Clinical Characteristics of Corynebacterium ulcerans Infection, Japan.

Corynebacterium ulcerans is a closely related bacterium to the diphtheria bacterium C. diphtheriae, and some C. ulcerans strains produce toxins that are similar to diphtheria toxin. C. ulcerans is widely distributed in the environment and is considered one of the most harmful pathogens to livestock and wildlife. Infection with C. ulcerans can cause respiratory or nonrespiratory symptoms in patients. Recently, the microorganism has been increasingly recognized as an emerging zoonotic agent of diphtheria-like illness in Japan. To clarify the overall clinical characteristics, treatment-related factors, and outcomes of C. ulcerans infection, we analyzed 34 cases of C. ulcerans that occurred in Japan during 2001-2020. During 2010-2020, the incidence rate of C. ulcerans infection increased markedly, and the overall mortality rate was 5.9%. It is recommended that adults be vaccinated with diphtheria toxoid vaccine to prevent the spread of this infection.

[A case of effective chemoradiotherapy using docetaxel and nedaplatin for recurrent anal canal squamous cell carcinoma].

69-year-old woman underwent resection of a tumor diagnosed as squamous cell carcinoma of the anal canal. After 4 years and 5 months, computed tomography(CT)showed abdominal and pelvic lymph node swelling. Chemotherapy consisting of biweekly docetaxel(35mg/m2)+nedaplatin(35mg/m2)achieved a partial response. After 20 cycles of chemotherapy, the patient was treated with radiotherapy because of a pelvic lymph node recurrence. Since then, no recurrence has occurred for 16 months. The adverse event was Grade 2 in leucopenia and neutropenia. This case suggested that chemoradiotherapy consisting of docetaxel +nedaplatin may be effective and safe for treating anal canal squamous cell carcinoma.

Early effects of the ex vivo evaluation system on graft function after swine lung transplantation.

OBJECTIVES: Ex vivo lung evaluation (ex vivo) has been developed as a useful method by which to assess lungs from donation-after-cardiac death (DCD) donors prior to transplant. However, the safety of the ex vivo circulation itself with respect to grafts has not been fully investigated. The aim of this study is to evaluate the effects of the ex vivo circuit using a swine lung transplant model. METHODS: Lungs with or without 2-h warm ischemia were used. To assess post-transplant graft function, the left lung was transplanted after 2-h ex vivo or cold preservation; blood gas analysis of the left pulmonary vein (partial pressure of oxygen, PO(2)) was performed during the 6-h post-transplant follow-up period. Data were compared between the ex vivo (+) and ex vivo (-) groups. RESULTS: Partial pressure of oxygen/ inspired oxygen fraction (PO(2)/FiO(2)) in the ex vivo (-) group was significantly greater than that in the ex vivo (+) group until 3h after transplant. The PO(2)/FiO(2) levels in both groups then increased and became similar at 6 h after transplant, regardless of whether ischemic or non-ischemic lungs (p<0.001 and p=0.004, respectively) were used. CONCLUSIONS: Negative effects of the ex vivo system were limited and seen only in the immediate post-transplant period. Therefore, in DCD swine lung transplantation, the ex vivo system appears to be safe.

Effect of donor pre-mortem hypoxia and hypotension on graft function and start of warm ischemia in donation after cardiac death lung transplantation.

BACKGROUND: The start of warm ischemic time (WIT) of donor lungs in donation after cardiac death (DCD) is not clearly defined. We investigated the effect of donor pre-mortem hypotension and hypoxia to determine which physiologic factor is the determinant of WIT onset in controlled DCD lung transplantation. METHODS: Twenty mechanically-ventilated donor pigs were placed in 4 groups (n = 5 each) and exposed to each of the pseudo-agonal conditions for 60 minutes: (1) control group, no intervention and optimum ventilation, followed by cardiac arrest; (2) hypotension (HT) group, controlled cardiac tamponade reducing systolic blood pressure to <50 mm Hg, followed by cardiac arrest; (3) hypoventilation (HV) group, ventilation with room air at 5 breaths/min, followed by cardiac arrest; (4) non-circulation (NC) group, initial cardiac arrest, followed by a 60-minute standoff time. The lung graft was retrieved and the left lung was transplanted to the recipient. Graft function was evaluated for 4 hours after contralateral pulmonary artery ligation. The reperfusion injury was evaluated based on tissue cytokine expression, wet weight-to-dry weight ratio, and histology at the end of the reperfusion period. RESULTS: Impaired post-transplant graft function was seen in the HV group, which had significantly poorer oxygenation during the reperfusion period than the other groups (p < 0.001). The HV group also had higher tissue levels of interleukin-8 (p < 0.05), a higher wet weight-to-dry weight ratio (p < 0.05), and histologic findings of graft tissue injury than the control group. The difference in these parameters among the control, HT, and NC groups was not significant. CONCLUSIONS: Only pre-mortem hypoxia provoked by hypoventilation significantly impaired lung graft function in DCD lung transplantation. Ventilatory rather than circulatory deterioration can trigger the onset of warm ischemia.

Suppression of inflammatory cytokines during ex vivo lung perfusion with an adsorbent membrane.

BACKGROUND: Lung grafts can be perfused ex vivo for 2 hours without edema formation; however, prolonged ex vivo lung perfusion (EVLP) eventually induces lung injury. This study evaluated the change in proinflammatory cytokines of the perfusate during EVLP and investigated the effect of cytokine removal using an adsorbent membrane. METHODS: Porcine heart-lung blocks were harvested after electrically induced cardiac arrest and underwent 12-hour EVLP with an adsorbent membrane (membrane group: n = 5) and without an adsorbent membrane (control group: n = 6). RESULTS: In the control group, both tumor necrosis factor-alpha and interleukin 8 levels were elevated in the perfusate 2 hours after perfusion. Although tumor necrosis factor-alpha and interleukin 8 levels were significantly lower in the membrane group than in the control group during the EVLP period, there was no significant difference in oxygenation, pulmonary vascular resistance, edema formation, or myeloperoxidase activity between the two groups. CONCLUSIONS: Tumor necrosis factor-alpha and interleukin 8 levels of the perfusate were elevated during EVLP. Although adverse effects of these inflammatory cytokines were anticipated, removal of inflammatory cytokines by the adsorbent membrane did not improve lung function during prolonged EVLP. Factors other than the cytokines may play a major role in causing lung injury during EVLP. Further research is needed to investigate the real mechanism of lung graft injury during prolonged EVLP and to establish longer EVLP duration for graft treatment. This strategy could contribute to the salvage of potentially damaged lungs, especially from cardiac death donors, and to expansion of the donor pool.

An intervention to improve the interrater reliability of clinical EEG interpretations.

Several studies have noted modest interrater reliability of clinical electroencephalogram (EEG) interpretations. Moreover, no study to date has investigated a means to improve the observed interrater agreement. The purpose of the present study was to examine (i). the interrater reliability of EEG interpretations among three raters (two psychiatrists and one pediatrician); and (ii). how to improve the reliability by establishing a consensus guideline for EEG interpretation. Three raters, two psychiatrists and a pediatrician, interpreted 100 consecutive EEG recorded at Tajimi General Hospital. After discussing the results of the first trial, the raters established a consensus guideline for EEG interpretation. They then interpreted 50 consecutive EEG recorded at Nagoya City University Hospital following this guideline. Kappa for global judgment of EEG abnormality in three grades (abnormal/borderline/normal) was 0.42 on the first and 0.63 on the second trial. Kappa significantly improved by using the guideline (P = 0.004). It is suggested that discussing and establishing the consensus guideline among the raters offers a feasible method to improve interrater reliability in clinical EEG interpretations.

Depression as a potential causal factor in subsequent miscarriage in recurrent spontaneous aborters.

BACKGROUND: Unexplained miscarriage is speculated to be due to a Th1/Th2 cytokine imbalance at the feto-maternal interface and immunological functions are known to be under the influence of various psychological factors. Indeed, the psycho-neuro-immuno-endocrine network has been proposed to contribute to miscarriage. To assess whether psychological disorders might induce spontaneous abortion we carried out a prospective study to determine if any psychological parameter influenced risk in those patients with a history of recurrent miscarriages. METHODS: A prospective study was carried out on 61 patients with a history of two consecutive first-trimester miscarriages. A battery of self-report questionnaires including Symptom Checklist-90 Revised and the NEO Five Factor Index and semi-structured interviews were conducted before a subsequent pregnancy. We investigated whether or not these parameters predicted subsequent miscarriages. RESULTS: Ten (22.2%) of the 45 patients who conceived miscarried again. Baseline depressive symptoms influenced subsequent miscarriage (P = 0.004). This statistically significant effect remained when we corrected with Bonfferoni adjustment (P = 0.036). CONCLUSIONS: A high depression scale is associated with a high miscarriage rate in those patients suffering recurrent miscarriage.

Parents, personality or partner? Correlates of marital relationships.

BACKGROUND: Intimate relationships play an important role in the psychological and physical wellbeing of women during and after pregnancy. Our previous analyses demonstrated the significant role of marital relations on the woman's emotional status among a cohort of 61 married Japanese couples with a history of two consecutive spontaneous abortions. METHODS: The present analyses examined factors which may be related to the wife's perceived marital quality, including her parental rearing experiences, personality of the woman herself, or the personality of the husband. RESULTS: The wife's perception of care received from her mother correlated positively with her husband's care whereas overprotection received from the mother also correlated positively with the husband's control. A woman scoring high on the Conscientiousness scale of the five-factor model of personality tended to report more care, and a woman high on the Agreeableness scale less control from her husband, whereas a husband high on the Openness scale tended to show more care in his marital relation. CONCLUSION: The continuity hypothesis between the quality of parental relations in childhood and the quality of intimate bonds in adulthood received partial support in a non-Western sample. This hypothesis merits further exploration, preferably within a more integrated model of marital quality.

Japanese version of the Quality of Relationship Inventory: its reliability and validity among women with recurrent spontaneous abortion.

Until now most of the research on social support has concentrated on general support in relationship to the whole group of people around each individual. In contrast, only a few studies have dealt with individual-specific support (i.e. social support from a particular individual relationship). The Quality of Relationship Inventory (QRI) is a recently developed questionnaire to measure individual-specific social support. We developed the Japanese version by means of back translation and ascertained its reliability and validity among the Japanese women who had had two recurrent spontaneous abortions without known organic etiologies. Factor analysis revealed that the Japanese QRI had a two-factor structure, representing supportive and conflictual aspects of a particular relationship (named Factor-S and Factor-C, respectively). Each factor showed satisfactory reliability with Cronbach's alphas of 0.95 and 0.89. When the QRI scores were compared with the scales from the Social Support Questionnaire, a measure of general social support, the Factor-C of the former with respect to the mother correlated negatively with the Social Support Satisfaction of the latter (r = - 0.40; 95% confidence interval (CI) - 0.64 to - 0.09). Childhood experiences with parents also showed expected correlations with the QRI: care received from the parent before age 16 years strongly predicted Factor-S with that parent (r = 0.50, 95% CI 0.21-0.71 in the case of the mother; r = 0.54, 95% CI 0.27-0.73 in the case of the father). Although we still need to examine the Japanese QRI with different populations, it appears to be a promising measure of individual-specific relationship for the Japanese population.