Multicentred surgical site infection surveillance using partitioning analysis.

BACKGROUND: Surgical site infection (SSI) is an ongoing major public health problem throughout the world that increases healthcare costs. Utilizing a methodology that can help clinicians to continuously collect data about SSIs, analyse it and implement the feedback into routine hospital practice has been identified as a top national priority in Japan. AIM: To conduct an intervention study through 'operations research' using partitioning at multiple facilities, and to reduce the incidence and consequences of SSI. METHODS: The Setouchi SSI Surveillance Group, which consists of seven institutes, started SSI surveillance in 2006. Until May of 2008, there were four surveillance periods (A-D). In all, 3089 patients underwent gastrointestinal surgery and were followed up for 30 days after their operations. Twenty-six factors that have been reported to be related to SSI were evaluated for all patients. The top three factors from each surveillance period were determined and then actual practice improvements were planned for each subsequent period. FINDINGS: The total SSI occurrence was 6.9% for period A, 6.3% for period B, 6.4% for period C and 3.9% for period D. Comparing periods A and D, there was a statistical significance in the decrease of SSI occurrence (P = 0.012). CONCLUSION: Using the results and partitioning analysis of active SSI surveillance to contribute to action plans for improving clinical practice was effective in significantly reducing SSIs.

Nutrient recovery from biomass cultivated as catch crop for removing accumulated fertilizer in farm soil.

As a result of long-term continuous use of fertilizers in farm land, a large amount of nutrients accumulate in the soil, increasing the risk of eutrophication or nitrate pollution of groundwater. For rehabilitating the farm soil and recovering nutrients such as nitrogen, phosphorus and potassium, a new system has been developed by our research group. This paper discusses the methodology of extracting nutrients from biomass in order to recover phosphorus and other nutrients in crystal form. Around 80% or higher extraction rates were achieved for phosphorus and potassium by soaking the powdered tissue in distilled water or 1% NaOH solution for 24 h. The extracted phosphorus and potassium act as a potential resource for recycled fertilizer or other industrial materials.

Randomized clinical trial of treatment for TMJ disc displacement.

Of the various conservative treatment modalities available for temporomandibular disorders, we believe that therapeutic exercise has a good prognosis, especially for anterior disc displacement without reduction. Since its effectiveness has not been extensively evaluated, we conducted a comparative study to verify the hypothesis that treatment efficacy would not differ for exercise and occlusal splints. Fifty-two individuals with anterior disc displacement without reduction were randomly assigned to a splint or a joint mobilization self-exercise treatment group. Four outcome variables were evaluated: (i) maximum mouth-opening range without and (ii) with pain, (iii) current maximum daily pain intensity, and (iv) limitation of daily functions. All outcome variables significantly improved after 8 weeks of treatment in both groups. In particular, the mouth opening range increased more in the exercise group than in the splint group. This result demonstrates that therapeutic exercise brings earlier recovery of jaw function compared with splints.

Formation of chlorinated aromatics in model fly ashes using various copper compounds.

Various copper compounds found in fly ash are related to the formation of chlorinated aromatics. The formation potentials of chlorinated aromatics in different model fly ashes containing various copper compounds and the chemical behavior of such copper compounds were investigated. In model fly ash with copper metal, hydroxide, carbonate, or oxides, the generated amounts of chlorobenzene (CBz) and polychlorinated biphenyls (PCBs) and the average chlorination numbers were low and at the same level, respectively. The maximum generated amounts of chlorinated aromatics were observed at 300 degrees C. Although X-ray absorption near edge structure (XANES) spectra indicated that the chemical form of copper compounds changed little, they were found to promote the formation of chlorinated aromatics. Therefore, these copper compounds play the same role as CuO. On the other hand, in model fly ash with copper chloride, the generated amounts of CBz and PCBs were quite high and the average chlorination numbers was high. Dynamic changes were observed in XANES spectra, and the pre-edge peak attributed to monovalent copper compounds appeared at around 300 degrees C. A large difference was observed between these two groups in the amount of CuCl generated and the homologs of chlorinated aromatics present, indicating that CuCl played an important role in the formation of chlorinated aromatics.

Behaviour and adsorptive removal of siloxanes in sewage sludge biogas.

We investigated the behaviour of siloxanes, which adversely affect biogas engines, as well as their concentration levels in sewage sludge biogas in Japan. We also performed experiments on the absorptive removal of siloxanes using various adsorbents and determined the main adsorbent characteristics required for the removal of siloxanes. The results of our study on the concentration and composition of siloxanes in biogas were similar to previous reports. Moreover, we found that the concentration of siloxanes changes in relation to the outside air temperature based on real-time measurements of siloxanes using a continuous analyser. We further speculated that the continuous analyser would accurately indicate the siloxane concentration in model biogas but overestimate the siloxane concentration in actual biogas because of positive interference by VOCs and other biogas components. In the siloxane adsorption experiment, the equilibrium uptake of both cyclic siloxanes, D4 and D5, was positively related to the BET-specific surface area of the adsorbents and the fraction of the external surface area taken up by relatively large diameter pores. We attributed the adsorption results to the fact that the siloxane molecules are generally larger than micropores; therefore, they are less susceptible to adsorption to micropores. Based on these results, we concluded that adsorbents with large BET-specific surface areas, especially those with a high external specific surface area and pores of relatively large diameters, are desired for the removal of siloxanes.

Avaliação da interação de compostos ativos hidratantes com modelo de biomembrana de Crotalus durissus por meio de calorimetria exploratória diferencial e espectroscopia RAMAN / Study of the interaction of moisturizers with a Crotalus durissus biomembrane by differential scanning calorimetry and RAMAN spectroscopy

O objetivo foi verificar as alterações no estrato córneo em modelos alternativos de membrana após a aplicação de ativos hidratantes envolvendo métodos biofísicos. O modelo de biomembrana utilizado foi a muda de pele de Crotalus durissus e os ativos hidratantes foram: uréia, silício orgânico, extrato vegetal de Imperata cylindrica, reação de xilitol e glicose e componentes de NMF. Os resultados da avaliação das alterações do modelo por meio de Espectroscopia Raman com Transformada de Fourier sugerem que os ativos hidratantes confirmam segurança necessária, pois não alteraram de forma acentuada a estrutura do estrato córneo. Utilizando-se Calorimetria Exploratória Diferencial pode-se indicar que a solução de silício orgânico e o gel hidrofílico com uréia apresentaram melhor poder hidratante.

The objective of this research was to use biophysical techniques to investigate the alterations induced in a biomembrane model of the stratum corneum by the application of moisturizers. The biomembrane was obtained from the skin shed by the rattlesnake Crotalus durissus and the active moisturizing compounds were: urea, dimethylsilanol hyaluronate, Imperata cylindrical plant extract, carbohydrates and natural moisturizing factors (NMF components). Results from FT-Raman spectroscopy suggested that the moisturizers were safe, since they did not promote modifications in the structure of the stratum corneum. Differential scanning calorimetry results indicated that the solution containing the organic silicon compound and the gel with urea showed the best hydrating effects on the stratum corneum.

Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series.

BACKGROUND AND STUDY AIMS: Although endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal anatomy, a double-balloon enteroscope (DBE) permits examinations of a much longer segment of the small bowel than does a standard endoscope, and may be used to perform ERCP in such patients. Since only limited accessories are available for a conventional DBE, we performed ERCP with a "short" DBE, which has a 2.8-mm working channel and a 152-cm working length and for which conventional accessories are available, in patients with altered gastrointestinal anatomy, and evaluated this alternative technique. PATIENTS AND METHODS: In 68 patients with a Roux-en-Y total gastrectomy (n = 36), Billroth II gastrectomy (n = 17), or pancreatoduodenectomy (n = 15), ERCP (103 procedures) was performed with a "short" DBE. RESULTS: Deep insertion was successful in 100/103 procedures (97 %). Cholangiogram was successfully obtained in 98/100 procedures (98 %). Treatment was accomplished in all 98 procedures in which a cholangiogram was obtained (100 %). Therapeutic interventions including stone extraction (n = 47), nasobiliary drainage (n = 38), stent placement (n = 36), sphincterotomy (n = 31), choledochojejunostomy dilation (n = 29), tumor biopsy (n = 10), and naso-pancreatic duct drainage (n = 1) were performed successfully. Complications occurred in 5/103 procedures (5 %), all in patients with Roux-en-Y reconstruction. CONCLUSIONS: Despite the relatively high rate of complications seen in patients with Roux-en-Y reconstruction, ERCP with a "short" DBE is effective in patients who have undergone bowel reconstruction.

Detection of Pb-LIII edge XANES spectra of urban atmospheric particles combined with simple acid extraction.

Pb-LIII edge XANES spectra of atmospheric particles are directly obtained by fluorescent XAFS spectroscopy using a 19-element solid state detector (SSD). Particulate sample was collected on a quartz fiber filter using a high-volume air sampler, and the filter was cut into small pieces (25x25 mm). Then, surface layer of the filter piece was scaled and accumulated in order to enhance the particle density per filter unit. Use of 10 pieces of the surface layer enables the measurement of Pb-LIII edge XANES spectra on beamline BL01B1 at SPring-8, Hyogo, Japan. The shape of the Pb-LIII edge XANES spectra of the particulate sample is similar to the shapes of the spectra for PbS, PbCO(3), PbSO(4) and/or PbCl(2). Additionally, the filter sample is also divided into water-soluble, 0.1 M HCl-extractable, and residual fractions of Pb compounds by a simple acid extraction procedure. We discuss the possibility of Pb speciation in the particulate samples with combination of highly sensitive XANES spectroscopy and simple acid extraction.

Diet among Japanese female university students and asthmatic symptoms, infections, pollen and furry pet allergy.

OBJECTIVES: To study associations between diet, respiratory symptoms and allergy among female university students in Japan. METHODS: A standardised questionnaire was distributed to students in Kobe and Kamakura (N=153). Multiple logistic/linear regression was applied, controlling for age, smoking, heredity and diet. RESULTS: Totally 15.7% reported doctor-diagnosed asthma, 3.3% current asthma medication, 56.9% pollen allergy, 15.7% cat allergy, 11.1% dog allergy, 25.0% wheeze, 24.2% daytime and 9.3% nocturnal attacks of breathlessness. Meat consumption was related to wheeze (OR=2.00; 95% CI 1.12-3.60) and respiratory infections (OR=2.10; 95% CI 1.08-4.09). Fish consumption was related to less respiratory infections (OR=0.49; 95% CI 9.28-0.86), seafood to less pollen allergy (OR=0.66; 95% CI 0.44-0.99), and milk consumption to less daytime breathlessness (OR=0.72; 95% CI 0.55-0.95). Fast food consumption was related to wheeze (OR=1.89; 95% CI 1.23-2.91), daytime breathlessness (OR=1.50; 95% CI 1.00-2.28) and pollen allergy (OR=1.69; 95% CI 1.07-2.65). In total, 23.0% used butter, 21.7% margarine, 40.1% olive oil and 55.3% rapeseed oil. Those consuming butter (OR=2.65; 95% CI 1.11-6.32) and rapeseed oil (OR=2.35; 95% CI 1.03-5.38) had more wheeze. Those consuming margarine had more nocturnal breathlessness (OR=4.40; 95% CI 1.42-13.7). An asthma symptom score was related to fast food (p<0.05) and margarine consumption (p<0.01). Factor analysis identified five dietary patterns. A pattern including fast food, juice and soft drinks was related to wheeze and respiratory infections. CONCLUSION: Fish, seafood and milk consumption seems to be beneficial, while butter, margarine, rapeseed oil, fast food and soft drinks could be risk factors for allergy and respiratory health.

Chemical states of trace elements in sewage sludge incineration ash by using x-ray absorption fine structure.

In this study, the chemical states of chromium (Cr), arsenic (As), and selenium (Se) in sewage sludge incineration ash were determined by X-ray absorption fine structure (XAFS) spectroscopy. Sewage sludge incineration ash was sampled from several facilities, and XAFS measurements were carried out with a beam line BL01B1 at the SPring-8 facility. Cr K-edge X-ray absorption near-edge structure (XANES) spectra suggested that Cr compounds were predominantly speciated as Cr(III) and the fraction of Cr(VI) was very minor. Compared to the reference materials, Cr XANES spectra of the incineration ashes were similar to those of FeCr2O4, Cr(OH)3, and CaCr2O4. As K-edge XANES spectra indicated that As(V) compounds were present in incineration ashes. Because the chemical state of As in sewage sludge was As3+ in our previous study, we speculated that the chemical state of As changed into As(V) during the incineration process. According to Se K-edge XANES spectra, Se compounds were predominantly Se(IV), and a slight difference was observed in the chemical states amongst facilities using inorganic or organic coagulants in the dewatering process.

Protective effect of 17beta-estradiol on ischemic acute renal failure through the PI3K/Akt/eNOS pathway.

Estrogens attenuate renal injury induced by ischemia/reperfusion (I/R), an effect that is related to nitric oxide production in the post-ischemic kidney. The compound 17beta-estradiol (E(2)-beta) acting via estrogen receptors (ERs) is known to activate endothelial nitric oxide synthase (eNOS) through the phosphatidylinositol-3 kinase (PI3K)/Akt pathway. We determined if this pathway contributes to the renoprotective effect of E(2)-beta in the uninephrectomized ischemia reperfusion rat model of acute renal injury. Treatment with E(2)-beta suppressed the I/R-induced increases in blood urea nitrogen, plasma creatinine, urine flow, and fractional excretion of sodium while augmenting creatinine clearance, renal blood flow, and urine osmolality, indicating attenuation of renal injury. Phosphorylation of Akt and eNOS protein was significantly increased 30-60 min after reperfusion in estradiol-treated compared to vehicle-treated rats. The protective effects of E(2)-beta and protein phosphorylation were reversed by the PI3K inhibitor wortmannin or the ER antagonist tamoxifen. Furthermore, the E(2)-beta-induced renoprotective effects were not seen in eNOS knockout mice with renal injury. We conclude that the E(2)-beta-induced renoprotective effect is due to activation of the PI3K/Akt pathway followed by increased eNOS phosphorylation in the post-ischemic kidney.

AKT induces senescence in primary esophageal epithelial cells but is permissive for differentiation as revealed in organotypic culture.

Epidermal growth factor receptor (EGFR) overexpression and activation is critical in the initiation and progression of cancers, especially those of epithelial origin. EGFR activation is associated with the induction of divergent signal transduction pathways and a gamut of cellular processes; however, the cell-type and tissue-type specificity conferred by certain pathways remains to be elucidated. In the context of the esophageal epithelium, a prototype stratified squamous epithelium, EGFR overexpression is relevant in the earliest events of carcinogenesis as modeled in a three-dimensional organotypic culture system. We demonstrate that the phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway, and not the MEK/MAPK (mitogen-activated protein kinase) pathway, is preferentially activated in EGFR-mediated esophageal epithelial hyperplasia, a premalignant lesion. The hyperplasia was abolished with direct inhibition of PI3K and of AKT but not with inhibition of the MAPK pathway. With the introduction of an inducible AKT vector in both primary and immortalized esophageal epithelial cells, we find that AKT overexpression and activation is permissive for complete epithelial formation in organotypic culture, but imposes a growth constraint in cells grown in monolayer. In organotypic culture, AKT mediates changes related to cell shape and size with an expansion of the differentiated compartment.

Extraction efficiency of phosphate from pre-coagulated sludge with NaHS.

The recovery of phosphorus from sewage and sludge treatment systems is particularly important because it is a limited resource and a large proportion of the phosphorus currently used in Japan must be imported. We have been experimentally evaluating recovery methods with sulphide. In this study, we focussed on the extraction of phosphate from the sludge, and sought to achieve a greater extraction efficiency and to validate the extraction mechanism. We conducted three experiments, i.e. a sludge-type experiment, a coagulant ratio of pre-coagulated sludge experiment, and a concentration of pre-coagulated sludge experiment. Phosphate was extracted not with normal sewage sludge but with pre-coagulated sludge and FePO4 reagent at S/Fe = 1.0-2.0. A coagulant ratio of 23mg Fe L(-1) was required in the precoagulation process to effectively extract phosphate. A high concentration of pre-coagulated sludge was required for the phosphate extraction. The mass balance was calculated, and 44.0% of phosphorus was extracted to supernatant, and 98.5% of iron and 98.3% of sulphur (44.1% of sulphur was sulphide). Thus, phosphate can be selectively separated from iron by the phosphate extraction method with NaHS, and phosphorus and iron can be recovered and reused at sewage treatment plants using ferric chloride as a coagulant.

Heparanase expression correlates with malignant potential in human colon cancer.

PURPOSE: Heparanase cleaves carbohydrate chains of heparan sulphate proteoglycans and is an important component of the extracellular matrix. This study was designed to determine the relation between heparanase expression and prognosis of patients with colon cancer. METHODS: The study included 54 patients (35 males and 19 females) who underwent colorectal resection for colorectal cancer between January 1992 and December 1994. Expression of heparanase protein and mRNA were determined and correlated with various clinicopathological parameters. In vitro studies were also performed to examine tumor invasion and to test the effects of heparanase inhibition, and in vivo studies were performed to examine tumor metastasis and prognosis. RESULTS: Heparanase expression was detected in the invasion front of the tumor in 37 of 54 (69%) colon cancer samples, whereas 17 of 54 (31%) tumors were negative. Expression of heparanase was significantly more frequent in tumors of higher TNM stage (P=0.0481), higher Dukes stage (P=0.0411), higher vascular infiltration (P=0.0146), and higher lymph vessel infiltration (P=0.0010). Heparanase expression in colon cancers correlated significantly with poor survival (P=0.0361). Heparanase-transfected colon cancer cells exhibited significant invasion compared with control-transfected colon cancer cells (P=0.001), and the peritoneal dissemination model also showed the malignant potential of heparanase-transfected cells, as assayed by number of nodules (P=0.017) and survival (P=0.0062). Inhibition of heparanase significantly reduced the invasive capacity of cancer cells (P=0.003). CONCLUSIONS: Heparanase is a marker for poor prognosis of patients with colon cancer and could be a suitable target for antitumor therapy in colon cancer.

TNF combined with IFN-alpha accelerates NF-kappaB-mediated apoptosis through enhancement of Fas expression in colon cancer cells.

Immunostaining and EMSA revealed that NF-kappaB was activated strongly by TNF/IFN-alpha compared to TNF alone in a human colon adenocarcinoma cell line, RPMI4788. Although inhibition of activated NF-kappaB, by using an NF-kappaB decoy, reduced cell viability after treatment with TNF only, NF-kappaB decoy resulted in recovery of cell viability after TNF/IFN-alpha treatment. Caspase-3 activity was increased in cells induced by TNF/IFN-alpha, while suppression of caspase-3 activity was observed in cells transfected with NF-kappaB decoy and then treated by TNF/IFN-alpha. On the other hand, Fas expression was strongly enhanced by TNF/IFN-alpha, and inhibition of TNF/IFN-alpha-induced NF-kappaB activation, by using NF-kappaB decoy, decreased Fas expression. Cell viability and caspase-3 activity decreased in cells treated with TNF/IFN-alpha and anti-FasL antibody. Taken together, our findings suggest that activated NF-kappaB induced by the crosstalk between TNF and IFN-alpha is a novel pro-apoptotic signal acting via enhancement of Fas expression.

Pathophysiological role of proteasome-dependent proteolytic pathway in endothelin-1-related cardiovascular diseases.

A proteasome-dependent proteolytic pathway serves important functions in cell cycle control and transcriptional regulation; however, its pathophysiological role in cardiovascular diseases is still unclear. We have recently obtained evidence that proteasome inhibitors are capable of preventing the development of deoxycorticosterone acetate (DOCA)-salt-induced hypertension or hypertrophy and of ischemic acute renal failure (ARF). Beneficial effects of the proteasome inhibitors were accompanied by a decrease in endothelin-1 (ET-1) content in the aorta and kidney of DOCA-salt and ischemic ARF animals, respectively. In addition, there is evidence showing that the reduction of nuclear factor-kappaB (NF-kappaB) activation is involved in the mechanisms for suppressive effects of proteasome inhibitors on ET-1 gene transcription and the consequent decrease in ET-1 mRNA expression in the cultured vascular endothelial cells. These findings suggest that a proteasome-dependent proteolytic pathway has a crucial role in the pathogenesis of ET-1-related cardiovascular diseases, probably through the activation of NF-kappaB, and also that the use of proteasome inhibitors may be a novel approach to the treatment of cardiovascular diseases.