Local fungus-specific Immunoglobulin E production in chronic rhinosinusitis with nasal polyps.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease, and its pathogenesis remains controversial. This study aimed to examine the involvement of fungi in CRSwNP pathogenesis. METHODS: We enrolled 29 controls and 111 CRSwNP patients. We analyzed fungi in the nasal secretions, serum fungus-specific immunoglobulin E (IgE) levels, and nasal polyp (NP) IgE levels. Moreover, we evaluated the correlation between patients' IgE levels and computed tomography (CT) scores. RESULTS: There was no difference in fungal detection rate between CRSwNP patients with and without asthma. Specific IgEs against various antigens were highly detectable in NPs of CRSwNP patients. In CRSwNP patients, fungus-specific IgE levels in NPs were correlated with CT scores. Serum fungus-specific IgEs became undetectable after operation in more than half of the CRSwNP patients without asthma but not in those with asthma. Other serum airborne antigen-specific IgEs did not become undetectable after operation. CONCLUSIONS: Fungus-specific IgEs were highly detectable in NPs of CRSwNP patients, and NPs comprised a major region of specific IgE production. Fungi may therefore play an important role in CRSwNP pathogenesis by inducing Th2 immune responses, including IgE synthesis.

Glucoamylase is a major allergen of Schizophyllum commune.

BACKGROUND: Schizophyllum commune is one of the causative agents of basidiomycosis including disorders such as allergic bronchopulmonary mycosis, allergic fungal sinusitis, and mucoid impaction of bronchi, the incidence of those of which has been increasing. These mycoses are difficult to diagnose because only a limited number of diagnostic tools are currently available. The biggest problem is that no specific antigens of S. commune have been identified to enable serodiagnosis of the disease. OBJECTIVE: In this study, we attempted to identify a major antigen of S. commune to establish a reliable serodiagnostic method. METHODS: We used mass spectrometry to identify an antigen that reacted with the serum of a patient with allergic bronchopulmonary mycosis caused by S. commune. The protein was expressed in Escherichia coli, highly purified, and the patient sera IgG and IgE titres against the protein were determined by enzyme-linked immunosorbent assay. RESULTS: The protein identified as a major antigen of S. commune was named Sch c 1; it was a homolog of glucoamylase. The IgG and IgE titres against Sch c 1 in patient sera were significantly higher than those in healthy volunteer sera (P < 0.01). CONCLUSIONS AND CLINICAL RELEVANCE: Sch c 1 is recognized by the host immune system of patients as an antigen/allergen. The purified glucoamylase Sch c 1 is a promising candidate antigen for the serodiagnosis of S. commune-induced mycosis.

Drain outlets in patient rooms as sources for invasive fusariosis: an analysis of patients with haematological disorders.

BACKGROUND: Invasive fusariosis (IF) is a frequently fatal disease as there are few antifungals to treat it, making the prevention of IF crucial. However, fusarium infections have not been as thoroughly studied as other common pathogenic fungi such as Aspergillus or Candida. AIM: To investigate the epidemiology of IF in patients with haematological diseases in Japan and to elucidate the infectious route of fusarium infection. METHODS: We retrospectively analysed 29 IF cases in patients with haematological diseases from 2009 to 2019 in Japan. To discover the infectious source of IF, we performed an indoor environment survey targeted at indoor air and drain outlets in medical institutions and residences using culture-based and metagenomic methods. Finally, we performed aerosol- and droplet-mediated dispersion studies. FINDINGS: The epidemiological study showed that the primary pathogen of IF was Fusarium solani species complex (FSSC), and the most common species was Fusarium petroliphilum. Most patients were likely to develop IF during hospitalization. A fusarium culture was positive in 26 of 72 drain samples. Few fusarium were detected from air samples; by contrast, 29 of 108 isolates from the drain outlets were identified as fusarium. Furthermore, similar results were obtained in the metagenomic analysis. Interestingly, species belonging to FSSC were isolated from indoor drain outlets, which was similar to those of the IF patients. In the droplet-mediated dispersion study, eight to 17 colonies of fusarium were isolated. CONCLUSION: Our study indicates that causative Fusarium spp. could inhabit drain outlets in hospitals or residences, and droplet-mediated fusarium dispersion is a potential cause of IF.

Clonality of primary pulmonary lymphoproliferative disorders; using in situ hybridization and polymerase chain reaction for immunoglobulin.

Primary pulmonary lymphoproliferative disorders (PLDs) are histologically divided into a neoplastic state of high and low grade malignant lymphoma (ML), and a reactive state of follicular bronchitis/bronchiolitis (FB) and lymphoid interstitial pneumonia (LIP). We reviewed 19 cases with PLDs, including 4 cases each of high and low grade B cell ML, 6 FB cases, and 5 cases of LIP. To clarify the clonality of the proliferating cells, we performed an immunohistochemical examination (IHC), in situ hybridization (ISH) for the immunoglobulin light chain and a polymerase chain reaction (PCR) analysis of the immunoglobulin heavy chain gene using DNA obtained from paraffin sections. In addition, a Southern blot analysis was also performed in 6 cases using fresh materials. In IHC, all ML were positive for L26 (CD20), while the monoclonality of the kappa light chain was observed in only one high grade case. However, using ISH we could detect the clonality in three of four high grade ML cases and in one of four low grade ML cases. In FB and LIP, no clonality of immunoglobulin by ISH was observed. In a PCR analysis for the immunoglobulin heavy chain gene, we could detect one or two prominent bands in all 8 cases of high and low grade ML. On the other hand, in all cases of FB and LIP, we could only detect either an oligoclonal or polyclonal population. In summary, the presence of monoclonality of ISH and/or PCR for the immunoglobulin heavy chain gene were limited in the neoplastic state, but not in the reactive state.

Effects of addition of arginine, cystine, and glycine to the bovine milk-simulated amino acid mixture on the level of plasma and liver cholesterol in rats.

The effects of the addition of varying levels of arginine (Arg), cystine (Cys), and glycine (Gly) to the bovine milk-simulated amino acid mixture on the levels of plasma and liver cholesterol were investigated in rats. The diets containing a high amount of Cys lowered significantly the level of plasma cholesterol as the amount of Cys in diets increased. The serum high density lipoprotein (HDL)-cholesterol level and fecal excretion of acidic steroids were higher in rats fed the Cys diets than in those fed the Arg and Gly diets. No differences, however, was observed in the content of liver cholesterol. Liver triglyceride contents elevated significantly on feeding the Arg and Cys diets. Furthermore, liver phospholipid contents elevated significantly on feeding the Arg diet but lowered on feeding the Cys diet. Therefore, these results indicated that the feeding of a high amount of Cys lowers the plasma cholesterol levels as the result of the enhanced conversion of cholesterol to bile acids.

Combined effects of dietary protein and fat on lipid metabolism in rats.

The combined effects of dietary protein (casein, whey protein, or soy protein) and fat (safflower oil, perilla seed oil, or their mixed oil; linoleic acid/alpha-linolenic acid = 5.0) on several lipid parameters were studied in rats. Serum cholesterol and triglyceride levels were lower in perilla seed oil groups irrespective of the protein sources. Liver triglyceride level, and fecal excretion of steroids were influenced mainly by protein sources, particularly isolated soy protein lowered liver triglyceride level, and increased the fecal steroid excretion. The fatty acid composition of liver phosphatidylcholine was influenced by dietary fat sources. The proportion of arachidonic acid was significantly lower in rats fed perilla seed oil than in those fed safflower oil or mixed oil, while the proportion of eicosapentaenoic acid was higher in rats fed perilla seed oil than in those fed safflower oil. Arachidonic acid/linoleic acid ratio was significantly lower in perilla seed oil groups, and tended to be higher in casein groups. Eicosapentaenoic acid/arachidonic acid ratio was influenced by both dietary protein and fat, and protein-fat interaction was observed. Eicosapentaenoic acid/arachidonic acid ratio was higher in perilla seed oil groups, and isolated soy protein in perilla seed oil groups lowered the ratio in comparison with other protein sources in perilla seed oil groups.

Effects of whey protein on calcium and bone metabolism in ovariectomized rats.

We studied the effects of whey protein (WP) from cow's milk on calcium and bone metabolism in ovariectomized (OVX) rats. Six-week-old female Sprague-Dawley rats were ovariectomized and fed a low-calcium diet (0.03% Ca, 0.3% P) for 4 weeks. The OVX rats were divided into three groups and subjected to two experiments: Exp. 1, Cont group (20% casein, 0.3% Ca), WP (1%) group (19% casein, 1% whey protein, 0.3% Ca) and Low-Ca group (20% casein, 0.03% Ca); and Exp. 2, Cont group (20% casein, 0.3% Ca), WP (1%) group (19% casein, 1% whey protein, 0.3% Ca) and WP (2%) group (18% casein, 2% whey protein, 0.3% Ca). The rats were fed each experimental diet for 4 weeks. The final body weight, weight gain, food intake and food efficiency showed no significant difference between the Cont and WP (1%, 2%) groups in Exps. 1 and 2. There were no significant differences in the calcium balance, serum ALP or serum calcitonin levels between the Cont and WP groups in Exp. 1. But the breaking energies of the WP (1%, 2%) groups were higher than those of the Cont groups in Exps. 1 and 2. As for the amount of calcium, phosphorus and magnesium in the femur, there were no significant differences between the Cont and WP (1%, 2%) groups; however, the amounts of total amino acids in the femur of the WP (1%, 2%) groups were higher than those of the Cont groups in Exps. 1 and 2. The amounts of proline and hydroxyproline in the femur of the WP (1%, 2%) groups were also higher than those of the Cont groups in Exps. 1 and 2. These data indicate that the milk whey protein influence in OVX rats is an increase in bone proteins such as collagen and enhanced bone-breaking energy.

The Cummins model: a framework for teaching nursing students for whom English is a second language.

The health care system requires nurses with the language ability and the cultural knowledge to meet the health care needs of ethnic minority immigrants. The recruitment, admission, retention, and graduation of English as a Second Language (ESL) students are essential to provide the workforce to meet the demands of the multicultural community. Yet, ESL students possess language difficulties that affect their academic achievement in nursing programs. The application of the Cummins Model of language proficiency is discussed. The Cummins Model provides a framework for nursing faculty to develop educational support that meets the learning needs of ESL students.

A critical thinking model for nursing judgment.

Increasingly, the characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Critical thinking is an essential component of nursing. Yet, no clear definition or conceptualization of critical thinking for nursing judgment has existed. Lack of consensus and overlapping definitions may well diminish the profession's ability to articulate this concept and facilitate its development. This article proposes the Critical Thinking Model for Nursing Judgment, which specifies five components: specific knowledge base, experience, competencies, attitudes, and standards. The model has three levels of critical thinking: basic, complex, and commitment. It provides a definition and conceptualization of critical thinking based on a review of the literature and input from nurses and nurse educators. The model provides a first step for development of further research and educational strategies to promote critical thinking as an essential part of autonomous, excellent nursing practice.

Culturally competent teaching strategies for Asian nursing students for whom English is a second language.

Asian nursing students for whom English is a second language have unique educational needs. These educational issues have not been addressed in the literature. The dynamic changes in the delivery of health care today and in the nursing profession have rapidly changed the academic and clinical requirements of nursing students and sometimes placed them at a disadvantage. This paper presents culturally competent teaching strategies specific to helping English-as-a-Second-Language (ESL) Asian nursing students become active learners in their nursing programs.

Continuous passive motion after internal fixation of distal humerus fractures.

Two patients with severe intra-articular fractures of the distal humerus were treated with internal fixation and postoperative continuous passive motion (CPM) of the elbow. The CPM machine's range of motion was initially set at 30 degrees to 70 degrees of flexion for one patient and 45 degrees to 90 degrees of flexion for the other. The arc of motion was gradually increased daily without discomfort. There was no occurrence of wound complications, nonunion, loss of reduction, heterotopic ossification, or failure of fixation. At last evaluation, both patients had full pronation and supination. One patient had 0 degrees to 135 degrees of elbow flexion, and the other had 30 degrees to 110 degrees. Both patients had pain-free elbows. CPM was found to be a valuable therapeutic modality in the postoperative management of intra-articular fractures of the elbow.