Evaluation of Urinary Stone Composition and Differentiation between Urinary Stones and Phleboliths Using Single-source Dual-energy Computed Tomography

The aim of this study was to investigate the utility of single-source dual-energy computed tomography (SS-DECT) composition analysis in characterizing different types of urinary stones and differentiating them from phleboliths. This study included 29 patients with urinary stones who were scheduled for surgery. All patients were scanned, first using single-energy computed tomography acquisition and then DECT acquisition on SS-DECT. Dual-energy data were archived to a Gemstone spectral imaging (GSI) viewer (GE Healthcare, Milwaukee, WI, USA). Hounsfield units (HU) and effective atomic numbers (Zeff) were estimated using the GSI viewer. The results of dual-energy analysis were compared with the biochemical constitution of the stones. The chemical analysis determined that the stones included 32 calcium-based, 6 cystine and 1 struvite stone. Both HU and Zeff values were helpful in differentiating calcium-based stones from cystine and struvite stones and phleboliths. The Zeff values of phleboliths were significantly higher than those for struvite and cystine stones, whereas it was difficult to distinguish phleboliths from struvite and cystine stones using the HU values. Composition analysis using SS-DECT is helpful for distinguishing urinary stone types and discriminating phleboliths from urinary stones. Zeff values may be more useful than HU values for differentiating urinary stones from phleboliths

Mental Condition and Treatment of Patients after Disclosure of Cancer Diagnosis

In Japan, historically, doctors had refrained from disclosing a cancer diagnosis to patients, but attitudes regarding disclosure have recently been changing. We investigated the mental condition and treatment of patients after disclosure of cancer. Thirty-seven cancer patients (7 gastric cancer, 23 colorectal cancer, 5 breast cancer, 2 hepatocellular carcinoma) participated in this study. We divided the patients at Week 1 after disclosure of the diagnosis of cancer into two groups according to their score of Hospital Anxiety and Depression Scale (HADS): one group whose HADS was 8 points or more (Group A), and another group whose points were below 8 (Group B) at Week 1 after disclosure. There were 11 (29.7%) patients in Group A, and 26 (70.3%) in Group B. The average HADS differed between the two groups before disclosure, and at Weeks 1 to 5 after disclosure. Group A was treated with paroxetine hydrochloride hydrate (PAX) and about 70% of the patients showed an improvement of anxiety or depression by Week 5. While, there was 0% in HADS of 8 or more in breast cancer patients after disclosure. Some patients felt anxiety and depression unrelated to the stage of cancer. Furthermore, we noted that anxiety and depression were not detected after the cancer disclosure in any of the breast cancer patients, suggesting the possibility that anxiety and depression were alleviated by events such as surgery. It is necessary for medical treatment to advance to new steps in the treatment of cancer, providing enough support to the patients in the future

Efficiency of Incentive Spirometry for Video-Assisted Thoracoscopic Surgery for Esophagectomy

Transthoracic subtotal esophagectomy for esophageal cancer is a highly invasive procedure, associated with high mortality and morbidity rates. We examined the use of video-assisted thoracoscopic and laparoscopic surgery for esophagectomy (VATS-E). Further, incentive spirometry (IS) is commonly used in perioperative rehabilitation for esophagectomy. We investigated whether pulmonary complications after VATS-E are related to changes in the perioperative IS volumes and whether such changes could be predictive of these complications. This study included 63 patients who underwent VATS-E from June 2008 to December 2009. IS volumes before and after surgery were recorded for all patients. The perioperative IS volumes and clinicopathological factors were correlated with the incidence of postoperative pneumonia and atelectasis. Nine patients (14.5%) had postoperative pneumonia, and thirteen (22.2%) had atelectasis. Univariate analysis showed an increased risk of atelectasis in patients with diabetes and an increased risk of pneumonia in patients with a long operating time and for whom the lung was adhered to the thoracic wall. The vital capacity (VC) correlation coefficient was 0.674. Further, the risk of pneumonia was high in patients with 13% less than the minimum IS volume/preoperative VC ratio and 22% with less than the average IS volume/preoperative VC ratio. Multivariate regression models for pneumonia showed the same results regarding the IS volume/VC ratio. The results indicated that IS volumes could be used to predict the incidence of complications after VATS-E, and thereby facilitate early application of interventions to prevent pulmonary complications

Effect of Preoperative Carbohydrate and Amino Acid Infusion on Postoperative Counter-Regulatory Hormone in Patients Undergoing Elective Thoracoscopic Esophagectomy

Compared with the conventional open surgery, thoracoscopic esophagectomy results in decreased thorax destruction, fewer postoperative complications, and shorter hospitalisation. However, preoperative fasting causes hyperglycemia, prompting attempts to improve postoperative hyperglycemia by preoperatively administering carbohydrate orally or intravenously. Herein, we examined the effect of preoperative carbohydrate and amino acid infusion on counter-regulatory hormone levels in patients undergoing elective thoracoscopic esophagectomy. The glucose and amino acid (GA) group (n=12) were infused with a low concentration of sugar accelerant and amino acid, and the control (GAF) group (n=12) was infused with a sugar-free extracellular fluid, until entering the operating room. We evaluated plasma catecholamine 3 fractions, cortisol, and glucose, as well as 3-methylhistidine in the urine. Adrenaline levels were significantly higher in the GAF group (263.0±201.8µIU/ml) than in the GA group (114.7±127.0µIU/ml) at the end of the surgery (P=0.042), and at postoperative day (POD) 1 (200.8±137.4 vs. 80.5±64.3µIU/ml; P=0.013). The noradrenalin level was also significantly higher in the GAF group (517.9±523.6µIU/ml) than in the GA group (254.3±205.4µIU/ml) at POD1 (P=0.028), as was the cortisol level (20.0±10.6µIU/ml vs. 10.2±8.0µIU/ml; P=0.015). No significant differences were observed between the two groups in levels of blood glucose or 3-methylhistidine in the urine. Preoperative glucose-amino acid administration improved catabolism suppression in this study

Clinicopathological Significance of FOXP3 Expression in Esophageal Squamous Cell Carcinoma

The expression of transcription factor forkhead box protein 3 (FOXP3), a master control gene for regulatory T cells, has been reported to influence patient survival. However, there have been few reports of the relationship between FOXP3 positive cells and esophageal squamous cell carcinoma (ESCC). The aim of this study was to clarify the prognostic value of FOXP3 expression in ESCC. Ninety-five patients who were diagnosed with primary ESCC and underwent subtotal esophagectomy during 2009 and 2010 were retrospectively analyzed. Deepest sections from each tumor were selected for immunohistochemistry and the number of FOXP3 positive cells was counted. The median number was used as a cutoff to divide into FOXP3 positive and FOXP3 negative subgroups. Relationships between FOXP3 expression and clinicopathological features, disease-free survival (DFS) and overall survival (OS) were determined. Statistical values of p < 0.05 were considered significant. FOXP3 positive cells were found in all 95 cases and the number of FOXP3 positive cells was significantly higher in the peri-tumor compartment than in the intra-tumor compartment (p = 0.0006). For this reason, the peri-tumor compartment numbers were used for all of the association studies. Results showed that the FOXP3 positive group had a significantly larger mean tumor size (43.8 ± 4.1mm vs 29.1 ± 4.0mm, p = 0.0055), and the FOXP3 negative group had a significantly higher percentage of deep invasion (T2, T3, T4)(p = 0.0399). There was no significant association for DFS, however, for OS the FOXP3 positive group demonstrated a significantly better prognosis (p = 0.0024). Multivariate analysis showed that peri-tumor FOXP3 expression is an independent prognostic factor for OS (p = 0.0035). Peri-tumoral FOXP3 expression is an independent and favorable prognostic factor for ESCC

Analysis of Radioactive Elements in Testes of Large Japanese Field Mice Using an Electron Probe Micro-Analyser after the Fukushima Accident

The Fukushima Daiichi nuclear power plant (FDNPP) accident drew global attention to the health risks of radiation exposure. The large Japanese field mice (Apodemus speciosus) are rodents endemic to, and distributed throughout, Japan. This wild rodent live in and around the ex-evacuation zone on the ground surface and/or underground. In this study, we evaluated the effect of chronic radiation exposure associated with FDNPP accident on the testes of large Japanese field mice. Morphological analysis and electron-prove X-ray microanalysis (EPMA) was undertaken on the testes. Morphological analysis of testes based on H&E staining showed that the spermatogenesis was observed normally in the breeding season of wild mice in the heavily contaminated area. However, caesium (Cs) was not detected in all testes of wild mice from FDNPP ex-evacuation zone. In conclusion, even if the testes and the process of spermatogenesis are hypersensitive to radiation, we could not detect radiation effects on the spermatogenesis and Cs in the examined large Japanese field mice testes following chronic radiation exposure associated with the FDNPP accident

Evaluation of Surgical Stress Associated with Video-assisted Thoracic Surgery for Esophageal Cancer According to Interleukin-6 Variation in Pleural Cavity Lavage Fluid

Esophagectomy for esophageal cancer is one of the most invasive gastrointestinal surgeries. In 1996, we introduced video-assisted thoracic surgery for esophageal cancer (VATS-E) to reduce surgical stress. In 2010, we started employing artificial pneumothorax (AP) using carbon dioxide gas in VATS-E to further reduce surgical stress. In this study, we evaluated interleukin-6 (IL-6) levels in pleural cavity lavage fluid (PLF) of patients undergoing VATS-E with or without AP, and examined the effect of AP on VATS-E-induced stress. This non-randomized study included patients who underwent VATS-E with or without AP at Showa University Hospital between 2009 and 2013 and from whom PLF could be collected. IL-6 concentrations in PLF were examined before and after the thoracic part of the operation. We compared IL-6 variation, defined as the difference between IL-6 concentrations in PLF before and after the thoracic part of the operation, between patients for whom AP was used and those for whom it was not used. A total of 52 patients were included in the study; 26 underwent VATS-E with AP (group AP), and 26 underwent VATS-E without AP (group NP). IL-6 concentrations in PLF were significantly elevated immediately after the thoracic part of the operation in both groups. IL-6 variation in PLF correlated with both thoracic operative time and blood loss, which were considered practical parameters of surgical stress, and was significantly lower in group AP than in group NP. In conclusion, IL-6 variation in PLF is a useful and sensitive maker of surgical stress during VATS-E. VATS-E with AP is less invasive than VATS-E without AP because AP lowers the perioperative systemic inflammatory response to thoracic surgery

A prospective observational study of community-acquired bacterial bloodstream infections in Metro Manila, the Philippines

Community-acquired bacterial bloodstream infections are caused by diverse pathogens with changing antimicrobial-resistance patterns. In low-middle income countries in Southeast Asia, where dengue fever is endemic and a leading cause of fever, limited information is available about bacterial bloodstream infections due to challenges of implementing a blood culture service. This study describes bacterial bloodstream pathogens and antimicrobial-resistance patterns in Metro Manila, the Philippines. We aimed to identify the proportion of patients with a positive blood culture, the bacteria isolated and their antimicrobial resistance patterns, and the clinical characteristics of these patients, in this dengue endemic area. We conducted a prospective observational study in a single hospital enrolling febrile patients clinically suspected of having a community-acquired bacterial bloodstream infection between 1st July 2015 and 30th June 2019. Each patient had a blood culture and additional diagnostic tests according to their clinical presentation. We enrolled 1315 patients and a significant positive blood culture was found in 77 (5.9%) including Staphylococcus aureus (n=20), Salmonella enterica Typhi (n=18), Escherichia coli (n=16), Streptococcus pneumoniae (n=3) and Burkholderia pseudomallei (n=2). Thirty-four patients had meningococcal disease diagnosed by culture (n=8) or blood PCR (n=26). Additional confirmed diagnoses included leptospirosis (n=177), dengue virus infection (n=159) and respiratory diphtheria (n=50). There were 79 (6.0%, 95%CI 4.8%−7.4%) patients who died within 28 days of enrollment. Patients with a positive blood culture were significantly more likely to die than patients with negative culture (15.2 % vs 4.4 %, P<0.01). Among S. aureus isolates, 11/20 (55%) were methicillin-resistant (MRSA) and ST30 : USA1100 was dominant sequence type (88.9%). Antimicrobial-susceptibility was well preserved in S. enterica Typhi. Among hospitalized patients with clinically suspected community-acquired bacterial bloodstream infection in Metro Manila, the Philippines, 5.9% had a blood culture confirmed infection of whom 15.6% died. S. aureus, including a significant number of MRSA (USA1100 clones), S. enterica Typhi, E.coli and Neisseria meningitidis were frequently identified pathogens

Prediction of Opioid-Induced Respiratory Depression on Inpatient Wards Using Continuous Capnography and Oximetry: An International Prospective, Observational Trial.

BACKGROUND: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring. METHODS: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and Asia. Vital signs were intermittently monitored per standard of care. A total of 1335 patients receiving parenteral opioids and continuously monitored on the general care floor were included in the analysis. A respiratory depression episode was defined as respiratory rate ≤5 breaths/min (bpm), oxygen saturation ≤85%, or end-tidal carbon dioxide ≤15 or ≥60 mm Hg for ≥3 minutes; apnea episode lasting \u3e30 seconds; or any respiratory opioid-related adverse event. A risk prediction tool was derived using a multivariable logistic regression model of 46 a priori defined risk factors with stepwise selection and was internally validated by bootstrapping. RESULTS: One or more respiratory depression episodes were detected in 614 (46%) of 1335 general care floor patients (43% male; mean age, 58 ± 14 years) continuously monitored for a median of 24 hours (interquartile range [IQR], 17-26). A multivariable respiratory depression prediction model with area under the curve of 0.740 was developed using 5 independent variables: age ≥60 (in decades), sex, opioid naivety, sleep disorders, and chronic heart failure. The PRODIGY risk prediction tool showed significant separation between patients with and without respiratory depression (P \u3c .001) and an odds ratio of 6.07 (95% confidence interval [CI], 4.44-8.30; P \u3c .001) between the high- and low-risk groups. Compared to patients without respiratory depression episodes, mean hospital length of stay was 3 days longer in patients with ≥1 respiratory depression episode (10.5 ± 10.8 vs 7.7 ± 7.8 days; P \u3c .0001) identified using continuous oximetry and capnography monitoring. CONCLUSIONS: A PRODIGY risk prediction model, derived from continuous oximetry and capnography, accurately predicts respiratory depression episodes in patients receiving opioids on the general care floor. Implementation of the PRODIGY score to determine the need for continuous monitoring may be a first step to reduce the incidence and consequences of respiratory compromise in patients receiving opioids on the general care floor