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Bare stent infection is an extremely rare complication of endovascular treatment. In such cases, surgical resection of the infected bare stent and revascularization are recommended; however, the revascularization strategy remains controversial. We present a case of a 78-year-old man with an infected aneurysm caused by a bare iliac artery stent infection. We resected the infected aneurysm and performed in situ anatomic reconstruction using a rifampicin-soaked prosthesis with omental coverage. The patient had no reinfection at the 3-year follow-up. Therefore, this procedure may be a useful treatment for bare iliac artery stent infections.

Since 2010, mycobacterial examination results have been used widely to survey nontuberculous mycobacteria (NTM) lung disease.To reveal the clinical and epidemiological status of NTM lung disease in Japan.All data on the isolation and identification of mycobacteria in 2012 and 2013 were obtained from three dominant commercial laboratories in Japan. Pulmonary NTM disease was defined on the basis of bacteriological diagnostic criteria issued by the American Thoracic Society/Infectious Diseases Society of America. The coverage population was estimated using the ratio between national tuberculosis registration data and laboratory results for each of the eight regions of Japan.A total of 113,313 mycobacterial specimens from 4,710 institutes were collected, and specimens from 26,059 patients tested positive for NTM cultures at least once. Among patients with positive cultures, 7,167 (27.5%) satisfied the American Thoracic Society/Infectious Diseases Society of America criteria for NTM lung disease, resulting in a 2-year prevalence rate of 24.0 per 100,000. Mycobacterium avium complex (MAC) was the most commonly isolated species (93.3%), and 29.0% of the patients from whom MAC was isolated satisfied the criteria for NTM lung disease. Individuals older than 70 years of age accounted for the majority of cases, and 65.5% of cases involved females. After MAC, Mycobacterium kansasii and Mycobacterium abscessus exhibited the highest (43.6%) and second-highest (37.1%) incidence per isolation, respectively. The prevalence of M. kansasii was highest in the Kinki region (P 0.05), and M. abscessus had the greatest prevalence in the Kyushu-Okinawa region (P 0.005). The proportion of Mycobacterium intracellulare in MAC cases was higher in the southwestern part of Japan than in other regions. The period prevalence was highest in the southwestern part of Japan, and the standardized prevalence ratio was highest in central regions. Evaluations of clarithromycin susceptibility revealed a clear binomial distribution.This investigation is the first laboratory-based study in which a large number of NTM isolated from clinical samples in Japan have been assessed. Although the calculated prevalence of NTM disease might be underestimated, the approach may prove useful for monitoring relative epidemiological data for NTM lung disease.

目的:切除不能悪性腫瘍に伴う上部消化管狭窄に対する胃空腸バイパス手術の直接成績や予後に関する報告は少ない．当科におけるバイパス手術症例について検討したので報告する．方法:1999年1月から2007年12月までにバイパス手術を施行した33症例について，背景因子，術後経口摂取開始日および経口摂取期間，術後生存期間，術後生存期間に影響を及ぼす因子について検討を行った．結果:平均年齢は69歳，男女比は19:14，疾患は胃癌が16例で最多であった．平均術後経口摂取開始日は7.2病日，経口摂取期間中央値は127日間，32例で術後5分粥以上を摂取できた．退院率は93.9％，50％生存期間は149日であった．術後生存期間は，術前全身合併症，貧血，低栄養，術後化学療法未施行の群で有意に低下した．結語:バイパス手術は，術後早期の経口摂取が可能で，切除不能悪性腫瘍患者のQOLの改善に大きく貢献する．ただし，全身合併症，貧血や低栄養などがある場合には適応を慎重に決定する必要がある．

食道胃接合部（esophagogastric junction；以下，EGJ）は扁平円柱上皮境界を有するため重複癌が発生しやすいが，衝突癌の報告はまれである．今回，EGJに発生した食道扁平上皮癌と胃管状腺癌の衝突癌の1例を経験したので報告する．症例は85歳の男性で，嚥下困難を主訴に来院し，上部消化管内視鏡検査で下部食道から噴門部にかけて3型腫瘍を指摘された．当初は食道癌の噴門部浸潤を疑ったが，細胞診で扁平上皮癌と管状腺癌を認めた．噴門部重複癌の診断で下部食道切除，胃全摘，Roux-en Y再建を施行した．病理組織学的には，扁平上皮癌と管状腺癌が組織学的移行を伴わず，明瞭な境界を持って接しており衝突癌と考えられ，また一部のリンパ節には両成分の転移を認めた．衝突癌は病理組織学的検索なくして術前に診断することは困難であり，EGJに発生する悪性腫瘍では常に衝突癌を念頭に入れる必要があると考えられた．

As the most common cause of neonatal sepsis, Lancefield Group B Streptococcus (GBS) must be diagnosed as early as possible in pregnant women is prevent neonatal infection. A selective enrichment broth medium has been widely recommended to optimally recover GBS from genital and anorectal samples. To establish a culture suitable for screening vaginal swab specimens, we compared subcultures of three selective enrichment media to direct culture on agar medium. Vaginal swab samples were inoculated directly onto 5% sheep blood agar and into New Granada medium (Eiken), Lim broth (Becton, Dickinson, and Company), and Todd Hewitt broth with gentamicin and nalidixic acid (Becton, Dickinson, and Company, Todd). Of the 288 specimens tested, GBS was recovered from 43 samples (14.9%) on direct agar media, with 82 (28.5%), positive on New Granada medium subculture, 67 (23.3%) on Lim broth subculture, and 61 (21.2%) on Todd, subculture. These results demonstrates that selective enrichment broth media provides more superior sensitivity than direct agar media for detection of GBS colonization in vaginal specimens, underscoring the usefulness of selective enrichment broth media in GBS screening for vaginal swabs in pregnant woman.

A gastric tube has been widely used for reconstruction of the esophagus after esophagectomy for esophageal cancer. Reflux esophagitis after esophagectomy is frequently observed. Therefore we retrospectively investigated the risk factors for reflux esophagitis after gastric pull-up esophagectomy in 74 outpatients with thoracic esophageal cancer. Reflux esophagitis was diagnosed endoscopically. Esophagitis was classified according to the Los Angeles classification. Reflux symptoms, medications, and the surgical procedure were reviewed. The relation between reflux symptoms and reflux esophagitis and the influence of the anastomotic site were evaluated. Reflux esophagitis was observed in 53 patients. Severe esophagitis (grade C or D) was found in 75.6% of these patients. Although all patients with esophagitis took antacid agents, histamine receptor-2 blocker was effective in only 35% of them. The correlation between reflux symptoms and reflux esophagitis was not significant. Reflux esophagitis was present in 56.4% of patients with neck anastomosis and in 88.6% of patients with intrathoracic anastomosis ( p = 0.0039). We concluded that routine endoscopic examination is necessary after gastric pull-up esophagectomy because reflux esophagitis is not diagnosed based on reflux symptoms. When a gastric tube is used for reconstruction after esophagectomy, neck anastomosis is recommended to lower the risk of reflux esophagitis.

A novel peptide Ghrelin, found to be a ligand to growth hormone (GH) secretagogue receptor (GHS-R), exeterts to stimulates GH release from pituitary gland. Recently, it has been shown that ghrelin and its receptor are existed in a adrenal ground. At concentrations of 10 nM and over (10 nM, 100 nM, and 1 microM), ghrelin significantly inhibited basal dopamine release by 30, 32 and 34%, respectively (P0.05) in PC12 cells, suggesting that ghrelin may be involved in the mechanism of catecholamine regulation in chromaffin cells.

We previously showed that CGP 42112 (an angiotensin type 2 [AT 2 ] agonist) markedly reduces catecholamine biosynthesis by decreasing cGMP production mediated by AT 2 , a subtype of Ang II receptor that is dominantly expressed in cultured porcine chromaffin cells. To elucidate the relationship of the 2 types of Ang II receptors, angiotensin type 1 (AT 1 ) and AT 2 , in the synthesis of catecholamine in adrenal medullary cells, we have examined the effect of Ang II plus CV-11974 (an AT 1 antagonist that selectively simulates AT 2 stimulation) and the effect of Ang II plus PD 123319 (an AT 2 antagonist that selectively simulates AT 1 stimulation) on catecholamine synthesis. We found that Ang II reduced cGMP production via AT 2 , in a similar manner to that found with CGP 42112. Stimulation of AT 1 significantly upregulated protein kinase C activity. Tyrosine hydroxylase (TH) is a rate-limiting enzyme involved in the biosynthesis of catecholamine, and this catecholamine synthesis depends both on TH enzyme activity and on the levels of TH protein after TH gene transcription. We found that AT 2 stimulation significantly inhibited TH enzyme activity, whereas AT 1 stimulation significantly upregulated TH enzyme activity. The stimulatory effect of AT 1 was completely inhibited by Ro-32-0432 (a protein kinase C inhibitor) and PD 98059 (a MAP kinase kinase-1 [MEK-1] inhibitor). Pretreatment of cells with either 8-Br-cGMP (a membrane-permeable cGMP analog) or Zaprinast (a phosphodiesterase inhibitor) abolished the inhibitory effect of AT 2 on TH enzyme activity, indicating that the stimulatory effect of AT 2 may be mediated through a reduction in cGMP concentration. Similar to the effect on TH enzyme activity, AT 2 stimulation significantly reduced TH mRNA and protein levels and net catecholamine content below basal levels, whereas AT 1 stimulation increased them. We confirmed these findings by gel mobility shift assay. Our results show that stimulation of AT 2 reduces catecholamine biosynthesis via a decrease in cGMP levels. In contrast, stimulation of AT 1 stimulates catecholamine biosynthesis through activation of PKC. Thus, we conclude that AT 1 and AT 2 have counter-regulatory roles in the synthesis of catecholamine in adrenal medullary chromaffin cells.

Background Two distinct types of angiotensin II (Angll) receptors, AT 1 and AT 2 , have been cloned. We have shown previously that stimulation of AT 2 reduces intracellular cyclic guanosine monophosphate (cGMP) levels in cultured porcine chromaffin cells in which AT 2 is the predominantly expressed receptor. However, it has not been determined whether AT 1 or AT 2 affects signal transduction pathways involving mitogen-activated protein kinases (MAPKs) and signal transducers and activators of transcription (STATs) in chromaffin cells. Also, it is unclear whether cGMP/protein kinase G (PKG) is involved in the regulation of MAPKs and STATs in these cells. Design Chromaffin cells were derived from porcine adrenal medulla. The effects of Angll alone (representing physiological conditions), Angll plus CV-11974 (an AT 1 antagonist, which simulates specific AT 2 stimulation), Angll plus PD 123319 (an AT 2 antagonist, which simulates specific AT 1 stimulation), and 8-Br-cGMP (a membrane-permeable cGMP analogue) alone on MAPKs (ERKs, JNK, p-38 MAPK) and STATs (STATs 1, 3 and 5) activity were measured. Methods Phosphorylated MAPKs (extracellular signal-related kinases (ERKs), c-jun N-terminal kinase (JNK) and p38 MAPK) and STATs (STATs 1, 3 and 5) were measured by immunoprecipitation-Western blot analysis (IP-Western blot). Results AT 1 stimulation markedly increased expression of ERKs, JNK, p38 MAPK via Ca 2+ -dependent protein kinase C (PKC) isoforms (cPKC), as well as STATs 1, 3 and 5 in cultured porcine chromaffin cells. In contrast, AT 2 stimulation markedly decreased the expression of these signaling molecules. Also, 8-Br-cGMP alone induced increases in ERKs, JNK, p38 MAPK, and STATs 1, 3 and 5. Because AT 2 inhibits cGMP production, we speculate that AT 2 may act to suppress cGMP production, which in turn reduces the activity of both MAPKs and STATs in chromaffin cells. Conclusion AT 2 negatively regulates AT 1 in signal transduction pathways in chromaffin cells.

As the most common cause of neonatal sepsis, Lancefield Group B Streptococcus (GBS) must be diagnosed as early as possible in pregnant women is prevent neonatal infection. A selective enrichment broth medium has been widely recommended to optimally recover GBS from genital and anorectal samples. To establish a culture suitable for screening vaginal swab specimens, we compared subcultures of three selective enrichment media to direct culture on agar medium. Vaginal swab samples were inoculated directly onto 5% sheep blood agar and into New Granada medium (Eiken), Lim broth (Becton, Dickinson, and Company), and Todd Hewitt broth with gentamicin and nalidixic acid (Becton, Dickinson, and Company, Todd). Of the 288 specimens tested, GBS was recovered from 43 samples (14.9%) on direct agar media, with 82 (28.5%), positive on New Granada medium subculture, 67 (23.3%) on Lim broth subculture, and 61 (21.2%) on Todd, subculture. These results demonstrates that selective enrichment broth media provides more superior sensitivity than direct agar media for detection of GBS colonization in vaginal specimens, underscoring the usefulness of selective enrichment broth media in GBS screening for vaginal swabs in pregnant woman.

The effectiveness of antibacterial agents against 70 strains of clinically isolated multiple-drug resistant Pseudomonas aeruginosa (MDRP) was measured by the micro dilution method. Fifty of all strains (71%) produced metallo-beta-lactamase and the IMP-1 gene was detected by polymerase chain reaction (PCR). The MIC90 (the minimum inhibitory concentration of an antibiotic necessary to inhibit the growth of 90% of bacterial strains) values of biapenem (BIPM), meropenem (MEPM), tazobactam/piperacillin (TAZ/PIPC), sulbactam/ cefoperazone (SBT/CPZ), cefepime (CFPM), ciprofloxacin (CPFX), pazufloxacin (PZFX), amikacin (AMK) and aztreonam (AZT) were found to be 265, 512, 256, 512, 512, 64, 128, 128 and 128 microg/mL, respectively. The in vitro combination effects of antibacterial agents were examined against 62 strains of MDRP and the synergy or additive effects were evaluated by fractional inhibitory concentration (FIC) index calculated by the checkerboard method. The combination of AMK and AZT showed synergy effects on 15/59 (25.4%) strains of MDRP. The synergy and additive effects on the MDRP strains were also found by the other antibacterial agents combination such as TAZ/PIPC and AMK, CFPM and AMK, and SBT/CPZ and AZT. These results suggested the necessity of further investigation of clinical usefulness.

Urocortin is a novel mammalian member of the corticotrophin releasing factor (CRF)-related peptides. We have investigated the expression, mechanism of action and second messenger for urocortin in rat pheochromocytoma PC12 cells. We initially confirmed the expression of urocortin and CRF-R2beta, which is thought to be an endogenous receptor for urocortin, in PC12 cells. We also demonstrate that urocortin (> or = 1 nM) significantly elevates the level of cAMP in these cells. Moreover, alpha-helical CRF-(9-41), a more specific antagonist of CRF-R2 than CRF-R1 and the adenylate cyclase inhibitor SQ22536, inhibited the urocortin-induced increase in the level of cAMP. Thus, urocortin may exert its physiological role in chromaffin cells via CRF-R2beta coupling to adenylate cyclase. Urocortin (> or = 1 nM) significantly increased the mRNA level and activity of tyrosine hydroxylase (TH), a rate-limiting enzyme in the biosynthesis of catecholamine. Furthermore, urocortin-induced changes in TH-mRNA and activity were inhibited by H89 (a PKA inhibitor) and SQ22536 as well as alpha-helical CRF-(9-41). However, urocortin did not affect DNA synthesis or catecholamine secretion in these cells. In conclusion, we have demonstrated that urocortin stimulates catecholamine biosynthesis via the cAMP/protein kinase A pathway in PC12 cells, where both urocortin and its receptor, CRF-R2, are expressed.

We surveyed the prevalence of vancomycin-resistant Enterococcus (VRE) in six hospitals in Ibaraki prefecture. Three hundred and fifty-five fecal specimens were examined and 18 Enterococcus intermediately resistant to vancomycin were isolated. All of them were vanC genotypes (16 vanC-1 and 2 vanC-2 genotypes) and susceptible or intermediately resistant to ampicillin, teicoplanin, linezolid, and quinupristin-dalfopristin. Neither the vanA nor vanB gene was detected. Two of the vanC genotypes were not motile. We concluded that VRE of either VanA or VanB phenotype or those highly resistant to the antibiotics commonly used against enterococcal infection were not epidemic in this prefecture to date. In addition, we consider that detection of vancomycin-resistant genes should be encouraged for the characterization of VRE, because the vanC genotypes are occasionally motility-negative and can be misinterpreted as other Enterococcus species.