Antecubital vein approach of retrograde transvenous obliteration using a steerable triaxial system for portosystemic encephalopathy.

We report a case of portosystemic encephalopathy treated by retrograde transvenous obliteration (RTO) with an antecubital vein approach using a steerable triaxial system. A 77-year-old female was referred to our department complaining of dizziness and tremor. Laboratory data showed hyperammonemia. Contrast-enhanced CT and 3D-CT reconstruction images demonstrated an inferior mesenteric vein (IMV)-left common iliac vein shunt and a splenorenal shunt. The former was treated as a responsible shunt. The spleen volume was 212 mL, and the liver volume was 757 mL; giving a spleen/liver volume ratio of 0.3. Partial splenic artery embolization (PSE) was employed to control portal venous pressure. The hepatic venous pressure gradient (HVPG) changed from 13.2 to 9.6 mm Hg and the spleen/liver volume ratio improved from 0.3 to 0.2 by PSE. Two months after PSE, RTO with an antecubital vein approach using a steerable triaxial system was performed. HVPG changed to 12.5 mm Hg after RTO. Contrast-enhanced CT and 3D-CT reconstruction images 3 days after the procedure demonstrated the thrombus in the IMV-left common iliac vein shunt. We conclude that the antecubital vein approach using a steerable triaxial system is a feasible and minimally invasive technique in RTO for portosystemic shunts.

Stent-Graft Placement and Coil Embolization for Splenic Artery Aneurysm Derived from Isolated Spontaneous Celiac Artery Dissection.

We encountered a case of complex isolated spontaneous celiac artery dissection with a patent false lumen with both entry and re-entry and extensive aneurysmal degeneration of the splenic artery. The dissection entry was wide and was located at the origin of the celiac artery. The false lumen extended to the distal part of the splenic artery, obstructed the true lumen, and was connected to the true lumen at the splenic hilum via the re-entry. Treatment was successful by stent-graft placement for the occlusion of the entry and embolization of the re-entry with microcoils via the false lumen of the splenic artery.

Symptomatic Chronic Severe Stenosis of the Iliac Vein Successfully Treated Endovascularly Using an Interventional Radiology Computed Tomography System.

We report a woman with chronic severe stenosis of the left common and external iliac veins and severe post-thrombotic syndrome symptoms. We successfully recanalized the stenotic segment via interventional radiology, which immediately relieved the symptoms. The interventional radiology computed tomography system was helpful for the safe and precise performance of endovascular treatments.

Emergency transileocolic vein obliteration for life-threatening bleeding from gastric varices.

We report a case of life-threatening bleeding from gastric varices in a patient with alcoholic cirrhosis, which was treated by emergency transileocolic vein obliteration (TIO). A 46-year-old male with a massive hematemesis was transported to our hospital by ambulance. Contrast-enhanced computed tomography demonstrated large gastric varices. Temporary hemostasis using balloon tamponade was attempted, however, bleeding could not be controlled, and his vital signs were unstable despite massive blood transfusions. First, endoscopic treatment was attempted, but the visual field could not be secured due to massive bleeding. Therefore, emergency TIO under general anesthesia was attempted. After laparotomy, 5 Fr. sheath was inserted into the ileocolic vein. Posterior and left gastric veins, which were the blood supply routes of gastric varices, were identified and embolized using microcoils and a 50% glucose solution. Hemostasis was achieved and vital signs recovered. Three days after TIO, transjugular retrograde obliteration was attempted successfully to embolize the residual gastric varices. After the procedures, his condition improved. We conclude that emergency TIO is a useful rescue option for life-threatening bleeding from gastric varices if endoscopic treatment or balloon tamponade is ineffective.

Surveillance in hospitalized children with infectious diseases in Japan: Pre- and post-coronavirus disease 2019.

INTRODUCTION: The epidemic of coronavirus disease 2019 (COVID-19) rapidly spread worldwide, and the various infection control measures have a significant influence on the spread of many infectious diseases. However, there have been no multicenter studies on how the number of hospitalized children with various infectious diseases changed before and after the outbreak of COVID-19 in Japan. METHODS: We conducted a multicenter, prospective survey for hospitalized pediatric patients in 18 hospitals in Hokkaido Prefecture, Japan, from July 2019 to February 2021. We defined July 2019 to February 2020 as pre-COVID-19, and July 2020 to February 2021 as post-COVID-19. We surveyed various infectious diseases by sex and age. RESULTS: In total, 5300 patients were hospitalized during the study period. The number of patients decreased from 4266 in the pre-COVID-19 period to 701 (16.4%) post-COVID-19. Patients with influenza and RSV decreased from 308 to 795 pre-COVID-19 to zero and three (0.4%) post-COVID-19. However, patients with adenovirus (respiratory infection) only decreased to 60.9% (46-28) of pre-COVID levels. Patients with rotavirus, norovirus, and adenovirus gastroenteritis decreased markedly post-COVID-19 to 2.6% (38-1), 27.8% (97-27) and 13.5% (37-5). The number of patients with UTIs was similar across the two periods (109 and 90). KD patients decreased to 31.7% (161-51) post-COVID-19. CONCLUSIONS: We suggest that current infection control measures for COVID-19 such as wearing masks, washing hands, and disinfecting hands with alcohol are effective against various infectious diseases. However, these effects vary by disease.

Targeted Nuclear Irradiation with an X-Ray Microbeam Enhances Total JC-1 Fluorescence from Mitochondria.

Several studies have demonstrated that mitochondria are critically involved in the pleiotropic manifestation of radiation effects. While conventional whole-cell irradiation compromises the function of mitochondria, the effects of subcellular targeted radiation are not yet fully understood. In this study, normal human diploid cells with cell-cycle indicators were irradiated using a synchrotron X-ray microbeam, and mitochondrial membrane potential was quantified by JC-1 over the 72-h period postirradiation. Cytoplasmic irradiation was observed to temporarily enlarge the mitochondrial area with high membrane potential, while the total mitochondrial area did not change significantly. Unexpectedly, cell-nucleus irradiation promoted a similar increase not only in the mitochondrial areas with high membrane potential, but also in those with low membrane potential, which gave rise to the apparent increase in the total mitochondrial area. Augmentation of the mitochondrial area with low membrane potential was predominantly observed among G1 cells, suggesting that nucleus irradiation during the G1 phase regulated the mitochondrial dynamics of the cytoplasm, presumably through DNA damage in the nucleus.

Point-of-care detection of Tannerella forsythia using an antigen-antibody assisted dielectrophoretic impedance measurement method.

UNLABELLED: The importance of periodontal treatment planning based on diagnosis with clinical detection of periodontal pathogens has been well recognized. However, reliable detection and quantification methods that can be conveniently used at chair-side have yet to be developed. This study aimed to evaluate the clinical use of a novel apparatus which uses an antigen-antibody reaction assisted dielectrophoretic impedance measurement (AA-DEPIM) for the detection of a prominent periodontal pathogen, Tannerella forsythia. A total of 15 patients with a clinical diagnosis of chronic periodontitis, three periodontally healthy volunteers and two with gingivitis were subjected to clinical and microbiological examinations. Saliva samples were analyzed for the presence of T. forsythia using AA-DEPIM, PCR-Invader and real-time PCR methods. The measurement values for total bacteria and T. forsythia using the prototype AA-DEPIM apparatus were significantly greater in periodontitis group than those in healthy/gingivitis group. Using the AA-DEPIM apparatus with tentative cut-off values, T. forsythia was detected for 14 (12 with periodontitis and 2 either healthy or with gingivitis) out of 20 individuals. The measurement for the detection of T. forsythia by the AA-DEPIM method showed a significant positive correlation with the detection by PCR-Invader (r = 0.541, p = 0.01) and the real-time PCR method (r = 0.834, p = 0.01). When the PCR-Invader method was used as a reference, the sensitivity and specificity of the AA-DEPIM method were 76.5% and 100%, respectively. The results suggested that the AA-DEPIM method has potential to be used for clinically evaluating salivary presence of T. forsythia at chair-side. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR) UMIN000012181.

Relationship between oral bacteria count and pneumonia onset in elderly nursing home residents.

AIM: Oral bacteria, which are a source of infection for aspiration pneumonia, were examined in frail older adults with the aim of establishing a standard bacteria count that indicates the risk of pneumonia onset in this group. METHODS: A survey of bacteria count in the saliva using a simple instrument for measurement of the number of oral bacteria, along with factors including swallowing function and nutritional status, was carried out in 691 elderly individuals requiring care (137 men; mean age 82.6 ± 8.3 years; 554 women; mean age 88.0 ± 7.1 years; total mean age 86.7 ± 7.8 years) at 16 nursing homes in Japan. All participants gave their consent for inclusion in the present study. During a 6-month follow-up period, participants who developed pneumonia were identified, and relationships between the factors measured at the start of the period and pneumonia onset were examined. RESULTS: During the 6-month follow-up period, 33 participants (4.8%; 5 men, 28 women; mean age 88.3 ± 7.4 years) developed pneumonia. Pneumonia onset was significantly associated with reduced activities of daily living, swallowing dysfunction and undernourishment. Logistic regression analysis identified a saliva bacteria count of 10(8.5) colony-forming units/mL as an independent explanatory factor for pneumonia onset (P = 0.012, RR = 3.759). CONCLUSIONS: Oral bacteria count of 10(8.5) colony-forming units/mL saliva in an elderly person requiring care was identified as a risk factor for pneumonia onset.

Evaluation of a rapid oral bacteria quantification system using dielectrophoresis and the impedance measurement.

To clarify the availability of the dielectrophoretic impedance measurement (DEPIM) system as the evaluator for oral care, we evaluated the usefulness of DEPIM system by comparison with the standard plate counting (SPC) method. First, the relationship between the DEPIM results and bacterial concentration measured by SPC was clarified. Next, the measurement of the microorganism number in a mixed suspension was evaluated with DEPIM and SPC. The bacterial counts with DEPIM strongly correlated with those with SPC (r(2)=0.633-0.997) and this correlation was also shown in the measurement of a mixed bacterial suspension (ranging from 10(5) to 10(8) cfu/ml) of two bacterial species. Moreover, the experiments using dissociating enzymes to eliminate the influence of the size of the bacterial aggregates demonstrated that the microbial measurement results with DEPIM are unaffected by bacterial aggregates. This study demonstrated that bacterial counts with DEPIM strongly correlated with those with SPC and were unaffected by bacterial aggregates.

A novel rapid oral bacteria detection apparatus for effective oral care to prevent pneumonia.

OBJECTIVE: To clarify the oral environment, we evaluated the usefulness and clinical applicability of a new apparatus developed for the simple and rapid quantification of oral bacteria. BACKGROUND: Professional oral health care can reduce the number of oral bacteria and days of fever and inhibit the development of pneumonia. A novel detection apparatus was developed by applying the dielectrophoretic impedance measurement method. METHODS: First, to determine the accuracy of this apparatus, employing standard samples of Escherichia coli. Next, to evaluate the oral environment, samples were taken from the tongue in elderly (mean age: 86.6 years) in nursing home. RESULTS: In the first study, a good correlation was observed between the two methods (R = 0.999). In the second study, there were significant correlations between measurement values obtained using this apparatus and those obtained by the culture method (R = 0.852), as well as those obtained by the FM method (R = 0.885). CONCLUSION: Our data showed that this rapid oral bacterial detection apparatus is effective in evaluating the oral hygiene to prevent pneumonia in the elderly.