Phylogenetic and phylodynamic analyses of hepatitis C virus subtype 1a in Okinawa, Japan.

Okinawa Island, located in Southern Japan, has a higher prevalence rate of hepatitis C virus subtype 1a (HCV-1a) infection than that in mainland Japan. Okinawa has a history of US military occupation after World War II. To elucidate the transmission history of HCV-1a in Okinawa, 26 whole-genome sequences were obtained from 29 patients during 2011-2016. Phylogenetic trees were reconstructed to identify the origin and characteristics of HCV-1a in Okinawa with epidemiological information. A phylogenetic tree based on whole-genome sequencing revealed that all of the samples were located below the US branches. Additionally, we identified one cluster comprised of 17 strains (Okinawa, n = 16; United States, n = 1). The majority of the patients in this cluster were people who inject drugs (PWID), indicating the presence of a people who inject drugs (PWID) cluster. Subsequently, Bayesian analyses were employed to reveal viral population dynamics. Intriguingly, a phylodynamic analysis uncovered a substantial increase in effective population size of HCV-1a from 1965 to 1980 and a slight increase in mid-2000, which were associated with an increase in illicit drug use in Okinawa. The estimated divergence time of the PWID cluster was 1967.6 (1964.2-1971.1). These findings suggest that HCV-1a was introduced into Okinawa from the United States in the late 1960s, coincident with the Vietnam War. Subsequently, HCV-1a might have spread among the Japanese population with the spread of injecting drug use. Our study provides an understanding of HCV transmission dynamics in Okinawa, as well as the key role of PWID in HCV transmission.

Alcoholic liver cirrhosis complicated with torsade de pointes during plasma exchange and hemodiafiltration.

A 36-year-old man with severe alcoholic hepatitis was treated with plasma exchange combined with hemodiafiltration to remove endotoxins and inflammatory cytokines. During the treatment, he had critical arrhythmia (torsade de pointes [TdP]). His laboratory data showed hypomagnesemia, which was suspected to be responsible for the development of TdP. Patients with alcoholic liver disease tend to have hypomagnesemia and Q-T interval prolongation. Furthermore, hemodiafiltration may cause hypomagnesemia. Careful observation for electrolytic imbalance is necessary when clinicians treat patients with alcoholic liver failure with a liver support system.

A patient with primary biliary cirrhosis associated with autoimmune hemolytic anemia.

Primary biliary cirrhosis is often associated with autoimmune conditions, such as thyroid disease, sicca complex, and rheumatoid arthritis. However, an association with autoimmune hemolytic anemia has rarely been reported. We present a case of primary biliary cirrhosis associated with warm type autoimmune hemolytic anemia, and we review prior reports.

IgG subclasses of islet cell surface antibodies and their cytotoxic activity against pancreatic islet cells.

IgG subclasses of islet cell surface antibodies (ICSA) and their cytotoxic activities against pancreatic islet cells in the presence of complements were simultaneously investigated in ICSA-positive patients with insulin-dependent diabetes mellitus (n = 15). ICSA (IgG class) and ICSA-IgG subclasses were determined by flow cytometry using a fluorescence-activated cell sorter (FACS). Complement-dependent antibody-mediated cytotoxicity (CAMC) was measured by release of 51Cr from target cells. For these assays, rat insulinoma (RINr) cells were used as antigenic or target cells. Sera from 11 out of 15 patients who were positive for ICSA possessed at least one positive ICSA-IgG subclass, though these sera did not always exert positive CAMC activities. When the relationship between ICSA-IgG subclasses and CAMC was tested by chi-square analysis, a significant relationship (P less than 0.01) was observed between ICSA-IgG3 and CAMC. In sera from the other four patients, not any positive ICSA-IgG subclass or CAMC activity was found. The data suggest that (1) ICSA (IgG class) found in diabetics are not always cytotoxic to pancreatic islet cells, (2) the IgG subclass of ICSA varies with the patients, and (3) ICSA-IgG3 have a significantly higher association with CAMC to pancreatic islet cells. Thus, ICSA (IgG class) might not always be responsible for the impairment of pancreatic islet cells, at least in part, because of the heterogenous ICSA-IgG subclass.

[Histopathological analysis of herniated cerebellar tonsils resected from the patients with Chiari type I malformation with syringomyelia].

Cerebellar tonsillectomy is a controversial treatment for Chiari type I malformation combined with syringomyelia. To demonstrate the validity of this procedure, we evaluated the postoperative clinical course, the histopathological finding in the resected cerebellar tonsils and the MR images of four patients. The patients were all women, ranging in age from 27 to 58 years old (mean: 43 years). The postoperative follows-up period lasted from 28 to 51 months (average: 38 mos), and the neurological symptoms and signs improved in all patients. Histopathological examination of the resected tonsils revealed a loss of Purkinje cells and granule cells. Vacuolated degeneration and chromatolysis were also seen, and modified Bielschowsky stain revealed axonal degeneration. These findings appeared to be irreversible. Postoperative T1-weighted MR images of the cervical and thoracic spine demonstrated a decrease in the size of the syrinx and the disappearance of evidence of tonsillar herniation in all patients. Postoperative phase-contrast MR images showed good CSF pulsation in the subarachnoid space at the craniocervical junction in all three patients examined. It was possible to avoid surgical complications by using careful microsurgical techniques. Based on these results, we concluded that cerebellar tonsillectomy is an adequate surgical strategies for treating Chiari type I malformation associated with syringomyelia.

[A case of local recurrent breast cancer with complete response to combination of systemic chemotherapy and topical use of adriamycin ointment].

A Case of local recurrent breast cancer in a 45-year-old female with complete response to Combination of chemotherapy and topical administration of Adriamycin is reported. The patient had left mastectomy for breast cancer in 1978, and then right mastectomy for breast cancer in 1987. Two years later, she was readmitted to our hospital with right neck lymph node metastasis and local recurrence at right chest wall. Neck lymph node metastasis was treated with irradiation with good response. On the other hand, Adriamycin ointment was applied to recurrent cancer on the right chest. The cancer was gradually diminished in size. Seventy-eight days after treatment, the local chest wall with cancer was resected. Histologically, the entire resected tissue showed no viable cancer cells and Adriamycin concentration in the tissue was extraordinary high (ten to forty fold over on systemic chemotherapy). Adriamycin ointment may be an alternative treatment of choice for local recurrent breast cancer.

[A infant case of rhabdomyosarcoma arising from the left iliac region with complete remission for 2 years after combination therapy].

A case of rhabdomyosarcoma in a 14-year-female is reported herein. The patient developed left inguinal pain and tumor. She was initially seen by her local medical doctor, who biopsied her left inguinal tumor with a pathological report of malignancy. She was referred to the Ryukyu University Hospital in July, 1990. CT and MRI demonstrated a large tumor 10 cm in diameter arising from the left iliac region. The tumor was extirpated and the pathological report indicated rhabdomyosarcoma (alveolar type). The patient was treated with VAC chemotherapy and local irradiation. Her course has been uneventful for the past 2 years without any clinical manifestation of recurrence since surgery.