Many previous studies on near-infrared spectroscopy (NIRS) based evaluation of muscle oxygenation, have assessed the association of muscle oxygenation with muscle fatigue and exercise tolerance. To examine the changes in oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb) levels, some studies performed occlusion of arterial blood flow in the upper arm and measured the biarticular forearm muscle oxygenation; however, these muscles are subject to contractions based on the position of the arm, which could have led to discrepancies in the findings. Therefore, this study aimed to assess the association between muscle oxygenation and vascular occlusion in the tibialis anterior muscle during isometric exercise using NIRS. Twenty-nine women of mean age of 20.00 ± 1.56 years were included. Maximum isometric contraction performed for successive 30 sec and 60 sec was assessed under occlusive and non-occlusive conditions of the unilateral femoral artery, with and without the use of a tourniquet, at the same time. The O2Hb level was reduced in both conditions, with a significant decrease observed earlier during an initial quarter of the exercise (p < 0.05). This significant decrease in the O2Hb level may be due to decreased oxygenation in the muscle associated with muscle contraction, primarily during aerobic exercise. Under the occlusive condition, the total rate of increase in the HHb levels was smaller than the total rate of decrease in the O2Hb levels. Therefore, adequate oxygen supply to meet the increased demand for the O2Hb cannot be achieved and the increase in the HHb level is suppressed during muscle contractions.
Background: Streptococcus gallolyticus ssp. pasteurianus is a commensal bacterium of the alimentary tract in humans and animals. This microorganism not only causes sepsis, endocarditis, and meningitis but is also associated with colorectal tumors. We report herein a rare case of S. gallolyticus ssp. pasteurianus bacteremia in a patient with concomitant colon cancer and aggressive malignant lymphoma during the neutropenic period after chemotherapy against lymphoma. Case presentation: A 79-year-old man was found to have an adenoma in the ascending colon, and endoscopic mucosal resection (EMR) was planned to remove the lesion. However, he was diagnosed with diffuse large B-cell lymphoma during the pre-operation examination. The EMR was postponed, and he received rituximab, cyclophosphamide, etoposide, vincristine, and prednisolone (R-CEOP). He had a neutropenic fever with positive blood cultures for S. gallolyticus ssp. pasteurianus during the first course of R-CEOP. He improved as soon as cefepime was administered. Bacteremia did not recur thereafter, and he underwent EMR after completing six cycles of R-CEOP. The histological diagnosis of the colon tumor was welldifferentiated adenocarcinoma in adenoma. Streptococcus gallolyticus ssp. pasteurianus was not detected in the culture of the resected tissue. Conclusion: Although there have been few reports of bloodstream infection due to S. gallolyticus ssp. pasteurianus in patients with hematological malignancies undergoing cytotoxic chemotherapy, physicians should investigate the presence of coexisting colorectal tumors when this bacterium is isolated from blood cultures.
This research was partially supported by the PUH Research Grant Program (Advanced Research A).
This research was partially supported by a Grant-in-Aid for Scientific Research (A) (No.19H0105600) from the Ministry of Education, Culture, Sports, Science and Technology.
Splenic injury is common in blunt trauma. As post-injury splenic volume changes are unclear, the aim of this study was to elucidate such changes. This retrospective study included 18 patients (14 males, median age 24.5 years) with a splenic injury treated between January 2009 and December 2016. All underwent computed tomography (CT) during admission to our hospital and at the last follow-up visit. The splenic volumes on the first and last enhanced delayed-phase CT scans were compared. The fluid response, transfusion, injury severity score, trauma grade, and extent of splenic artery embolization (SAE) were obtained from medical records. The volume change was assessed with a Mann-Whitney U-test. The volume change in patients treated conservatively was also evaluated to study the natural course after injury. On the first and last scans, the median splenic volume was 105.8 (interquartile range [IQR] 65.4–139.7) and 123.6 (IQR 102.0–225.0) cm3, respectively. The volume increased by 67 (-0.4 ± 120.0) %. SAE was the only factor significantly related to the volume change (p < 0.05). The median follow-up period was 13 (IQR 6–20) days. In conservatively treated patients, the splenic volume change was correlated with the interval between the first and last CT studies. Our findings suggest that the volume of the injured spleen increases in the natural course after trauma. SAE resulted in a decrease in the splenic volume.
Purpose: The purpose of this study was to examine the outer retinal layer thicknesses in normal and glaucomatous eyes with a Topcon 3D spectral domain optical coherence tomography (SD-OCT) instrument. Methods: Fifty-nine normal eyes and 139 glaucomatous eyes were included in this study. The SD-OCT images were assessed to determine the overall average, superior, and inferior thicknesses of the inner and outer retinal layers. The macula was examined in an area of 7 × 7 mm centered on the fovea and divided into 10 × 10 grids. The thicknesses of the inner and outer macular layers in each square of the ten grids horizontally aligned below the fovea were plotted in a line graph. Results: The findings indicated that all the inner retinal parameters decreased with increasing glaucoma severity. The difference in outer retinal layer thickness between the normal and all the glaucoma groups was not significant. However, the outer retinal layer thickness was significantly different for different glaucoma severity subgroups (P < 0.05). The changes in thickness in the outer retinal layer in the ten small squares horizontally aligned under the fovea revealed significant differences between the normal control group and the various glaucoma severity subgroups. Conclusions: Changes in the thickness of the outer macular retinal layer can be detected using a Topcon 3D SD-OCT 2000. The findings of this study indicate that the outer retinal layer might be involved in glau-
Background and Purpose: The concept of early chronic pancreatitis was proposed in Japan with the aim to improve the prognosis of patients with chronic pancreatitis. Endoscopic ultrasonography plays an important role in early diagnoses, but is limited by its invasiveness and poor objectivity. Hence, this study aimed to determine the usefulness of transabdominal ultrasound real-time tissue elastography as a screening method for early chronic pancreatitis. Methods: We retrospectively examined 73 patients who underwent simultaneous ultrasound real-time tissue elastography and endoscopic ultrasonography from 2011 to 2014. The correlation between feature values (MEAN, %AREA, COMP) calculated by real-time tissue elastography and the Rosemont classification of endoscopic ultrasonography diagnostic criteria for chronic pancreatitis, and the diagnostic ability of ultrasound real-time tissue elastography to recognize “indeterminate for chronic pancreatitis” findings, which correspond to early chronic pancreatitis, were evaluated. Main Results: Based on the Rosemont classification, 26 patients were “normal”, 16 were “indeterminate for chronic pancreatitis”, 13 were “suggestive of chronic pancreatitis”, and 18 were “consistent with chronic pancreatitis”. There were significant correlations between the feature values (MEAN, %AREA, COMP) and the Rosemont classification (p < 0.001; ρ = –0.788, 0.779, and 0.489, respectively). The area under the curve for the ability of MEAN to diagnose “indeterminate for chronic pancreatitis” was 0.889 (sensitivity, 93.8%; specificity, 76.9%). Conclusions: The feature values calculated by ultrasound real-time tissue elastography were correlated with the Rosemont classification. Ultrasound real-time tissue elastography may be a useful screening method for early chronic pancreatitis.
Concurrent chemoradiotherapy (CRT) for head and neck cancer (HNC) is associated with substantial side effects, most notably those related to swallowing function. Recently, early implementation of protective exercises has been recommended as an important intervention in patients treated with chemoradiotherapy. Several studies, including randomized controlled trials, have evaluated prophylactic swallowing exercises and swallowing outcomes. Although several clinical outcome measures to assess the severity of swallowing dysfunction are available, they are indirect measures. Videofluorography is the most popular and efficient examination that visually demonstrates the dynamic state of swallowing. This study aimed to determine whether prophylactic swallowing rehabilitation provided to HNC patients receiving CRT would result in better swallowing outcomes. Thirty patients were enrolled in this study. Fifteen patients (the control group) received swallowing rehabilitation after CRT on demand, and the other 15 (the rehabilitation group) received prophylactic swallowing rehabilitation from the beginning. Swallowing motion was evaluated with motion analysis software. There were statistically significant differences in hyoid bone displacement, duration of swallowing onset, larynx elevation time, and total swallowing time between the control and rehabilitation groups. Based on the results of this study, prophylactic swallowing rehabilitation seems to reduce the extent and severity of the functional problems that occur after CRT.
Cell-free DNA (cfDNA) analysis may provide a non-invasive diagnostic approach for lung adenocarcinoma patients. Recently, droplet digital PCR (ddPCR) has been developed as a highly sensitive detection method for a low mutant allele percentage. The ddPCR detection limit for epithelial growth factor receptor (EGFR) mutations was evaluated using cell lines, NCI-H1975 for EGFR L858R point mutation and PC-9 for EGFR E746-A750del. Subsequently, detection of EGFR mutations by ddPCR was performed in tumor DNA (tDNA) and cfDNA samples of 19 lung adenocarcinoma patients whose tumor biopsies were already evaluated for EGFR mutations by clamp PCR (13 of L858R, 3 of E746-750del, and 3 of EGFR negative). In 12 cases, immunohistochemical analysis was performed to quantify the number of EGFR L858R-positive cells rate. EGFR point mutation or deletion were detected in 16 tumor DNA samples. In the measurable cfDNA samples, the rate of detection by ddPCR in cfDNA was 61.5% (8/13) for L858R and 100% (3/3) for E746A750del. A relative correlation was found between the allele fraction (AF) of tDNA and the number of EGFR L858R-positive cells rate. No correlation was found between the AF of tDNA and AF of cfDNA. In our study, cfDNA mutation detection was not associated with clinicopathological features, but cases with high AF of cfDNA did have metastatic lesions. Our study shows that ddPCR enables cfDNA analysis for EGFR L858R and E746-A750del, with a high detection rate. Therefore, cfDNA analysis using ddPCR may complement to tumor biopsy and is beneficial for precision medicine in lung adenocarcinoma patients.
Introduction : Non alcoholic steatohepatitis (NASH) is a subset spectrum of NAFLD that can progress toward cirrhosis. Tumor necrosis factorα (TNFα) polymorphism play a significant role in liver inflammation and Insulin resistance its pathophysiological hallmark. The association between TNFα (-238 and -308) polymorphism) and the severity of NAFLD was evaluated. Method: A total of 155 subjects (80 NAFLD cases and 75 controls) were included. Liver biopsy was performed for evaluated severity of NAFLD based on NAFLD Activity ScoreCRN in all cases. Controls subjects defined was not any liver disease by ultrasound. Plasma TNF– α was measured in all subjects. Polymorphism of` TNFα promoter gene -308 and -238 were identified using PCR-RFLP confirmed with direct sequencing. Results: Liver biopsy established the diagnosis of NASH in 29 cases. There was no association between the incidence of NAFLD with TNFα polymorphism at the TNF– α -308 or the -238 (p>0.05). The prevalence ratio of TNF– α polymorphism -238 was significantly higher for subject with NASH (p< 0.02). There was no different prevalence ratio for TNF– α polymorphism -308 (p>0,05). We found novel polymorphism of TNFα -245 T/C in a subject with possible NASH, high plasma TNFα level (20.27 pg/cc) and very high value of Homeostasis Model of Assessment Insulin Resistance HOMA-IR (22.73). Conclusion : Polymorphism TNFα -238 is likely to be a risk factor for NASH in Indonesia. The identification of new possible polymorphism of TNFα -245 requires further study in more samples.
