Intestinal Perforation by Ingested Foreign Bodies

Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%

Feasibility and problem in managements of the patients with acute cholecystitis: A historical study at a single province institute.

Objectives: "Practice Guidelines for Acute Cholecystitis and Acute Cholangitis (in Japanese)," issued in 2005 in Japan, recommends early cholecystectomy in patients with acute cholecystitis. We evaluated the feasibility and problems in management of this condition. Method: We analyzed the clinical and laboratory data of 120 consecutive patients in whom cholecystectomy was performed for treatment of acute cholecystitis between April 2003 and March 2010 in our hospital. Results: After the Guidelines were issued, the rate of urgent operations increased (from 2.4% to 35.4%; p < 0.001) and the length of preoperative hospital stay decreased (form 12.5 days to 7.6 days; p < 0.05). Urgent operation, however, was chosen in only 35.4% of the patients even after the Guidelines were issued, mainly because of the shortage of surgeons and anesthesiologists. In these patients with moderate to severe acute cholecystitis, percutaneous cholecystostomy (PC) was performed without severe complications, followed by cholecystectomy. Conclusion: Urgent operation for acute cholecystitis has the advantages of earlier alleviation of symptoms and shorter hospital stays than PC followed by surgery or elective operation. PC followed by surgery may be a suboptimal option for patients with moderate to severe acute cholecystitis who might be able to tolerate an urgent operation, given that appropriate human resources are not available

INCS suppresses H1R gene expression

The purpose of this study is to examine the effect of intranasal corticosteroid (INCS) administration on histamine H1 receptor (H1R) gene expression in the nasal mucosa of healthy participants and the effects of dexamethasone on basal and histamine-induced H1R mRNA expression, and histamine-induced phosphorylation of extracellular signal-regulated kinase (ERK) in HeLa cells. Sixteen healthy participants were given INCS once daily for a week. After pretreatment of dexamethasone, HeLa cells were treated with histamine. Levels of H1R mRNA and phosphorylation of ERK were measured using real time PCR and immunoblot analysis, respectively. Levels of H1R mRNA in the nasal mucosa of healthy participants receiving INCS was significantly decreased. Dexamethasone suppressed basal levels of H1R mRNA, and histamine-induced up-regulation of H1R mRNA and ERK phosphorylation in HeLa cells. These data suggested that corticosteroid inhibited both basal transcription and histamine-induced transcriptional activation of H1R through its suppression of ERK phosphorylation in the signaling pathway involved in H1R gene transcription. It is further suggested that pre-seasonal prophylactic administration of INCS suppresses both basal and pollen-induced upregulation of H1R gene expression in the nasal mucosa of patients with pollinosis, leading to prevention of the exacerbation of nasal symptoms during peak pollen season

Transcriptionally linked simultaneous overexpression of P450 genes for broad-spectrum herbicide resistance

雑草が獲得した最強の除草剤抵抗性メカニズムの解明 --解毒酵素の一斉活性化--. 京都大学プレスリリース. 2023-06-14.Broad-spectrum herbicide resistance (BSHR), often linked to weeds with metabolism-based herbicide resistance, poses a threat to food production. Past studies have revealed that overexpression of catalytically promiscuous enzymes explains BSHR in some weeds; however, the mechanism of BSHR expression remains poorly understood. Here, we investigated the molecular basis of high-level resistance to diclofop-methyl in BSHR late watergrass (Echinochloa phyllopogon) found in the United States, which cannot be solely explained by the overexpression of promiscuous cytochrome P450 monooxygenases CYP81A12/21. The BSHR late watergrass line rapidly produced 2 distinct hydroxylated diclofop acids, only 1 of which was the major metabolite produced by CYP81A12/21. RNA-seq and subsequent reverse transcription quantitative PCR (RT-qPCR)-based segregation screening identified the transcriptionally linked overexpression of a gene, CYP709C69, with CYP81A12/21 in the BSHR line. The gene conferred diclofop-methyl resistance in plants and produced another hydroxylated diclofop acid in yeast (Saccharomyces cerevisiae). Unlike CYP81A12/21, CYP709C69 showed no other herbicide-metabolizing function except for a presumed clomazone-activating function. The overexpression of the 3 herbicide-metabolizing genes was also identified in another BSHR late watergrass in Japan, suggesting a convergence of BSHR evolution at the molecular level. Synteny analysis of the P450 genes implied that they are located at mutually independent loci, which supports the idea that a single trans-element regulates the 3 genes. We propose that transcriptionally linked simultaneous overexpression of herbicide-metabolizing genes enhances and broadens the metabolic resistance in weeds. The convergence of the complex mechanism in BSHR late watergrass from 2 countries suggests that BSHR evolved through co-opting a conserved gene regulatory system in late watergrass

Nephrotoxicity with VCM and Nephrotoxins

There is a growing concern about the relationship between vancomycin-associated nephrotoxicity (VAN) and concomitant use of nephrotoxins. We examined this relationship by combined retrospective analyses of two real-world databases. Initially, the FDA Adverse Event Reporting System (FAERS) was analyzed for the effects of concomitant use of one or more nephrotoxins on VAN and the types of combinations of nephrotoxins that exacerbate VAN. Next, electronic medical records (EMRs) of patients who received vancomycin (VCM) at Tokushima University Hospital between January 2006 and March 2019 were examined to confirm the FAERS analysis. An elevated reporting odds ratio (ROR) was observed with increases in the number of nephrotoxins administered (VCM + one nephrotoxin, adjusted ROR (95% confidence interval [CI]) 1.67 [1.51–1.85]; VCM + ≥ 2 nephrotoxins, adjusted ROR [95% CI] 1.54 [1.37–1.73]) in FAERS. EMRs analysis showed that the number of nephrotoxins was associated with higher incidences of VAN [odds ratio: 1.99; 95% CI: 1.42–2.78]. Overall, concomitant use of nephrotoxins was associated with an increased incidence of VAN, especially when at least one of those nephrotoxins was a renal hypoperfusion medication (furosemide, non-steroidal anti-inflammatory drugs, and vasopressors). The concomitant use of multiple nephrotoxins, especially including renal hypoperfusion medication, should be avoided to prevent VAN

Concomitant Use of Multiple Nephrotoxins including Renal Hypoperfusion Medications Causes Vancomycin-Associated Nephrotoxicity: Combined Retrospective Analyses of Two Real-World Databases

There is a growing concern about the relationship between vancomycin-associated nephrotoxicity (VAN) and concomitant use of nephrotoxins. We examined this relationship by combined retrospective analyses of two real-world databases. Initially, the FDA Adverse Event Reporting System (FAERS) was analyzed for the effects of concomitant use of one or more nephrotoxins on VAN and the types of combinations of nephrotoxins that exacerbate VAN. Next, electronic medical records (EMRs) of patients who received vancomycin (VCM) at Tokushima University Hospital between January 2006 and March 2019 were examined to confirm the FAERS analysis. An elevated reporting odds ratio (ROR) was observed with increases in the number of nephrotoxins administered (VCM + one nephrotoxin, adjusted ROR (95% confidence interval [CI]) 1.67 [1.51-1.85]; VCM + ≥2 nephrotoxins, adjusted ROR [95% CI] 1.54 [1.37-1.73]) in FAERS. EMRs analysis showed that the number of nephrotoxins was associated with higher incidences of VAN [odds ratio: 1.99; 95% CI: 1.42-2.78]. Overall, concomitant use of nephrotoxins was associated with an increased incidence of VAN, especially when at least one of those nephrotoxins was a renal hypoperfusion medication (furosemide, non-steroidal anti-inflammatory drugs, and vasopressors). The concomitant use of multiple nephrotoxins, especially including renal hypoperfusion medication, should be avoided to prevent VAN