RESUMEN
PURPOSE: In Japan, a national surveillance study of antimicrobial consumption has never been undertaken. This study aimed to describe antimicrobial consumption and resistance to Pseudomonas aeruginosa in 203 Japanese hospitals, to identify targets for quality improvement. METHODS: We conducted an ecological study using retrospective data (2010). Antimicrobial consumption was collected in the World Health Organization (WHO) anatomical therapeutic chemical/defined daily dose (ATC/DDD) format. Rates of imipenem (IPM), meropenem (MEPM), ciprofloxacin (CPFX), or amikacin (AMK) resistance were expressed as the incidence of non-susceptible isolates. Additionally, hospitals were asked to provide data concerning hospital characteristics and infection control policies. Hospitals were classified according to functional categories of the Medical Services Act in Japan. RESULTS: Data were collected from 203 Japanese hospitals (a total of 91,147 beds). The total antimicrobial consumption was 15.49 DDDs/100 bed-days (median), with consumptions for penicillins, carbapenems, quinolones, and glycopeptides being 4.27, 1.60, 0.41, and 0.49, respectively. The median incidences of IPM, MEPM, CPFX, and AMK resistance were 0.15, 0.10, 0.13, and 0.03 isolates per 1,000 patient-days, respectively. Antimicrobial notification and/or approval systems were present in 183 hospitals (90.1 %). In the multivariate analysis, the piperacillin/tazobactam, quinolones, and/or total consumptions and the advanced treatment hospitals showed a significant association with the incidence of P. aeruginosa resistant to IPM, MEPM, CPFX, and AMK [adjusted R (2) (aR (2)) values of 0.23, 0.30, 0.22, and 0.35, respectively). CONCLUSION: This is the first national surveillance study of antimicrobial consumption in Japan. A continuous surveillance program in Japan is necessary in order to evaluate the association among resistance, antimicrobial restriction, and consumption.
Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Utilización de Medicamentos/estadística & datos numéricos , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Revisión de la Utilización de Medicamentos/métodos , Hospitales/normas , Humanos , Imipenem/uso terapéutico , Incidencia , Japón/epidemiología , Meropenem , Pruebas de Sensibilidad Microbiana , Programas Nacionales de Salud , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa/aislamiento & purificación , Estudios Retrospectivos , Encuestas y Cuestionarios , Tienamicinas/uso terapéuticoRESUMEN
A delay in establishing the diagnosis of an occult fracture of the hip that remains unrecognised after plain radiography can result in more complex treatment such as an arthroplasty being required. This might be avoided by earlier diagnosis using MRI. The aim of this study was to investigate the best MR imaging sequence for diagnosing such fractures. From a consecutive cohort of 771 patients admitted between 2003 and 2011 with a clinically suspected fracture of the hip, we retrospectively reviewed the MRI scans of the 35 patients who had no evidence of a fracture on their plain radiographs. In eight of these patients MR scanning excluded a fracture but the remaining 27 patients had an abnormal scan: one with a fracture of the pubic ramus, and in the other 26 a T(1)-weighted coronal MRI showed a hip fracture with 100% sensitivity. T(2)-weighted imaging was undertaken in 25 patients, in whom the diagnosis could not be established with this scanning sequence alone, giving a sensitivity of 84.0% for T(2)-weighted imaging. If there is a clinical suspicion of a hip fracture with normal radiographs, T(1)-weighted coronal MRI is the best sequence of images for identifying a fracture.
Asunto(s)
Fracturas del Cuello Femoral/diagnóstico , Fracturas Cerradas/diagnóstico , Distribución por Edad , Anciano , Anciano de 80 o más Años , Diagnóstico Precoz , Femenino , Fracturas Cerradas/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Although recent studies have suggested that purinergic receptors are expressed in the anterior pituitary gland, their involvement in the regulation of pituitary hormone gene expression is not completely understood. In the present study, we examined the expression of purinergic receptors and the effects of purinergic receptor ligands on pro-opiomelanocortin (POMC) gene expression, in AtT20 mouse corticotroph cells. We identified the expression of most of the purinergic receptor subtypes (A1, A2, P2X1, 3-7, P2Y1, 2, 4) mRNAs, analysed by the reverse transcriptase-polymerase chain reaction. We also found that adenosine and ATP, two representative and endogenous agonists of A1-3 and P2X/P2Y receptors, respectively, stimulated the 5'-promoter activity of the POMC gene in a dose- and time-related manner. When these ligands were simultaneously used with corticotrophin-releasing hormone (CRH), effects that were more than additive were observed, suggesting an enhancing role of these compounds in CRH-mediated adrenocorticotrophic hormone (ACTH) synthesis. These ligands also stimulated the expression of transcription factors involved in the regulation of the POMC gene, but did not enhance ACTH secretion. Finally, the positive effect of adenosine as well as CRH was completely inhibited by the protein kinase A inhibitor H89, whereas that of ATP was not influenced, indicating that different intracellular signalling pathways mediate these effects. Altogether, our results suggest a stimulatory role for these purinergic receptor ligands in the regulation of POMC gene expression in corticotroph cells. Because adenosine and ATP are known to be produced within the pituitary gland, it is possible they may be acting in an autocrine/paracrine fashion.
Asunto(s)
Adenosina/metabolismo , Hormona Liberadora de Corticotropina/metabolismo , Regulación de la Expresión Génica/fisiología , Hipófisis/metabolismo , Proopiomelanocortina/metabolismo , Receptores Purinérgicos/metabolismo , Adenosina Trifosfato/metabolismo , Hormona Adrenocorticotrópica/metabolismo , Análisis de Varianza , Animales , Línea Celular , Ligandos , Ratones , Hipófisis/citología , Proopiomelanocortina/genética , ARN Mensajero/análisis , Receptores Purinérgicos/genética , Transducción de Señal/fisiología , Estadísticas no Paramétricas , TransfecciónRESUMEN
BACKGROUND/AIMS: Patients who survive partial hepatectomy sometimes have unsatisfactory liver regeneration and restoration of liver function. Although the extent of resection should be adjusted to attain favorable liver regeneration and restoration of liver function, a guiding principle for this has not been established. METHODOLOGY: Seventy patients with hepatic tumors associated with liver disorders of various severity who underwent hepatectomy were studied. We calculated the removal rate of the liver and the regeneration rate of the remnant liver using computed tomography. The liver function was investigated using ICG R-15 (retention rate of indocyanine green). Liver disorder was classified into 4 groups, according to the severity of fibrosis. RESULTS: The regeneration rates of the remnant liver indicated a significant decline in patients with severe fibrosis. In the no fibrosis and mild fibrosis groups, an increased removal rate was associated with increased regeneration rate, and post-operative ICG R-15 improved with time. However, in the moderate fibrosis and severe fibrosis groups, an increased removal rate was not associated with increased regeneration rate, and post-operative ICG R-15 showed no change or became worse with time. CONCLUSIONS: Severe fibrosis of the liver parenchyma is associated with poorer regeneration of the remnant liver leading to poor restoration of post-operative liver function. The severity of fibrosis is useful as a predictive factor for liver regeneration and restoration of liver function after partial hepatectomy.
Asunto(s)
Hepatectomía , Pruebas de Función Hepática , Neoplasias Hepáticas/cirugía , Regeneración Hepática/fisiología , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Verde de Indocianina , Hígado/diagnóstico por imagen , Hígado/patología , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/patologíaAsunto(s)
Transfusión Sanguínea , Supervivencia de Injerto , Trasplante de Corazón/inmunología , Terapia de Inmunosupresión/métodos , Trasplante Heterólogo/inmunología , Animales , Anticuerpos Heterófilos/sangre , Cricetinae , Citotoxicidad Inmunológica , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Ratas , Ratas Endogámicas Lew , Ratas Desnudas , Factores de TiempoRESUMEN
In the hamster to rat liver transplant model, we determined the efficacy of tacrolimus in attenuating natural xenospecific humoral immunity and in abrogating the hyperacute liver rejection that is produced by presensitizing the Lewis rat recipient. Hamster livers, transplanted orthotopically into naive rats (controls), were rejected with animal death after 6.4.+/- 0.5 (SD) days. The infusion on (day -6) of 1.5 x 10(7) hamster hepatocytes, or of 1.5 x 10(8) nonparenchymal cells (NPC), resulted in hyperacute rejection and death in < or = 1.9 days. However, when the rats were pretreated with 1 mg/kg/day tacrolimus from days -6 to -1, survival of non-presensitized animals was prolonged to 25 +/- 20 days and that of recipients presensitized with hamster hepatocytes to 36 +/- l6 days or with NPC to 32 +/- 1.7 days. The tacrolimus pretreatment significantly reduced the hamster-specific complement-dependent cytotoxic antibodies response directed to liver NPC but not to lymph node cell targets. These observations suggest that the prolongation of survival by appropriately timed treatment with this T cell directed drug model is caused by the inhibition of humoral as well as cellular xenograft rejection.
Asunto(s)
Rechazo de Injerto/prevención & control , Inmunosupresores/uso terapéutico , Trasplante de Hígado/inmunología , Tacrolimus/uso terapéutico , Animales , Formación de Anticuerpos/efectos de los fármacos , Formación de Anticuerpos/inmunología , Especificidad de Anticuerpos , Citotoxicidad Celular Dependiente de Anticuerpos/efectos de los fármacos , Cricetinae , Rechazo de Injerto/inmunología , Supervivencia de Injerto/efectos de los fármacos , Supervivencia de Injerto/inmunología , Inmunoglobulina G/análisis , Inmunoglobulina G/inmunología , Inmunoglobulina M/análisis , Inmunoglobulina M/inmunología , Inmunohistoquímica , Hígado/química , Hígado/inmunología , Masculino , Mesocricetus , Ratas , Ratas Endogámicas Lew , Linfocitos T/inmunología , Trasplante HeterólogoAsunto(s)
Transfusión Sanguínea , Supervivencia de Injerto , Trasplante de Corazón/fisiología , Trasplante Heterólogo/fisiología , Animales , Anticuerpos Heterófilos/sangre , Antígenos Heterófilos/administración & dosificación , Cricetinae , Trasplante de Corazón/inmunología , Inmunoglobulina M/sangre , Terapia de Inmunosupresión/métodos , Mesocricetus , Ratas , Ratas Endogámicas Lew , Ratas Desnudas , Trasplante Heterólogo/inmunologíaAsunto(s)
Trasplante de Médula Ósea/inmunología , Supervivencia de Injerto , Trasplante de Corazón/inmunología , Trasplante Heterólogo/inmunología , Animales , Quimera , Supervivencia de Injerto/efectos de los fármacos , Terapia de Inmunosupresión/métodos , Inmunosupresores/farmacología , Prueba de Cultivo Mixto de Linfocitos , Ratones , Ratones Endogámicos , Ratas , Ratas Endogámicas Lew , Tacrolimus/farmacología , Trasplante Isogénico/inmunología , Irradiación Corporal TotalAsunto(s)
Trasplante de Médula Ósea/fisiología , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/inmunología , Esplenectomía , Tacrolimus/uso terapéutico , Trasplante Heterólogo/fisiología , Animales , Anticuerpos Heterófilos/sangre , Trasplante de Médula Ósea/inmunología , Trasplante de Médula Ósea/patología , Quimera , Cricetinae , Enfermedad Injerto contra Huésped/prevención & control , Inmunoglobulina G/sangre , Inmunosupresores/uso terapéutico , Mesocricetus , Ratas , Ratas Endogámicas Lew , Factores de Tiempo , Trasplante Heterólogo/inmunología , Trasplante Heterólogo/patología , Irradiación Corporal TotalRESUMEN
The results of 31 right side hepatic resections approached through thoracoabdominal incision are described, with emphasis on the benefit of the approach and systematized liver resection. Regarding postoperative mortality rate (0%) and morbidity rate (32.3%), the thoracoabdominal approach for right side hepatic resection seemed as safe and effective as the conventional abdominal approach. Even though there were no significant differences in the complications, the fluctuation of alanine aminotransferase and the hospital stay, the average operation time for the right segmentectomy through the thoracoabdominal approach was 1.3 hours less (p = 0.0078) than that of the abdominal approach. Technically, this approach was accomplished in almost the same fashion as in the abdominal approach by the utilization of systematized hepatic resection. Thoracotomy itself was not more harmful than the abdominal approach, even in patients with impaired liver function. This combination could take the advantage of a shorter operation time.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Toracotomía , Adulto , Anciano , Alanina Transaminasa/sangre , Humanos , Tiempo de Internación , Persona de Mediana Edad , Complicaciones PosoperatoriasAsunto(s)
Antígenos Heterófilos/uso terapéutico , Rechazo de Injerto/prevención & control , Trasplante de Corazón/inmunología , Trasplante de Hígado/inmunología , Tacrolimus/uso terapéutico , Trasplante Heterólogo/inmunología , Enfermedad Aguda , Animales , Cricetinae , Rechazo de Injerto/inmunología , Terapia de Inmunosupresión/métodos , RatasAsunto(s)
Rechazo de Injerto/prevención & control , Trasplante de Corazón/inmunología , Trasplante de Hígado/inmunología , Trasplante Heterólogo/inmunología , Animales , Formación de Anticuerpos , Complejo CD3/análisis , Proteínas del Sistema Complemento/inmunología , Cricetinae , Citotoxicidad Inmunológica , Rechazo de Injerto/inmunología , Supervivencia de Injerto/inmunología , Terapia de Inmunosupresión/métodos , Mesocricetus , Ratas , Ratas Endogámicas Lew , Tacrolimus/uso terapéuticoAsunto(s)
Rechazo de Injerto/inmunología , Antígenos de Histocompatibilidad/inmunología , Complejo Mayor de Histocompatibilidad , Trasplante Heterólogo/inmunología , Animales , Formación de Anticuerpos , Cricetinae , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/inmunología , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos , Ratas , Ratas Endogámicas LewRESUMEN
Long-term survival after hamster-to-rat liver xenotransplantation has provided the opportunity to study the posttransplantation source of major serum proteins and the functional consequences of several different receptor-ligand interactions, where one or the other is a xenogeneic protein. We report here that serum albumin, α-1-antitrypsin, complement component 3, and other acute phase reactants switch from recipient to donor origin during the first week after transplantation while serum immunoglobulins remain largely that of recipient. Despite the disparate source of complement (hamster) and immunoglobulins (rat), these two proteins were able to cooperate effectively to produce lysis of sheep red blood cells. Moreover, rat IgA was successfully processed by hamster hepatocytes and biliary epithelial cells, being present in the bile of successful liver xenograft recipients within one day after transplantation. The ability of these liver xenograft recipients to survive long-term in conventional and viral-free animal facilities without grossly obvious morbidity or unusual susceptibility to stress, suggests that xenogeneic proteins are able to successfully interact with several different physiologic systems in the hamster-to-rat combination.