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Distinguishing between live births and stillbirths is substantially important in forensic autopsies. Lung-gastric flotation tests and histopathological examinations have been widely used for determining the diagnosis. In addition, postmortem computed tomography (PMCT) has recently been investigated as a potential diagnostic tool. In this report, we investigated the characteristic PMCT findings of stillbirths in three forensic autopsy cases. PMCT was performed in three male newborns (estimated gestational age: 7-9 months) with postmortem intervals of 10 hours (Case 2), 2 days (Case 1), and 1 week (Case 3). All cases comprised out-of-hospital deliveries: two infants were transported to the hospital after birth, while one was found deceased. In each case, the lungs and gastrointestinal tract sank during the flotation test, and no microscopic alveolar dilation was observed, leading to a diagnosis of stillbirth. The mean CT value of the lung field ranged between 42.1 and 49.0 Hounsfield units, indicating soft tissue-like density. In all cases, the ductus arteriosus appeared to be more dilated than did the left and right pulmonary arteries. No gas or fluid was detected in the main or lobar bronchi among all cases. This study is limited by the small number of cases with all being stillbirths. However, the imaging findings described in these cases of stillbirth suggest that PMCT might contribute to the differentiation between live births and stillbirths. In conclusion, the combination of high lung field density, ductus arteriosus patency, and absence of gas in the main and lobar bronchi on PMCT suggests a characteristic pattern of stillbirths.
The genus Aeromonas is increasingly implicated in human infections. However, accurate species-level identification remains challenging, particularly in clinical microbiology laboratories. This study aimed to develop a multiplex polymerase chain reaction (PCR) assay to identify four Aeromonas species-Aeromonas hydrophila, Aeromonas caviae, Aeromonas veronii, and Aeromonas dhakensis-most frequently associated with human infectious diseases. A total of 788 whole genome sequencing (WGS) data sets from 31 Aeromonas species were analyzed to identify open reading frames (ORFs) specifically present in A. hydrophila, A. caviae, A. veronii, and A. dhakensis. Primer sets were designed based on sequences of ORFs specific to each species to develop a multiplex PCR assay. To validate the efficacy of the assay, 256 clinical Aeromonas isolates were tested, and the results were compared with taxonomic affiliation inferred by WGS data, along with 19 type strains. The multiplex PCR successfully identified all strains of the four target species and produced no amplification in non-target species strains except the band for internal control. The multiplex PCR enables rapid and reliable identification of four Aeromonas spp. commonly involved in human infectious diseases.IMPORTANCEThe multiplex PCR assay facilitates accurate identification of clinically important Aeromonas spp. in clinical microbiology laboratories, providing crucial information to guide appropriate antimicrobial therapy and advance understanding of the epidemiology of Aeromonas spp.
Objectives: Cytomegalovirus (CMV) reactivation during immunosuppressive therapy poses a risk of severe infections. This study aimed to investigate the risk factors of CMV reactivation in patients with microscopic polyangiitis and granulomatosis with polyangiitis using a nationwide cohort in Japan. Methods: This retrospective cohort study used data from the Japan Collaborative Registry of antineutrophil cytoplasmic antibody-associated vasculitis. The outcome was as CMV reactivation up to 48 weeks after treatment initiation. We explored the risk factors for CMV reactivation by comparing the two groups. Results: Of the 454 patients, CMV reactivation occurred in 89 (19.6%). The univariate analysis showed that patients with CMV reactivation were older (P < .001), had higher Birmingham Vasculitis Activity Scores (BVAS) (P = .004) and BVAS renal scores (P < .001), and had received glucocorticoid pulse (P = .004). The logistic regression analysis showed that hypoalbuminemia (odds ratio: 0.55, 95% confidence interval: 0.31-0.98), and low serum IgG (OR: 0.94, 95% CI: 0.89-1.00) were risk factors for CMV reactivation. Conclusions: Hypoalbuminemia and low serum IgG levels were risk factors for CMV reactivation. It is necessary to accurately identify high-risk patients and closely monitor their condition.
PURPOSE:We investigated breastfeeding patterns, behaviors, and association with breast cancer (BC) outcomes in women with early hormone receptor-positive (HR+) BC who had a live birth in the POSITIVE trial. PATIENTS AND METHODS:POSITIVE is a prospective trial that demonstrated no increased short-term risk of BC events in women with early HR+ BC who interrupted endocrine therapy (ET) to attempt pregnancy. We describe the frequency, duration, and laterality of breastfeeding and estimate the cumulative incidence of BC events by breastfeeding status. RESULTS:At a median follow-up of 41 months, 317 patients had at least one live birth and 313 were eligible for this analysis. A total of 196 of 313 (62.6%) patients breastfed. A total of 130 of the 167 women (77.8%) who had breast-conserving surgery breastfed, and 90 of 130 (69.2%) breastfed from the unaffected breast only. Sixty-six of the 146 women (45.2%) who underwent unilateral mastectomy breastfed. The frequency of breastfeeding was higher in women older than 35 years (67.6% v 55.7%) and in those without previous children (66.4% v 48.5%). Over half (103 of 196, 52.6%) of women breastfed their first live birth for >4 months (median 4.4 months; 95% CI, 4.0 to 5.3). The cumulative incidence of a BC event at 24 months from first on-study live birth was 3.6% and 3.1% in the breastfeeding and nonbreastfeeding groups, respectively (0.5% difference; 95% CI, -4.3% to 5.2%). CONCLUSION:In POSITIVE, two thirds of women who gave birth after BC diagnosis breastfed, mostly for 4 months or more. In early follow-up, we did not observe differences in BC-related events in women who breastfed compared with those who did not. These results are key for women who wish to pursue pregnancy and breastfeeding after BC.
