Prognostic impact of MRI-derived feature tracking myocardial strain in patients with non-ischaemic dilated cardiomyopathy: a systematic review and meta-analysis.

AIM: To evaluate the clinical utility of feature tracking (FT)-derived myocardial strain in patients with non-ischaemic dilated cardiomyopathy (NIDCM). MATERIALS AND METHODS: Electronic database searches of PubMed, Web of Science Core Collection, Cochrane advanced search, and EMBASE were performed. Studies on NIDCM were divided into categories according to left ventricular ejection fraction (LVEF; <30%, 30-40%, >40%), and correlations between strains and prevalence of late gadolinium enhancement (LGE) were evaluated by weighted correlation coefficients. Global longitudinal strain (GLS) hazard ratios were also integrated for prediction of future adverse events. RESULTS: The present meta-analysis analysed data from 5,767 patients with NIDCM from 30 eligible studies. GLS and global circumferential strain significantly differed across the three LVEF categories (all p<0.05); however, global radial strain did not. Only GLS showed a strong correlation with the prevalence of LGE (Spearman's correlation coefficient = 0.61). The pooled HR of GLS for predicting adverse events was 1.15 (95% confidence interval [CI]: 1.07-1.23, p<0.001). CONCLUSION: In this meta-analysis, FT-derived GLS was strongly correlated with myocardial fibrosis and was an important predictor of future adverse events. These results suggest that FT-derived GLS may be useful in the pathological evaluation and risk stratification of NIDCM.

Multisystem Inflammatory Syndrome in Children (MIS-C) with COVID-19: Insights from simultaneous familial Kawasaki Disease cases.

Recently, an increasing number of SARS-CoV-2 patients with COVID-19 syndrome, which overlaps with Kawasaki Disease (KD), have been reported, supporting the suggestion that infection is one of the triggers of KD. We summarized the reports of simultaneous familial KD cases to better understand the etiopathogenesis of both KD and Multisystem Inflammatory Syndrome in Children (MIS-C) related to COVID-19. Here we discuss the etiology of these syndromes from the point of view of infection and genetic susceptibility.

Comparing treatments for basal cell carcinoma in terms of long-term treatment-failure: a network meta-analysis.

Although many variations of guidelines have been released, there is limited research that compares multiple treatment strategies for basal cell carcinoma (BCC). The aim of this study was to systematically review the studies reporting on multiple treatments for BCC with systematic review and network meta-analyses. Search formulas for databases, such as PubMed, EMBASE, Web of Science Core Collection and Cochrane Central Register of Controlled Trials, were created with the support of Cochrane Japan. The patient-level and tumour-level meta-analyses were performed for both the long-term treatment-failure and treatment-success. Of the 1464 studies identified from the database and hand searches, 14 met our inclusion criteria. These 14 studies included 2524 patients and 1738 tumours. Our study indicated that the incidence of treatment-failure of invasive treatments such as surgery and Mohs micrographic surgery was significantly lower than that of superficial therapies such as cryotherapy, photodynamic therapy, radiotherapy or topical therapies, in the patient-level and the tumour-level analyses, despite histological-type and pretreatment. Relapse of BCC may be a low life-threatening risk, and there are merits of non-surgical treatment. However, the significant difference in the recurrence rate is essential. Our study can provide useful guidance to clinicians in selecting treatment options for BCC.

Diagnostic test accuracy of antigenaemia assay for PCR-proven cytomegalovirus infection-systematic review and meta-analysis.

OBJECTIVES: We aimed to assess diagnostic test accuracy of antigenaemia assay for PCR-proven cytomegalovirus (CMV) infection. METHODS: We systematically searched studies that provide data both on sensitivity and specificity of the CMV antigenaemia assay using the PCR as the reference standard. Adults, children, infants, individuals who were immunocompromised for any reason, symptomatic patients and asymptomatic individuals were all included. A hierarchical summary receiver operating characteristics model was used for diagnostic meta-analysis. Study quality was assessed by Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Protocol registration identification is CRD42016035892. RESULTS: We identified 75 eligible articles including 9058 CMV PCR-positive individuals and 22 232 PCR-negative individuals. The diagnostic odds ratio for positive antigenaemia was 30 (95% CI 24-38, I2 = 28%) and the area under the hierarchical summary receiver operating characteristic curve was 0.86 (95% CI 0.83-0.88). The summary estimates of sensitivity and specificity were 0.65 (95% CI 0.59-0.70) and 0.94 (95% CI 0.93-0.95), respectively. The positive likelihood ratio of 10.9 (95% CI 8.5-14.0) suggested that a positive result from the antigenaemia assay greatly increased the probability of PCR-proven CMV infection, but a negative likelihood ratio of 0.38 (95% CI 0.32-0.44) indicated that a negative result led to a small decrease in the probability of PCR-proven CMV infection. Sensitivity and subgroup analyses replicated these results. CONCLUSIONS: The antigenaemia assay overlooked 35% of PCR-proven CMV infections; hence, a negative result of an antigenaemia assay could not rule out a CMV infection.

Comparison of antipseudomonal ß-lactams for febrile neutropenia empiric therapy: systematic review and network meta-analysis.

OBJECTIVES: To compare the effectiveness and safety of antipseudomonal ß-lactam empiric monotherapy for febrile neutropenia by network meta-analysis. METHODS: Searches using Pubmed, Cochrane CENTRAL, EMBASE and Web of Science Core Collection were carried out in June 2016. English articles, non-English articles, full-length articles, short articles and conference abstracts were allowed. Eligible trial design was a parallel-group individual randomization. We included febrile neutropenia adult and paediatric patients undergoing chemotherapy for either solid tumours or haematological malignancies and treated with intravenous antipseudomonal ß-lactams for initial empiric therapy. Protocol was registered with PROSPERO ID 42016043377. RESULTS: Of 1275 articles detected by the search, 50 studies with 10 872 patients were finally included. Among the guideline-recommended cefepime, meropenem, imipenem/cilastatin, piperacillin/tazobactam and ceftazidime; imipenem/cilastatin showed the highest odds of treatment success without modification, which was the primary endpoint, based on the random-effect model network analysis. Ceftazidime was related to lower treatment success rate without modification compared with imipenem/cilastatin with OR of 0.71 (95% CI 0.57-0.89, p 0.006). Imipenem/cilastatin showed the lowest odds of all-cause death. Patients treated with cefepime had higher risk for all-cause death compared with those treated with imipenem/cilastatin (OR 2.05, 95% CI 1.11-3.78, p 0.029). Any adverse event was significantly more prevalent in the imipenem/cilastatin arm; however, there was no difference concerning adverse events leading to discontinuation. CONCLUSIONS: Imipenem/cilastatin, piperacillin/tazobactam and meropenem may be reasonable first-choice medications for empiric therapy of febrile neutropenia.

Development and validation of a tuberculosis prognostic score for smear-positive in-patients in Japan.

BACKGROUND: No scoring system has ever been used to estimate the prognosis of individual tuberculosis (TB) patients. OBJECTIVE: To develop and validate a tuberculosis prognostic score. METHODS: This retrospective cohort study conducted in Japan comprised the development (n = 179; mean age 65.9 ± 18.8 years) and validation (n = 244; mean age 64.3 ± 20.1 years) of a tuberculosis prognostic score among patients with newly diagnosed smear-positive non-multidrug-resistant pulmonary tuberculosis without human immunodeficiency virus infection. The score (raw score) was defined by modifying a logistic regression formula using known risk factors as independent variables and in-patient death as a dependent variable. RESULTS: The raw score was calculated as follows: age (years) + (oxygen requirement, 10 points) - 20 × albumin (g/dl) + (activity of daily living: independent, 0 point; semi-dependent, 5 points; totally dependent, 10 points). The raw scores were grouped into risk groups 1 (raw score < -30) to 5 (raw score ≥ 60) using 30-point intervals. Every increase in risk group was equivalent to a 7.3-fold increase in the odds ratio for in-hospital death (P < 0.001). The area under the receiver operating characteristics curve by risk group for in-patient death was 0.875 (P < 0.001). CONCLUSIONS: In this study we were able to develop and validate a tuberculosis prognostic score.

Close relationship of tissue plasminogen activator-plasminogen activator inhibitor-1 complex with multiple organ dysfunction syndrome investigated by means of the artificial pancreas.

BACKGROUND: Glucose tolerance (GT) has not been taken into consideration in investigations concerning relationships between coagulopathy and multiple organ dysfunction syndrome (MODS), and endothelial cell activation/endothelial cell injury (ECA/ECI) in septic patients, although coagulopathy is known to be influenced by blood glucose level. We investigated those relationships under strict blood glucose control and evaluation of GT with the glucose clamp method by means of the artificial pancreas in nine septic patients with glucose intolerance. The relationships between GT and blood stress related hormone levels (SRH) were also investigated. METHODS: The amount of metabolized glucose (M value), as the parameter of GT, was measured by the euglycemic hyperinsulinemic glucose clamp method, in which the blood glucose level was clamped at 80 mg/dl under a continuous insulin infusion rate of 1.12 mU/kg per min, using the artificial pancreas, STG-22. Multiple organ failure (MOF) score was calculated using the MOF criteria of Japanese Association for Critical Care Medicine. Regarding coagulopathy, the following parameters were used: disseminated intravascular coagulation (DIC) score (calculated from the DIC criteria of the Ministry of Health and Welfare of Japan) and the parameters used for calculating DIC score, protein-C, protein-S, plasminogen, antithrombin III (AT-III), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator-PAI-1 (tPA-PAI-1) complex. Thrombomodulin (TM) was measured as the indicator of ECI. RESULTS: There were no significant correlations between M value and SRH, parameters indicating coagulopathy and the MOF score. The MOF score and blood TM levels were positively correlated with DIC score, thrombin-AT-III complex and tPA-PAI-1 complex, and negatively correlated with blood platelet count. CONCLUSIONS: GT was not significantly related to SRH, coagulopathy and MODS under strict blood glucose control. Hypercoagulability was closely related to MODS and ECI. Among the parameters indicating coagulopathy, tPA-PAI-1 complex, which is considered to originate from ECA, seemed to be a sensitive parameter of MODS and ECI, and might be a predictive marker of MODS. The treatment for reducing hypercoagulability and ECA/ECI were thought to be justified as one of the therapies for acutely ill septic patients.

[A case of idiopathic interstitial pneumonia that responded well to intermittent intravenous administration of high doses of cyclophosphamide and a steroid].

A 78-year-old man was hospitalized on February 29, 2000 because of dyspnea. A chest radiograph showed diffuse bilateral interstitial shadows associated with pulmonary volume loss. We could not obtain histological evidence of idiopathic interstitial pneumonia (IIP) because of his advanced age and severe respiratory dysfunction. IIP was diagnosed on the basis of radiographic findings and clinical symptoms. The patient was intubated and mechanical ventilation was performed. After one course of pulsed cyclophosphamide (CPM) and methylprednisolone therapy, the hypoxemia improved and it became possible to wean the patient from the ventilator. After five courses of pulsed CPM therapy, the dose of oral corticosteroid was tapered. CPM was administered safely without any severe side effects. Pulsed CPM therapy appears to be a viable alternative method of treatment for IIP.

Churg-Strauss syndrome associated with pregnancy.

Churg-Strauss syndrome, an uncommon condition, occurs even more rarely in association with pregnancy. One month postpartum, a 25-year-old Japanese woman was hospitalized for dyspnea, fever, diarrhea, and complaints of dysesthesia in the right lower limb and right lumbar and abdominal region. Marked eosinophilia was present. Symptoms of bronchial asthma had developed early in the pregnancy, which concluded with delivery of a healthy baby at 39 weeks of gestation. Churg-Strauss syndrome was diagnosed and prednisolone was administered with a good response leading to remission. Three years after the first pregnancy, low-dose steroid therapy was continued through another pregnancy. The patient delivered another healthy baby at 39 weeks of gestation, this time with no exacerbation of symptoms.

[A case of elderly patient with pulmonary tuberculosis considered to be caused by exogenous reinfection].

A 84-year-old woman presented with chronic febrile illness and anorexia from June 1998. She was diagnosed as pulmonary tuberculosis and was admitted to our hospital in August 1998. Her sputum smear was Gaffky 2, and the type of chest radiograph was b III 3. By family contact examination in August 1998, chest radiological examinations of her husband, a 86-year-old man, showed consolidation in middle lobe, right pleural effusion and two calcified mediastinal lymphnodes. He was diagnosed as pulmonary tuberculosis complicated with pleurisy. He had poor controlled diabetes mellitus. Tubercle bacilli isolated from their sputa showed the same pattern in restriction fragment length polymorphism analysis. Pulmonary tuberculosis of the husband was considered to be caused by exogenous reinfection.

[Serum soluble interleukin-2 receptor in patients with pulmonary mycobacterial diseases].

Serum soluble interleukin-2 receptor (sIL-2R) levels were measured in patients with untreated pulmonary tuberculosis (24 cases), patients with multidrug-resistant intractable pulmonary tuberculosis (7 cases) and patients with pulmonary non-tuberculous mycobacteriosis (27 cases). Serum sIL-2R levels were elevated in patients with pulmonary mycobacterial diseases and were elevated in untreated pulmonary tuberculosis patients than in other patients. In patients with new tuberculosis, serum sIL-2R levels were higher in patients with extensive lesions. Serum sIL-2R level showed significant positive correlation with serum C-reactive protein level and erythrocyte sedimentation rate, and significant negative correlation with serum albumin level. In patients with intractable tuberculosis and patients with non-tuberculous mycobacteriosis, serum sIL-2R levels were lower than in patients with new tuberculosis. Even in patients with extensive lesions, serum sIL-2R levels were not elevated. Lower levels of serum sIL-2R, marker of immunocompetent cell activity, suggested that immunocompetent cell activity was suppressed in intractable tuberculosis and in non-tuberculous mycobacteriosis.

Patients with methamphetamine psychosis admitted to a psychiatric hospital in Japan. A preliminary report.

To examine the clinical characteristics of methamphetamine (MAP) psychosis in Japan, we evaluated 104 patients with MAP psychosis (80 men and 24 women) admitted to the closed psychiatric units of Tokyo Metropolitan Matsuzawa Hospital between 1988 and 1991. There has recently been a steep increase in the number of admissions for MAP psychosis, reflecting the growth of the epidemic of MAP abuse in Japan. Although more than half of the patients were discharged within one month, 16 patients were hospitalized for more than 3 months. Most of the patients showed paranoid psychotic state similar to schizophrenia, consistent with previous reports. Despite the abstinence from MAP and antipsychotic medication, psychotic symptoms tended to persist in some of the patients. The etiological role of MAP psychosis in the development of long-lasting psychotic state was discussed.

Neuropathologic changes in suckling and weanling rats with pyrithiamine-induced thiamine deficiency.

Pregnant and nursing Wistar rats were fed a thiamine-deficient diet, and their offspring were injected daily with pyrithiamine. The pathologic lesions in the suckling rats were examined at different times of development. There were distinct changes at 22 days of age, by which time the rats are weaned, and the morphogenesis of the cerebellum is almost completed. Before 22 days of age, there were no pathologic changes except for scattered petechial hemorrhages in the brain. After 22 days of age, acute pathologic changes were observed, in decreasing order of severity, in the vestibular nuclei, inferior olivary nuclei, mammillary body, periventricular gray matter, thalamus, and quadrigeminal plates. The initial changes were swelling of post-synaptic dendrites and distension of the periaxonal space of myelinated axons in the parenchyma and ring-shaped hemorrhages in the perivascular space. Pyrithiamine injections into the offspring of rats fed a thiamine-deficient diet probably induce disturbance of the electrolyte permeability of the neuronal excitable membrane, resulting in swelling of this element. These changes were followed by the filtration of erythrocytes and plasma into the parenchyma and astrocytic swelling, which may be a secondary effect of neuronal changes on the brain vascular permeability.

Ultrastructure of Alzheimer type II glia in hepatocerebral disease.

In a case of hepatocerebral disease of Inose type the astrocytes, corresponding to Alzheimer type II glia, had swollen cytoplasm containing glycogen granules and focal aggregates of lipofuscin granules. Their nuclei contained bodies of simple and of complex types as well as conglomerates of glycogen granules without any capsules. The nuclear bodies of simple type were also observed in the nuclei of endothelial cells. It is concluded that these changes in the appearance of Alzheimer type II glia suggest reactive and defensive changes in the brain against ammonium ions, rather than being merely degenerative in nature.