Interhospital transmission of vancomycin-resistant Enterococcus faecium in Aomori, Japan.

BACKGROUND: Spread of vancomycin-resistant Enterococcus (VRE) is a global concern as a significant cause of healthcare-associated infections. A series of VRE faecium (VREf) outbreaks caused by clonal propagation due to interhospital transmission occurred in six general hospitals in Aomori prefecture, Japan. METHODS: The number of patients with VREf was obtained from thirty seven hospitals participating in the local network of Aomori prefecture. Thirteen hospitals performed active screening tests for VRE. Whole genome sequencing analysis was performed. RESULTS: The total number of cases with VREf amounted to 500 in fourteen hospitals in Aomori from Jan 2018 to April 2021. It took more than three years for the frequency of detection of VRE to return to pre-outbreak levels. The duration and size of outbreaks differed between hospitals according to the countermeasures available at each hospital. Whole genome sequencing analysis indicated vanA-type VREf ST1421 for most samples from six hospitals. CONCLUSIONS: This was the first multi-jurisdictional outbreak of VREf sequence type 1421 in Japan. In addition to strict infection control measures, continuous monitoring of VRE detection in local medical regions and smooth and immediate communication among hospitals are required to prevent VREf outbreaks.

Biopathways representation and simulation on hybrid functional petri net.

The following two matters should be resolved in order for biosimulation tools to be accepted by users in biology/medicine: (1) remove issues which are irrelevant to biological importance, and (2) allow users to represent biopathways intuitively and understand/manage easily the details of representation and simulation mechanism. From these criteria, we firstly define a novel notion of Petri net called Hybrid Functional Petri Net (HFPN). Then, we introduce a software tool, Genomic Object Net, for representing and simulating biopathways, which we have developed by employing the architecture of HFPN. In order to show the usefulness of Genomic Object Net for representing and simulating biopathways, we show two HFPN representations of gene regulation mechanisms of Drosophila melanogaster (fruit fly) circadian rhythm and apoptosis induced by Fas ligand. The simulation results of these biopathways are also correlated with biological observations. The software is available to academic users from http://www.GenomicObject.Net/.

[Usefulness of transthoracic freehand three-dimensional echocardiography for the evaluation of mitral valve prolapse].

BACKGROUND: Two-dimensional (2D) echocardiography is routinely used in evaluating patients with mitral valve prolapse but requires a systematic examination for accurate assessment of the involved lesion of mitral valve prolapse, because the sonographer is required to mentally reconstruct two-dimensional images into three dimensions. Recently, freehand three-dimensional (3D) echocardiography has been introduced in the clinical setting for three-dimensional visualization of the mitral valve apparatus. OBJECTIVES: To evaluate the accuracy of the freehand 3D echocardiography system in assessing the involved lesion in patients with mitral valve prolapse. METHODS: This study consisted of 25 consecutive patients (15 men, 10 women, mean age 55 +/- 17 years) with mitral valve prolapse who were scheduled for 3D echocardiography. Mitral valve was reconstructed in the view from the left atrium (surgeon's view) by 3D echocardiography. The location of the involved lesion in mitral valve was classified as the medial, middle and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet, respectively. The results by 3D echocardiography were compared with those of 2D echocardiography as the clinical standard. RESULTS: An adequate three-dimensional display of the entire mitral valve for analysis of the involved lesion could be reconstructed in all 25 patients (feasibility 100%). The sensitivity of 3D echocardiography for detecting the lesions at the medial, middle and lateral portions of the anterior leaflet was 80%, 100% and 75%, and the medial, middle and lateral scallops of the posterior leaflet was 100%, 100% and 0%, respectively. The specificities were 100% at all locations in the mitral valve. CONCLUSIONS: These results indicate that freehand 3D echocardiography is useful for assessment of the involved lesion of the mitral valve in patients with mitral valve prolapse.

Biopathways representation and simulation on hybrid functional Petri net.

The following two matters should be resolved in order for biosimulation tools to be accepted by users in biology/medicine: (1) remove issues which are irrelevant to biological importance, and (2) allow users to represent biopathways intuitively and understand/manage easily the details of representation and simulation mechanism. From these criteria, we firstly define a novel notion of Petri net called Hybrid Functional Petri Net (HFPN). Then, we introduce a software tool, Genomic Object Net, for representing and simulating biopathways, which we have developed by employing the architecture of HFPN. In order to show the usefulness of Genomic Object Net for representing and simulating biopathways, we show two HFPN representations of gene regulation mechanisms of Drosophila melanogaster (fruit fly) circadian rhythm and apoptosis induced by Fas ligand. The simulation results of these biopathways are also correlated with biological observations. The software is available to academic users from http://www.GenomicObject.Net/.

[Spinal cord stimulation for complex regional pain syndrome: report of 2 cases].

Two adolescents with complex regional pain syndrome (CRPS) were treated safely and effectively by spinal cord stimulation (SCS). They complained of intractable pain resistant to conservative therapies. Whereas continuous epidural anesthesia temporarily reduced pain, SCS was more effective in alleviating chronic severe pain and improving the quality of life. With careful selection of patients, SCS therapy might be recommended even in young cases.

Acute transverse myelitis after Japanese B encephalitis vaccination in a 4-year-old girl.

Fourteen days after Japanese B encephalitis (JBE) vaccination, a 4-year-old girl developed the full clinical manifestation of ATM within 24h. She showed acute ascending flaccid paraplegia with sensory disturbance, bladder dysfunction and meningeal sign. Cerebrospinal fluid examination revealed neutrophil pleocytosis and elevated protein level. Magnetic resonance imaging (MRI) showed diffuse swelling of the cervical and lumbar cord with low signal intensity on T1 and high signal intensity on T2-weighted imaging. These findings suggested that she had developed meningo-radiculomyelopathy. Since sequential MRI studies showed prompt reduction of the cord swelling, the high-dose methylprednisolone therapy employed seemed to have been effective for improvement of inflammation. Even with such potent drug treatment, she still has substantial flaccid diplegia and sphincter disorder 1 year later, and so we are convinced that the pathological change of the cord was as severe as in necrotizing myelopathy. Although the pathological process remains unknown, cellular autoimmune mechanism against the JBE vaccination is suspected.