TB-related technical enquiries received in Japan, 2017-2019.

SETTING: Japan, an intermediate TB burden country. OBJECTIVE: To review TB-related technical enquiries received at the Research Institute of Tuberculosis, Japan, from January 2017 to December 2019. DESIGN: This was a cohort study. RESULTS: A total of 2,197 enquiries were analysed. On average, 61.0 enquiries/month (range: 42-81) were received. The enquiry rates were highest for the Yamanashi (4.65/100,000 population) and Ishikawa (4.55) Prefectures, and lowest in the Yamagata (0.46) and Tochigi (0.56) Prefectures. The main organisations the enquirers belonged to were local governments (n = 1,585, 72.1%) and healthcare facilities (n = 307, 14.0%). The enquirers were medical doctors (n = 391, 17.8%), nurses (n = 1,207, 54.9%), other healthcare professionals (n = 57, 2.6%), the general public (n = 168, 7.6%) and others/unknown (n = 374, 17.0%). The most frequent enquiries were about TB diagnosis and treatment (n = 501, 22.8%), including laboratory diagnosis (n = 88, 4.0%), TB treatment in general (n = 93, 4.2%) and management of comorbidities (n = 86, 3.9%), followed by contact investigations (n = 385, 17.5%) and TB in foreigners (n = 344, 15.7%). CONCLUSION: As the most frequent enquiries were about diagnosis and treatment of TB, the health ministry of Japan should maintain a few specialised TB institutions with TB physicians to provide technical assistance.

LIEU: Le Japon, un pays à charge intermédiaire en matière de TB. OBJECTIF: Examiner les demandes de renseignements techniques liées à la TB reçues au Research Institute of Tuberculosis, au Japon, de janvier 2017 à décembre 2019. METHODE: Il s'agissait d'une étude de cohorte. RÉSULTATS: Au total, 2 197 demandes ont été analysées. En moyenne, 61,0 demandes de renseignements/mois (fourchette : 42­81) ont été reçues. Les taux de demande étaient les plus élevés dans les préfectures de Yamanashi (4,65/100 000 habitants) et d'Ishikawa (4,55), et les plus faibles dans les préfectures de Yamagata (0,46) et de Tochigi (0,56). Les principales organisations auxquelles appartiennent les enquêteurs sont les administrations locales (n = 1 585 ; 72,1%) et les établissements de santé (n = 307; 14,0%). Les enquêteurs étaient des médecins (n = 391 ; 17,8%), des infirmières (n = 1 207 ; 54,9%), d'autres professionnels de la santé (n = 57 ; 2,6%), le grand public (n = 168 ; 7,6%) et autres/inconnus (n = 374 ; 17,0%). Les demandes les plus fréquentes concernaient le diagnostic et le traitement de la TB (n = 501 ; 22,8%), y compris le diagnostic en laboratoire (n = 88 ; 4,0%), le traitement de la TB en général (n = 93 ; 4,2%) et la prise en charge des comorbidités (n = 86 ; 3,9%), suivis par les enquêtes sur les contacts (n = 385 ; 17,5%) et la TB chez les étrangers (n = 344 ; 15,7%). CONCLUSION: Comme les demandes de renseignements les plus fréquentes concernaient le diagnostic et le traitement de la TB, le ministère de la santé du Japon devrait maintenir quelques institutions spécialisées dans la TB avec des médecins spécialistes de la TB pour fournir une assistance technique.

Causes of pre-treatment loss to follow-up in patients with TB.

SETTING: Five urban TB diagnostic centres in Lusaka, Zambia. OBJECTIVE: To determine the proportion of bacteriologically confirmed pre-treatment lost to follow-up (LTFU) patients with TB found at the study settings in 2020. DESIGN: This was a retrospective cohort study in which the TB laboratory and treatment registers at the study sites were cross-matched. RESULTS: A total of 1,085 bacteriologically confirmed patients with TB were found in the laboratory TB registers at the study settings. Of these, 809 (74.6%) were males, whereas 8 (0.7%) were children, 1,005 (92.6%) were diagnosed using Xpert, 78 (7.2%) by microscopy. A total of 91 (8.4%, 95% CI 6.8-10.2) were determined to be pre-treatment LTFU. Those who had very low (14.0%, 95% CI 8.5-21.2) and low (11.8%, 95% CI 8.4-16.0) results on Xpert were respectively 3.1 (95% CI 1.6-6.0) and 2.6 (95% CI 1.4-4.8) times more likely to become pre-treatment LTFU than those who had medium (4.5%, 95% CI 2.5-7.4) results. The proportions of pre-treatment LTFU varied among the study sites from 0.7% to 16.1%. CONCLUSION: Health facilities should strive to account for every patient with TB, with particular attention to those who are bacteriologically confirmed.

CADRE: Cinq centres urbains de diagnostic de la TB à Lusaka, en Zambie. OBJECTIF: Déterminer la proportion de patients atteints de TB perdus de vue (LTFU) avant le traitement et confirmés bactériologiquement dans les centres d'étude en 2020. MÉTHODE: Il s'agit d'une étude de cohorte rétrospective dans laquelle les registres de laboratoire et de traitement de la TB des sites étudiés ont été appariés. RÉSULTATS: Au total, 1 085 patients atteints de TB confirmée par une analyse bactériologique ont été trouvés dans les registres de laboratoire de la TB des sites de l'étude. Parmi eux, 809 (74,6%) étaient des hommes, tandis que 8 (0,7%) étaient des enfants. 1 005 (92,6%) ont été diagnostiqués à l'aide d'Xpert, 78 (7,2%) par microscopie. Au total, 91 (8,4% ; IC 95% 6,8­10,2) ont été déterminés comme étant des cas de LTFU avant traitement. Ceux qui avaient obtenu des résultats très faibles (14,0% ; IC 95% 8,5­21,2) et faibles (11,8% ; IC 95% 8,4­16,0) au test Xpert étaient respectivement 3,1 (IC 95% 1,6­6,0) et 2,6 (IC 95% 1,4­4,8) fois plus susceptibles de devenir des cas de LTFU avant traitement que ceux qui avaient obtenu des résultats moyens (4,5% ; IC 95% 2,5­7,4). Les proportions de LTFU avant traitement variaient entre les sites de l'étude de 0,7% à 16,1%. CONCLUSION: Les établissements de santé devraient s'efforcer de comptabiliser tous les patients atteints de TB, en accordant une attention particulière à ceux dont la présence est confirmée par la bactériologie.

Analysis of 605 tuberculosis outbreaks in Japan, 1993-2015: time, place and transmission site.

Since 1993, reports on tuberculosis (TB) outbreaks have been collected in Japan; however, there has never been an overall analysis of these TB outbreaks. We aim to provide one here. The TB outbreak data were obtained from the Ministry of Health, Labour and Welfare and are described in terms of time, place and transmission site. The average number of TB cases and latent tuberculosis infection (LTBI) were compared by the transmission site. Some 605 TB outbreaks with 3491 TB cases were reported in 1993-2015 with an increasing trend (r = 0.45), during which time 728 777 TB cases were reported nationwide. On an average, TB outbreaks occurred more often in April to May (5.5 outbreaks per 2 months) than in December to January (3.4). The most common transmission sites were workplaces (n = 255), followed by health facilities (n = 144), schools (n = 60) and welfare facilities (n = 48). Psychiatric hospitals and nursing homes had the highest average number of TB cases per outbreak (8.5 each), whereas schools and prisons had the highest numbers of LTBI cases (29.1 and 38.9, respectively). Countries, particularly those that have resources to investigate TB outbreaks, should collect and analyse findings of TB outbreaks, as it informs surveillance systems and eventually strengthens general health systems.

Re-evaluated treatment outcomes of bacteriologically positive TB patients registered at a clinic in Lusaka, Zambia in 2018.

SETTING: An urban TB diagnostic centre in Lusaka, Zambia. OBJECTIVE: To re-evaluate treatment outcomes of all bacteriologically confirmed TB patients registered in 2018. DESIGN: This was a retrospective cohort study on TB patients. Treatment outcomes of patients who were transferred out were retrieved. RESULTS: A total of 182 patients were registered, 26 of whom had missing documents; these were excluded from the study. Of the remaining 156 patients who were reviewed, 86 (55.1%) were correctly evaluated by the centre, 35 (22.4%) were incorrectly evaluated and 35 (22.4%) were 'transferred out' (not evaluated). As a result of this review, the number of evaluated patients increased from 86 (55.1%) to 150 (96.2%). The cure and treatment success rates rose from 43.6% and 44.2%, respectively, to 57.7% and 73.1%, respectively. Of note, 14 of the 35 patients who were initially declared 'transferred out' did not actually reach their treatment facilities and ended up being lost to follow-up. CONCLUSION: This study shows that it is possible to evaluate almost all TB patients. Re-evaluation of treatment outcomes of TB patients revealed the problems in the TB services that need to be improved in the future.

CONTEXTE: Un centre urbain de diagnostic de la TB à Lusaka, Zambie. OBJECTIF: Réévaluer les résultats du traitement de tous les patients atteints de TB bactériologiquement confirmée qui étaient enregistrés en 2018. SCHÉMA: Ceci est une étude rétrospective de cohorte de patients. Des résultats du traitement des patients TB qui ont été transferés dans un autre hôpital étaient retrouvés. RÉSULTATS: D'un total de 182 patients enregistrés, 26 ont été exclus car leur dossier était incomplet. Sur les 156 patients restants qui ont été revus, 86 (55,1%) ont eu une évaluation correcte dans le centre, pour 35 (22,4%) patients, elle était incorrecte et les 35 (22,4%) derniers ont été transférés donc pas évalués. A la suite de cette revue, la proportion de patients évalués augmenté de 86 (55,1%) à 150 (96,2%). Le taux de guérison et de succès du traitement ont augmenté de 43,6% et 44,2%, respectivement, à 57,7% et 73,1%, respectivement. Il faut noter que 14 des 35 patients initialement déclarés « transférés ¼ n'ont pas atteint leurs structures de traitement et ont fini par être perdus de vue. CONCLUSION: Cette étude montre qu'il est possible d'évaluer presque tous les patients TB. Une ré-évaluation des résultats du traitement des patients TB a révélé les problèmes des services TB qui doivent être améliorés à l'avenir.

Tuberculosis-related technical enquiries received by a national level institution in Japan, 2014-2016.

Background: Japan had a tuberculosis (TB) notification rate of 13.9 per 100 000 population in 2016. Objectives: To characterise TB-related enquiries received by the Research Institute of Tuberculosis, Tokyo, Japan, between January 2014 and December 2016. Design: A descriptive study of the time, place and other attributes of the enquiries. Results: A total of 1864 enquiries were listed for analysis. On average, 51.8 enquiries (range 30-77) were received per month. The enquiry rates were highest for Yamanashi (5.87/100 000) and Kochi (5.77) Prefectures, and lowest in Miyazaki (0.45) and Saga (0.48) Prefectures. Enquirers belonged mostly to local governments (n = 1212, 65%) and health care facilities (n = 386, 21%), and included medical doctors (n = 412, 22%), nurses (n = 926, 50%) and the general public (n = 150, 8.0%). Most enquiries concerned TB diagnosis and treatment (n = 475, 25%), including diagnosis in general (n = 38, 2.0%), laboratory diagnosis (n = 83, 4.5%), anti-tuberculosis treatment in general (n = 62, 3.3%) and the management of comorbidities or adverse events (n = 60, 3.2%), followed by contact investigations (n = 371, 20%). Conclusions: As most enquiries concerned the diagnosis and treatment of TB, the Ministry of Health of Japan should maintain a number of specialised TB institutions with TB clinicians to provide technical assistance.

Contexte : Le Japon avait un taux de notification de la tuberculose (TB) de 13,9 par 100 000 habitants en 2016.Objectif : Caractériser les demandes liées à la TB reçues par le Research Institute of Tuberculosis, Tokyo, Japon, de janvier 2014 à décembre 2016.Schéma : Une étude descriptive en termes de date, lieu et autres caractéristiques des demandes.Résultats : Un total de 1864 demandes ont été listées pour l'analyse. En moyenne, 51,8 demandes (fourchette 30­77) par mois ont été reçues. Les taux de demande ont été les plus élevés pour les préfectures de Yamanashi (5,87/100 000 habitants) et de Kochi (5,77) et les plus bas dans les préfectures de Miyazaki (0,45) et de Saga (0,48). Les organisations principales auxquelles appartenaient les demandeurs ont été les gouvernements locaux (n = 1212 ; 65%) et les structures de soins de santé (n = 386 ; 21%). Les demandeurs ont été des médecins (n = 412 22%), des infirmiers (n = 926 ; 50%) et le public général (n = 150 ; 8,0%). Les demandes les plus fréquentes ont été liées au diagnostic et au traitement de la TB (n = 475 ; 25%), incluant le diagnostic en général (n = 38 ; 2.0%), le diagnostic de laboratoire (n = 83 ; 4,5%), le traitement de la TB en général (n = 62 ; 3,3%) et la prise en charge des comorbidités ou des effets secondaires (n = 60 ; 3,2%), suivies par la recherche des contacts (n = 371 ; 20%).Conclusion : Comme les demandes les plus fréquentes ont été relatives au diagnostic et au traitement de la TB, le Ministère de la santé du Japon devrait maintenir quelques institutions spécialisées dans la TB avec des cliniciens qui pourraient fournir une assistance technique.

Marco de referencia: En el Japón, la tasa de notificación de tuberculosis (TB) fue 13,9 por 100 000 habitantes en el 2016.Objetivos: Caracterizar las consultas relacionadas con la TB que se recibieron en el Instituto de Investigación en Tuberculosis, Tokyo, Japón, de enero del 2014 a finales de diciembre del 2016.Método: Se llevó a cabo un estudio descriptivo de las consultas con respecto al tiempo, el lugar y otros atributos de las mismas.Resultados: Se registraron 1864 consultas para análisis. En promedio, se recibieron 51,8 consultas por mes (entre 30 y 77). La tasa de consultas más alta correspondió a las prefecturas de Yamanashi (5,87/100 000 habitantes) y Kochi (5,77) y la más baja a las prefecturas de Miyazaki (0,45) y Saga (0,48). Las principales organizaciones de los solicitantes pertenecían a los gobiernos locales (n = 1212; 65%) y a los establecimientos de salud (n = 386; 21%). Los solicitantes fueron médicos (n = 412; 22%), enfermeros (n = 926; 50%) y el público en general (n = 150; 8,0%). Las consultas más frecuentes se relacionaban con el diagnóstico y el tratamiento de la TB (n = 475; 25%), entre otros, el diagnóstico en general (n = 38; 2,0%), el diagnóstico en el laboratorio (n = 83; 4,5%), el tratamiento antituberculoso en general (n = 62; 3,3%) y el manejo de las enfermedades intercurrentes o las reacciones adversas (n = 60; 3,2%), seguidos de la investigación de contactos (n = 371; 20%).Conclusiones: Dado que las consultas más frecuentes se referían al diagnóstico y el tratamiento de la TB, el Ministerio de Salud del Japón debe conservar algunas instituciones especializadas en TB con médicos experimentados que presten asistencia técnica en esta esfera.

'Transfer out' tuberculosis patients: treatment outcomes after cross-checking registers, 2012-2013, Lusaka, Zambia.

SETTING: Lusaka, Zambia. OBJECTIVE: To assess the actual treatment outcomes of 'transfer out' (TO) cases at a diagnostic centre in Lusaka, in the third and fourth quarters of 2012, and to see the impact of this cross-check in treatment success rates (TSR) in 2013 and early 2014. DESIGN AND METHOD: In this retrospective cohort study, treatment outcomes for new bacteriologically positive tuberculosis (TB) cases referred from the diagnostic centre were reviewed and compared with those at the receiving treatment units. RESULTS: Of 49 (58%) cases referred to three treatment units, the treatment outcomes of nine had to be updated at the diagnostic centre, which reduced the proportion of TO cases from 17.6% to 11.8% and increased the TSR to 70.6% from 64.7%. CONCLUSION: The review and cross-checking of the TB registers at the diagnostic and treatment units led to a significant reduction in non-assessed cases, suggesting that the TB registers in the diagnostic and treatment units should be cross-checked regularly. There is also need for a complementary intervention to reduce the proportion of TOs associated with high loss to follow-up and non-evaluated TO rates.

Contexte : Lusaka, Zambie.Objectif : Evaluer les vrais résultats du traitement des cas « transférés hors zone ¼ (TO) dans un centre de diagnostic, à Lusaka, pendant les troisième et quatrième trimestres de 2012, et voir l'impact du croisement des informations dans le taux de succès du traitement (TSR) en 2013 et au début de 2014.Schéma et méthode : Dans cette étude rétrospective de cohorte, les résultats du traitement de nouveaux cas de tuberculose (TB) à bactériologie positive qui avaient été référés du centre de diagnostic ont été revus et comparés à ceux de l'unité de traitement.Résultats : Sur 49 cas (58%) qui ont été référés à trois unités de traitement, les résultats du traitement de neuf cas ont dû être mis à jour au centre de diagnostic, ce qui a abouti à la réduction de la proportion de cas « TO ¼ de 17,6% à 11,8% et à l'augmentation du TSR de 64,7% à 70,6%.Conclusion : La revue et le croisement des registres TB des unités des centres de diagnostic et de traitement a abouti à une réduction significative des cas non évalués, ce qui suggère que les registres TB des unités de diagnostic et de traitement devraient être fréquemment croisés. Il y a également un besoin d'interventions complémentaires afin de réduire la proportion de TO, qui est associée à un taux élevé de perdus de vue et de cas non évalués.

Marco de referencia: La ciudad de Lusaka en Zambia.Objetivo: Evaluar los desenlaces terapéuticos reales de los pacientes con tuberculosis (TB) 'transferidos a otro centro' (TO), en una unidad de diagnóstico de Lusaka durante el tercero y cuarto trimestres del 2012 y examinar el efecto de la verificación cruzada de las tasas de éxito terapéutico (TSR) en el 2013 y comienzos del 2014.Método: En el presente estudio retrospectivo de cohortes, se analizaron los desenlaces terapéuticos de los casos nuevos de TB con confirmación bacteriológica de una unidad diagnóstica que se remitieron a otros centros y se compararon con los resultados obtenidos en las unidades de tratamiento que los recibieron.Resultados: Se remitieron 49 pacientes (58%) del centro diagnóstico a tres unidades de tratamiento. Faltaba la actualización del desenlace terapéutico de nueve de estos pacientes en el centro de diagnóstico y tras la verificación cruzada, disminuyó la proporción de casos TO de 17,6% a 11,8% y la TSR aumentó de 64,7% a 70,6%.Conclusión: La revisión y la verificación cruzada de los registros de TB de las unidades de diagnóstico y las unidades de tratamiento dio lugar a una disminución considerable de los casos clasificados como no evaluados, lo cual destaca la necesidad de cotejar con frecuencia los registros de tuberculosis de las diferentes unidades. Se precisan intervenciones complementarias encaminadas a disminuir la proporción de TO, las cuales se asocian con una alta tasa de pérdida durante el seguimiento y de casos TO no evaluados.

An experimental method for quantitatively evaluating the elemental processes of indoor radioactive aerosol behavior.

An experimental method for quantitatively evaluating the elemental processes governing the indoor behaviour of naturally occurring radioactive aerosols was proposed. This method utilises transient response of aerosol concentrations to an artificial change in aerosol removal rate by turning on and off an air purifier. It was shown that the indoor-outdoor exchange rate and the indoor deposition rate could be estimated by a continuous measurement of outdoor and indoor aerosol number concentration measurements and by the method proposed in this study. Although the scatter of the estimated parameters is relatively large, both the methods gave consistent results. It was also found that the size distribution of radioactive aerosol particles and hence activity median aerodynamic diameter remained not largely affected by the operation of the air purifier, implying the predominance of the exchange and deposition processes over other processes causing change in the size distribution such as the size growth by coagulation and the size dependence of deposition.

Effect on radioactivity concentration estimation of radon progenies with NaI(Tl) pulse height distribution from considering geometric structure around detector and infiltration of radionuclides.

The surface radioactivity concentrations of the radon progenies, (214)Pb and (214)Bi, were estimated from NaI(Tl) pulse height distributions during rain. The improvement in estimation errors caused by considering geometric structures around measuring points and infiltration of radionuclides was discussed. The surface radioactivity concentrations were determined by comparing the count rates at the full-energy peak ranges between observation and calculation with the electron-photon transport code EGS5. It was shown that the concentrations can be underestimated by about 30 % unless the obstacles around the detector or infiltration of radionuclides are considered in gamma ray transfer calculations at measuring points, where there are many tall obstacles, or the ground is covered with unpaved areas.

Inverse estimation of radon flux distribution for East Asia using measured atmospheric radon concentration.

In this study, the (222)Rn flux density distribution at surface was estimated in East Asia with the Bayesian synthesis inversion using measurement data and a long-range atmospheric (222)Rn transport model. Surface atmospheric (222)Rn concentrations measured at Hateruma Island in January 2008 were used. The estimated (222)Rn flux densities were generally higher than the prior ones. The area-weighted mean (222)Rn flux density for East Asia in January 2008 was estimated to be 44.0 mBq m(-2) s(-1). The use of the estimated (222)Rn flux density improved the discrepancy of the model-calculated concentrations with the measurements at Hateruma Island.

Quantitative evaluation of 218Po behaviour in air in an artificial environment.

Experiments were carried out in a small enclosed booth for the purpose of understanding and modelling (218)Po behaviour. The experiment was conducted under two kinds of conditions without and with injection of incense smoke. A working model of (218)Po behaviour was applied to analyse the measured data. Under the condition without incense smoke, temporal changes in aerosol-attached and unattached (218)Po concentrations were successfully reproduced by the model. The deposition rate of unattached fraction and the rate of attachment were determined by the working model. Under the condition with incense smoke, temporal changes in (218)Po concentration were poorly simulated by the model. This can be attributed to the significantly increased aerosol concentration in small size ranges which is not properly considered in the attachment rate calculation in the model.

Estimation of surface anthropogenic radioactivity concentrations from NaI(Tl) pulse-height distribution observed at monitoring station.

A method of estimating surface radioactivity concentrations of key anthropogenic radionuclides from NaI(Tl) pulse-height distribution observed at a monitoring station (MS) was discussed. In the estimation, a realistic assumption on geometric distribution of source and obstacles around the detector of the MS including the infiltration of radionuclides into the ground was used and the results were compared with ones with a commonly used assumption of a uniformly distributed plane source. The surface radioactivity concentration was determined by comparing the count rates at the full-energy peak ranges between observation and calculation with an electron-photon transport code EGS5. It was shown that the estimated absolute values of concentration differed by a factor of ∼1.5 depending on the assumption of infiltration depth. The estimated surface concentrations of (131)I, (134)Cs and (137)Cs were in good agreement with ones determined by the in situ measurements with an HPGe detector and the cumulative values of daily surface depositions.

[Coronary artery aneurysm with various clinical course].

Case 1: A 77-year-old woman had effort angina pectoris. Coronary angiography (CAG) revealed a coronary artery aneurysm on the left descending artery. Coronary artery bypass grafting (CABG) and patch angioplasty for the aneurysm were performed. Case 2 : A 69-year-old woman had effort dyspnea CAG showed dilation of the left main trunk and beaded aneurysms (maximum 6 cm in diameter) behind the ascending aorta with a fistula to the right atrium. We closed the fistula and performed CABG to the circumflex branch. Case 3 : A 78-year-old woman had had general fatigue for 2 weeks. Previous CAG had revealed coronary artery aneurysms and current chest computered tomography revealed pericardial effusion. She was, therefore, diagnosed with the rupture of the coronary artery aneurysm. We closed the coronary artery aneurysm and performed CABG. Case 4: A 55-year-old man had been diagnosed with acute myocardial infarction and had undergone percutaneous coronary intervention 3 years before. CAG revealed a coronary artery aneurysm on the right coronary artery. We resected the aneurysm and interposed with saphenous vein graft. Although coronary artery aneurysm often has no symptoms, in the cases of angina, myocardial infarction, rupture or large aneurysm more than 3 times larger than the normal diameter, surgical repair should be considered.

[Preservation of aortic root with severe destruction in Stanford type A acute aortic dissection].

From November 1999 to December 2008, 197 patients with Stanford type A acute aortic dissection underwent the surgical treatment on an emergency basis. In 19 cases, we preserved the severely destroyed aortic root using gelatin-resorcin-formalin (GRF) glue avoiding aortic root replacement. We examined the indication and limitation of repair of the destroyed aortic root. The 19 patients were classified into 3 groups (A, B and C). Group A consisted of 7 patients who had no aortic regurgitation (AR). Group B consisted of 6 patients who had moderate to severe AR. Group C consisted of 6 patients who had coronary involvement. We preserved the broken aortic root in group A and group B. But it seemed to be rather difficult to repair the destroyed aortic root in some cases of group C.

Same-day smears in the diagnosis of tuberculosis.

OBJECTIVE: To assess the feasibility of completing the diagnosis of tuberculosis (TB) in 1 day by collecting only on-the-spot specimens. METHODS: Individuals with suspected TB attending district hospitals in Abuja submitted three sputum samples for routine diagnosis (the standard approach). One additional sample was collected 1 h after the first sputum (the same-day approach). One sputum sample was cultured. Blood samples were tested for HIV. RESULTS: Two hundred and twenty-four patients with chronic cough had 135/672 (20%) positive on-the-spot smears and 47/224 (21%) positive morning smears. The same-day and internationally recommended approaches identified 44 and 45 of the 78 patients with positive cultures, respectively. 106/194 (55%) patients were HIV positive. Only 9-11% of their smears were positive compared with 30-32% for HIV negatives (P < 0.01). CONCLUSION: It could be possible to diagnose TB in a single day by examining two spot specimens, but the feasibility needs to be confirmed on a larger scale.

[Surgical treatment for acute type A aortic dissection; for better postoperative quality of life].

From November 1999 to December in 2005, 114 patients with acute type A aortic dissection underwent surgical treatment on an emergency basis. The overall in-hospital mortality was 7.9% (9 patients). Four were rupture cases before cardiopulmonary bypass. De novo postoperative stroke rate was 3.5% (4 patients). But all of them were discharged on foot. There were 6 rupture cases before operation. Unfortunately only 2 patients survived. Preoperative stroke due to malperfusion occurred in 19 cases (16.7%). Among them, those with clear consciousness had tendency to better social rehabilitation than those with drowsiness. We had experienced 2 vegetable states in the group of drowsiness after the operations. For better outcome, we must avoid rupture before operation and reconsider the timing of operation in the case of brain ischemia.

A population-based study of immunohistochemical detection of p53 alteration in bladder cancer.

The molecular pathology of bladder cancer has been the subject of considerable interest and mutation of the p53 gene, which has been associated with more invasive bladder cancer, has been widely studied. Further, there is evidence that p53 inactivation (either mutation or protein dysregulation), independent of stage, may be predictive of bladder cancer progression. In an effort to avoid possible biases associated with selection of more advanced cases, we examined p53 inactivation in a population-based study of bladder cancer in New Hampshire, using both mutation and immunohistochemical methods. We found the overall prevalence of mutation to be approximately 10%, while immunohistochemical analysis suggests that approximately 66% of the tumours have dysregulated p53 at the protein level. There was a significant association of mutation with persistent p53 staining, but there remained a marked number of tumours discordant for mutation and aberrant p53 immunohistochemistry. Based upon immunohistochemical staining alone, intensity rather than extent of p53 staining was more strongly related to tumour invasiveness. Additionally, all tumours with a mutation in exon 8 stained intensely. Taken together, this suggests that intense staining represents a distinct phenotype of dysfunctional protein. Our data indicate that population-based approaches to somatic alteration of p53 in bladder cancer are crucial to understanding the relationship of p53 changes to aetiology and the outcome of this disease, and further suggest that the pattern of immunohistochemical staining may represent distinct, discernible phenotypes. British Journal of Cancer (2004) 90, 1572-1576. doi:10.1038/sj.bjc.6601748 www.bjcancer.com Published online 6 April 2004

Annexin II overexpression correlates with stromal tenascin-C overexpression: a prognostic marker in colorectal carcinoma.

BACKGROUND: Overexpression of annexin II, a calcium-dependent phospholipid-binding protein, has been reported in various carcinomas. One of its ligands is tenascin-C, an extracellular matrix glycoprotein with predominantly antiadhesive qualities that also has been reported to be a prognostic marker for several carcinomas. In the current study, the authors investigated the correlation between the overexpression of annexin II and tenascin-C in colorectal carcinoma. METHODS: Western blot analysis of annexin II expression was examined in four human colorectal carcinoma cell lines. Using immunohistochemical methods, the authors also examined expression of annexin II and tenascin-C in 105 primary colorectal carcinoma cases. RESULTS: Although annexin II was expressed in human colon carcinoma cell lines, there was no apparent correlation between its expression level and the metastatic potential of these cell lines. The authors observed overexpression of annexin II and tenascin-C proteins in 29.5% and 49.5%, respectively, of colorectal carcinoma cases. Overexpression of annexin II was found to be correlated significantly with histologic type, tumor size, depth of invasion, and pTNM stage, whereas tenascin-C overexpression was noted to be correlated significantly with histologic type, depth of invasion, lymphatic invasion, venous invasion, lymph node metastasis, and pTNM stage. Expression of annexin II was shown to be correlated significantly with that of tenascin-C. Multivariate analysis demonstrated that annexin II and tenascin-C cooverexpression was an independent factor of poor prognosis in patients with colorectal carcinoma. CONCLUSIONS: The data from the current study suggest that both annexin II and tenascin-C are overexpressed in advanced colorectal carcinoma and that they may be related to the progression and metastatic spread of colorectal carcinoma.

Tumor-specific chemo-radio-gene therapy for colorectal cancer cells using adenovirus vector expressing the cytosine deaminase gene.

We studied the effect of suicide gene therapy using an adenovirus vector expressing the cytosine deaminase (CD) gene combined with irradiation therapy (chemo-radio-gene therapy) for human colorectal cancer cells. Since serum CEA levels are elevated in patients with some malignant tumors including colorectal cancer, we applied the CEA promoter to chemo-radio-gene therapy, expecting tumor-specific expression of the CD gene. In in vitro study, we succeeded in selective expression of the target CD gene and growth inhibition in only CEA-producing tumor cells; Further the inhibitory effect was enhanced by combination with radiation therapy in an irradiation dose-dependent manner. In addition, in in vivo study, a significant growth inhibition was observed in chemo-radio-gene therapy in comparison with radiation therapy alone or suicide gene therapy alone. Thus, we suggest that tumor-specific chemo-radio-gene therapy may be a useful strategy for human colorectal cancer.

Bcl-X expression in esophageal squamous cell carcinoma: association with tumor progression and prognosis.

BACKGROUND AND OBJECTIVES: Bcl-2 family proteins are regulators of programmed cell death and important in the development and progression of human various tumors. The role of these proteins in the development, progression and differentiation of esophageal squamous cell carcinoma (ESCC) is unclear. METHODS: We investigated the expression of Bcl-2, Bcl-X, and Bax using immunohistochemistry in 86 ESCCs, and scored the expression by the weighted score. RESULTS: Bcl-2 expression related to pT category (P=0.043) and histological grade (P = 0.001). Bcl-X expression related to pT category (P = 0.003), pN category (P = 0.041) and the number of positive nodes (P = 0.036), and had a tendency to relate to histological grade (P = 0.086). Bax expression had a tendency to relate to pN category (P = 0.081). The inverse relationship between Bcl-2 and Bcl-X expression was detected (P = 0.001), while the positive one between Bcl-X and Bax expression was detected (P = 0.014). Patients with low Bcl-X weighted score had a significantly longer survival compared with those with high Bcl-X weighted score. Multivariate analysis revealed Bcl-X expression as the independent prognostic factors (P = 0.022). CONCLUSION: These results imply that Bcl-2 family proteins, especially Bcl-X, may contribute to the progression in ESCC.