Mechanochemical synthesis of fluoride-ion conducting glass and glass-ceramic in ZrF4-BaF2 binary system.

Fluoride glasses in the binary system ZrF4-BaF2 were prepared via mechanochemical treatment. The glass-forming region of the ZrF4-BaF2 system obtained using the mechanochemical method was wider than that obtained using the conventional melt-quenching method. The glass-ceramic 60ZrF4·40BaF2 (mol%) sample was obtained by heat treatment and shows a higher conductivity of 1.2 × 10-6 S cm-1 at 200 °C than the pristine glass. This study revealed that mechanochemical treatment was effective for the synthesis of fluoride glasses.

The hepatic niche leads to aggressive natural killer cell leukemia proliferation through the transferrin-transferrin receptor 1 axis.

Aggressive natural killer cell leukemia (ANKL) is a rare lymphoid neoplasm frequently associated with Epstein-Barr virus, with a disastrously poor prognosis. Owing to the lack of samples from patients with ANKL and relevant murine models, comprehensive investigation of its pathogenesis including the tumor microenvironment (TME) has been hindered. Here we established 3 xenograft mice derived from patients with ANKL (PDXs), which enabled extensive analysis of tumor cells and their TME. ANKL cells primarily engrafted and proliferated in the hepatic sinusoid. Hepatic ANKL cells were characterized by an enriched Myc-pathway and proliferated faster than those in other organs. Interactome analyses and in vivo CRISPR-Cas9 analyses revealed transferrin (Tf)-transferrin receptor 1 (TfR1) axis as a potential molecular interaction between the liver and ANKL. ANKL cells were rather vulnerable to iron deprivation. PPMX-T003, a humanized anti-TfR1 monoclonal antibody, showed remarkable therapeutic efficacy in a preclinical setting using ANKL-PDXs. These findings indicate that the liver, a noncanonical hematopoietic organ in adults, serves as a principal niche for ANKL and the inhibition of the Tf-TfR1 axis is a promising therapeutic strategy for ANKL.

Pneumatosis Cystoides Intestinalis: A Case Report.

BACKGROUND Pneumatosis cystoides intestinalis (PCI) is a rare condition in which cystic gas is found in the submucosal and serosal tissues of the intestinal wall. CASE REPORT The patient, an 84-year-old woman, was referred to us because of abdominal distention and diarrhea lasting 2 weeks. On initial physical examination, there was marked abdominal distention without tenderness. Blood tests revealed no abnormalities, but simple abdominal radiographs showed gas in the small intestine. Contrast-enhanced computed tomography showed massive emphysema in the intestinal wall with no signs of portal gas or intestinal ischemia. The patient was diagnosed with PCI, and the prognosis was good. The patient showed improvement when managed with an elimination diet and follow-up. CONCLUSIONS Herein, we present the characteristics and diagnosis of PCI because the imaging findings of PCI can appear more severe than the actual condition, causing it to be mistaken for other serious diseases, which leads to unnecessary surgical procedures.

Prediction of ESBL-producing E coli for suspected urinary tract infection.

AIM: The widespread existence of extended-spectrum ß-lactamase (ESBL) producing Escherichia coli (E. coli) has become a critical threat in developed countries. Prediction rule for ESBL producing E. coli is relevant to see patients with suspected urinary tract infection. MATERIALS AND METHODS: We collected clinical and laboratory data and constructed multivariate logistic regression models to develop a clinical prediction rule in the derivation cohort with 1185 patients with urine cultures and validated the rule in the validation cohort with 516 patients. RESULTS: ESBL-producing E. coli was found in 185 patients (16%) in the derivation cohort. When assigning 14 points for being female (odds ratio (OR): 4.2), six points for CRP >5 mg/dl (OR: 1.87), and four points for a history of urinary tract infection (OR: 1.52), the area under the curve (AUC) had 0.67 (95% confidence interval (CI): 0.63-0.70) in the derivation cohort and 0.64 (95% CI: 0.59-0.69] in the validation cohort. CONCLUSIONS: The developed prediction rule had moderate accuracy to predict ESBL-producing E. coli in patients with suspected urinary tract infection.

Clinical characteristics and treatment of IMP-type carbapenemase-producing Enterobacteriaceae bacteremia: Case series and literature review.

BACKGROUND: Several carbapenemases have been identified globally in Enterobacteriaceae. In Japan, IMP-type carbapenemase is the most prevalent, although cases of carbapenemase-producing Enterobacteriaceae (CPE) bacteremia are still scarce. The present case series and literature review aimed to elucidate the clinical characteristics and treatment strategies for IMP-type CPE bacteremia. METHODS: Clinical data on pediatric cases of IMP-type CPE bacteremia at the Tokyo Metropolitan Children's Medical Center between 2010 and 2020 were collected, and a review of past studies of IMP-type CPE bacteremia has been provided. RESULTS: Five pediatric episodes of IMP-type CPE bacteremia were identified. Our review of previous literature on IMP-type CPE bacteremia revealed 24 adult patients, but no pediatric patients. All 29 cases had underlying diseases, and 23 (79%) received combination therapy. The median duration of antibiotic therapy was 14 days (interquartile range: 9-14 days). The overall mortality rate was 38% (11/29). The mortality rates associated with monotherapy and combination therapy were 67% (4/6) and 30% (7/23), respectively. CONCLUSIONS: We report the first case series of IMP-type CPE bacteremia in children. Our review of past studies suggests that combination therapy might lead to better survival outcomes in patients with IMP-type CPE bacteremia. Further research is needed to establish an optimal treatment strategy for IMP-type CPE bacteremia.

Unexplained Abdominal Pain Caused by Fracture of the Thoracic Vertebra.

BACKGROUND It is important to identify the cause of chronic abdominal pain, especially in older adults. Thoracolumbar vertebral compression fractures are one potential cause, and can be difficult to identify. We report a case of an older man with severe unexplained abdominal pain and nausea due to an inadequately treated thoracolumbar vertebral compression fracture. CASE REPORT A 93-year-old man fell 89 days prior to visiting the hospital and was diagnosed with a compression fracture in the Th12 vertebra. He started wearing a corset on the day of the injury. Two days later, he developed abdominal pain, mild nausea, and a decreased appetite. He attributed the symptoms to wearing the corset; therefore, he stopped wearing it. The cause of his abdominal symptoms could not be determined by blood tests and computed tomography of the abdomen. A 45° upper body elevation induced marked right lower abdominal pain (consistent with the dominant region of Th12-L1), and decreased temperature sensation was observed in the same region. We concluded that the abdominal pain was caused by neuropathy owing to a ruptured Th12 vertebral fracture. The patient was treated conservatively, the abdominal pain and nausea resolved 7 weeks after admission, and the patient was discharged. CONCLUSIONS When assessing patients with unexplained abdominal pain, vertebral compression fractures should be included in the differential diagnosis and the necessary diagnostic assessments should be made as early as possible. Early diagnosis provides a wider range of treatment options and can contribute to minimizing functional decline.

Large Reduction in Postoperative Posterior Tibial Slope Risks Anterior Collapse of the Tibial Component in Fixed-Bearing Unicompartmental Knee Arthroplasty.

Background: Although the posterior tibial slope (PTS) of the tibial component in unicompartmental knee arthroplasty is recommended to be between 3° and 7°, variations in preoperative PTS are wide. The purpose of this study was to evaluate the influence of the changes in preoperative and postoperative PTS on clinical outcomes. Methods: One-hundred and eighty-two knees that underwent medial fixed-bearing unicompartmental knee arthroplasty were evaluated retrospectively. The mean follow-up period was 36.4 ± 13.2 months (range, 24 to 63 months). Preoperative and postoperative PTS were measured on lateral radiographs. Knees were classified in the large reduction group if the postoperative PTS was reduced by more than 5° compared with the preoperative value and in the small reduction group if not. Knee flexion angle and 2011 Knee Society Knee Scoring System were evaluated at the last follow-up of at least 2 years. Results: Thirty-three knees were classified in the large reduction group, and 149 knees were classified in the small reduction group. The preoperative and postoperative PTS of large and small reduction groups were 10.9 ± 2.2, 3.6 ± 2.4 degrees and 7.7 ± 2.7, 7.1 ± 2.4 degrees, respectively. Flexion angle and 2011 Knee Society Knee Scoring System were not significantly different between the groups. However, the incidence of anterior collapse of the tibial component in the large group was significantly higher than that in the other group (P < .001). Conclusions: Large reduction in the postoperative PTS may be associated with anterior tibial collapse, and therefore this study shows one potential benefit for matching native slope.

Secreted phospholipase A2 modifies extracellular vesicles and accelerates B cell lymphoma.

Extracellular vesicles (EVs) including exosomes act as intercellular communicators by transferring protein and microRNA cargoes, yet the role of EV lipids remains unclear. Here, we show that the pro-tumorigenic action of lymphoma-derived EVs is augmented via secreted phospholipase A2 (sPLA2)-driven lipid metabolism. Hydrolysis of EV phospholipids by group X sPLA2, which was induced in macrophages of Epstein-Barr virus (EBV) lymphoma, increased the production of fatty acids, lysophospholipids, and their metabolites. sPLA2-treated EVs were smaller and self-aggregated, showed better uptake, and increased cytokine expression and lipid mediator signaling in tumor-associated macrophages. Pharmacological inhibition of endogenous sPLA2 suppressed lymphoma growth in EBV-infected humanized mice, while treatment with sPLA2-modified EVs reversed this phenotype. Furthermore, sPLA2 expression in human large B cell lymphomas inversely correlated with patient survival. Overall, the sPLA2-mediated EV modification promotes tumor development, highlighting a non-canonical mechanistic action of EVs as an extracellular hydrolytic platform of sPLA2.

WWP1 inactivation enhances efficacy of PI3K inhibitors while suppressing their toxicities in breast cancer models.

Activation of the phosphatidylinositol 3-kinase (PI3K) signaling pathway is a pervasive event in tumorigenesis due to PI3K mutation and dysfunction of phosphatase and tensin homolog deleted on chromosome 10 (PTEN). Pharmacological inhibition of PI3K has resulted in variable clinical outcomes, however, raising questions regarding the possible mechanisms of unresponsiveness and resistance to treatment. WWP1 is an oncogenic HECT-type ubiquitin E3 ligase frequently amplified and mutated in multiple cancers, as well as in the germ lines of patients predisposed to cancer, and was recently found to activate PI3K signaling through PTEN inactivation. Here, we demonstrate that PTEN dissociated from the plasma membrane upon treatment with PI3K inhibitors through WWP1 activation, whereas WWP1 genetic or pharmacological inhibition restored PTEN membrane localization, synergizing with PI3K inhibitors to suppress tumor growth both in vitro and in vivo. Furthermore, we demonstrate that WWP1 inhibition attenuated hyperglycemia and the consequent insulin feedback, which is a major tumor-promoting side effect of PI3K inhibitors. Mechanistically, we found that AMPKα2 was ubiquitinated and, in turn, inhibited in its activatory phosphorylation by WWP1, whereas WWP1 inhibition facilitated AMPKα2 activity in the muscle to compensate for the reduction in glucose uptake observed upon PI3K inhibition. Thus, our identification of the cell-autonomous and systemic roles of WWP1 inhibition expands the therapeutic potential of PI3K inhibitors and reveals new avenues of combination cancer therapy.

Significance of trogocytosis and exosome-mediated transport in establishing and maintaining the tumor microenvironment in lymphoid malignancies.

It is widely accepted that the tumor microenvironment plays an important role in the progression of lymphoid malignancies. Interaction between the tumor and its surrounding immune cells is considered a potential therapeutic target. For example, anti-programmed cell death 1 (PD-1) antibody stimulates the surrounding exhausted immune cells to release PD-1/PD-L1, thereby leading to the regression of PD-L1-positive tumors. Recently, biological phenomena, such as trogocytosis and exosome-mediated transport were demonstrated to be involved in establishing and maintaining the tumor microenvironment. We found that trogocytosis-mediated PD-L1/L2 transfer from tumor cells to monocytes/macrophages is involved in immune dysfunction in classic Hodgkin lymphoma. Exosomes derived from Epstein-Barr virus (EBV)-associated lymphoma cells induce lymphoma tumorigenesis by transferring the EBV-coding microRNAs from the infected cells to macrophages. In this review, we summarized these biological phenomena based on our findings.

Proteomic and phospholipidomic characterization of extracellular vesicles inducing tumor microenvironment in Epstein-Barr virus-associated lymphomas.

Epstein-Barr virus (EBV) causes malignant carcinomas including B cell lymphomas accompanied by the systemic inflammation. Previously, we observed that phosphatidylserine (PS)-exposing subset of extracellular vesicles (EVs) secreted from an EBV strain Akata-transformed lymphoma (Akata EVs) convert surrounding phagocytes into tumor-associated macrophages (TAMs) via induction of inflammatory response, which is in part mediated by EBV-derived micro RNAs. However, it is still unclear about EV-carried other potential inflammatory factors associated with TAM formation in EBV lymphomas. To this end, we sought to explore proteomic and phospholipidomic profiles of PS-exposing EVs derived from EBV-transformed lymphomas. Mass spectrometric analysis revealed that several immunomodulatory proteins including integrin αLß2 and fibroblast growth factor 2 (FGF2) were highly expressed in PS-exposing Akata EVs compared with another EBV strain B95-8-transformed lymphoma-derived counterparts which significantly lack TAM-inducing ability. Pharmacological inhibition of either integrin αLß2 or FGF2 hampered cytokine induction in monocytic cultured cells elicited by PS-exposing Akata EVs, suggesting the involvement of these proteins in EV-mediated TAM induction in EBV lymphomas. In addition, phospholipids containing precursors of immunomodulatory lipid mediators were also enriched in PS-exposing Akata EVs compared with B95-8 counterparts. Phospholipidomic analysis of fractionated Akata EVs by density gradient centrifugation further demonstrated that PS-exposing Akata EVs might be identical to certain Akata EVs in low density fractions containing exosomes. Therefore, we concluded that a variety of immunomodulatory cargo molecules in a certain EV subtype are presumably conducive to the development of EBV lymphomas.

A Histological Comparison Between Anterior Cruciate Ligament Remnant Tissue, Anatomically Reconstructed Graft, and Non-Anatomically Reconstructed Graft.

INTRODUCTION: To our knowledge, no studies have investigated the histological comparison between primary injured anterior cruciate ligament (ACL), initially anatomically reconstructed grafts and non-anatomically reconstructed grafts at the time of revision ACL reconstruction. The purpose of this study was to histologically clarify the differences between ACL remnant tissue, reconstructed graft after anatomic double-bundle ACL reconstruction, and reconstructed graft after non-anatomic single-bundle ACL reconstruction. METHODS: This histological study included five patients after anatomic double-bundle ACL reconstruction, three patients after non-anatomic single-bundle ACL reconstruction performed who injured their operated knees again, and five patients who injured their ACL for the first time and agreed to participate. All of the grafts and ACL remnant tissue were harvested, stained with hematoxylin and eosin, S-100, and alpha smooth muscle actin and evaluated using light microscopy. RESULTS: There was no area of necrosis in the reconstructed graft after an anatomic double-bundle ACL reconstruction. However, there were obvious areas of necrosis in the reconstructed graft after non-anatomic single-bundle ACL reconstruction. Additionally, the collagen fibers were more longitudinally oriented, and most cells were spindle shaped like those in ACL remnant tissue after an anatomic double-bundle ACL reconstruction in contrast with the finding of the grafts after non-anatomic single-bundle ACL reconstruction. CONCLUSION: Initially reconstructed graft after an anatomic double-bundle ACL reconstruction may be beneficial if preserved at the time of the revision surgery.

Comparison of Intravenous and Periarticular Administration of Corticosteroids in Total Knee Arthroplasty: A Prospective, Randomized Controlled Study.

BACKGROUND: Corticosteroids are widely used in total knee arthroplasty (TKA) to relieve postoperative pain and prevent postoperative nausea. The aim of this prospective, randomized controlled study was to compare the effects of intravenous and periarticular administration of corticosteroids on pain control, prevention of postoperative nausea, and inflammation and thromboembolism markers following TKA. METHODS: One hundred patients undergoing TKA were randomly allocated to either the intravenous administration or periarticular injection group. The intravenous administration group received 10 mg dexamethasone 1 hour before and 24 hours after the surgical procedure, as well as a periarticular injection placebo during the procedure. The periarticular injection group received a 40-mg injection of triamcinolone acetonide during the surgical procedure, as well as an intravenous administration placebo 1 hour before and 24 hours after the procedure. Postoperative pain scores at rest and during walking and nausea scores were recorded according to the 0-to-10 Numerical Rating Scale. Interleukin-6 (IL-6), C-reactive protein (CRP), and prothrombin fragment 1.2 (PF1.2) were measured preoperatively and postoperatively. RESULTS: Pain scores at rest and during walking 24 hours postoperatively were significantly lower in the periarticular injection group than in the intravenous administration group. Nausea scores showed no significant difference between groups. IL-6 at 24 and 48 hours postoperatively also showed no significant difference between groups. CRP at 24 and 48 hours postoperatively was significantly lower in the intravenous administration group than in the periarticular injection group. In contrast, CRP at 1 week postoperatively was significantly higher in the intravenous administration group than in the periarticular injection group. The mean PF1.2 was significantly lower in the intravenous administration group than in the periarticular injection group at 4 hours postoperatively. Two cases of deep venous thrombosis in each group were detected with use of ultrasonographic examination. CONCLUSIONS: Periarticular injection of corticosteroids showed a better pain-control effect at 24 hours postoperatively than did intravenous administration, whereas the antiemetic effect was similar between treatments. Although intravenous administration had a better anti-thromboembolic effect than periarticular injection, the incidence of deep venous thrombosis was low in both groups. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Medial Meniscal Ramp Lesion Repair Concomitant With Anterior Cruciate Ligament Reconstruction Did Not Contribute to Better Anterior Knee Stability and Structural Properties After Cyclic Loading: A Porcine Model.

PURPOSE: To investigate the biomechanical efficacy of medial meniscal ramp lesion (MMRL) repair in anterior cruciate ligament (ACL) reconstruction regarding the graft protection effect after cyclic loading. METHODS: Specimens were randomized into 2 groups: (1) ACL reconstruction with unaddressed MMRL (Group U; n = 10), and (2) ACL reconstruction with repaired MMRL (Group R; n = 12). The specimens were tested cyclically (2,000 cycles, 0-40 N, 100 mm/min) in the direction of the native ACL and loaded to failure (100 mm/min) on a tensile tester. Statistically significant differences between the structural properties (length changes and anterior translations at the 100th, 500th, 1,000th, 1,500th, and 2,000th cycles, upper yield load, maximum load, linear stiffness, and elongation at failure) under cyclic loading and single-cycle loading were analyzed. RESULTS: There were no significant differences in length changes and anterior translations at the 100th, 500th, 1,000th, 1,500th, and 2,000th cycles. There were no significant differences in upper yield load (82.4 ± 31.2 N in Group U, 90.0 ± 38.5 N in Group R, P = .62), maximum load (109.9 ± 28.6 N in Group U, 124.0 ± 56.4 N in Group R, P = .48), linear stiffness (12.1 ± 4.7N/mm in Group U, 12.5 ± 4.3 N/mm in Group R, P = .84), or elongation at failure (13.5 ± 7.3 mm in Group U, 16.6 ± 7.5 mm in Group R, P = .30). CONCLUSIONS: Simultaneous MMRL repair at the time of ACL reconstruction did not decrease length changes and anterior translations during cyclic loading. In addition, simultaneous MMRL repair at the time of ACL reconstruction did not contribute to better postoperative structural properties. CLINICAL RELEVANCE: Simultaneous MMRL repair at the time of ACL reconstruction does not show a graft protective effect after cyclic loading. Graft elongation may occur during early rehabilitation.

Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction.

BACKGROUND: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)-deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. PURPOSE: To compare the postoperative outcomes for ramp lesions between patients treated with all-inside repair through the posteromedial portal and those whose ramp lesions were left in situ without repair during ACL reconstruction. We also determined whether ramp lesion healing status affected postoperative knee stability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 57 patients who underwent anatomic double-bundle ACL reconstruction between August 2011 and December 2017 had attendant ramp lesions. Of these, 25 ramp lesions that were considered stable were left in situ without repair (Nonrepaired group), and 25 ramp lesions, including 21 stable and 4 unstable lesions, were treated using all-inside repair through the posteromedial portal (Repaired group). We evaluated the side-to-side difference (SSD) in anterior tibial translation on stress radiographs and rotational stability by using the pivot-shift test 2 years after surgery, and healing status of the ramp lesions was evaluated on 3.0-T magnetic resonance imaging (MRI) scans 1 year after surgery. RESULTS: The mean SSDs in anterior translation were 2.4 ± 1.6 mm for the Nonrepaired group and 1.9 ± 1.6 mm for the Repaired group, with no significant differences. The positive ratios on the pivot-shift test were not significantly different between groups. Healing rates of ramp lesions on MRI scans showed a significant difference between the Nonrepaired group (60%) and the Repaired group (100%) (P = .001). The mean SSDs for knees in which the ramp lesion had healed as shown on MRI scans and those in which it had not healed were 1.9 ± 1.6 mm and 3.2 ± 1.1 mm, respectively, which was a significant difference (P = .02). CONCLUSION: Healing rates of ramp lesions were significantly better in the Repaired group than in the Nonrepaired group, although postoperative knee stability was not significantly different between groups. Anterior laxity in the knees in which the ramp lesion was unhealed was significantly greater compared with the knees in which the ramp lesion healed. All-inside repair through the posteromedial portal was a reliable surgical procedure to heal ramp lesions.

Dasatinib exacerbates splenomegaly of mice inoculated with Epstein-Barr virus-infected lymphoblastoid cell lines.

Latent infection of Epstein-Barr virus (EBV) is associated with a poor prognosis in patients with B cell malignancy. We examined whether dasatinib, a multi kinase inhibitor, which is broadly used for chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia is effective on EBV-positive B cell malignancies, using lymphoblastoid cell lines (LCLs) in vitro and in vivo. As a result, in vitro experiments showed that dasatinib induced cell death of the EBV-LCLs which was not accompanied with a lytic reactivation of EBVs. To evaluate the effectiveness in EBV latency type III represented by immunodeficiency lymphoma, LCL-inoculated immunodeficient NOD/shi-scid/Il2rgnul (NOG) mice were treated with dasatinib. However, in vivo experiments revealed that dasatinib treatment exacerbated tumor cell infiltration into the spleen of LCL-inoculated NOG mice, whereas tumor size at the inoculated site was not affected by the treatment. These results suggest that dasatinib exacerbates the pathogenesis at least in some situations although the drug is effective in vitro. Hence, we should carefully examine a possibility of dasatinib repositioning for EBV+ B cell malignancies.

PD-L1/L2 protein levels rapidly increase on monocytes via trogocytosis from tumor cells in classical Hodgkin lymphoma.

In classical Hodgkin lymphoma (cHL)-characterized by the presence of Hodgkin and Reed-Sternberg (HRS) cells-tumor-associated macrophages (TAMs) play a pivotal role in tumor formation. However, the significance of direct contact between HRS cells and TAMs has not been elucidated. HRS cells and TAMs are known to express PD-L1, which leads to PD-1+ CD4+ T cell exhaustion in cHL. Here, we found that PD-L1/L2 expression was elevated in monocytes co-cultured with HRS cells within 1 h, but not in monocytes cultured with supernatants of HRS cells. Immunofluorescence analysis of PD-L1/L2 revealed that their upregulation resulted in membrane transfer called "trogocytosis" from HRS cells to monocytes. PD-L1/L2 upregulation was not observed in monocytes co-cultured with PD-L1/L2-deficient HRS cells, validating the hypothesis that there is a direct transfer of PD-L1/L2 from HRS cells to monocytes. In the patients, both ligands (PD-L1/L2) were upregulated in TAMs in contact with HRS cells, but not in TAMs distant from HRS cells, suggesting that trogocytosis occurs in cHL patients. Taken together, trogocytosis may be one of the mechanisms that induces rapid upregulation of PD-L1/L2 in monocytes to evade antitumor immunity through the suppression of T cells as mediated by MHC antigen presentation.

Pediatric acute dacryocystitis due to Eikenella corrodens: A case report.

Eikenella corrodens is a facultatively anaerobic gram-negative rod bacterium in the oropharynx and respiratory tract. It is a member of HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, E. corrodens, and Kingella kingae) group commonly associated with endocarditis and craniofacial infections. It is usually susceptible to penicillin, second and third-generation cephalosporins, and carbapenem, but has variable susceptibility to first-generation cephalosporin. We herein provide a description of the first case of pediatric acute dacryocystitis caused by E. corrodens. The patient did not respond to oral cephalexin and required surgical drainage followed by intravenous cefotaxime. Also provided is a brief review of the current literature.

Preoperative hand-grip strength can be a predictor of stair ascent and descent ability after total knee arthroplasty in female patients.

BACKGROUND: Hand-grip strength was reported to be important predictor of functional limitation and disability related to low muscle strength in old people. The purpose of this study was to determine whether preoperative hand-grip strength predicts stair ascent and descent ability after total knee arthroplasty (TKA). METHODS: A total of 83 female patients (mean age 75.6 ± 7.2 years) who underwent unilateral TKA were included in this study. We measured body mass index, range of motion of both knees, bilateral quadriceps strength and hand-grip strength before and one year after TKA. One year after TKA, we had the subjects ascend and descend some stairs and recorded the gait pattern (step-to-step or step-over-step) and pain in both knees using a numerical rating scale. We divided the subjects into two groups according to gait pattern. These factors were compared between groups. Receiver Operating Characteristics (ROC) analysis was performed to estimate the preoperative hand-grip strength cut off point for the stair gait pattern. RESULTS: Pre- and postoperative mean hand-grip strengths were 20.1 ± 5.0 kg and 20.7 ± 5.4 kg, respectively, and there was a strong positive correlation between them (r = 0.82, P < 0.001). Quadriceps strength of both limbs significantly improved after TKA (P < 0.001). After TKA, all patients were able to perform both stair ascent and descent. The gait patterns of 27 patients were step-to-step, and 56 patients were step-over-step. Preoperative and postoperative quadriceps strength of both limbs and preoperative and postoperative hand-grip strength were significantly different between the groups. According to the ROC curve, the optimal cut off values of preoperative hand-grip strength for which female patients could ascend and descend the stairs by step-over-step after TKA was set at 19 kg. CONCLUSION: Preoperative hand-grip strength can be used in preoperative screening for stair ascent and descent ability after TKA.

Quantitative evaluation of digital-image enhancement during heads-up surgery.

Image-processing is an advantage of heads-up surgery and expected to facilitate ophthalmic surgeries. To evaluate image-processing quantitatively, we analyzed the surgical images of twenty eyes that underwent vitrectomy with internal limiting membrane (ILM) peeling assisted by Brilliant Blue G (BBG). Still images of the peeling procedure were obtained from the surgical video, and the color difference was calculated between two adjacent spots inside and outside the ILM-peeling contour, i.e., without and with BBG staining, respectively. The color differences were compared between the two settings with and without image-processing, delivered by an algorithm to enhance the color and contrast. Color differences were calculated using two methods: the Euclidean distance based on RGB values (RGB distance) and the Delta-E00 formula provided by the International Commission on Illumination. In five cases, minimum light intensities required to recognize the contour of ILM-peeling were compared during surgeries between the two settings with and without enhancement. Image-processing increased the mean color difference significantly (P < 0.001) from 15.47 and 4.49 to 34.03 and 8.00, respectively, for the RGB distance and Delta-E00. The minimum light intensity was reduced from 15 to 5 on average by image-enhancement. These results showed image-processing enhances color differences and reduces light intensities during vitrectomy.