Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report.

Amniotic fluid embolism (AFE) is a rare but fatal obstetric complication, characterized by sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation. Maternal mortality associated with AFE is high, making early recognition and prompt treatment important. In AFE with cardiac arrest, survival following acute cardiopulmonary dysfunction is crucial. In recent years, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has attracted attention as an aggressive treatment for AFE with cardiac arrest. A 40-year-old woman experienced sudden cardiac arrest due to AFE during cesarean section. Cardiopulmonary resuscitation and VA-ECMO (also called percutaneous cardiopulmonary support) were initiated early. Finally, she recovered without any complications. VA-ECMO can provide temporary respiratory and hemodynamic support until cardiopulmonary function improves after a few days in intensive care. VA-ECMO should be considered as an early treatment for AFE with cardiac arrest.

Atazanavir-induced urine crystals demonstrated by infrared spectroscopic analysis.

Atazanavir sulfate, an azapeptide inhibitor of HIV protease, has been associated with urolithiasis. A 60-year-old man with atazanavir-induced urinary sediment crystals verified by infrared spectroscopic analysis is described. He had been receiving highly active antiretroviral therapy (HAART) for HIV infection and also had a history of urinary lithiasis and been undergoing urinalysis once every month. Needle-shaped crystals were seen in his urine sediment and infrared spectroscopic analysis revealed that these were atazanavir crystals. Because the presence of the crystals in urine do not always reveal an abnormality in the urinary test strip analysis, the urinary sediment needed to be observed microscopically in order to prevent future urolithiasis and renal failure in this HIV patient receiving atazanavir.

[Clinical significance of hyaline casts in the new CKD risk classification (KDIGO 2009)].

Chronic kidney disease (CKD) significantly contributes to the increased number of dialysis patients with end stage renal disease. A new CKD risk classification (KDIGO 2009) established in 2011, which is defined by albuminuria and estimated glomerular filtration rate (eGFR) values, demonstrates the relative risks of CKD in great detail. In this study, we evaluated the clinical significance of urinary casts by categorizing a risk Group 1 to 5 according to the KDIGO 2009 classification. In the high risk CKD group (risk group 3 and over), we found a significantly higher number of patients who had > 100 hyaline casts/whole field (WF) in their urine than those that had < 100 hyaline casts/WF. Further, we determined the diagnostic accuracy for the high risk CKD group when the cutoff value for the number of hyaline casts was set at > or = 100 hyaline casts/WF (sensitivity: 44.7%, specificity: 96.5%). The eGFR value was significantly lower in the group with > or = 100 hyaline casts/WF, particularly in hypertensive patients, than that in the group with < 100 hyaline casts/ WF. Of interest is that the eGFR value was significantly lower in patients with 100-999 hyaline casts/WF and > or = 1,000 hyaline casts/WF than that in patients with < 100 hyaline casts/WF in A1 stage. Thus, our present study suggests that the presence of > or = 100 hyaline casts/WF indicates decreased eGFR, and the urinary casts counting may be important and useful for the screening and early detection of high-risk CKD.

First Report of Spinal Anesthesia for Cesarean Delivery in a Parturient With Jeune Syndrome: A Case Report.

Jeune syndrome, also known as asphyxiating thoracic dystrophy, is a rare form of autosomal recessive skeletal dysplasia. Respiratory distress due to thoracic and lung dysplasia is the primary complication associated with this disorder in neonates. Women with Jeune syndrome seldom conceive and give birth, as only a few survive until adulthood. Herein, we report the world's first case of a cesarean delivery under spinal anesthesia in a pregnant woman with Jeune syndrome with a history of chest wall reconstruction and spinal fusion surgeries.

Imaging of intracellular behavior of polymeric nanoparticles in Staphylococcus epidermidis biofilms by slit-scanning confocal Raman microscopy and scanning electron microscopy with energy-dispersive X-ray spectroscopy.

In drug delivery systems employing polymeric nanoparticles, accurate delivery of drugs to target sites such as bacterial cells, cell tissues, and organelles is essential. In particular, when designing drug delivery systems for the treatment of the biofilm infections, evaluation of the interaction between polymeric nanoparticles and biofilm or bacterial cells using a simple technique is of significant importance. Here we develop two types of novel techniques for the biological imaging of the intracellular behavior of two types of polymeric nanoparticles, biodegradable chitosan-modified poly (dl-lactide-co-glycolide) (PLGA) nanoparticles and chitosan-modified polyvinyl caprolactam - polyvinyl acetate -polyethylene glycol graft copolymer (Soluplus®, Sol) nanoparticles, within a Staphylococcus epidermidis biofilm. As the first technique, Raman imaging of unstained biological materials using slit-scanning confocal Raman microscopy (unstained Raman imaging) was performed, and as the second, field-emission scanning electron microscopy with energy-dispersive X-ray spectroscopy analysis of biological materials labeled with quantum dots (SEM-QD imaging) was demonstrated. These analyses revealed differing localization of the respective nanoparticles within the biofilm in accordance with the specific interactions of PLGA nanoparticles and Sol nanoparticles with the biofilm. These novel techniques open the door to biological imaging and analyses with high spatial resolution, which will help to understand the efficacy of drug delivery to target materials.

Utilization of cancer registry data for monitoring quality of care.

BACKGROUND: Cancer Program Practice Profile Reports (CP(3)R), established by the Commission on Cancer, are based on 6 guidelines for breast and colorectal cancer care using cancer registry data. The long-term goal is the use of cancer registry data for real-time interventions to optimize the process of individual patient multidisciplinary care. METHODS: CP(3)R results using 593 analytic breast cancer cases in 2008 were compared in 3 databases: an institutional breast cancer research database, an institutional cancer registry, and a regional Cancer Surveillance System. RESULTS: Compliance with the CP(3)R guidelines calculated using the 3 databases was 80% to 98% for radiation therapy following breast-conserving surgery, 78% to 88% for combination chemotherapy of hormone receptor-negative stage T1c, II, or III disease, and 53% to 85% for hormone therapy of hormone receptor-positive stage T1c, II, or III disease. There was a high rate of discrepancy of tumor characteristics, treatment, and CP(3)R resulting from inaccurate and incomplete data. CONCLUSIONS: Using national cancer databases prospectively to monitor and ensure optimal multidisciplinary cancer care will require dramatic changes in cancer registry processes.