Rhabdomyolysis with Multiple Electrolyte Imbalances under Proton Pump Inhibitor Treatment after Total Thyroidectomy

A 90-year-old man presented with muscle weakness, difficulty concentrating, and dysphagia. About eighteen months prior to presentation, lansoprazole had been initiated to prevent stress ulcers; he also had a history of total thyroidectomy due to papillary thyroid cancer ten years prior. Laboratory findings were as follows: K 2.4 mEq/L, Ca 3.7 mg/dL, Mg 1.3 mg/dL, CK 5386 U/L, and intact PTH (iPTH) 14 pg/mL. Rhabdomyolysis with multiple electrolyte imbalances under proton pump inhibitor (PPI) treatment was diagnosed. We initiated intravenous hydration and electrolyte supplementation with discontinuation of PPI. After discontinuing PPI, the patient’s serum magnesium, potassium, and calcium levels normalised with oral vitamin D and calcium supplementation. PPIs can cause hypocalcaemia and hypokalaemia via hypomagnesemia; hypocalcaemia is also a common postoperative complication of thyroidectomy. Careful monitoring of electrolyte levels is required in patients with long-term PPI treatment, especially in post-thyroidectomy cases

Fine definition of the pedigree haplotypes of closely related rice cultivars by means of genome-wide discovery of single-nucleotide polymorphisms

<p>Abstract</p> <p>Background</p> <p>To create useful gene combinations in crop breeding, it is necessary to clarify the dynamics of the genome composition created by breeding practices. A large quantity of single-nucleotide polymorphism (SNP) data is required to permit discrimination of chromosome segments among modern cultivars, which are genetically related. Here, we used a high-throughput sequencer to conduct whole-genome sequencing of an elite Japanese rice cultivar, Koshihikari, which is closely related to Nipponbare, whose genome sequencing has been completed. Then we designed a high-throughput typing array based on the SNP information by comparison of the two sequences. Finally, we applied this array to analyze historical representative rice cultivars to understand the dynamics of their genome composition.</p> <p>Results</p> <p>The total 5.89-Gb sequence for Koshihikari, equivalent to 15.7× the entire rice genome, was mapped using the Pseudomolecules 4.0 database for Nipponbare. The resultant Koshihikari genome sequence corresponded to 80.1% of the Nipponbare sequence and led to the identification of 67 051 SNPs. A high-throughput typing array consisting of 1917 SNP sites distributed throughout the genome was designed to genotype 151 representative Japanese cultivars that have been grown during the past 150 years. We could identify the ancestral origin of the pedigree haplotypes in 60.9% of the Koshihikari genome and 18 consensus haplotype blocks which are inherited from traditional landraces to current improved varieties. Moreover, it was predicted that modern breeding practices have generally decreased genetic diversity</p> <p>Conclusions</p> <p>Detection of genome-wide SNPs by both high-throughput sequencer and typing array made it possible to evaluate genomic composition of genetically related rice varieties. With the aid of their pedigree information, we clarified the dynamics of chromosome recombination during the historical rice breeding process. We also found several genomic regions decreasing genetic diversity which might be caused by a recent human selection in rice breeding. The definition of pedigree haplotypes by means of genome-wide SNPs will facilitate next-generation breeding of rice and other crops.</p

Discovery of Genome-Wide DNA Polymorphisms in a Landrace Cultivar of Japonica Rice by Whole-Genome Sequencing

Molecular breeding approaches are of growing importance to crop improvement. However, closely related cultivars generally used for crossing material lack sufficient known DNA polymorphisms due to their genetic relatedness. Next-generation sequencing allows the identification of a massive number of DNA polymorphisms such as single nucleotide polymorphisms (SNPs) and insertions–deletions (InDels) between highly homologous genomes. Using this technology, we performed whole-genome sequencing of a landrace of japonica rice, Omachi, which is used for sake brewing and is an important source for modern cultivars. A total of 229 million reads, each comprising 75 nucleotides of the Omachi genome, was generated with 45-fold coverage and uniquely mapped to 89.7% of the Nipponbare genome, a closely related cultivar. We identified 132,462 SNPs, 16,448 insertions and 19,318 deletions between the Omachi and Nipponbare genomes. An SNP array was designed to validate 731 selected SNPs, resulting in validation rates of 95 and 88% for the Omachi and Nipponbare genomes, respectively. Among the 577 SNPs validated in both genomes, 532 are entirely new SNP markers not previously reported between related rice cultivars. We also validated InDels on a part of chromosome 2 as DNA markers and successfully genotyped five japonica rice cultivars. Our results present the methodology and extensive data on SNPs and InDels available for whole-genome genotyping and marker-assisted breeding. The polymorphism information between Omachi and Nipponbare is available at NGRC_Rice_Omachi (http://www.nodai-genome.org/oryza_sativa_en.html)

Long-Term Follow-up Data of a Multi-Institutional Phase-2 Study of S-1/oxaliplatin and Bevacizumab Therapy in Patients with Advanced Colorectal Cancer: The HiSCO-02 Study

Oral fluoropyrimidines (FUs) have certain advantages over intravenous FUs, such as longer intervals between outpatient visits, no requirement for central venous port (CVP) implantation, and lower incidence of neutropenia. We previously reported the efficacy of S-1/oxaliplatin (SOX) with bevacizumab therapy as a first-line treatment for advanced colorectal cancer (CRC) in a prospective phase-II multi-institutional clinical trial (HiSCO-02 study). However, our prognostic data at the time lacked a sufficient observation period. Herein, we analyze the longer-term follow-up data, focusing on the status of eventual CVP implantation via an open-label, non-randomized, multicenter study. This study enrolled 55 patients (mean age, 64 years), of whom 43 died (41 of primary cancer). The median overall survival was 22.7 months (95% CI: 20.1-34.7 months). Post-treatment regimens after failure of first-line treatment were initiated in 43 patients; CPT11-based regimens were selected in most cases, and other oral FU combinations in nine. CVP was implanted in 35 patients prior to first-line treatment; eleven of the remaining 20 patients did not require CVP implantation. In conclusion, we report here the final prognostic update of the Phase II clinical trial examining the efficacy of SOX plus bevacizumab therapy, the results of which confirm the clinical efficacy of this regimen

Pore-size expansion of hexagonal-structured nanocrystalline titania/CTAB Nanoskeleton using cosolvent organic molecules

Pore-size expansion of hexagonal-structured assembly of nanocrystalline titania (anatase) combined with cetyltrimethyammonium bromide (CH(3)(CH(2))(15)N(+)(CH(3))(3)Br(-), CTAB) (named as Hex-ncTiO(2)/CTAB Nanoskeleton) was achieved with the aid of cosolvent organic molecules (COMs). The pore-size expanded Hex-ncTiO(2)/CTAB Nanoskeleton was prepared through the sot-gel reaction of titanium oxysulfate sulfuric acid hydrate (TiOSO(4)center dot xH(2)SO(4)center dot xH(2)O, TiOSAH) in an aqueous solution initiated by CAB swollen micelles pre-prepared with the addition of COMs into aqueous CTAB micellar solutions at 60 degrees C (the product was named as Hex-ncTiO(2)/CTAB/COM Nanoskeleton). Long-chain alcohol (1-hexadecanol. C16OH), normal alkane (n-decane, C10) and benzene derivatives (benzene. Bz; 1,3,5-trimethylbenzene, TMB; 1,3,5-triethylbenzene, TEB; 1,3,5-triisopropylbenzene, TiPB) were used as COMs to evaluate the effects of COM solubilization site in CTAB micelles and COM molecular size on the pore-size expansion of the Hex-ncTiO(2)/CTAB/COM Nanoskeleton. We found that 1,3,5-trimethylbenzene (TMB) and 1,3,5-triethylbenzene (TEB) act as effective COMs for pore-size expansion of the Hex-ncTiO(2)/CTAB/COM Nanoskeleton in aqueous media. Pore sizes (average diameters) of the Hex-ncTiO(2)/CTAB/TMB Nanoskeleton and Hex-ncTiO(2)/CTAB/TEB Nanoskeleton were enlarged up to 4.2 nm and 4.3 nm, respectively, while pore size (average diameter) of the Hex-ncTiO(2)/CTAB Nanoskeleton prepared in the absence of any COMs was 2.9 nm. We also revealed that thermal stability of the Hex-ncTiO(2)/CTAB/TMB Nanoskeleton became higher than that of Hex-ncTiO(2)/CTAB Nanoskeleton. The hexagonally pore-structure of the Hex-ncTiO(2)/CTAB/TMB Nanoskeleton was retained up to 400 degrees C, while the hexagonally pore-structure of the Hex-ncTiO(2)/CTAB Nanoskeleton was kept up to 300 degrees C.ArticleCOLLOIDS AND SURFACES A-PHYSICOCHEMICAL AND ENGINEERING ASPECTS. 371(1-3):29-39 (2010)journal articl

Levels of soluble vascular endothelial growth factor receptor 1 are elevated in the exudative pleural effusions

Purpose : Vascular endothelial growth factor (VEGF) plays a critical role in the production of malignant pleural effusions. In the present study, we examined the levels of soluble VEGF receptor-1 (sVEGFR-1) and angiopoietin-2 (Ang-2), as possible regulators of VEGF activity, in transudative and exudative pleural effusions. Methods : Forty-two patients were included in this study : 4 with transudative pleural effusions due to heart failure (HF), 38 with exudative pleural effusions (lung cancer [LC], 22 ; other malignant diseases [MD], 10 ; tuberculosis [TB], 6) . The levels of VEGF, Ang-2, and sVEGFR-1 in the pleural effusions were measured by an enzyme-linked immunosorbent assay. Results : The levels of VEGF, Ang-2, and sVEGFR-1 in exudative effusions were higher than those in transudative effusions. Interestingly, the levels of VEGF and Ang-2 in bloody effusions were significantly higher than those in non-bloody effusions (p < 0.05), but the level of sVEGFR-1 in bloody effusions was lower than that in non-bloody effusions. The levels of VEGF and Ang-2 were significantly higher in the malignant effusions, compared with effusion from HF and TB (p < 0.05). In addition, sVEGFR-1 was significantly higher in the effusion from LC, MD, and TB compared with effusion from HF (p < 0.05). In the malignant effusions, direct correlations were observed among VEGF, sVEGFR-1, and Ang-2. Conclusions : The sVEGFR-1 levels were elevated in exudative pleural effusions, and were lower in bloody effusions than in non-bloody effusions, thus suggesting the regulatory role of sVEGFR-1 in the exudative pleural effusions

Effects of Intravenous Diltiazem on Supraventricular Tachyarrhythmias

The effects of intravenous diltiazem on supraventricular tachyarrhythmias were studied in 16 patients : 6 with paroxysmal supraventricular tachycardia using an accessory pathway retrogradely, 6 with atrial fibrillation, 3 with atrial flutter and 1 with chronic atrial tachycardia. Diltiazem (0.1 or 0.2 mg/kg) was administered intravenously over 5 minutes. Termination of paroxysmal supraventricular tachycardia was achieved in 6 out of 10 episodes during or just after the injection. Diltiazem slowed the ventricular conduction from 2 : 1 to 4 : 1 in atrial flutter, but sinus rhythm was not restored in either case. Diltiazem increased the ventricular response through an accessory pathway in a patient with atrial fibrillation associated with Wolff-Parkinson-White syndrome. Atrial rate in a case of chronic atrial tachycardia did not change significantly. There were no adverse clinical effects. It is concluded that diltiazem is effective in slowing ventricular rate in atrial fibrillation and flutter and in terminating paroxysmal supraventricular tachycardia. However, diltiazem may be contraindicated in atrial fibrillation associated with Wolff-Parkinson- White syndrome

Serum and urinary ferritin levels in patients with rheumatoid arthritis

The serum and urinary ferritin levels in 52 RA patients were measured by the 2-site immunoradiometric assay method. Serum ferritin levels in RA patients correlated with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) but not with serum iron levels and hemoglobin concentrations, although they were within the normal range. High serum ferritin levels were associated with sera with hyper gamma-globulin and rheumatoid factors. In sequential studies, serum ferritin changed in parallel with ESR, CRP and disease activity in a majority of the patients. The urinary ferritin levels and u/s ratios in some RA patients were higher than control values. Higher values were found particularly in the group of patients under gold therapy but not in groups under other treatments.</p

Successful Resuscitation from Ventricular Fibrillation during Jogging in a Young Patient with Hypertrophic Cardiomyopathy

A 15-year-old girl, who was previously in good health, suddenly collapsed while jogging. Immediate cardiopulmonary resuscitation (CPR) was initiated, and she arrived at our hospital 13 minutes later. The ventricular fibrillation (VF) on admission was reverted to sinus rhythm 18 minutes after collapse by the second cardioversion. The echocardiogram revealed hypertrophic nonobstructed cardiomyopathy (HNOCM), although the 24hr ambulatory electrocardiographic, electrophysiologic and exercise stress tests could not define the exact cause of VF. Exercise-induced ischemia with sustained mild hypokalemia was suspected to be the cause of VF. The patient recovered consciousness three days after admission, and followed an uneventful course of treatment with oral atenolol not associating with disabling neurological deficit. Immediate basic life support and delivery of automatic external defibrillator on the spot is needed to rescue patients with out-of-hospital cardiac arrest