Five-year point prevalence survey of healthcare-associated infections and antimicrobial use in a Japanese university hospital.

BACKGROUND: Periodic point prevalence surveys (PPSs) provide a method for assessing changes in healthcare-associated infections (HAIs) and antimicrobial use over time. Following the introduction of an antimicrobial stewardship programme at Nagoya University Hospital (Aichi, Japan) a five-year PPS study was performed to highlight any epidemiological changes. METHODS: One-day PPSs were performed annually in July at Nagoya University Hospital. Data on patient characteristics, medical devices, active HAIs and antimicrobial use were collected using a standard data-collection form. RESULTS: A total of 4339 patients were included. Over the five-year study period the median patient age was 62 years, median duration of hospital admission was nine days, 9% of patients had an HAI and 35.2% received at least one antimicrobial. Overall there were 406 HAIs (95% confidence interval, 369-447) with surgical site infection, pneumonia and febrile neutropenia occurring most frequently. Enterobacterales were the most common pathogens (N = 78, 28.6%) and 32.1% were third-generation cephalosporin-resistant. Meropenem was the most frequently prescribed antimicrobial for HAIs. Surgical antimicrobial prophylaxis changed drastically, with shorter durations and a marked reduction in oral cephalosporin use. However, antimicrobials for medical prophylaxis gradually increased. CONCLUSIONS: This five-year PPS study shows consistent data for patient background, HAIs and causative pathogens and highlights changes in antimicrobial use during the era of the National Action Plan on Antimicrobial Resistance. To describe the epidemiology of Japanese hospitals by PPS, multicentre PPSs including in community hospitals should be performed annually.

The Japan-Multimodal Intervention Trial for Prevention of Dementia (J-MINT): The Study Protocol for an 18-Month, Multicenter, Randomized, Controlled Trial.

BACKGROUND/OBJECTIVES: The Japan-multimodal intervention trial for prevention of dementia (J-MINT) is intended to verify the effectiveness of multi-domain interventions and to clarify the mechanism of cognitive improvement and deterioration by carrying out assessment of dementia-related biomarkers, omics analysis and brain imaging analysis among older adults at high risk of dementia. Moreover, the J-MINT trial collaborates with partnering private enterprises in the implementation of relevant interventional measures. This manuscript describes the study protocol. DESIGN/SETTING: Eighteen-month, multi-centered, randomized controlled trial. PARTICIPANTS: We plan to recruit 500 older adults aged 65-85 years with mild cognitive impairment. Subjects will be centrally randomized into intervention and control groups at a 1:1 allocation ratio using the dynamic allocation method with all subjects stratified by age, sex, and cognition. INTERVENTION: The multi-domain intervention program includes: (1) management of vascular risk factors; (2) group-based physical exercise and self-monitoring of physical activity; (3) nutritional counseling; and (4) cognitive training. Health-related information will be provided to the control group every two months. MEASUREMENTS: The primary and secondary outcomes will be assessed at baseline, 6-, 12-, and 18-month follow-up. The primary outcome is the change from baseline to 18 months in a global composite score combining several neuropsychological domains. Secondary outcomes include: cognitive change in each neuropsychological test, incident dementia, changes in blood and dementia-related biomarkers, changes in geriatric assessment including activities of daily living, frailty status and neuroimaging, and number of medications taken. CONCLUSIONS: This trial that enlist the support of private enterprises will lead to the creation of new services for dementia prevention as well as to verify the effectiveness of multi-domain interventions for dementia prevention.

Putrescine-dependent invasive capacity of rat ascites hepatoma cells.

The effects of inhibitors of polyamine synthesis on the invasive capacity of rat ascites hepatoma (LC-AH) cells were examined by in vitro assay of penetration of the LC-AH cells through a monolayer of calf pulmonary arterial endothelial (CPAE) cells. Pretreatment of LC-AH cells with alpha-difluoromethylornithine (DFMO), an inhibitor of ornithine decarboxylase, before seeding them onto a CPAE cell monolayer and culturing them for 24 h in the absence of DFMO decreased the number of penetrating tumor cells time and dose dependently (about 35% of the maximal inhibition) without affecting their viability or proliferative activity. DFMO treatment caused a marked decrease in the intracellular level of putrescine but not of spermidine or spermine. The DFMO-induced decreases in invasive capacity and putrescine level were almost completely reversed by the addition of putrescine to the medium during pretreatment with DFMO or invasion assay but were not affected by exogenous spermidine or spermine. No change in the invasive capacity was observed when the CPAE cells were treated with DFMO and the LC-AH cells with methylglyoxal-bis(guanylhydrazone), an inhibitor of S-adenosylmethionine decarboxylase, which depressed the spermidine and spermine levels but increased the putrescine level in the LC-AH cells. These results suggest that intracellular putrescine modulates the in vitro invasive capacity of LC-AH cells.

Role of alpha-adrenergic mechanism in regulating tonic luteinizing hormone release in conscious ovariectomized rats.

The role of brain catecholamines in controlling tonic LH secretion was studied in unanesthesized, freely moving, ovariectomized rats. Pretreatment with reserpine (10 mg/kg), given 24 h before the experiment, significantly suppressed pulsatile LH secretion in these rats. Intraperitoneal administration of clonidine (1 mg/kg), an alpha-adrenergic stimulating agent, significantly raised plasma LH levels in reserpine-treated rats. On the other hand, the administration of apomorphine (1.5 mg/kg), a dopamine receptor-stimulating agent, had no effect on the plasma LH levels. These findings suggest an excitatory role of noradrenaline, operating through alpha-adrenergic receptors, in pulsatile LH secretion in ovariectomized rats.

Suppressive effect of prostaglandin (PG)D2 on pulsatile luteinizing hormone release in conscious castrated rats.

The effect of intraventricular administration of prostaglandin (PG)D2 on pulsatile LH release was studied in castrated conscious rats. The administration of 5 micrograms of PGD2 into the lateral ventricle inhibited pulsatile discharge of LH secretion, in contrast to the stimulatory effect of PGE2. Intraventricular administration of 13,14-dihydro-15-keto-PGD2, a metabolite of PGD2, had no significant effect. Intravenous administration of 100 micrograms of PGD2 caused only a slight decrease in LH secretion. Intravenous administration of naloxone, a specific opiate antagonist, blocked the suppressive effect of PGD2 on Lh release. These results suggest that PGD2 plays an inhibitory role in pulsatile LH secretion in castrated male rats and that opiate receptors are involved in the PGD2-induced inhibition of LH secretion.

Characterization of gamma-melanotropin-like immunoreactivity and its secretion in an adrenocorticotropin-producing mouse pituitary tumor cell line.

gamma MSH, a putative hormone in the N-terminal region of the ACTH/beta-endorphin (beta-EP) precursor protein, was studied by RIA with an antiserum against gamma 3MSH in ACTH-producing mouse pituitary tumor cells, AtT-20/D16v. Serial dilution of the culture medium or the cell extract gave parallel lines to the standard curve in the RIA for gamma MSH. Rat median eminence extracts enhanced the release of gamma MSH-like immunoreactivity (gamma MSH-LI) concomitant with ACTH-like immunoreactivity (ACTH-LI) and beta-EP-like immunoreactivity (beta-EP-LI). Dexamethasone suppressed the release of gamma MSH-LI as well as ACTH-LI and beta-EP-LI. Gel exclusion chromatography of the culture medium and the cell extract has revealed that gamma MSH-LI consists of two peaks; one eluted near the elution position of beta-lipotropin and the other near the elution position of beta-EP. There was no peak corresponding to the elution position of synthetic gamma 3MSH. However, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) has demonstrated that gamma MSH-LI migrated at five positions with molecular weights of 31K, 21-23K, 16-17K, 13-14K, and 3.8K, respectively. The 31K gamma MSH coincided with the migration position of 31K ACTH of 31K beta-EP, and 21-23K gamma MSH coincided with the position of 21-23K ACTH on SDS-PAGE. The 16-17K gamma MSH coincided with the mouse 16K fragment (reported by Eipper and Mains) of ACTH-beta-lipotropin precursor protein in the migration in SDS-PAGE and in immunoreactivity to anti-gamma MSH antiserum. [3H]Glucosamine was incorporated into 16K, 13K, and 3.8K gamma MSH. These results suggest that AtT-20/D16v cells produce gamma MSH-LIs with molecular weights of 31K, 21-23K, 16-17K, 13-14K, and 3.8K, and they are secreted concomitantly with ACTH-LI and beta-EP-LI.

The activity and expression of thymidine phosphorylase in human solid tumours.

Thymidine phosphorylase (dThdPase) is identical to platelet-derived endothelial cell growth factor (PD-ECGF) and has angiogenic activity. Since dThdPase seems to have an important role in angiogenesis of tumours, we measured the activity and expression of dThdPase in various tumours and the adjacent non-neoplastic tissues. We assayed dThdPase activity by spectrophotometric means, and the expression of dThdPase was examined by immunoblotting and by immunohistochemical staining using a monoclonal antibody against dThdPase. In the oesophagus, stomach, colorectum, pancreas, and lung, dThdPase activity in carcinomas was significantly higher (P < 0.05) than that in the adjacent non-neoplastic tissues. The expression level of dThdPase detected by immunoblotting correlated well with the activity of dThdPase. In the oesophagus, stomach, colorectum, gall bladder, pancreas and lung, the proportion of dThdPase-positive tumours was significantly higher (P < 0.05 or 0.01) than that of the dThdPase-positive adjacent normal tissues. In oesophageal, gastric colorectal and lung carcinomas, the proportion of dThdPase positivity in advanced carcinomas was significantly higher (P < 0.01) than that in early carcinomas. Tumour-infiltrative macrophages or lymphocytes in the lymph node, alveolar macrophages and Kupffer cells expressed high levels of dThdPase. The results indicate that dThdPase activity and expression level in many tumours are higher than those in the adjacent non-neoplastic tissues, and that dThdPase may have an important role in the proliferation of these solid tumours.

Coping style of schizophrenic patients in the recovery from acute psychotic state: a preliminary study.

This study was undertaken to clarify a clinically effective coping style of 13 schizophrenic patients during recovery from an acute psychotic state. Sixteen recovered depressives served as the control group. A comparison of the coping behavior profile between the two groups revealed that changes in physical activity were significantly more frequent in the schizophrenics (62%) than in the depressives (25%).

Sodium butyrate stimulates hCG and hCG-alpha production in a human choriocarcinoma cell line (BeWo).

To assess regulatory mechanism(s) of hormone production between ectopic and eutopic tumor cells, the effect of sodium butyrate on cell growth and hormone production was studied in BeWo, a trophoblastic cell line and in HeLa S3, a nontrophoblastic cell line. The addition of 2 mM sodium butyrate to HeLa S3 produced a marked increase in hCG-alpha both in the medium and in the cell extract, in contrast to its inhibitory effects on cell growth. Sodium butyrate had a similar effect on cell growth and hormone secretion in BeWo cells, as seen with an increase in release of hCG and hCG-alpha were also increased after exposure to sodium butyrate in BeWo. Thus, the regulation of hormone production in trophoblastic and nontrophoblastic tumor cells probably does not differ.

Effects of low-intensity aerobic training on the high-density lipoprotein cholesterol concentration in healthy elderly subjects.

The concentration of high-density lipoprotein cholesterol (HDL-C) is inversely correlated with the risk of coronary heart disease. The effects of low-intensity aerobic training on serum HDL-C and other lipoprotein concentrations were examined in healthy elderly subjects. The subjects were randomly assigned to two groups matched for sex, age, height, and weight. The training group (n = 20, 10 men and 10 women aged 67 +/- 4 years) participated in a supervised physical exercise regimen using a bicycle ergometer at an intensity of 50% estimated maximal oxygen consumption (VO2max) for 60 minutes two to four times per week for 5 months. In contrast, the control group (n = 20, 10 men and 10 women aged 68 +/- 4 years) did not perform any particular physical training. The training protocol resulted in significant increases in the VO2max (P < .05), HDL-C, HDL2-C, and HDL2-C/HDL3-C ratio (P < .01). The change in HDL2-C (r = .57, P < .01) and HDL2-C/HDL3-C (r = .63, P < .01) was positively associated with an increase in the total exercise duration per week. In addition, the total weekly exercise duration also showed a significant positive relationship with HDL-C (r = .75, P < .01), HDL2-C (r = .81, P < .01), and HDL2-C/HDL3-C (r = .71, P < .01) after the training period. The changes in body weight and the VO2max were not significantly correlated with any lipid parameters. Low-intensity aerobic training may improve the profile of HDL-C and its subfractions in healthy elderly subjects. Also, the total exercise duration may be an important factor for improving HDL-C and HDL2-C in elderly subjects.

Serotonin involvement in the inhibition of luteinizing hormone (LH) release induced by prostaglandin D2 (PGD2) in castrated male rats.

p-Chlorophenylalanine (PCPA, 320 mg/kg i.p.), an inhibitor of serotonin (5-HT) synthesis, and 5,6-dihydroxy-tryptamine (5,6-DHT, 50 micrograms i.c.v.), a drug toxic to the indoleaminergic system were used to test the involvement of 5-HT in the mediation of the inhibitory effect of prostaglandin D2 (PGD2) on luteinizing hormone (LH) release in castrated male rats. The i.c.v. administration of PGD2 suppressed the episodic LH release characteristic of castrated rats and decreased mean plasma LH levels and mean LH pulse amplitude significantly. Pretreatment with PCPA or 5,6-DHT apparently eliminated the inhibitory effect of PGD2 on LH secretion. These results suggest the possible involvement of a serotonergic mechanism in the mediation of the suppression of LH secretion induced by PGD2 in castrated male rats.

Evidence for noradrenergic involvement in naloxone-induced stimulation of luteinizing hormone release in prepubertal female rats.

The effects of phenoxybenzamine an alpha-adrenergic blocker, propranolol a beta-adrenergic blocker, and diethyldithiocarbamate a noradrenaline synthesis inhibitor, on the LH increase induced by naloxone an opiate antagonist, was investigated in 25 day old female rats. Pretreatment with phenoxybenzamine or diethyldithiocarbamate suppressed the LH increase induced by naloxone, whereas pretreatment with propranolol had no significant effects on the naloxone-induced LH release. These results suggest that naloxone-induced increase in LH release is mediated via a noradrenergic mechanism.

Suppressive effect of dynorphin-(1-13) on luteinizing hormone release in conscious castrated rats.

The effect of intraventricular administration of dynorphin-(1-13) on luteinizing hormone (LH) release was studied in castrated conscious rats. The administration of 5 micrograms of dynorphin-(1-13) into the lateral ventricle inhibited LH secretion. Intravenous administration of naloxone blocked this suppressive effect of dynorphin on LH release. These results suggest a possible role of dynorphin, in addition to beta-endorphin and Met5-enkephalin, in the control of LH release in male rats.

Serotonin involvement in the inhibition of luteinizing hormone (LH) release during immobilization in castrated male rats.

The involvement of serotonin in mediating the inhibitory effect of immobilization stress on LH secretion in castrated male rats was examined by employing p-chlorophenylalanine (PCPA, 320 mg/kg, ip), an inhibitor of serotonin synthesis, and 5,6-dihydroxytryptamine (5,6-DHT, 50 micrograms, icv), a drug toxic to the indoleaminergic system. Immobilization stress suppressed pulsatile LH release and decreased mean plasma LH levels. Pretreatment with PCPA or 5,6-DHT apparently eliminated the inhibitory effect of immobilization stress on LH release. These results suggest the possible involvement of a serotoninergic mechanism in mediating the suppression of LH release induced by immobilization stress in castrated male rats.

Blood pressure lowering effect of low intensity aerobic training in elderly hypertensive patients.

PURPOSE: The purpose of this investigation was to determine the effect of 9 months of low intensity aerobic training on blood pressure in elderly hypertensive patients who were receiving antihypertensive medication. METHODS: The training group (N = 13; mean age 75.4 +/- 5.4 yr) agreed to take part in physical training using a treadmill with an exercise intensity at the blood lactate threshold (LT) for 30 min three to six times a week for 9 months. The rest (N = 13; mean age 73.1 +/- 4.2 yr) served as controls. RESULTS: The resting systolic (-15 +/- 8 mm Hg), mean (-11 +/- 6 mm Hg), and diastolic blood pressures (-9 +/- 9 mm Hg) decreased significantly after 3 months of training and the blood pressure of all participants stabilized at a significantly lower level by the end of the study (9 months) in the training group, whereas no significant changes in blood pressure were found in the control group. Both the pretraining systolic and diastolic blood pressure of those recruited patients negatively correlated with those changes after the training (SBP: P < 0.01; DBP: P < 0.05, respectively). After 1 month of detraining in five patients, the blood pressure levels were similar to those in the pretraining state. The LT increased significantly in the training group (P < 0.01). CONCLUSION: In conclusion, an additional antihypertensive effect of mild aerobic training at the LT was confirmed in elderly patients receiving antihypertensive medication. The cessation of such training in five patients, however, resulted in a relatively rapid return to pretraining levels within a month.

Evaluation of the safety of sodium pectate as a food ingredient.

New potential uses of pectates in food products have recently stimulated interest in re-evaluating the information available concerning the safety of pectins and pectates as food ingredients. Data relevant to this re-evaluation have been obtained in rats in recent 14-day and 13 wk subchronic feeding studies with sodium pectate. Ames tests and other mutagenicity tests have been conducted with sodium pectate, bleached sodium pectate and mixed sodium/calcium pectate salts. These toxicological studies with pectates have provided further evidence of their safety, and support of the continued GRAS status of pectins and pectate salts.

67Ga planar imaging with a low-energy collimator and scatter correction using the triple energy window method.

To improve the spatial resolution and contrast of 67Ga planar imaging, we used a low-energy collimator and two lower-energy windows with a triple-energy-window (TEW) scatter compensation method. The spatial resolution is better than with a medium-energy collimator, and the TEW method can correct for scattered photons and reduce the background counts. In a phantom study and a clinical study involving 44 patients, the images obtained by the proposed method were compared with the images obtained with a medium-energy collimator and three energy windows without scatter compensation (the conventional method). The spatial resolution and the counts were measured. Two nuclear medicine physicians interpreted the images and clinical usefulness was evaluated. The spatial resolution and contrast were improved by our proposed method. It enabled the detection of lesions in five locations in the clinical study. The counts were reduced but misreadings were not seen. We conclude that our proposed method shows a clinical advantage over the conventional method. It can be used easily and quickly with commercially available equipment and is useful in clinical practice.

Giant hypertrophic gastritis and acute hepatitis associated with cytomegalovirus infection.

A 38-year-old man developed prominent hypoproteinemia after acute elevation of serum transaminase levels. Giant hypertrophy of the gastric mucosa, a short serum albumin half-life, and the absence of massive hepatocyte necrosis established the diagnosis of protein-losing gastropathy. The hypoproteinemia, gastric fold hypertrophy and hepatitis remitted spontaneously within 4 months. A high antibody titer against cytomegalovirus suggested an association between the viral infection and the patient's disease.

Quantitative evaluation in tumor SPECT and the effect of tumor size: fundamental study with phantom.

An experimental study with phantoms was performed in order to evaluate the effect of the tumor volume on the quantitative estimation in tumor SPECT. The ratio of mean count/pixel in the phantom to that of the background (T/N ratio) was well correlated with the size of the phantom: even when the concentration of the Tc-99m O-4 solution of globular phantoms with diameters of 29, 37 and 46 mm was constant, the greater the size of the phantom, the higher was the T/N ratio. This study showed that we should understand that the T/N ratio was certainly affected by the reduction of the tumor size itself whenever we evaluate treatment-response or assess tumor viability after treatment by reference to the T/N ratio.

Demonstration of abnormal perfusion in the pons with high resolution SPECT and technetium-99m HMPAO in a patient with acoustic neuroma.

We detected a regional defect in the pons with ipsilateral cerebellar hypoperfusion in a patient with acoustic neuroma by brain SPECT with 99mTc HMPAO. A high spatial resolution SPECT system with three detectors equipped with fan-beam collimators was employed. This is the first report of a defect in the brainstem being visualized by perfusion SPECT and this method could make it possible to clarify the cause of a remote effect on the cerebellar perfusion by injury to the brainstem.