A pediatric case of pancreaticobiliary maljunction demonstrated by endoscopic ultrasonography

AbstractPancreaticobiliary maljunction (PBM) is a congenital anomaly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. Diagnosis of PBM in children is usually made by magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasonography (EUS) is a high-resolution imaging modality and a well-established diagnostic tool in adults with pancreaticobiliary (PB) disease. There are several articles which report the value of EUS in the diagnosis and evaluation of PBM in adults, but there are no reports of PBM demonstrated by EUS in children. Here, we present a case of PBM in a pediatric patient that was clearly demonstrated by EUS. EUS can be used as a second line examination modality for demonstrating PBM in pediatric patients in whom first line examinations, such as MRCP or ERCP, cannot be carried out or have not been conclusive

Study on an Axial Flow Hydraulic Turbine with Collection Device

We propose a new type of portable hydraulic turbine that uses the kinetic energy of flow in open channels. The turbine comprises a runner with an appended collection device that includes a diffuser section in an attempt to improve the output by catching and accelerating the flow. With such turbines, the performance of the collection device, and a composite body comprising the runner and collection device were studied using numerical analysis. Among four stand-alone collection devices, the inlet velocity ratio was most improved by the collection device featuring an inlet nozzle and brim. The inlet velocity ratio of the composite body was significantly lower than that of the stand-alone collection device, owing to the resistance of the runner itself, the decreased diffuser pressure recovery coefficient, and the increased backpressure coefficient. However, at the maximum output tip speed ratio, the inlet velocity ratio and the loading coefficient were approximately 31% and 22% higher, respectively, for the composite body than for the isolated runner. In particular, the input power coefficient significantly increased (by approximately 2.76 times) owing to the increase in the inlet velocity ratio. Verification tests were also conducted in a real canal to establish the actual effectiveness of the turbine

Further Case Studies of Human Infestation with Hard Tick (Acarina: Ixodidae) Found in Okayama, Japan

Six new cases of human infestation with hard tick (a 58-year-old man, a 85-year-old woman, a 54-year-old woman, a 74-year-old woman, a 68-year-old woman and a 76-year-old man) from Okayama Prefecture are further reported. The tick bites were found on the skin surface of left upper eyelid (Case 1), neck region (Cases 2 and 5), right abdomen (Case 3), left rump (Case 4) and left thorax (Case 6). On acarological observation, the removed ticks were identified as Ixodes ovatus Neumann, 1899 at nymphal stage (Case 1), the adult female of Haemaphysalis flava Neumann, 1897 (Case 2), Ixodes nipponensis Kitaoka and Saito, 1967 (Cases 3 and 6), H. flava (Case 4) and I. ovatus (Case 5) based on morphology of capitulum (hypostome and palps), internal and external spurs on coxae, spiracular plates and genital aperture. The tick bites have been occurred on hilly area (Cases 1 and 3), on farm garden (Case 2), and on grassy plain (Cases 5 and 6). The location of bite acquisition of Case 4 is not reported. To our best knowledge, the present report deals with 14th to 19th findings of human infestation with hard tick in Okayama Prefecture, Japan

Long-term effectiveness of right septal pacing vs. right apical pacing in patients with atrioventricular block

AbstractBackgroundLong-term right ventricular apical (RVA) pacing increases the risk of heart failure (HF) by inducing ventricular dyssynchronization. Although recent studies suggest that right ventricular septal (RVS) pacing results in improved short-term outcomes, its long-term effectiveness remains unclear.Methods and resultsThis study investigated 149 consecutive patients who underwent implantation of a dual chamber pacemaker for atrioventricular block with either RVS-pacing between July 2007 and June 2010 or RVA-pacing between January 2003 and June 2007. The endpoint was defined as death and hospitalization due to heart failure (HF). The rates of mortality and hospitalization due to HF were significantly lower in the RVS-pacing group than that in the RVA-pacing group (event free RVS: 1 year, 98% and 2 years, 98%; RVA: 1 year, 85% and 2 years, 81%; p<0.05). None of the patients died from HF in the RVS-pacing group, while 4 patients died from HF in the RVA-pacing group within 2 years after pacemaker implantation. The paced QRS interval was significantly shorter with RVS pacing than with RVA pacing at different times after pacemaker implantation (RVS: immediately 157.8±24.0ms, after 3 months 157.3±17.5ms, after 6 months 153.6±21.7ms, after 12 months 153.6±19.4ms, after 24 months 149.3±24.0ms vs. RVA: immediately 168.3±23.7ms, after 3 months 168.7±26.0ms, after 6 months 168.0±22.8ms, after 12 months 171.2±22.3ms, after 24 months 176.1±25.5ms; p<0.05).ConclusionsRVS pacing is feasible and safe with more favorable clinical benefits than RVA pacing

Large Right Pulmonary Vein Is a Predictor of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

Pulmonary vein isolation（PVI）is an effective treatment for atrial fibrillation（AF）. However, outcomes differ between paroxysmal AF and persistent AF. We analyzed the predictors of recurrence by examining the recurrence group after ablation. Of 372 consecutive patients with AF who underwent PVI between June 2016 and December 2018, we evaluated 250 patients（age, 67±12y, 65％ men）whose left atrium（LA）was constructed using the PENTARAY catheter（BioSense Webster, Los Angeles, CA）, a multipolar electrode catheter with a novel shape and excellent mapping capability. We measured the LA total volume（LATV）, right pulmonary vein＋antrum volume（RPAV）, left PV＋antrum volume（LPAV）, LA central volume（LACV）, and LA bipolar voltage. Of the 250 patients, 78 had persistent AF（recurrence, 20）and 172 had paroxysmal AF（recurrence, 16）. In all patients, LATV, LACV, RPAV, and LPAV were significantly larger in patients with persistent AF than those with paroxysmal AF. The mean LA bipolar voltage in patients with persistent AF was significantly lower than those with paroxysmal AF. In cases of persistent AF, RPAV was significantly larger in the recurrence group than that in the non-recurrence group（15.9±4.8 vs 13.4±5.4ml; P＜0.05）. In cases of paroxysmal AF, there were no differences in any volume between the recurrence and non-recurrence groups. In conclusion, larger right PV is a predictor of AF recurrence after PVI in patients with persistent AF. The right PV is close to the atrial septum and the septopulmonary bundle, and the expansion of RPAV reflects the disruption of these structures, which may be involved in this result

Recurrence of Atrial Fibrillation within Three Months after Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation : Analysis Using an External Loop Recorder with Auto-trigger Function

Pulmonary vein isolation (PVI) via catheter ablation has been shown to be a highly effective option for patients with symptomatic paroxysmal atrial brillation (AF). The recurrence of AF within 3 months after PVI is not considered a failure of the ablation procedure because early recurrence of AF is not always associated with late recurrence. We examined the usefulness of an external loop recorder with auto-trigger function (ELR-AUTO) to detect AF following PVI to characterize early recurrence and determine the implication of AF within 3 months after PVI. The study included 53 consecutive patients with symptomatic paroxysmal AF (age, 61.6 ± 12.6 years ; 77％ male) who underwent PVI, and were fitted with an ELR-AUTO for 7 ± 2 days within 3 months after PVI. Of the 33 patients(62.2％) who did not have AF within the 3-month period, only 1 patient had AF recurrence at 12 months. Seven of 20 patients (35％) who experienced AF within 3 months had symptomatic AF recurrence at 12 months. The sensitivity, specificity, positive predictive value, and negative predictive value of early AF recurrence for late recurrence was 87.5％, 71.1％, 35.0％, and 96.9％, respectively. Thus, AF recurrence detected by ELR-AUTO within 3 months after PVI can predict late AF recurrence. Freedom from AF in the firrst 3 months following ablation significantly predicts long-term freedom from AF. An ELR-AUTO is useful for detecting symptomatic and asymptomatic AF

Molecular Identification of Rickettsial Endosymbionts in the Non-Phagotrophic Volvocalean Green Algae

Background: The order Rickettsiales comprises Gram-negative obligate intracellular bacteria (also called rickettsias) that are mainly associated with arthropod hosts. This group is medically important because it contains human-pathogenic species that cause dangerous diseases. Until now, there has been no report of non-phagotrophic photosynthetic eukaryotes, such as green plants, harboring rickettsias. Methodology/Principal Findings: We examined the bacterial endosymbionts of two freshwater volvocalean green algae: unicellular Carteria cerasiformis and colonial Pleodorina japonica. Epifluorescence microscopy using 49-6-deamidino-2phenylindole staining revealed the presence of endosymbionts in all C. cerasiformis NIES-425 cells, and demonstrated a positive correlation between host cell size and the number of endosymbionts. Strains both containing and lacking endosymbionts of C. cerasiformis (NIES-425 and NIES-424) showed a.10-fold increase in cell number and typical sigmoid growth curves over 192 h. A phylogenetic analysis of 16 S ribosomal (r)RNA gene sequences from the endosymbionts of C. cerasiformis and P. japonica demonstrated that they formed a robust clade (hydra group) with endosymbionts of various non-arthropod hosts within the family Rickettsiaceae. There were significantly fewer differences in the 16 S rRNA sequences of the rickettsiacean endosymbionts between C. cerasiformis and P. japonica than in the chloroplast 16 S rRNA or 18 S rRNA of the host volvocalean cells. Fluorescence in situ hybridization demonstrated the existence of the rickettsiacea