Utility of dual-energy computed tomography in the association of COVID-19 pneumonia severity.

Aim: Coronavirus disease 2019 pneumonia differs from ordinary pneumonia in that it is associated with lesions that reduce pulmonary perfusion. Dual-energy computed tomography is well suited to elucidate the etiology of coronavirus disease 2019 pneumonia, because it highlights changes in organ blood flow. In this study, we investigated whether dual-energy computed tomography could be used to determine the severity of coronavirus disease 2019 pneumonia. Methods: Patients who were diagnosed with coronavirus disease 2019 pneumonia, admitted to our hospital, and underwent dual-energy computed tomography were included in this study. Dual-energy computed tomography findings, plane computed tomography findings, disease severity, laboratory data, and clinical features were compared between two groups: a critical group (18 patients) and a non-critical group (30 patients). Results: The dual-energy computed tomography results indicated that the percentage of flow loss was significantly higher in the critical group compared with the non-critical group (P < 0.001). Additionally, our data demonstrated that thrombotic risk was associated with differences in clinical characteristics (P = 0.018). Receiver operating characteristic analysis revealed that the percentage of flow loss, evaluated using dual-energy computed tomography, could predict severity in the critical group with 100% sensitivity and 77% specificity. However, there were no significant differences in the receiver operating characteristic values for dual-energy computed tomography and plane computed tomography. Conclusion: Dual-energy computed tomography can be used to associate the severity of coronavirus disease 2019 pneumonia with high accuracy. Further studies are needed to draw definitive conclusions.

Two cases of post-traumatic inferior vena cava thrombosis.

BACKGROUND: Inferior vena cava thrombosis is a rare blunt abdominal trauma complication often associated with severe liver injury. We present two cases of inferior vena cava thrombosis due to mild liver injuries. CASE PRESENTATION: Case 1 was a 25-year-old woman taking oral contraceptives for dysmenorrhea who was injured in a motorcycle accident. Contrast-enhanced computed tomography revealed hepatic contusion of the sixth segment. At 1 week after the accident, inferior vena cava thrombosis was detected. Case 2 was a 58-year-old man injured in a motorcycle accident. Contrast-enhanced computed tomography showed traumatic subarachnoid hemorrhage, right hemothorax, and liver injury with hepatic contusion of the sixth segment. At 1 week after the accident, inferior vena cava thrombosis was observed. CONCLUSION: Inferior vena cava thrombosis can occur following liver injury, regardless of damage severity. When there are thrombogenic factors and damage near the inferior vena cava, follow-up examinations should be carried out.

DUAL-energy computed tomography findings in a case of COVID-19.

BACKGROUND: COVID-19 pneumonia has lesions with a decreased blood flow. Dual-energy computed tomography is suitable to elucidate the pathogenesis of COVID-19 pneumonia because it highlights the blood flow changes in organs. We report the dual-energy computed tomography findings of a successfully treated case of COVID-19 pneumonia. CASE PRESENTATION: An obese 49-year-old man with COVID-19 pneumonia was transferred from another hospital on day 11 after onset of illness. Although he was hypoxemic (PaO2/FiO2 = 100), tracheal intubation was not performed after anticipating difficulty in weaning from mechanical ventilation. Prone position therapy and nasal high flow therapy were administered, and the patient was discharged after his condition improved. Dual-energy computed tomography was performed three times during hospitalization, and it revealed improvement in the blood flow defect, unlike plain computed tomography that did not show much improvement. CONCLUSION: Dual-energy computed tomography can assess perfusion in COVID-19 pneumonia in real time and may be able to predict its severity.

Intraoperative maneuvers may affect the development of early postoperative small bowel obstruction after laparoscopic colorectal cancer surgery: Multicenter prospective cohort study.

BACKGROUND: Early postoperative small bowel obstruction (EPSBO) is one of the most common complications after colorectal cancer (CRC) surgery, and clarification of its causes is desired. Several reports have demonstrated the risks of EPSBO, but few have focused on laparoscopic surgery for CRC and intraoperative maneuvers. We therefore prospectively examined the risk factors for EPSBO after laparoscopic CRC resection. METHODS: We prospectively enrolled 706 patients with CRC that underwent laparoscopic CRC resection in our hospital and affiliated hospitals. We analyzed several factors concerning EPSBO including intraoperative procedures. RESULTS: EPSBO developed in 43 of the 706 cases (6.1%). Univariate analysis showed that risk factors for EPSBO were male sex, increased operative time, repositioning of the small intestine before wound closure and anastomotic leakage. Risk factors for EPSBO according to multivariate analysis were increased operative time (odds ratio (OR) 2.41; P = 0.032), repositioning of the small intestine before wound closure (OR 3.58; P = 0.005) and anastomotic leakage (OR 3.91; P = 0.006). CONCLUSION: To reduce EPSBO after laparoscopic CRC surgery, the operation should be finished as soon as possible without performing optional maneuvers. To avoid development to EPSBO, particular care is required in cases where the risk of anastomotic leakage is predicted to be high.

Hospital transfer for patients with postpartum hemorrhage in Yokohama, Japan: a single-center descriptive study.

AIM: To describe the transport time and timing of transfer of patients with postpartum hemorrhage to a tertiary care institution in an urban area. METHODS: We included patients with postpartum hemorrhage transferred to our hospital from a perinatal care facility. We defined transfer time as the time between the referring physician's request for transfer and the patient's arrival at our hospital. We examined transfer time and its breakdown, the shock index before and after transfer, and the prognosis. RESULTS: Overall, 79 patients with postpartum hemorrhage were transported to our hospital within a median (interquartile range) of 53 min (47-63 min). In 70 cases (89%), the request for transport was made before the shock index reached 1.5, and two cases had cardiac arrest during transport. CONCLUSIONS: Most patients who were transferred to our hospital were transferred according to the criteria recommended by the guideline. However, the occurrence of cardiac arrest during transport indicates the need to shorten the time from transfer requests to emergency calls by strengthening cooperation with regional perinatal care facilities.

Engineering antimicrobial coating of archaeal poly-γ-glutamate-based materials using non-covalent crosslinkages.

We are now entering a new age of intelligent material development using fine, sustainable polymers from extremophiles. Herein we present an innovative (but simple) means of transforming archaeal poly-γ-glutamate (PGA) into extremely durable polyionic complexes with potent antimicrobial performance. This new supra-polymer material (called PGA/DEQ) was subjected to nuclear magnetic resonance and X-ray diffraction spectroscopies to characterize in structural chemistry. Calorimetric measurements revealed its peculiar thermal properties; to the best of our knowledge, it is one of the most heat-resistant biopolymer-based polyionic complexes developed to date. PGA/DEQ is particularly useful in applications where surface functionalization is important, e.g., antimicrobial coatings. The spontaneously assembled PGA/DEQ coatings (without any additional treatments) were remarkably resistant to certain organic solvents (including chloroform), even at high salt concentrations (theoretically greater than those found in sea water), and various pH values. However, the pH-response tests also implied that the PGA/DEQ coatings could be removed only when concentrated citrate di-salts were used, whereas most crosslinked polymer composites (e.g., thermoset matrices) are difficult to recycle and treat downstream. We also discuss PGA/DEQ-immobilized surfaces that exhibit enigmatic microbicidal mechanisms.

Coordinated regulation of hepatic and adipose tissue transcriptomes by the oral administration of an amino acid mixture simulating the larval saliva of Vespa species.

BACKGROUND: VAAM is an amino acid mixture that simulates the composition of Vespa larval saliva. VAAM enhanced physical endurance of mice and have been used by athletes as a supplementary drink before exercise. However, there is no information on the effect of VAAM on the physiology of freely moving animals. The purpose of this study was to obtain information about the VAAM-dependent regulation of liver and adipose tissue transcriptomes. RESULTS: Mice were orally fed a VAAM solution, an amino acid mixture mimicking casein hydrolysate (CAAM) or water under ad libitum feeding conditions for 5 days. Comparisons of the hepatic transcriptome between VAAM-, CAAM-, and water-treated groups revealed a VAAM-specific regulation of the metabolic pathway, i.e., the down-regulation of glycolysis and fatty acid oxidation and the up-regulation of polyunsaturated fatty acid synthesis and glucogenic amino acid utilization. Similar transcriptomic analyses of white and brown adipose tissues (WAT and BAT, respectively) indicated the up-regulation of phospholipid synthesis in WAT and the negative regulation of cellular processes in BAT. Because the coordinated regulation of tissue transcriptomes implied the presence of upstream signaling common to these tissues, we conducted an Ingenuity Pathways Analysis. This analysis showed that estrogenic and glucagon signals were activated in the liver and WAT and that beta-adrenergic signaling was activated in all three tissues. CONCLUSIONS: We found that VAAM ingestion had an effect on multiple tissue transcriptomes of freely moving mice. Utilization of glycogenic amino acids may have been activated in the liver. Fatty acid conversion into phospholipid, not to triacylglycerol, may have been stimulated in adipocytes contrasting that a little effect was observed in BAT. Analysis of upstream factors revealed that multiple hormonal signals were activated in the liver, WAT, and BAT. Our data provide some clues to understanding the role of VAAM in metabolic regulation.

[Motion Analysis of Lumbar Spine and Hip Joint on Sequential Radiographs Acquired with a Dynamic Flat-panel Detector (FPD) System].

PURPOSE: To design an evaluation method for lumbar spine and hip joint function using dynamic radiography using a flat-panel detector (FPD) system. METHOD: Sixteen healthy subjects (males; age range, 22-60 years; median, 27 years) and 9 patients (7 males and 2 females; age range, 67-85 years; median, 73 years) with L4 degenerative spondylolisthesis were examined using a dynamic FPD system (CANON Inc.). Sequential images were captured with the subjects in the standing position with maximal forward bending followed by backward bending for 10 s. The lateral lumbar radiographs were obtained at 2 frames/s (fps). The flexion-extension angles of L1 and S1 were measured on those images. RESULTS AND DISCUSSION: The range of motion (ROM) of the lumbar joints was significantly larger in the healthy group (82.4 ± 8.7°) than in the disease group (50.4 ± 8.5°; p<0.05). The ROM of the pelvic region was significantly smaller in the healthy group (26.9 ± 17.1°) than in the disease group (53.1 ± 17.6°; p<0.05). The healthy subjects exhibited a normal lumbar-pelvic rhythm. In the disease group, hip joint movements tended to be completed earlier compared with those in the healthy group. In the disease group, the loss of lumbar flexibility was compensated by an increase in hip joint motion due to the lumbar disease. CONCLUSION: The dynamic FPD system is a convenient imaging modality for the diagnosis of lumbar diseases through the assessment of locomotive function in the lumbar spine and hip joints.