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A 25-year-old male (Case 1) was waiting for a bone marrow transplant for myelodysplastic syndrome. Due to acute appendicitis, he was advised to undergo gastroenterological surgery. After blood transfusion, he underwent an emergency laparoscopic appendectomy, as no blood cell recovery was expected. The postoperative course was uneventful, and he was discharged. A 71-year-old female (Case 2) developed acute appendicitis during chemotherapy for acute myeloid leukemia (AML). At the time of onset, since her myelosuppression was expected to improve in approximately 1 week, a conservative treatment was administered. However, due to the progression of AML, the expected blood cell recovery did not occur. Therefore, laparoscopic appendectomy was performed 25 days after onset. She was discharged without postoperative adverse events. In cases of acute appendicitis in patients with hematologic disease accompanied by pancytopenia, it is important to establish a careful treatment plan considering the possibility of recovery from myelosuppression and the need to control an intraperitoneal infection in conjunction with a hematologist. Laparoscopic surgery, which is minimally invasive, was an effective surgical procedure.

Introduction The preoperative skin antiseptic, olanexidine gluconate (OLG), which has been available in Japan since 2015, is also known to be effective against methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Pseudomonas aeruginosa. This study attempted to clarify OLG efficacy against surgical site infections and antiseptic-related adverse events as compared to conventionally used povidone iodine (PVP–I). Methods Propensity score matching was performed on 307 patients who underwent surgery for colorectal tumors at our hospital. All 116 cases (58 PVP-I cases, 58 OLG cases) who were diagnosed with colorectal cancer were included. We examined surgical site infection rate after disinfection using PVP-I and OLG, length of hospitalization stay (days) after surgery, adverse events associated with antiseptics, and additional medical costs associated with adverse events caused by antiseptics. Results The surgical site infection rate was 8.6% in both the PVP-I and OLG groups, with no significant difference observed. The number of postoperative hospitalization days in the PVP-I group was 12.9 (±6.9) days and 16.4 (±14.6) days in the OLG group, which exhibited no significant difference (p = 0.10). Although no complications due to antiseptics were observed in the PVP-I group, skin-related side effects were observed in 8 patients (13.8%) in the OLG group. The median additional medical cost was 730 [120–1823] yen. Conclusions OLG was as effective as the conventional PVP-I for surgical site infections during colorectal cancer elective surgery. However, significantly higher skin disorders occurred in OLG, thereby making it necessary to evaluate antiseptic use in conjunction with patient burden.

Development of resistant cultivars has been an effective method for controlling rice blast disease caused by Magnaporthe oryzae. Quantitative blast resistance genes may offer durable resistance because the selection pressure on M. oryzae to overcome resistance is low as a result of the genes’ moderate susceptibility. Because the effects of individual resistance genes are relatively small, pyramiding these genes in rice cultivars is a promising strategy. Here, we used near-isogenic and backcross lines of rice cultivar Koshihikari with single- or two-gene combinations of blast resistance genes (pi21, Pi34, and Pi35) to evaluate the suppression of leaf blast. The severity of the disease was assessed throughout the infection process. Resistance varied among the lines: Pi35 conferred the strongest resistance, while Pi34 showed the weakest effects. Two types of combined-gene interactions were observed, and they varied on the basis of gene combination and characteristic of the infection: (i) the combination of two resistance genes was more effective than either of the genes individually or (ii) the combination of two resistance genes was similar to the level of the most effective resistance gene in the pair. The most effective gene combination for the suppression of leaf blast was pi21 + Pi35.

Cystic lymphangiomas are congenital malformations of the lymphatic system, such as benign tumors that may be seen in the neck of infants. Surgical therapy entails risk of complications, depending on the location and extent of the tumor. Therefore, alternative treatments such as sclerotherapy with OK-432, have been developed. We report here a case of cystic lymphangioma treated by ultrasonography (US)-guided percutaneous aspiration and intraregional injection of OK-432 under general anesthesia. The difficulty in this case was the location of the tumor, which contacted the trachea. If OK-432 were to induce an inflammatory response in the trachea, it could lead to tracheal stenosis and respiratory disturbances. Therefore, this case required endotracheal Intubation and mechanical ventilation after injection therapy for three days. OK-432 sclerotherapy is an effective treatment for cystic lymphangiomas in infants, and should be considered before surgical excision.

Objective The purpose of this study was to assess whether laughter influences the expression of the receptor gene for prorenin that participates in the progression of diabetic nephropathy. Methods Sixteen normal subjects and 23 patients with type 2 diabetes [12 nephropathy (−) and 11 nephropathy (+)] were recruited to examine the effects of laughter on the modulation of prorenin receptor gene expression. After watching a comedy show, laughter-induced changes in the levels of blood prorenin and the expression of prorenin receptor gene were analyzed by an antibody-activating direct enzyme kinetic assay and by reverse transcriptase polymerase chain reaction, respectively. Results In diabetic patients, laughter decreased the level of blood prorenin [93.4–60.4 ng/l in nephropathy (−) patients, 196.6–166.7 ng/l in nephropathy (+) patients] and up-regulated the prorenin receptor gene [1.49-fold in nephropathy (−) patients, 1.46-fold in nephropathy (+) patients]. No significant changes in the expression of this gene were recognized in normal subjects. Conclusion The beneficial effects of laughter on preventing the exacerbation of diabetic nephropathy are strongly suggested in terms of normalizing the expression of the prorenin receptor gene followed by reducing the level of blood prorenin.

Purpose: To understand better the relationship between the macular ganglion cell complex (mGCC) thickness and visual field sensitivity assessed by frequency-doubling technology (FDT) perimetry in the standard automated perimetry (SAP) normal hemifields of glaucomatous eyes, a model of preperimetric stage of glaucoma. Patients and Methods: Thirty-four eyes of 34 patients with glaucomatous visual field defects restricted to the superior or inferior hemifield were included. Patients underwent the mGCC and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements using spectral domain optical coherence tomography and the FDT testing with N-30 full-threshold protocol. SAP and FDT sensitivity values were averaged in the area corresponding to thickness measurements and the thickness sensitivity relationships were assessed in the SAP normal and SAP abnormal halves (Spearman’s rank correlation coefficient). Results: FDT sensitivity was significantly correlated with both the cpRNFL and mGCC thicknesses either in the SAP normal (ρ=0.384 and 0.462, respectively) or in the SAP abnormal (ρ=0.402 and 0.717, respectively) halves. Correlation between the FDT sensitivity and the mGCC thickness was significantly (P=0.016) stronger than that with the cpRNFL thickness in the SAP abnormal half. SAP sensitivity was correlated significantly (ρ=0.570) only with the mGCC thickness in the SAP abnormal half. Conclusions: Similarly strong correlations of the mGCC thickness with the FDT sensitivity in the SAP normal and SAP abnormal halves, but not with the SAP sensitivity, indicates that the mGCC thickness and the FDT sensitivity may be more optimal structure-function indicator in preperimetric stage of glaucoma.

連続的携行式腹膜透析(以下PD)は自己管理を主体とした在宅の透析療法である。今回バッグ交換困難な手指変形を有する59歳女性の関節リウマチ患者に対して，SMAP法を用いたPD導入を行ない自己管理可能となった事例を経験した。事例は著明な手指関節変形を有する末期腎不全患者でUV-Fツインバッグシステムを用いた自己管理によるPDを希望した。バッグ交換は1日4回行ない1回のバッグ交換には数種類のクランプ操作を必要とするが，手指関節変形により通常のバッグ交換操作は不可能であった。既存のデバイスの活用と新たなデバイスを作製することにより自己管理によるバッグ交換が可能となった。SMAP法はPD開始までに時間的猶予があるため自己管理方法の検討と操作習得の練習期間の確保が可能であり，手指関節変形を有する関節リウマチ患者に対してSMAP法でのPD導入は有用であった。

The relationship between the index of general trust and decision making process of civil engineers is examined by using analysis of answers to question sheet. From the analysis, it appears that there is a close relationships between them. As the score of general trust increases, the decision of engineers becomes more positive. It is also found out that socialization process of civil engineers is completed at around 30 years old. It is necessary to do ethics education before this age.

Purpose To report a case of optic neuropathy associated with prolonged use of a new antibiotic, linezolid. Design Interventional case report. Methods Optic and peripheral neuropathy occurred in a 27-year-old woman who was undergoing prolonged linezolid therapy for osteomyelitis. The use of corticosteroid exacerbated visual loss. Discontinuation of the linezolid therapy resulted in marked improvement of optic neuropathy. Results Linezolid-induced optic neuropathy was diagnosed in this case, because prolonged linezolid therapy was performed at a higher dose than usual and because the patient recovered after linezolid therapy was discontinued. Conclusions With prolonged linezolid therapy, ophthalmologists should be aware that bilateral optic neuropathy can occur and that corticosteroids are not indicated for this neuropathy.

To characterise the optic nerve head (ONH) configurations of superior segmental optic hypoplasia (SSOH) using a spectral-domain optical coherence tomography (SD-OCT).Horizontal cross-sectional images of the ONH were obtained by a SD-OCT in 20 eyes of 14 patients with clinically typical SSOH and 20 age- and refraction-matched normal eyes.Extension of retinal pigment epithelium (RPE) over the disc margin was observed in 20 eyes (100%) with SSOH and eight (40%) control eyes (p0.001). The maximum length of the overhanging RPE measured at the nasal disc margin was significantly longer in eyes with SSOH than in controls (295.9+/-112.6 vs 24.3+/-33.9 microm; p0.0001). In eyes with SSOH, the retinal nerve fibre layer (RNFL) was significantly thinner in the temporal-superior to nasal sectors (p0.01).The extension of RPE over the nasal disc margin was more common and longer in eyes with SSOH than in normal eyes, suggesting that the SD-OCT findings might facilitate the diagnosis of SSOH. Substantial thinning of the RNFL was present in wider areas than previously expected in SSOH.

持続性低血圧透析患者の臨床的特徴と看護について検討するために, 透析前収縮期血圧100mmHg以下の低血圧者10名A群と正常血圧者11名B群とについて比較した.両群の透析歴はA群11.3±6年, B群10.4±4年であり, 透析前平均血圧はA群69±7mmHg, B群では99.6±8mmHgであった.A群は合併症に2次性副甲状腺機能亢進症および手根管症候群を多数認めたが, 両群において副甲状腺ホルモン, β2-マイクログロブリン値には有意差を認めなかった, また貧血との相関関係も認められなかった. 心胸比, 体重増加率, 摂取栄養量においても両群間に差を認めなかった. A群の10例中8例においては, 循環血液量減少予防または低血圧の治療が必要であった. 血圧下降症状出現時の血圧値は各々の症例でほぼ一定であり, 透析中の血圧維持レベルを決めることにより下降防止が可能であった. また水分, 塩分摂取量の管理により適正体重を維持することが重要と考えられた.

Aims Reduction of left atrial appendage (LAA) flow velocity (FV) is a risk factor for thrombus formation and increases the risk of stroke in patients with atrial fibrillation (AF). Furthermore, LAA morphology is correlated with stroke in patients with AF. The aim of this study was to correlate LAAFV with LAA morphology in patients with AF. Methods and results We studied 96 patients (age 59.0 ± 10.2 years, 75% male) referred for radiofrequency catheter ablation for paroxysmal AF. All patients underwent computed tomography (CT) and transthoracic and transoesophageal echocardiography during sinus rhythm. LAA morphology was classified as one of the four types (chicken wing, windsock, cactus, and cauliflower) on CT images. There were significant differences in LAAFV among LAA morphologies (chicken wing 73.7 ± 21.9 cm/s, windsock 61.9 ± 19.6 cm/s, cactus 55.3 ± 14.1 cm/s, cauliflower 52.7 ± 18.1 cm/s, P = 0.008). Post hoc multiple comparisons showed that LAAFV was higher in patients with chicken wing than in those with cactus ( P = 0.006, vs . chicken wing) and cauliflower ( P = 0.006, vs . chicken wing), but not with windsock ( P = 0.102). After adjustment for clinical and LAA anatomical covariates (orifice area, volume, and trabeculation), multiple linear regression analyses revealed that LAA morphology was an independent determinant of LAAFV [chickens wing: standardized partial regression coefficients ( β ) = 0.317, P = 0.0014; windsock: β = 0.303, P = 0.038]. Conclusion LAA morphology is a significant determinant of LAAFV, suggesting an underlying mechanism for the association between LAA morphology and embolic events.

Background Oxidative stress is implicated in cardiac remodeling and failure. We tested whether xanthine oxidase (XO) inhibition could decrease myocardial oxidative stress and attenuate left ventricular (LV) remodeling and dysfunction in the TO-2 hamster model of dilated cardiomyopathy. Methods and Results TO-2 hamsters were randomized to treatment with the XO inhibitor, allopurinol, or vehicle from 6 to 12 weeks of age. F1B hamsters served as controls. TO-2 hamsters treated with vehicle progressively developed severe LV systolic dysfunction and dilation between 6 and 12 weeks. Marked cardiac fibrosis was apparent in these hamsters at 12 weeks in comparison with F1B controls. The ratio of reduced to oxidized glutathione (GSH/GSSG) was decreased and malondialdehyde levels were increased in the hearts of vehicle-treated TO-2 hamsters. Treatment with allopurinol from 6 to 12 weeks attenuated LV dysfunction and dilation as well as myocardial fibrosis and the upregulation of a fetal-type cardiac gene. Allopurinol also inhibited both the decrease in GSH/GSSG ratio and the increase in malondialdehyde levels in the heart. Conclusions These results indicate that chronic XO inhibition with allopurinol attenuates LV remodeling and dysfunction as well as myocardial oxidative stress in this model of heart failure. Allopurinol may prove beneficial for the treatment of heart failure.

The effect of laughter therapy on the plasma levels of renin, angiotensinogen, and prorenin was investigated in patients with type 2 diabetes. In the diabetic patients, the mean plasma renin concentrations were 24.6+/-12.1 ng/ml/h in the first observation (at the beginning of laughter therapy), 8.2+/-3.4 ng/ml/h in the second observation (three months after the beginning of laughter therapy) and 7.7+/-1.7 ng/ml/h in the third observation (six months after the beginning of laughter therapy). The mean plasma angiotensinogen concentrations in the 1st, 2nd and 3rd observations were 0.19+/-0.08, 0.47+/-0.12, 0.42+/-0.14 microg/ml, respectively. The mean plasma prorenin concentrations in the 1st, 2nd and 3rd observations during the laughter therapy were 195.1+/-66.2, 193.4+/-88.2 and 170.7+/-52.5 pg/ml, respectively. Plasma renin concentrations were significantly decreased (p

There have been several reports about Th1/Th2 imbalances in atopic dermatitis (AD), but there have been few precise investigations about the differences between Th1 and Th2 cytokine secretion patterns of peripheral blood mononuclear cells (PBMCs) in such patients. We cultured PBMCs, taken from AD patients and healthy subjects, with dust mite extract (DME) and measured subsequent immunoreactive interferon (IFN)-gamma (Th1 cytokine), interleukin (IL)-4, IL-5, and IL-13 (Th2 cytokines) levels in the supernatants by ELISA assays. There is a difference between IL-4 and IL-13 secretion patterns by DME-stimulated PBMCs in AD subjects; immunoreactive IL-4 levels were detectable maximally within 24-h cultures, while IL-13 levels increased time-dependently within 7-day cultures. IL-13 levels were significantly elevated in AD subjects compared to healthy subjects, while IFN-gamma levels did not significantly differ between the two groups. IL-13 levels were significantly higher in AD patients who had high levels (100 U/ml) of Dermatophagoides pteronyssinus-specific IgE (Dp-IgE) than in those AD patients who had low levels (10 U/ml) of Dp-IgE. Tacrolimus (FK-506), at a concentration of 10(-8) M, significantly inhibited DME-induced IL-13 production from PBMCs. These findings suggest that IL-13 produced by Th2 cells are involved in IgE overproduction in AD subjects.

Negative emotions such as anxiety, fear, and sorrow are known to be factors that elevate the blood glucose level (1). Conversely, positive emotions such as laughter have been reported to modify the levels of neuroendocrine factors involved in negative emotions (2,3) and to modulate immune function (3,4). However, there have been no studies on the effects of laughter on blood glucose level. The purpose of this study was to clarify changes in the blood glucose level after laughing episodes in patients with diabetes. A 2-day experiment was performed in 19 patients with type 2 diabetes not …

To investigate the influence of glaucoma and myopia on the cross-sectional configuration of the β-zone of peripapillary atrophy (PPA-β) using spectral-domain optical coherence tomography (SD-OCT).Cross-sectional B-scan images of PPA-β obtained with SD-OCT were evaluated in 100 eyes of 100 consecutive patients with POAG, regardless of intraocular pressure level, and in 100 eyes of 100 normal subjects. PPA bed configurations were classified, and associated factors were studied with multivariate analysis.In 147 eyes with PPA-β (84 POAG and 63 normal eyes; P = 0.0012), the PPA bed was composed of straight (14 POAG and 27 normal eyes) or downward-curved (19 and 8 eyes) Bruch's membrane (BM) or of a downward-bending slope lacking BM (BM defect; 51 and 28 eyes). Multivariate analysis revealed that absence of POAG (odds ratio [OR], 0.36; P = 0.034) and less myopic refractive error (OR, 1.43; P = 0.009) were significantly associated with straight-BM-type, presence of POAG (OR, 5.74; P = 0.008) and less myopic refractive error (OR, 3.02; P0.001) with curved-BM-type, and myopic refractive error (OR, 0.34; P0.001) with BM-defect-type. Within the PPA-β region, all retinal layers except for the nerve fiber layer frequently disappeared before reaching the disc edge, showing no significant intergroup difference (P0.05) between POAG and normal eyes.PPA bed configurations detected by SD-OCT were classified into three types. The lack of BM on the PPA bed was closely associated with myopia. The downward-curved appearance of BM may be related to the anatomic changes associated with glaucoma.