Recurrent venous thromboembolism after discontinuation of rivaroxaban therapy in a patient with antiphospholipid syndrome

A Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by thrombembolic events including thromboembolism (VTE) in association with the presence of antiphospholipid antibodies. The standard treatment of VTE historically consists of anticoagulation therapy with warfarin, a vitamin K antagonist. Recently, direct oral anticoagulants, including rivaroxaban have become available for the treatment of VTE. However, the choice of anticoagulant, and the duration of anticoagulation in patients with APS has not been determined yet due to lack of evidence. Here, we report a case of recurrent venous thrombosis after discontinuation of rivaroxaban therapy and avoiding sedentary life style in a patient with APS. We suggest that indefinite anticoagulation therapy might be needed even in low risk APS cases

Appearance of differentiated cells derived from polar body nuclei in the silkworm, Bombyx mori

In Bombyx mori, polar body nuclei are observed until 9 h after egg lying, however, the fate of polar body nuclei remains unclear. To examine the fate of polar body nuclei, we employed a mutation of serosal cell pigmentation, pink-eyed white egg (pe). The heterozygous pe/+(pe) females produced black serosal cells in white eggs, while pe/pe females did not produce black serosal cells in white eggs. These results suggest that the appearance of black serosal cells in white eggs depends on the genotype (pe/+(pe)) of the mother. Because the polar body nuclei had +(pe) genes in the white eggs laid by a pe/+(pe) female, polar body nuclei participate in development and differentiate into functional cell (serosal cells). Analyses of serosal cells pigmentation indicated that ~30% of the eggs contained polar-body-nucleus-derived cells. These results demonstrate that polar-body-nucleus-derived cells appeared at a high frequency under natural conditions. Approximately 80% of polar-body-nucleus-derived cells appeared near the anterior pole and the dorsal side, which is opposite to where embryogenesis occurs. The number of cells derived from the polar body nuclei was very low. Approximately 26% of these eggs contained only one black serosal cell. PCR-based analysis revealed that the polar-body-nucleus-derived cells disappeared in late embryonic stages (stage 25). Overall, polar-body-nuclei-derived cells were unlikely to contribute to embryos

Cross-cultural Analysis of Japanese and Mediterranean Entrepreneurs During the Global Economic Crisis

This paper aims to identify similarities and differences in the attitudes and traits of entrepreneurs in four countries, Japan and three Mediterranean countries, and it analyzes how cultural diversity can influence business and entrepreneurial experience. To this end, two questionnaires were completed by entrepreneurs of 188 small businesses in Japan, Italy, Spain and Portugal at a time when all these countries had been hit by the global economic crisis. The indices of the Hofstede dimensions were obtained from the VSM 94 questionnaire. The second open-ended questionnaire adds information about each case in the field of entrepreneurship. The qualitative case analysis shows a relationship between the cultural values of the countries and the traits and attitudes of entrepreneurs. The findings indicate that perseverance and tenacity traits emerge in times of economic crisis as values in entrepreneurship. Entrepreneurial motivation in Japanese society addresses personal achievement, while it seeks independence in the Mediterranean cultures. The index of individualism takes high values in the four countries. This supports the theory associating this dimension with the traits of creativity and achievement

Clonal origin of Epstein-Barr virus-infected T/NK-cell subpopulations in chronic active Epstein-Barr virus infection

Clonal expansion of Epstein-Barr virus (EBV) infected B-cells occasionally occurs in immunocompromized subjects. EBV-infected T/natural killer (NK)-cells proliferate in patients with chronic active EBV infection (CAEBV) that is a rare mononucleosis syndrome. It is classified into either T-cell type or NK-cell type according to the primary target of infection, while the pathogenesis remains unclear. To search the clonal origin of EBV-infected T/NK-cells, virus distribution and clonotype were assessed by using highly purified cell fractions obtained from 6 patients. Patient 1 had a monoclonal proliferation of EBV-infected T-cell receptor Vδ2/Vγ9-expressing cells, and carried lower copy number of EBV in αβT-cells. Patients 2 and 3 had a clonal expansion of EBV-infected CD4+T-cells, and lower EBV load in CD56+cells. Patients 4, 5 and 6 had an expansion of CD56+cells with higher EBV load than CD3+cells. EBV-terminal repeats were determined as clonal bands in the minor targeted populations of 5 patients. The size of terminal repeats indicated the same clonotype in minor subsets as in major subsets of 4 patients. However, EBV was not detected in bone marrow-derived lineage negative CD34+cells of patients. These results suggested that EBV could infect T/NK-cells at differentiation stage, but spared bone marrow CD34+hematopoietic stem cells in CAEBV patients

Contrast-enhanced Computed Tomography Screening Is Effective for Detecting Venous Thromboembolism not Prevented by Prophylaxis after Total Knee Arthroplasty

Venous thromboembolism (VTE) is a potential complication occurring after total knee arthroplasty (TKA). We investigated the incidence of VTE after TKA using contrast-enhanced computed tomography (CT), and assessed the efficacy of VTE prophylaxis (fondaparinux and enoxaparin). At our hospital, 189 patients (225 knees) underwent TKA between April 2007 and October 2011. The 225 knees were divided into a control group with no VTE prophylaxis (31 cases), a fondaparinux group (107 cases), and an enoxaparin group (87 cases). Contrast-enhanced CT screening for VTE was performed in all cases on day 5 or 6 after TKA. D-dimer levels were measured on day 5 after TKA, and were significantly lower in the fondaparinux (9.8±3.8) and enoxaparin groups (9.4±4.9) than in the control group (15.6±9.8) (p＜0.001). However, no statistically significant difference in the incidence of VTE was observed among the groups (control, 61.3%;fondaparinux, 49.5%;enoxaparin, 50.6%). Prophylaxis was not effective for the prevention of VTE as detected by contrast-enhanced CT after TKA. CT should be performed after TKA, even when VTE prophylaxis is used

Deep Learning for Echocardiography

Objectives: The aim of this study was to evaluate whether a deep convolutional neural network (DCNN) could detect regional wall motion abnormalities (RWMAs) and differentiate groups of coronary infarction territories from conventional 2-dimensional echocardiographic images compared with cardiologist/sonographer or resident readers. Background: An effective intervention for reduction of misreading of RWMAs is needed. We hypothesized that a DCNN trained with echocardiographic images may provide improved detection of RWMAs in the clinical setting. Methods: A total of 300 patients with history of myocardial infarction were enrolled. In this cohort, 100 each had infarctions of the left anterior descending branch (LAD), left circumflex branch (LCX), and right coronary artery (RCA). The age-matched 100 control patients with normal wall motion were selected from our database. Each case contained cardiac ultrasound images from short axis views at end-diastolic, mid-systolic and end-systolic phases. After 100 steps of training, diagnostic accuracies were calculated on the test set. We independently trained 10 versions of the same model, and performed ensemble predictions with them. Results: For detection of the presence of wall motion abnormality, the area under the receiver-operating characteristic curve (AUC) by deep learning algorithm was similar to that by cardiologist/sonographer readers (0.99 vs. 0.98, p =0.15), and significantly higher than the AUC by resident readers (0.99 vs. 0.90, p =0.002). For detection of territories of wall motion abnormality, the AUC by the deep learning algorithm was similar to the AUC by cardiologist/sonographer readers (0.97 vs. 0.95, p =0.61) and significantly higher than the AUC by resident readers (0.97 vs. 0.83, p =0.003). In a validation group from an independent site (n=40), the AUC by the DL algorithm was 0.90. Conclusions: Our results support the possibility of DCNN use for automated diagnosis of RWMAs in the field of echocardiography

Non-Pharmacological Management of Neurocardiogenic Syncope

AbstractNeurocardiogenic syncope is a common disorder. It is diagnosed by obtaining a detailed history and performing a head-up tilt test, with or without drug provocation. Several studies have been performed pertaining to its management. However, no treatment, whether pharmacological or non-pharmacological, except for counterpressure maneuvers and daily orthostatic tilt training, has been proven effective. Randomized studies of therapies for neurocardiogenic syncope are needed