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1.
Clin Transplant ; 33(12): e13753, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31692105

RESUMEN

BACKGROUND: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. METHODS: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. RESULTS: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P = .01). We identified MRSA carrier (odds ratio [OR], 19.1; P < .001), ABO incompatibility (OR, 2.9; P = .03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P = .02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. CONCLUSION: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.

2.
J Clin Med ; 8(10)2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31581534

RESUMEN

Uterus transplantation (UTx) is an option for women with uterine factor infertility to have a child, but is still in the experimental stage. Therefore, allogeneic animal models of UTx are required for resolution of clinical issues. In this study, long-term outcomes were evaluated in four recipients (cases 1-4) after allogeneic UTx in cynomolgus macaques. Immunosuppression with antithymocyte globulin induction and a triple maintenance regimen was used. Postoperative ultrasonography and biopsy of the transplanted uterus and immunoserological examinations were performed. All four recipients survived for >3 months after surgery, but continuous menstruation did not resume, although temporary menstruation occurred (cases 1 and 2). All animals were euthanized due to irreversible rejection and no uterine blood flow (cases 1, 2 and 4) and post-transplant lymphoproliferative disorder (case 3). Donor-specific antibodies against MHC class I and II were detected in cases 1, 2 and 4, but not in case 3. Peripheral lymphocyte counts tended to elevate for CD3+, CD20+ and NK cells in conjunction with uterine rejection, and all animals had elevated stimulation indexes of mixed lymphocyte reaction after surgery. Establishment of allogeneic UTx in cynomolgus macaque requires further exploration of immunosuppression, but the clinicopathological features of uterine rejection are useful for development of human UTx.

3.
J Pediatr Surg ; 2019 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-31575417

RESUMEN

BACKGROUND/PURPOSE: The delayed local treatment approach (DL) in high-risk neuroblastoma (HR-NB) refers to the process in which tumor resection is performed after the completion of all the courses of chemotherapy, including myeloablative high-dose chemotherapy (HDC). Alternatively, in the conventional local treatment approach (CL), tumor resection is performed during induction chemotherapy. In this study, we compared the surgical outcomes in HR-NB patients treated by CL and DL. METHOD: Forty-seven patients with abdominal HR-NB underwent primary tumor resection from 2002 to 2018. The timing of surgery was generally determined by following the trials and guidelines available at the time. The outcomes and surgical complications between the two strategies were compared. RESULT: Operation time, blood loss, and postoperative WBC counts were lower in the DL group (n = 25) when compared to the CL group (n = 22), statistical significance notwithstanding. Major vascular structures were less frequently encased in the DL group tumors, while immediate surgical complications were significantly more frequent in the CL group (P < 0.05). Furthermore, the 3-year EFSs were 50.0% and 53.9% in the DL and CL groups, respectively. CONCLUSION: DL appears to be a feasible and effective treatment option for HR-NB. Nonetheless, further verifications using larger cohorts are warranted. LEVEL OF EVIDENCE: Treatment study, Level III.

5.
Cancers (Basel) ; 11(8)2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31434361

RESUMEN

Fluorescence-guided surgery with indocyanine green (ICG) for malignant hepatic tumors has been gaining more attention with technical advancements. Since hepatoblastomas (HBs) possess similar features to hepatocellular carcinoma, fluorescence-guided surgery can be used for HBs, as aggressive surgical resection, even for distant metastases of HBs, often contributes positively to R0 (complete) resection and subsequent patient survival. Despite a few caveats, fluorescence-guided surgery allows for the more sensitive identification of lesions that may go undetected by conventional imaging or be invisible macroscopically. This leads to precise resection of distant metastatic tumors as well as primary liver tumors.

6.
World J Gastroenterol ; 25(15): 1899-1906, 2019 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-31057303

RESUMEN

BACKGROUND: Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY: The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION: This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.


Asunto(s)
Enfermedades del Colon/diagnóstico , Infecciones por Citomegalovirus/complicaciones , Gastroenteritis/complicaciones , Perforación Intestinal/diagnóstico , Trasplante de Hígado/efectos adversos , Antígenos Virales/sangre , Antígenos Virales/inmunología , Colon/diagnóstico por imagen , Colon/virología , Enfermedades del Colon/etiología , Citomegalovirus/inmunología , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/sangre , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/virología , Enfermedad Hepática en Estado Terminal/inmunología , Enfermedad Hepática en Estado Terminal/patología , Enfermedad Hepática en Estado Terminal/cirugía , Endoscopía Gastrointestinal , Femenino , Gastroenteritis/sangre , Gastroenteritis/inmunología , Gastroenteritis/virología , Hepatitis Autoinmune/inmunología , Hepatitis Autoinmune/patología , Hepatitis Autoinmune/cirugía , Humanos , Perforación Intestinal/etiología , Persona de Mediana Edad , Tomografía Computarizada por Rayos X
7.
Cancers (Basel) ; 11(5)2019 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-31130716

RESUMEN

The curability of chemotherapy-resistant hepatoblastoma (HB) largely depends on the achievement of radical surgical resection. Navigation techniques utilizing indocyanine green (ICG) are a powerful tool for detecting small metastatic lesions. We herein report a patient who underwent a second living donor liver transplantation (LDLTx) for multiple recurrent HBs in the liver graft following metastasectomy for peritoneal dissemination with ICG navigation. The patient initially presented with ruptured HB at 6 years of age and underwent 3 liver resections followed by the first LDLTx with multiple sessions of chemotherapy at 11 years of age. His alpha-fetoprotein (AFP) level increased above the normal limit, and metastases were noted in the transplanted liver and peritoneum four years after the first LDLTx. The patient underwent metastasectomy of the peritoneally disseminated HBs with ICG navigation followed by the second LDLTx for multiple metastases in the transplanted liver. The patient has been recurrence-free with a normal AFP for 30 months since the second LDLTx. To our knowledge, this report is the first successful case of re-LDLTx for recurrent HBs. Re-LDLTx for recurrent HB can be performed in highly select patients, and ICG navigation is a powerful surgical tool for achieving tumor clearance.

8.
Nutrients ; 11(4)2019 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-30987242

RESUMEN

n-3 polyunsaturated fatty acids (PUFAs) have been shown to have preventive effects against depression. In this study, we aimed to investigate the associations between the intake of n-3 PUFAs and depression among people according to sex and weight status. We utilized cross-sectional data from the Shika study in Japan. The study was conducted between 2013 and 2016. Data were collected from adults older than 65 years. Invitation letters were distributed to 2677 individuals, 2470 of whom participated in the study (92.3%). We assessed depressive states using the Japanese short version of the Geriatric Depression Scale (GDS-15). We assessed the intake of n-3 PUFAs using the validated food frequency questionnaire. One thousand six hundred thirty-three participants provided data, among which 327 (20.0%) exhibited depressive symptoms. When we performed the stratified analysis by sex and weight status, there were significant inverse relationships between total n-3 PUFAs, individual n-3 PUFAs, and n-3/n-6 PUFAs ratio and depressive symptoms in overweight/obese females. No correlations were observed between n-3 PUFAs intake and depressive states in males. The results demonstrated a relationship between n-3 PUFAs deficiencies and depressive states, particularly in overweight/obese females. Dietary modifications may help to prevent depressive symptoms in overweight/obese females.


Asunto(s)
Afecto/efectos de los fármacos , Peso Corporal , Depresión/epidemiología , Suplementos Dietéticos , Ácidos Grasos Omega-3/administración & dosificación , Obesidad/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios Transversales , Depresión/diagnóstico , Depresión/prevención & control , Depresión/psicología , Ácidos Grasos Omega-3/deficiencia , Femenino , Evaluación Geriátrica/métodos , Humanos , Japón , Masculino , Evaluación Nutricional , Encuestas Nutricionales , Estado Nutricional , Obesidad/diagnóstico , Obesidad/fisiopatología , Obesidad/terapia , Pronóstico , Factores Protectores , Factores de Riesgo , Factores Sexuales
9.
Ann Hepatol ; 18(2): 397-401, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31029562

RESUMEN

We report the case of a 53-year-old-man who developed human T-cell leukemia virus type-1-associated myelopathy (HAM) after ABO-incompatible liver transplantation for alcoholic liver cirrhosis. The living donor was seropositive for human T-cell leukemia virus type-1 (HTLV-1) and the recipient was seronegative for HTLV-1 before transplantation. After transplantation, the recipient developed steroid-resistant acute cellular rejection, which was successfully treated using anti-thymocyte globulin, and he was eventually discharged. He underwent spinal surgery twice after the transplantation for the treatment of cervical spondylosis that had been present for a period of 9 months before the transplantation. The surgery improved his gait impairment temporarily. However, his gait impairment progressed, and magnetic resonance imaging revealed multiple sites of myelopathy. He was diagnosed with HAM 16 months after the transplantation. Pulse steroid therapy (1000mg) was administered over a period of 3 days, and his limb paresis improved. Presently, steroid therapy is being continued, with a plan to eventually taper the dose, and he is being carefully followed up at our institution. Our case suggests that liver transplantation involving an HTLV-1-positive living donor carries the risk of virus transmission and short-term development of HAM after transplantation.

10.
Regen Ther ; 10: 84-91, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30705924

RESUMEN

Introduction: Lymphatic anomalies (LAs) refer to a group of diseases involving systemic dysplasia of lymphatic vessels. These lesions are classified as cystic lymphatic malformation (macrocystic, microcystic or mixed), generalized lymphatic anomaly, and Gorham-Stout disease. LAs occur mainly in childhood, and present with various symptoms including chronic airway problems, recurrent infection, and organ disorders. Individuals with LAs often experience progressively worsening symptoms with a deteriorating quality of life. Although limited treatment options are available, their efficacy has not been validated in prospective clinical trials, and are usually based on case reports. Thus, there are no validated standards of care for these patients because of the lack of prospective clinical trials. Methods: This open-label, single-arm, multicenter, prospective study will assess the efficacy and safety of a mammalian target of the rapamycin inhibitor sirolimus in the treatment of intractable LAs. Participants will receive oral sirolimus once a day for 52 weeks. The dose is adjusted so that the nadir concentration remains within 5-15 ng/ml. The primary endpoint is the response rate of radiological volumetric change of the target lesion confirmed by central review at 52 weeks after treatment. The secondary endpoints are the response rates at 12 and 24 weeks, respiratory function, pleural effusion, ascites, blood coagulation parameters, bleeding, pain, quality of life, activities of daily living, adverse events, side effects, laboratory examinations, vital signs, and pharmacokinetic data. Results: This is among the first multicenter studies to evaluate sirolimus treatment for intractable LAs, and few studies to date have focused on the standard assessment of the efficacy for LAs treatment. Our protocol uses novel, uncomplicated methods for radiological assessment, with reference to the results of our previous retrospective survey and historical control data from the literature. Conclusions: We propose a multicenter study to investigate the efficacy and safety of sirolimus for intractable LAs (SILA study; trial registration UMIN000028905). Our results will provide pivotal data to support the approval of sirolimus for the treatment of intractable LAs.

11.
Nutrients ; 11(2)2019 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-30781841

RESUMEN

The aim of this cross-sectional study was to examine the relationship of mineral intake, including sodium, potassium, calcium, magnesium, phosphorus, iron, zinc, copper and manganese, with depressive symptoms in both genders in the Japanese elderly population. A total of 1423 participants who were older than 65 years old were recruited in this study. Mineral intake was analyzed using a validated and brief self-administered diet history questionnaire. Depressive symptoms were assessed with a short version of the Geriatric Depression Scale. A logistic regression model was applied to determine the relationship between mineral intake and depressive symptoms. The prevalence of depressive symptoms was 20%. Except for sodium and manganese, mineral intake was significantly lower in the depressive symptoms group. There was no difference of mineral intake between male participants with depressive symptoms and those without such symptoms. However, in female participants, mineral intake was significantly lower in participants with depressive symptoms compared to those without such symptoms. Potassium, calcium, magnesium, phosphorus, iron, zinc, and copper were significantly and negatively correlated with depressive symptoms among female participants, but not male participants. Our results suggest that the deficiencies in mineral intake may be related to depressive symptoms, especially in women.


Asunto(s)
Minerales/administración & dosificación , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Estudios Transversales , Depresión/epidemiología , Dieta , Femenino , Humanos , Japón/epidemiología , Estudios Longitudinales , Masculino , Estado Nutricional , Factores Sexuales
12.
Nutrition ; 61: 8-15, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30682705

RESUMEN

OBJECTIVES: This study investigated the relationship between saturated fatty acid (SFA) intake and hypertension and oxidative stress. METHODS: The present cross-sectional study was conducted among the residents of Shika town, a rural area in Japan, using health examination data received between March 2014 and January 2016. Dietary intake was measured using a brief-type self-administered diet history questionnaire. Urinary 8-hydroxy-2'-deoxyguanosine levels were used to assess oxidative stress and were measured with an enzyme linked immunosorbent assay. We defined hypertension as the use of antihypertensive medication and/or blood pressure of 140/90 mmHg or higher, and elderly as subjects aged 65 years or older. RESULTS: Subjects comprised 585 Japanese individuals aged 40 years and older. The prevalence of hypertension was 54.2%. SFA intake was lower in hypertensive subjects and this relationship was significantly stronger for elderly subjects. A multiple logistic regression analysis after adjustments for various confounding factors revealed that SFA intake, such as total SFA, C8:0, C12:0, C14:0, C16:0, C17:0, C18:0, C20:0, and C22:0, was inversely related to hypertension in elderly subjects. It also showed that lower urinary 8-hydroxy-2'-deoxyguanosine levels correlated with a high intake of SFA, C4:0, C6:0, C8:0, C10:0, and C12:0. CONCLUSIONS: Our results support a relationship existing between SFA intake and hypertension and oxidative stress, and suggest that the regular consumption of SFA contributes to the prevention and treatment of hypertension in elderly patients.

13.
J Laparoendosc Adv Surg Tech A ; 29(4): 573-578, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30614751

RESUMEN

Extrahepatic congenital portosystemic shunts (CPSSs) can be occluded by surgical or endovascular approaches. However, when the estimated portal vein (PV) pressure after the closure is high enough to induce symptoms associated with portal hypertension, partial closure is recommended to avoid life-threatening events. In this study, we attempted laparoscopic partial closure of a CPSS in two patients. Along with intraoperative real-time measuring of the PV pressure and angiography, laparoscopic partial closure was performed to achieve a PV pressure of ≤25 mmHg. Subsequently, the intrahepatic portal system grew in both patients. The partially ligated CPSS closed spontaneously in the first patient. In the second patient, laparoscopic complete closure was performed for the residual CPSS 6 months after the first operation. To our knowledge, this is the first report of laparoscopic partial closure for CPSS. Minimally invasive laparoscopic partial ligation of CPSS is technically feasible and useful when the estimated PV pressure is too high to tolerate one-step complete closure.


Asunto(s)
Hipertensión Portal/cirugía , Laparoscopía/métodos , Vena Porta/anomalías , Vena Porta/cirugía , Malformaciones Vasculares/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Preescolar , Femenino , Humanos , Ligadura , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento
14.
Nutrients ; 10(12)2018 Nov 24.
Artículo en Inglés | MEDLINE | ID: mdl-30477201

RESUMEN

The relationship between dietary n-6 fatty acids and hypertension is not clear. The metabolic products of n-6 fatty acids include those that control blood pressure, such as prostaglandin and thromboxane, and that differ depending on the extent of glucose tolerance. This cross-sectional study investigated the association of dietary n-6 fatty acid intake on hypertension, and the effects of glycated hemoglobin (HbA1c) value in 633 Japanese subjects aged 40 years and older. Dietary intake was measured using a validated brief self-administered diet history questionnaire. We defined hypertension as the use of antihypertensive medication or a blood pressure of 140/90 mmHg. The prevalence of hypertension was 55.3%. A high n-6 fatty acids intake inversely correlated with hypertension in subjects with HbA1c values less than 6.5% (odds ratio, 0.857; 95% confidence interval, 0.744 to 0.987). On the contrary, in subjects with an HbA1c value of 6.5% or higher, the n-6 fatty acids intake was significantly associated with hypertension (odds ratio, 3.618; 95% confidence interval, 1.019 to 12.84). Regular dietary n-6 fatty acid intake may contribute to the prevention and treatment of hypertension in a healthy general population. By contrast, in subjects with diabetes, regular n-6 fatty acids intake may increase the risk of hypertension.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Dieta , Grasas Insaturadas en la Dieta/farmacología , Ácidos Grasos Omega-6/farmacología , Conducta Alimentaria , Hemoglobina A Glucada/metabolismo , Hipertensión , Adulto , Anciano , Estudios Transversales , Encuestas sobre Dietas , Grasas Insaturadas en la Dieta/administración & dosificación , Ácidos Grasos Omega-6/administración & dosificación , Femenino , Humanos , Hipertensión/sangre , Hipertensión/etiología , Hipertensión/prevención & control , Japón , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Encuestas y Cuestionarios
15.
Environ Health Prev Med ; 23(1): 34, 2018 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-30086711

RESUMEN

BACKGROUND: Sedentary behaviors have recently become an important public health issue. We aimed to investigate the relationship between screen time and nutrient intake in children and adolescents. METHODS: The present study was conducted in 2013. Data were collected from children and adolescents aged between 6 and 15 years old in Shika town. Questionnaires were distributed to 1459 subjects, 1414 of whom participated in the study (96.9%). Sedentary behaviors were assessed based on participants' screen behaviors (television (TV) viewing, personal computer (PC) use, and mobile phone (MP) use). The main outcomes were the intake of nutrients from a validated food frequency questionnaire. Analysis of covariance (ANCOVA) was used to examine the significance of differences in nutrient intake estimates. Multivariate linear regression analyses, adjusting for age, BMI, and physical activity, were used to provide parameter estimates (ß) and 95% CI for the relationship between screen time and nutrient intake. RESULTS: In boys, longer TV viewing times correlated or tended to correlate with a lower intake of protein, potassium, calcium, iron, vitamin K, vitamin B-2, and total dietary fiber. In girls, longer TV viewing times correlated with a lower intake of protein, sodium, calcium, vitamin D, and vitamin B-2. Longer TV viewing times correlated with a higher intake of n-6 fatty acids in girls. PC use was related or tended to be related to a lower intake of potassium, iron, vitamin K, and folic acid in boys, but not in girls. A relationship was observed between MP use and a lower intake of vitamin K in boys, and MP use and a higher intake of vitamin D in girls. CONCLUSIONS: The present results revealed that longer TV viewing times are associated with less protein, minerals, vitamins, and total dietary fiber intake in children and adolescents. It was also revealed that boys with PC use have less minerals and vitamins. These results support the need to design intervention programs that focus on decreasing TV viewing time in both sexes and PC use in boys while encouraging adherence to dietary guidelines among children and adolescents.


Asunto(s)
Dieta , Tiempo de Pantalla , Adolescente , Índice de Masa Corporal , Niño , Estudios Transversales , Ingestión de Energía , Ejercicio , Femenino , Humanos , Japón , Masculino , Conducta Sedentaria , Factores Sexuales , Factores Socioeconómicos
16.
J Laparoendosc Adv Surg Tech A ; 28(9): 1152-1155, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29906233

RESUMEN

BACKGROUND: The curability of hepatoblastoma (HB) largely depends on the achievement of radical surgical resection, even for metastatic tumors. However, the extension of the metastatic tumor when viewed through an endoscope with the conventional white-light mode is often unclear. Advancements in imaging technology utilizing indocyanine green (ICG) have facilitated precise resection of metastatic HBs, owing to the longer retention of ICG in such lesions than in other normal tissues. CASE: We utilized an endoscope loaded with the PINPOINT system (NOVADAQ Technologies, Inc., Ontario, Canada), which allows for real-time overlay visualization with the same focal range between the white-light mode and near-infrared mode. Metastatic HBs that have taken up ICG are visualized as an area of green color superimposed on a high-definition white-light image. A 19-year-old female who underwent liver transplantation for an unresectable HB 2 years earlier was noted to have metastases on the diaphragm and the pleura. Preoperative magnetic resonance imaging showed metastatic HBs on the right pleura extending from the ribs and the diaphragm. The margin of the metastatic tumor was more sharply demarcated by the PINPOINT system than that detected in the normal white-light mode. The tumor was successfully resected en bloc with real-time guidance utilizing the overlay image. The alphafetoprotein levels were normalized and have remained within normal limits in the 12 months since the operation. CONCLUSION: Novel overlay imaging technology with ICG makes it possible to achieve real-time precise resection of metastatic HBs.


Asunto(s)
Hepatoblastoma/secundario , Neoplasias Hepáticas/patología , Metastasectomía/métodos , Neoplasias de los Músculos/secundario , Imagen Óptica/métodos , Neoplasias Pleurales/secundario , Cirugía Asistida por Computador/métodos , Diafragma/cirugía , Femenino , Colorantes Fluorescentes , Hepatoblastoma/cirugía , Humanos , Verde de Indocianina , Neoplasias de los Músculos/cirugía , Neoplasias Pleurales/cirugía , Adulto Joven
17.
Anal Sci ; 34(6): 725-728, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29887562

RESUMEN

Herein, we determined the contents of Cu(I), Cu(II), and hydrophobic Cu in natural water using on-site sample treatment, solid-phase extraction (SPE), and inductively coupled plasma mass spectrometry (ICP-MS) analysis. To prevent Cu species changes in the sampling, filtering and preconditioning steps were performed in a closed system using plastic syringes and a disposable membrane filter. Bathocuproin disulfonate (BCS) and ethylenediaminetetraacetic acid (EDTA) were selected as a Cu(I)-selective complexing agent and a Cu(II) masking agent, respectively, whereas ascorbic acid (AA) was used to reduce Cu(II) to Cu(I). Pre-conditioned samples were passed through a hydrophobic SPE column, and the retained Cu species were eluted with ethanol. Subsequently, the eluate was concentrated, and the residue was re-dissolved in 2 M HNO3 and subjected to ICP-MS analysis. No artificial changes of Cu(I) and Cu(II) species were observed at any time, with the analytical detection limit of total Cu and the blank value equaling 0.0008 and 0.0025 µg kg-1, respectively. The developed method was applied to real estuarine, riverine, and seawater samples collected in Tokushima prefecture, Japan.

18.
Nagoya J Med Sci ; 80(1): 99-107, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29581619

RESUMEN

The number of patients with diabetes is increasing in Japan. Recently, Social capital (SC) has received increasing attention as a factor influencing health conditions. In the US, the relation between SC and diabetes control has been reported, but little attention has been paid to this connection in Japan. Three SC questionnaires, entitled "trust in people in a community," "social support," and "social relationships," were constructed. The subjects were adult patients with type 2 diabetes. Information on diabetic conditions, such as HbA1c, self-attainment of diet (SAD) and exercise (SAE), and complications were collected. The reliability coefficients for the SC questionnaire and factor analysis of SC were conducted. Multiple and logistic regressions were used to identify the influence of SC on diabetes control. Sixty-five patients participated in this study. The questionnaires "social support" and "social relationships" were adopted to measure Cronbach alpha coefficient. Factor analysis extracted the factors "hope to be helped (HH)," "participation in favorite events (PFE)," "sense of belonging (SB)," and "social movement (SM)." HbA1c was positively correlated with HH (P < 0.05). SAD and SAE were negatively correlated with HH (P < 0.05). SAE was positively correlated with PFE (P < 0.05). PFE reduced complication risks (P < 0.05). HH includes amae, which negatively affected self-efficacy that correlates with diabetes control. Therefore, higher HH might cause higher levels of HbA1c. PFE reduces distress and contributes to glucose control. Reduced distress through PFE might prevent complications. HH and PFE were identified as SC that influences diabetes control.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Capital Social , Anciano , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
19.
Pediatr Transplant ; 22(3): e13118, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29457852

RESUMEN

Children with single ventricle physiology have complete mixing of the pulmonary and systemic circulations, requiring staged procedures to achieve a separation of these circulations, or Fontan circulation. The single ventricle physiology significantly increases the risk of mortality in children undergoing non-cardiac surgery. As liver transplantation for patients with single ventricle physiology is particularly challenging, only a few reports have been published. We herein report a case of successful LDLTx for an 8-month-old pediatric patient with biliary atresia, heterotaxy, and complex heart disease of single ventricle physiology. The cardiac anomalies included total anomalous pulmonary venous return type IIb, intermediate atrioventricular septal defect, tricuspid regurgitation grade III, coarctation of aorta, interrupted inferior vena cava, bilateral superior vena cava, and polysplenia syndrome. Following LDLTx, the patient sequentially underwent total cavopulmonary shunt + Damus-Kaye-Stansel at 3 years of age and extracardiac total cavopulmonary connection (EC-TCPC) completion at 5 years of age; 7 years have now passed since LDLTx (2 years post-EC-TCPC). We describe the details of the management of LTx in the presence of cardiac anomalies and report the long-term cardiac and liver function, from peri-LDLTx through EC-TCPC completion.


Asunto(s)
Anomalías Múltiples/cirugía , Atresia Biliar/cirugía , Puente Cardíaco Derecho , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Trasplante de Hígado/métodos , Donadores Vivos , Niño , Preescolar , Ventrículos Cardíacos/cirugía , Humanos , Lactante , Masculino
20.
Transplant Direct ; 4(2): e342, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29464203

RESUMEN

Background: Multiple studies have failed to reveal an effective method for preventing the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LTx). A national study conducted in Japan revealed several risk factors for the recurrence after living donor LTx (LDLTx); however, recipients of ABO-blood type incompatible (ABO-I) LTx were excluded from the previous analysis. In the present study, we investigated the efficacy of an immunosuppressive protocol in ABO-I LTx on the recurrence of PSC after LDLTx. Methods: We conducted a national survey and analyzed the outcome of recipients who underwent ABO-I LDLTx for PSC (n = 12) between 1994 and 2010 in 9 centers and compared the outcome with that of ABO-compatible LDLTx for PSC (n = 96). The key elements of the immunosuppressive regimen in ABO-I LTx are plasma exchange sessions to remove existing antibodies, and the use of immunosuppression to control humoral immunity. Rituximab was added to the immunosuppression regimen from 2006 onward; 5 patients received rituximab perioperatively. Results: All 7 recipients who underwent ABO-I LDLTx before 2006 (who did not receive rituximab) died of infection (n = 3), antibody-mediated rejection (n = 1), ABO-incompatibility associated cholangiopathy (n = 1) or recurrence of PSC (n = 2). In contrast, we found that all 5 recipients from 2006 (who were treated with rituximab) retained an excellent graft function for more than 7 years without any recurrence of PSC. Conclusions: The findings of this study shed light on the efficacy of a novel strategy to prevent the recurrence of PSC and the possible mechanisms provided by rituximab treatment are discussed.

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