A Case of Drug-induced Agranulocytosis Diagnosed by Re-administration of Clopidogrel

Clopidogrel is an antiplatelet drug that is frequently used for coronary artery disease and cerebrovascular disease. Hematologic adverse effect is less common with clopidogrel than ticlopidine. A ５８-year-old man was treated with clopidogrel as antiplatelet therapy under the diagnosis of cerebral infarction. Six weeks later, he was transported to our emergency department with fever, sore throat and respiratory distress. Blood test showed marked leukopenia（neutrophil ５１/mm３）. A diagnosis of sepsis with acute epiglottitis and tonsillitis was made by blood culture and contrast-enhanced computed tomography. Clopidogrel was discontinued due to thrombocytopenia. After administration of antibacterial drugs and granulocyte colony-stimulating factor under ventilator in the Intensive Care Unit, the infection improved with the recovery of the neutrophil count. Clopidogrel was restarted, but he developed leukopenia and high fever again２weeks later. Histopathology of bone marrow revealed a marked decrease in myeloid cells, and he was diagnosed as drug-induced agranulocytosis due to clopidogrel. After withdrawal of clopidogrel and supportive therapy for febrile neutropenia, neutrophils recovered. Although clopidogrel associated agranulocytosis is a very rare adverse event, it can be serious and regular blood count monitoring is necessary after initiation of clopidogrel

Intensive endoscopic resection for downstaging of polyp burden in patients with familial adenomatous polyposis (J-FAPP Study III) : a multicenter prospective interventional study

Background Total colectomy is the standard treatment for familial adenomatous polyposis (FAP). Recently, an increasing number of young patients with FAP have requested the postponement of surgery or have refused to undergo surgery. We aimed to evaluate the effectiveness of intensive endoscopic removal for downstaging of polyp burden (IDP) in FAP. Method A single-arm intervention study was conducted at 22 facilities. Participants were patients with FAP, aged ≥ 16 years, who had not undergone colectomy or who had undergone colectomy but had ≥ 10 cm of large intestine remaining. For IDP, colorectal polyps of ≥ 10 mm were removed, followed by polyps of ≥ 5 mm. The primary end point was the presence/absence of colectomy during a 5-year intervention period. Results 222 patients were eligible, of whom 166 had not undergone colectomy, 46 had undergone subtotal colectomy with ileorectal anastomosis, and 10 had undergone partial resection of the large intestine. During the intervention period, five patients (2.3 %, 95 % confidence interval [CI] 0.74 %–5.18 %) underwent colectomy, and three patients died. Completion of the 5-year intervention period without colectomy was confirmed in 150 /166 patients who had not undergone colectomy (90.4 %, 95 %CI 84.8 %–94.4 %) and in 47 /56 patients who had previously undergone colectomy (83.9 %, 95 %CI 71.7 %–92.4 %). Conclusion IDP in patients with mild-to-moderate FAP could have the potential to be a useful means of preventing colorectal cancer without implementing colectomy. However, if the IDP protocol was proposed during a much longer term, it may not preclude the possibility that a large proportion of colectomies may still need to be performed

Successful cricothyrotomy for emergency airway management : a case report

A ６０ year-old male was brought to our emergency department by ambulance due to sudden onset of dyspnea. On examination, he was in coma since his level of consciousness decreased during transport, blood pressure was １９９／１１１mmHg, heart rate was１００ beats per minute, respirations were １０ per minute, blood oxygen saturation level（SpO２）was１００％ via assisted ventilation with Bag-Valve-Mask, and stridor was heard on auscultation. Those findings indicated airway emergency and endotracheal intubation was required. However, attempts at intubation were unsuccessful due to restriction of mouth opening. Muscle relaxant was then given to perform rapid sequence intubation, which caused vomiting. Failure to ventilation and intubation resulted in cardiopulmonary arrest. Chest compression was started immediately and decision for cricothyrotomy was made. １０ minute after cricothyrotomy, he revived. Subsequently, systemic management including therapeutic normothermia was performed at intensive care unit, then he regained consciousness. He was discharged １ month after admission

Anxiety- and depression-like behavior in mice lacking the CD157/BST1 gene, a risk factor for Parkinson\u27s disease

金沢大学疾患モデル総合研究センターCD157, known as bone marrow stromal cell antigen-1, is a glycosylphosphatidylinositolanchored ADP-ribosyl cyclase that supports the survival and function of B-lymphocytes and hematopoietic or intestinal stem cells. Although CD157/Bst1 is a risk locus in Parkinson\u27s disease (PD), little is known about the function of CD157 in the nervous system and contribution to PD progression. Here, we show that no apparent motor dysfunction was observed in young knockout (CD157-/-) male mice under less aging-related effects on behaviors. CD157-/- mice exhibited anxiety-related and depression-like behaviors compared with wild-type mice. These behaviors were rescued through treatment with anti-psychiatric drugs and oxytocin. CD157 was weakly expressed in the amygdala and c-Fos immunoreactivity in the amygdala was less evident in CD157-/- mice than in wild-type mice. These results demonstrate for the first time that CD157 plays a role as a neuro-regulator and suggest a potential role in pre-motor symptoms in PD. © 2014 Lopatina, Yoshihara, Nishimura, Zhong, Akther, Fakhrul, Liang, Higashida, Sumi, Furuhara, Inahata, Huang, Koizumi, Yokoyama, Tsuji, Petugina, Sumarokov, Salmina, Hashida, Kitao, Hori, Asano, Kitamura, Kozaka, Shiba, Zhong, Xie, Sato, Ishihara and Higashida.CC-BY 4.

Synchronization of coupled stick-slip oscillators

A rationale is provided for the emergence of synchronization in a system of coupled oscillators in a stick-slip motion. The single oscillator has a limit cycle in a region of the state space for each parameter set beyond the supercritical Hopf bifurcation. The two-oscillator system that has similar weakly coupled oscillators exhibits synchronization in a parameter range. The synchronization has an anti-phase nature for an identical pair. However, it tends to be more in-phase for a non-identical pair with a rather weak coupling. A system of three identical oscillators (1, 2, and 3) coupled in a line (with two springs <i>k</i>₁₂=<i>k</i>₂₃) exhibits synchronization with two of them (1 and 2 or 2 and 3) being nearly in-phase. These collective behaviours are systematically estimated using the phase reduction method

Post-transcriptional downregulation of sarcolipin mRNA by triiodothyronine in the atrial myocardium

AbstractThyroid hormone-mediated positive cardiotropic effects are differently regulated between the atria and ventricles. This regulation is, at least in part, dependent on sarcoplasmic reticulum (SR) proteins. Sarcolipin, a homologue of phospholamban, has been recently identified as an atrium-specific SR protein. The expression of sarcolipin mRNA was significantly decreased in the atria of mice with hyperthyroidism and in 3,5,3′-triiodo-l-thyronine-treated neonatal rat atrial myocytes. Promoter activity and mRNA stability analyses revealed that thyroid hormone post-transcriptionally downregulated the expression of sarcolipin mRNA. The atrium-specific effect of thyroid hormone may occur in part through the regulation of atrial sarcolipin gene expression