Effectiveness of pneumococcal polysaccharide vaccine against pneumonia and cost analysis for the elderly who receive seasonal influenza vaccine in Japan.

To determine the clinical efficacy and cost-saving effect of pneumococcal polysaccharide vaccine (PPV) against community-acquired pneumonia (CAP), an open-label, randomized clinical trial was conducted involving 786 Japanese subjects older than 65 years of age receiving a routine influenza vaccine during the 2-year period. Study subjects were randomly assigned to either a PPV group (n=394) or to a non-PPV group (n=392). The incidence, admission and the medical cost for all-cause pneumonia were compared between these two groups. PPV vaccination significantly reduced the incidence of admission for all-cause pneumonia for subjects older than 75 years of age (41.5%, P=0.039) and for those who had difficulty walking (62.7%, P=0.005), but not for all study subjects older than 65 years of age (P=0.183), for the 2-year period. The Kaplan-Meier survival curves for subjects who had difficulty walking free from all-cause pneumonia demonstrated a significant difference (P=0.0146) between the two groups. PPV vaccination significantly reduced medical costs for all study subjects during the first year period (P=0.027). Our present data demonstrated that PPV was effective for all-cause pneumonia for study subjects older than 75 years of age, although the effect was not significant for all study subjects older than 65 years of age.

[A case of pulmonary nocardiosis with Nocardia beijingensis].

A 60-year-old woman seen at the National Hospital Organization Nagasaki Medical Center of Neurology with a cough and abnormal chest radiography was found in CT to have interstitial shadows in the bilateral lower lung fields. She was diagnosed with interstitial pneumonia and treated with steroids. Treatment was effective, and the predonisolone dosage was gradually tapered. When dosage was 17.5 mg/day, her chest Xray showed exacerbation. Cyclophosphamide at 50mg/day was added, and chest radiography improved. Two months later, her chest radiography showed infiltration with cavities in the left lung field. Although several antibiotics (sulbactam/cefoperazone, levofloxacin) were administered, no improvement was seen. Sputa on hospital day 60 showed the presence of gram-positive branched rods, identified as Nocardia beijingensis. We administered sulfamethoxazole/trimethoprim, meropenem and levofloxacin together, and shadows improved. With recurrent aggravation of interstitial pneumonia, however, new cavity shadows occurred in the bilateral lung due to Aspergillus fumigatus. Shadows worsened and she died of respiratory failure. Testing for pulmonary nocardiosis should be added to differential diagnosis procedures as an opportunistic infection in immune-compromised hosts.

[Case of fatal liver failure due to anti-tuberculous therapy].

A 65-year-old female was started anti-tuberculous therapy for her pulmonary tuberculosis on admission. Liver dysfunction had occurred on 33rd day after starting treatment. AST was elevated to 301 IU/L, and ALT was also elevated to 141 IU/L. Therefore, all medicated drugs were stopped. She had jaundice on 42nd day and liver failure deteriorated. She was medicated with steroids, but she died by liver failure on 64th day. This is a rare case of fatal liver failure due to antituberculous therapy.

[Case of pulmonary multi-drug resistant tuberculosis with left destroyed lung, treated with pneumonectomy].

A 31-year-old woman complained of cough and fever for 2 months. She was admitted to a hospital and was diagnosed as pulmonary tuberculosis. She received combination therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide. As the drug susceptibility test revealed that the isolated strain was multi-drug resistant, the regimen was changed to pyrazinamide, ethionamide, cycloserine, enviomycin, and levofloxacin. The chemotherapy was not effective, so she received pneumonectomy for left destroyed lung. After surgical treatment, her sputa converted to negative for tubercle bacilli. Surgical treatment such as pneumonectomy is considered to be useful in a case of multi-drug resistant pulmonary tuberculosis.

Analysis of sucrose synthase genes in citrus suggests different roles and phylogenetic relationships.

The purpose of this work was 2-fold; first, a molecular/evolutionary characterization of three sucrose synthase genes from citrus, and second, an analysis of their differential expression related to potential physiological function. Three non-allelic genes (CitSUS1, CitSUSA and CitSUS2) encoding sucrose synthase were isolated from citrus fruit (Citrus unshiu Marc.). Phylogenetic analysis from the deduced amino acid sequences showed that CitSUS1 and CitSUS2 could be classified into a dicot group. However, CitSUSA, together with Arabidopsis SSA, sugar beet SS and pea SusA defined another dicot group designated SUSA. Unlike other dicot sucrose synthases, these show a distinctive, monocot-like arrangement of introns and exons. The CitSUS1 and CitSUSA were also differentially expressed in leaf, flower and fruit tissues. Contrasting expression patterns were observed for CitSUS1 and CitSUSA in edible tissue (juice sacs/segment epidermis) and peel tissue (albedo/flavedo) of fruit: CitSUS1 mRNA levels decreased throughout fruit development, whereas those of CitSUSA increased. Various sugars also influenced the transcript levels of the CitSUS1 and CITSUSA: These results indicate that the CitSUS1 and CitSUSA genes for sucrose synthase in citrus differ markedly in their molecular structure and potential physiological roles. Sucrose synthase activity in edible tissue was high in the early stages and decreased until mid-develoment, then rapidly increased during maturation. The increase in activity during maturation paralleled that of sucrose accumulation. This result suggests that sucrose synthase has important roles on sugar metabolism when sucrose is accumulated in fruit.