/body per day, continuous infusion) and low-dose cisplatin (5 mg/body per day on 1-5 days every week), was performed for 7 weeks. In addition, radiation therapy (2 Gy/day on 1-5 days every week) was employed for both the local and the metastatic lesions, along with the chemotherapy. Throughout the course of this therapy, the patient did not experience severe toxicity, and this chemoradiation therapy resulted in complete regression of both the local and the metastatic diseases. Subsequently, he was followed-up as an outpatient without any maintenance therapy, and he has been free of disease for 38 months after completion of the therapy. This concurrent chemoradiation therapy may be effective for esophageal cancer even with visceral metastasis.