A new clustering model based on the seminal plasma/serum ratios of multiple trace element concentrations in male patients with subfertility.

Purpose: To investigate whether seminal plasma (SP)/serum ratios of multiple trace elements (TEs) can classify patients with male subfertility. Methods: SP/serum ratios of 20 TEs (lithium, sodium, magnesium, phosphorus, sulfur, potassium, calcium, manganese, iron, cobalt, copper, zinc, arsenic, selenium, rubidium, strontium, molybdenum, cesium, barium, and thallium) were calculated for healthy volunteers (n = 4) and those consulting for male subfertility (n = 245). Volunteer semen samples were collected by split ejaculation into early and subsequent fractions, and SP/serum ratio data were compared between fractions. The patients' SP/serum ratio data were used in an unsupervised clustering analysis and qualitatively compared with the data from the fractions of ejaculation from the volunteers. Semen quality parameters and pregnancy outcomes were compared between patient clusters. Results: The early fraction of volunteers was characterized by lower phosphorus and arsenic and 18 other higher TEs than the subsequent fraction. Cluster analysis classified patients into four distinct clusters, one sharing characteristics with the early fraction and another with the subsequent fraction. One cluster with the early fraction characteristics had significantly lower semen volume and higher pregnancy rates from spontaneous pregnancies or intrauterine insemination. Conclusions: Classification of patients based on SP/serum ratios of multiple TEs represents the dominance of fractions of ejaculation samples.

Development of supercooling preservation method of adherent cultured human cells.

Cryopreservation of mammalian cells is an important technology; however, freezing damage due to osmotic pressure differences and ice crystal formation is inevitable. In addition, cryopreserved cells cannot be used immediately after thawing in many cases. Therefore, in this study, we developed a method for supercooling and preserving adherent cells using a precision temperature-controlled CO2 incubator. The effects of the cooling rate from 37 to -4°C, the warming rate from -4 to 37°C and a preservation solution on cell viability after storage were examined. Human hepatocarcinoma-derived cell line HepG2 cells, preserved with HypoThermosol FRS at -4°C with a cooling rate of -0.028°C/min (24 h from 37°C to -4°C) and warming to 37°C at a rate of +1.0°C/min (40 min from -4 to 37°C), displayed high cell viability after 14 days of preservation. The superiority of supercooling preservation at -4°C was demonstrated by comparing the obtained results with that of refrigerated preservation at +4°C. Cells preserved for 14 days under optimal conditions showed no cell shape abnormalities and may be used for experiments immediately after thawing. The optimized supercooling preservation method determined in this study is suitable for the temporary preservation of adherent cultured cells.

Non-occlusive mesenteric ischemia after trans-catheter aortic valve implantation with thyroid storm: A case report.

Non-occlusive mesenteric ischemia (NOMI) is a rare but well-known life-threatening disease. However, reports on NOMI following trans-catheter aortic valve implantation (TAVI) are limited. This report presents a case of NOMI after trans-apical (TA) TAVI with thyroid storm. A 73-year-old man was admitted for a planned aortic valve surgery. Because he had severe aortic calcification and a right renal tumor that was suspected to be malignant, TA-TAVI was performed. At 61 h after TAVI, the patient complained of abdominal pain, and contrast-enhanced computed tomography showed ischemic necrosis of the cecum to the ascending colon. An ileocecal resection was performed emergently. He was extubated 61 h postoperatively, but severe delirium, high fever, and atrial fibrillation persisted. Due to a history of Basedow's disease, he was diagnosed with thyroid storm and treated with thiamazole and supportive care. The general status gradually improved, and he was transferred to the rehabilitation unit on the 17th postoperative day. We encountered a case of NOMI following TA-TAVI with a thyroid storm, which made it difficult to understand the patient's medical condition. Learning objective: The occurrence of non-occlusive mesenteric ischemia after trans-catheter aortic valve implantation is rare but possible, and a thyroid storm could occur even after a less invasive surgery. It is important to perform postoperative management while considering the possible occurrence of this condition.

A Case of Alport Syndrome Associated with Recurrent Stanford Type B Aortic Dissections.

Alport syndrome is often characterized by renal dysfunction and hearing loss due to abnormalities in type IV collagen production. In this study, we report a rare case of recurrent aortic dissections that developed in a young patient with Alport syndrome over a short period. We discuss the associations between Alport syndrome and aortic dissection with a literature review and emphasize the need for regular follow-up of patients with Alport syndrome for early detection of aortic disease.

Infective Endocarditis with a Left Ventricular Pseudoaneurysm Caused by Proteus mirabilis: A Case Report.

Infective endocarditis (IE) due to Proteus mirabilis is rare. Given that cases of IE complicated with a left ventricular pseudoaneurysm (LVP) caused by P. mirabilis have not been reported thus far, here we report a case of IE complicated with an LVP caused by P. mirabilis. An 83-year-old woman was admitted to our hospital for urinary tract infection, and P. mirabilis was detected in blood cultures. Transesophageal echocardiography and electrocardiogram-gated computed tomography revealed mitral regurgitation and a mass protruding from the mitral annulus on the dorsal side. We made a diagnosis of an LVP due to IE and performed mitral valve replacement and patch plasty of the mitral annulus. Thus, P. mirabilis can cause bloodstream infections and lead to IE, which may result in LVPs. .

First case of an invasive Bacteroides dorei infection detected in a patient with a mycotic aortic aneurysm-raising a rebellion of major indigenous bacteria in humans: a case report and review.

BACKGROUND: Bacteroides dorei is an anaerobic gram-negative bacterium first described in 2006. Because of the high similarity in mass spectra between B. dorei and Bacteroides vulgatus, discriminating between these species is arduous in clinical practice. In recent decades, 16S rRNA gene sequencing has been a complementary method for distinguishing taxonomically close bacteria, including B. dorei and B. vulgatus, at the genus and species levels. Consequently, B. dorei has been shown to contribute to some diseases, including type 1 autoimmune diabetes mellitus and atherosclerotic diseases. However, there are no reports on invasive infectious diseases caused by B. dorei. This report describes the first case of direct invasion and colonisation of human tissue by B. dorei, thus providing a warning regarding the previously proposed application of B. dorei as a live biotherapeutic for atherosclerotic diseases. CASE PRESENTATION: A 78-year-old Japanese man complained of intermittent chest/back pain and was diagnosed with a mycotic thoracic aortic aneurysm by enhanced computed tomography on admission. Despite strict blood pressure control and empirical antibiotic therapy, the patient's condition worsened. To prevent aneurysmal rupture and eliminate infectious foci, the patient underwent surgical treatment. The resected specimen was subjected to tissue culture and 16S rRNA gene sequencing analysis to identify pathogenic bacteria. A few days after the surgery, culture and sequencing results revealed that the pathogen was B. dorei/B. vulgatus and B. dorei, respectively. The patient was successfully treated with appropriate antibacterial therapy and after improvement, was transferred to another hospital for rehabilitation on postoperative day 34. There was no recurrence of infection or aneurysm after the patient transfer. CONCLUSIONS: This report describes the first case of invasive infectious disease caused by B. dorei, casting a shadow over its utilisation as a probiotic for atherosclerotic diseases.

Primary percutaneous coronary intervention of anomalous origin of a high take-off of right coronary artery arising from ascending aorta with percutaneous cardiopulmonary support in acute myocardial infarction.

Coronary angiography of high take-off right coronary artery (RCA) arising from ascending aorta under percutaneous cardiopulmonary support may be more effective at the site distal to RCA ostium rather than proximal. Guide extension catheters (GECs) may be useful to strengthen backup of percutaneous coronary interventions (PCI) system and to contrast coronary lesions clearly during PCI of these RCAs.

Next-generation sequencing in two cases of de novo acute basophilic leukaemia.

Acute basophilic leukaemia (ABL) is a rare subtype of acute myeloid leukaemia (AML); therefore, few data are available about its biology. Herein, we analysed two ABL patients using flow cytometry and next-generation sequencing (NGS). Two cell populations were detected by flow cytometry in both patients. In Case no. 1, blasts (CD34+ , CD203c- , CD117+ , CD123dim+ ) and basophils (CD34- , CD203c+ , CD117± , CD123+ ) were identified, both of which were found by NGS to harbour the 17p deletion and have loss of heterozygosity of TP53. In Case no. 2, blasts (CD33+ , CD34+ , CD123- ) and basophils (CD33+ , CD34+ , CD123+ ) were identified. NGS detected NPM1 mutations in either blasts or basophils, and TET2 in both. These data suggest an overlap of the mutational landscape of ABL and AML, including TP53 and TET2 mutations. Moreover, additional mutations or epigenetic factors may contribute for the differentiation into basophilic blasts.

Isolation and Characterization of Novel Bacteria Capable of Degrading 1,4-Dioxane in the Presence of Diverse Co-Occurring Compounds.

Biodegradation is found to be a promising, cost-effective and eco-friendly option for the treatment of industrial wastewater contaminated by 1,4-dioxane (1,4-D), a highly stable synthetic chemical and probable human carcinogen. This study aimed to isolate, identify, and characterize metabolic 1,4-D-degrading bacteria from a stable 1,4-D-degrading microbial consortium. Three bacterial strains (designated as strains TS28, TS32, and TS43) capable of degrading 1,4-D as a sole carbon and energy source were isolated and identified as Gram-positive Pseudonocardia sp. (TS28) and Gram-negative Dokdonella sp. (TS32) and Afipia sp. (TS43). This study, for the first time, confirmed that the genus Dokdonella is involved in the biodegradation of 1,4-D. The results reveal that all of the isolated strains possess inducible 1,4-D-degrading enzymes and also confirm the presence of a gene encoding tetrahydrofuran/dioxane monooxygenase (thmA/dxmA) belonging to group 5 soluble di-iron monooxygenases (SDIMOs) in both genomic and plasmid DNA of each of the strains, which is possibly responsible for the initial oxidation of 1,4-D. Moreover, the isolated strains showed a broad substrate range and are capable of degrading 1,4-D in the presence of additional substrates, including easy-to-degrade compounds, 1,4-D biodegradation intermediates, structural analogs, and co-contaminants of 1,4-D. This indicates the potential of the isolated strains, especially strain TS32, in removing 1,4-D from contaminated industrial wastewater containing additional organic load. Additionally, the results will help to improve our understanding of how multiple 1,4-D-degraders stably co-exist and interact in the consortium, relying on a single carbon source (1,4-D) in order to develop an efficient biological 1,4-D treatment system.

Internal Risk Factors for Low Back Pain in Pole Vaulters and Decathletes: A Prospective Study.

BACKGROUND: Pole vaulters and decathletes frequently experience several types of injuries to their lower back, often resulting in mechanical low back pain (LBP). However, the risk factors for the occurrence of LBP in these athletes have not been defined. PURPOSE: To determine the physical factors that relate to LBP occurrence for collegiate pole vaulters and decathletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: We observed 31 pole vaulters and decathletes for 1 year. At the start of the observation period, isokinetic flexion and extension muscle strength of the knee and hip joints were recorded along with active and passive range of motion (ROM) and muscle tightness. Participants were then divided into 2 groups using the median value of each measurement: those below the median (low group) and those above the median (high group). The log-rank test was used to compare LBP occurrence between the low group and high group for all measurements. Multivariate regression analyses were thereafter applied using the Cox proportional hazards regression. RESULTS: Log-rank tests revealed a statistically significant change in the survival curve for the occurrence of LBP in the participants with chronic LBP (P = .037), the low group for hip flexion peak torque per body weight on the non-takeoff leg (P = .047), and the low group for passive hip flexion angle on both legs (takeoff leg: P = .034; non-takeoff leg: P = .023). In addition, log-rank tests revealed a statistically significant change in the survival curve for the occurrence of LBP in the low group for passive hip extension angle on the takeoff leg only for the participants without chronic LBP (P = .014). CONCLUSION: It may be necessary to acquire sufficient ROM and hip flexion to prevent LBP occurrence in pole vaulters and decathletes.

Injuries in Collegiate Track and Field Jumping: A 2-Year Prospective Surveillance Study.

BACKGROUND: Athletes participating in track and field jumping events (long jump, triple jump, high jump, and pole vault) are exposed to ground-reaction forces on the takeoff leg that are several times their body weight. This can cause injuries specific to such activities. PURPOSE: To determine the incidence of injuries in collegiate jumpers using the guidelines set forth by a 2014 consensus statement on injury surveillance during track and field events. STUDY DESIGN: Descriptive epidemiology study. METHODS: A total of 51 jumpers between April 2016 and March 2017 and 54 jumpers between April 2017 and March 2018 participated in this study. All athletes were from a single college in Japan. Baseline information on athletes participating in the long jump, triple jump, high jump, and pole vault was collected at study enrollment. Practice and competition exposures were reported by the team trainer. Injury incidence was calculated as the number of injuries per 1000 athlete-exposures (AEs). RESULTS: A total of 147 injuries were reported among 16,998 exposures (8.65 injuries per 1000 AEs). The most common injury locations were the posterior thigh and lateral ankle (17.0%), followed by the posterior foot or toe (12.9%); the most frequent type of injury was strain/muscle rupture/tear (21.1%). The most common injury for long jumpers was ankle sprain (23.3%); for high jumpers, flexor hallucis longus tendinosis (15.8%); and for pole vaulters, hamstring strain (13.2%). CONCLUSION: The overall characteristics are different for each event; therefore, injuries for each event need to be investigated.

The Incidence of Para-Anastomotic Aneurysm After Open Repair Surgery for Abdominal Aortic Aneurysm Through Routine Annual Computed Tomography Imaging.

OBJECTIVE: Open repair surgery (ORS) for an abdominal aortic aneurysm (AAA) remains an important treatment option, but the incidence of para-anastomotic aneurysms is unclear. The purpose of this study was to estimate the incidence of para-anastomotic aneurysms and reveal secondary complications through routine annual computed tomography (CT) imaging. METHODS: One hundred and forty-seven patients who underwent ORS for AAA between January 2006 and December 2015 and received routine CT imaging surveillance were enrolled. RESULTS: The follow up period was 7.1 ± 2.7 years. The total follow up time of all patients was 1 041.1 years, and 958 CT images were collected (0.92 CT scans/year/patient). A proximal para-anastomotic aneurysm was detected in five patients (3.4%). Four of the five patients had aneurysmal dilation at the initial ORS (proximal diameter >25 mm), which enlarged during follow up; thus, a de novo proximal para-anastomotic aneurysm was observed in one patient (0.7%). The time between surgery and the diagnosis of all proximal para-anastomotic aneurysms was 5.7 ± 1.4 years, and the de novo proximal para-anastomotic aneurysm was detected at 11.8 years. The incidence of all para-anastomotic aneurysms at five and 10 years was 2.2% and 3.6%, and the incidence of the de novo para-anastomotic aneurysm was 0% at five and 10 years. Nine synchronous thoracic aortic aneurysms (TAAs) and seven metachronous TAAs were detected, and 16 patients (10.9%) had a TAA. Neoplasms were detected in 18 of 147 patients (12.2%), and the most dominant neoplasm was lung cancer. CONCLUSION: The incidence of para-anastomotic aneurysms was low; thus, abdominal and pelvic CT imaging every five years may be sufficient and consistent with the current AAA guidelines. In contrast, TAAs were diagnosed in a high percentage of patients, and based on these observations, routine CT imaging should be expanded to include the chest.

THE RELATIONSHIP BETWEEN CHRONIC LOW BACK PAIN AND PHYSICAL FACTORS IN COLLEGIATE POLE VAULTERS: A CROSS-SECTIONAL STUDY.

BACKGROUND: The low back is the most common injury location in pole vaulters, and low back pain (LBP) can easily become chronic. Therefore, knowing the physical characteristics of athletes experiencing repeated LBP may be beneficial for recovery and injury prevention. PURPOSE: The purpose of this study was to describe and analyze the physical characteristics of pole vaulters with chronic LBP. STUDY DESIGN: A cross-sectional study. METHODS: Twenty male pole vaulters participated in this study. A questionnaire was used to garner descriptive and personal data, including personal best performance in the pole vault. Additionally, the following physical characteristics were measured: 1) isokinetic muscle strength of hip and knee flexors and extensors, 2) active/passive range of motion and muscle flexibility in multiple joints and regions, 3) performance on the Functional Movement Screen™ (FMS™) and 4) spinal column alignment. Subjects were categorized using the questionnaire and divided into two groups, one with and one without chronic LBP. RESULTS: The personal best performance and angle on the active straight leg raise test (SLR) were significantly lower and smaller, respectively, in the chronic LBP group than in the non-chronic LBP group. Additionally, the difference between the passive SLR angle and active SLR angle (ΔSLR) was significantly larger in the chronic LBP group than in the non-chronic LBP group. Those with chronic LBP had were more likely to have a FMS™ composite score ≤14. CONCLUSION: The active SLR angle and ΔSLR were significantly smaller and larger, respectively, in the chronic LBP group than in the non-chronic LBP group. This may be because of the poor stability of trunk or incompetence of the kinetic chain required for raising the lower limbs. The chronic LBP group had a significantly higher probability of having an FMS™ composite score of ≤14. it may be important to examine the active straight leg raise (vs. passive only), and fundamental movements as screened by the FMS ™ in pole vaulters. LEVEL OF EVIDENCE: 2b.

Persistence of constrictive pattern despite improvement in symptoms after the waffle procedure: A case report of constrictive pericarditis.

Constrictive pericarditis (CP) is an uncommon disease characterized by clinical signs of right-sided heart failure subsequent to loss of pericardial compliance. Although pericardiectomy is the accepted treatment for improving cardiac hemodynamics in CP, some patients fail to improve after pericardiectomy. We herein report a case of CP that showed some physical and hemodynamic features with a constrictive pattern that persisted despite the improvement in heart failure symptoms after pericardiectomy. A 61-year-old man was diagnosed with CP 7 months after the onset of symptoms of shortness of breath and edema in the legs. The waffle procedure was performed using an ultrasonic scalpel. Post-operative cardiac catheterization demonstrated a dip-and-plateau pattern in both right ventricular (RV) and left ventricular (LV) pressures, but the RV and LV end-diastolic pressures improved. Moreover, Doppler echocardiography showed an improvement in the change in mitral and tricuspid early velocities with respiration. Decrease in intraoperative right atrial pressure and respiratory variability in LV and RV inflow on echocardiography are important predictors of improvement in post-operative heart failure symptoms. Learning objective: Decrease in intraoperative right atrial pressure and respiratory variability in left ventricular and right ventricular inflow on post-operative echocardiography are important predictors of improvement in heart failure symptoms even if some hemodynamic features characterizing constrictive pericarditis (dip and plateau pattern, Friedreich's sign) persist.>.

Detection of Macrophage Localization in the Abdominal Aortic Aneurysm Wall Using Ex Vivo Superparamagnetic Iron Oxide-Enhanced Magnetic Resonance Imaging.

BACKGROUND: Macrophages in the aneurysmal wall play an important role in the pathogenesis of abdominal aortic aneurysms (AAAs). Superparamagnetic iron oxide (SPIO) is a macrophage-specific contrast agent that results in negative enhancement on magnetic resonance imaging (MRI). SPIO-enhanced MRI targeting the intraluminal thrombus of AAAs has been previously reported. However, macrophages in the media and adventitia of AAA wall have not been investigated in detail. This study aimed to evaluate macrophage localization using SPIO-enhanced MRI in the media and adventitia of AAA wall, as macrophages play a crucial role in AAA pathogenesis. METHODS: Here, we included study and control patients planning to undergo open surgery for AAA. The study patients received SPIO injection 2 days preoperatively (the SPIO group, n = 7), whereas the control patients did not receive this injection (the control group). Ex vivo MRI was performed on the harvested AAA wall in the SPIO group during the surgery. The concordance between the number of macrophages and berlin blue (BB)-stained areas was histologically evaluated in both groups. Moreover, the concordance between regions of interest in MR images and BB-stained areas was evaluated. RESULTS: The proportion of BB-stained macrophages was higher in the SPIO group (0.93; interquartile range [IQR], 0.83-0.95) than in the control group (0.03; IQR, 0.026-0.11) (P < 0.05), indicating uptake of SPIO by macrophages in the AAA wall. A significant positive correlation was found between the number of BB-stained macrophages and BB-stained areas using Kendall rank correlation coefficient in the SPIO group (τ = 0.58; P < 0.05). Significant correlations were found in the distributions of the region of interest of SPIO-enhanced MRI and BB-stained areas in the media and adventitia in 5 of 7 patients. CONCLUSIONS: Macrophages present in the media and adventitia of the AAA wall showed an uptake of the SPIO contrast agent injected 2 days prior, which were then detected by ex vivo MRI. This suggests that SPIO-enhanced MR images help detect the localization of macrophages on the AAA wall, indicating its potential to serve as a novel index for AAA pathogenesis.

A Case of Superior Mesenteric Venous Thrombosis Managed by Thrombectomy without Bowel Resection.

We present a case of superior mesenteric venous thrombosis (SMVT) treated successfully with thrombectomy without bowel resection. A 73-year-old female was referred to our hospital with complaints of stomach ache. The patient was diagnosed with SMVT with impending bowel necrosis and underwent an emergency operation, after computed tomography (CT) revealed a thrombus in the superior mesenteric vein (SMV) extending to the splenic vein, ascites, and extremely edematous intestines. The intestines were not necrotic though highly congested. To avoid massive bowel resection, aggressive thrombectomy was performed. Postoperative CT confirmed resolved SMV and improved bowel edema. Prompt thrombectomy should be considered in such cases.

Abdominal Aortic Graft Infection Caused by stG485.0, ST29 Streptococcus dysgalactiae subsp. equisimilis.

In recent years, the prevalence of invasive Streptococcus dysgalactiae subsp. equisimilis (SDSE) infections has increased gradually throughout the world, including Japan. Here, we report the case of an abdominal aortic graft infection caused by stG485.0, ST29 SDSE in an elderly patient with diabetes. The patient was an 86-year-old man who had undergone surgery 10 years ago for treating a non-infected abdominal aortic aneurysm using a bifurcated graft. He was referred to our hospital after being suspected of having an abdominal aortic graft infection based on computed tomography (CT) scans. He underwent surgery to drain the pus that had accumulated between the aneurysm and graft. Although blood cultures were negative, the surgical specimen culture was positive for a ß-hemolytic group G streptococci, which was subsequently identified as SDSE using 16S ribosomal RNA sequencing. Genetic relationships deduced from emm and multilocus sequence typing revealed the isolate to be types stG485.0 and ST29, respectively. Although aortic aneurysm graft infection has a poor prognosis, we successfully rescued the patient through prompt surgery and identification of the responsible pathogen. This case indicates that attention must be paid toward possible SDSE infections in the field of vascular surgery.

Changes in the Linear Relationship between Muscle Contraction Intensity and Muscle Hardness after Rectus Femoris Muscle Strain.

OBJECTIVE: Joint torque differences between healthy and rehabilitated legs are often measured as a clinical index of recovery from muscle strain injury. Unfortunately, it should be noted that this is a questionable evaluation measure of the muscle after injury because it is a composite value including related cooperating muscles. Meanwhile, the use of ultrasound elastography for the measurement of individual muscle mechanical properties (i.e., muscle hardness) has recently expanded. The purpose of this study was to examine, using ultrasound elastography, the differences in the linear relationship between muscle contraction intensity and muscle hardness during knee extension in athletes who had recovered from grade II rectus femoris muscle strain injury through comparison of the healthy and rehabilitated legs. METHODS: Six athletes participated. Rectus femoris muscle hardness, determined during isometric contraction at 10%, 20%, 30%, and 40% of maximum voluntary contraction, was evaluated using ultrasound strain elastography. RESULTS AND CONCLUSION: The results indicated that for the healthy legs, the strain ratios, as indicated by muscle hardness, decreased linearly (became harder) with contraction intensity, but the strain ratios for the rehabilitated legs decreased nonlinearly. These results show the danger of judging the recovery period using only the difference between healthy and rehabilitated muscle strengths and the importance of evaluating individual muscles.