Evaluation of an automated rapid plasma reagin test of serum and cerebrospinal fluid for monitoring neurosyphilis treatment: A case report.

This case report explores the utility of monitoring automated rapid plasma reagin (RPR) test results in both serum and cerebrospinal fluid (CSF) samples from a patient undergoing treatment for neurosyphilis. Syphilis treatment is based on the rapid plasma reagin (RPR) and syphilis treponema antibody levels, and in the case of RPR-positive syphilis, a 1/4 reduction in the RPR value by the manual card test is considered curative. However, it should be noted that when RPR is followed by the manual card test, there may seem to be no reduction when the automated method shows a steady reduction. In the present case, initially under surveillance for an unrelated condition, was found to have symptoms; imaging and serological findings suggestive of syphilis infection including syphilitic aortitis and neurosyphilis. After two weeks of high-dose intravenous Penicillin G, the patient was treated with oral amoxicillin as an indicator of RPR titers in both the serum and cerebrospinal fluid (CSF) by automated latex agglutination. RPR in serum automated latex agglutination decreased to 1/4 at 14 weeks and treatment was terminated, with a subsequent downward trend. The RPR using the manual card test was 1/2 at 14 weeks. If only the manual card method was used, the patient might require a longer treatment. In conclusion, the automated latex agglutination method for monitoring the treatment response may be useful, especially in patients with high RPR titers.

Superiority of high sensitivity cardiac troponin I over NT-proBNP and adiponectin for 7-year mortality in stable patients receiving haemodialysis.

Patients on haemodialysis (HD) have high mortality risk, and prognostic values of the major cardiovascular biomarkers cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), and adiponectin should be ascertained over longer follow-up periods using higher-sensitivity assays, which we undertook. In 221 HD patients, levels of high-sensitivity (hs)-cTnI, NT-proBNP, and adiponectin, were measured using high-sensitivity assays, and their associations with all-cause mortality (ACM) and cardiovascular mortality (CVM) were prospectively investigated for 7 years. Higher hs-cTnI and NT-proBNP levels were significant risk factors for ACM and CVM in the Kaplan-Meier analysis. Multivariate Cox proportional hazards analyses in a model including hs-cTnI and NT-proBNP identified log hs-cTnI, but not log NT-proBNP, as an independent risk factor for ACM (HR 2.12, P < 0.02) and CVM (HR 4.48, P < 0.0005). Stepwise analyses identified a high hs-cTnI tertile as a risk factor for ACM (HR 2.31, P < 0.01) and CVM (HR 6.70, P < 0.001). The addition of hs-cTnI to a model including age, CRP, DM, and NT-proBNP significantly improved the discrimination of ACM and CVM each over 7 years. Conclusively, hs-cTnI was superior to NT-proBNP and adiponectin in predicting ACM and CVM over 7 years in HD patients, suggesting the significance of baseline hs-cTnI measurements in long-term management.

Antibody level dynamics until after the third dose of COVID-19 vaccination.

The antibody titers of volunteers, including elderly people, were investigated after the second dose of the BNT162b2 vaccine (Pfizer-BioNTech) as an mRNA vaccine against the coronavirus disease 2019 (COVID-19). Serum samples were collected from 105 volunteers (44 healthcare workers and 61 elderly people) 7-14 days after the second vaccine dose, and antibody titers were measured. The antibody titers of study participants in their 20s were significantly higher than those of other age groups. Furthermore, the antibody titers of participants aged <60 years were significantly higher than those of participants aged ≥60 years. Serum samples were repeatedly collected from 44 healthcare workers until after the third vaccine dose. Eight months after the second round of vaccination, the antibody titer levels decreased to the same level as that before the second vaccine dose. After the third booster vaccination, the antibody titer recovered to the same level as that after the second dose. Neutralizing activities were also investigated at four time points before and after the second vaccine dose. The antibody titers and neutralizing activity were positively correlated. Therefore, neutralizing activity can be predicted by measuring the antibody titer. In conclusion, the antibody titers in the elderly population were significantly lower than those in the younger population. Although the antibody titers increased following vaccination, their levels showed a decline after several months, returning to the same level as that after a single dose of mRNA vaccination. The antibody titer levels recovered after the third dose of vaccination, which had already been administered in Japan. Routine administration of vaccine should be considered in the future.