Perioperative management for the prevention of bacterial infection in cardiac implantable electronic device placement

AbstractCardiac implantable electronic devices (CIEDs) have become important in the treatment of cardiac disease and placement rates increased significantly in the last decade. However, despite the use of appropriate antimicrobial prophylaxis, CIED infection rates are increasing disproportionately to the implantation rate. CIED infection often requires explantation of all hardware, and at times results in death. Surgical site infection (SSI) is the most common cause of CIED infection as a pocket infection. The best method of combating CIED infection is prevention. Prevention of CIED infections comprises three phases: before, during, and after device implantation. The most critical factors in the prevention of SSIs are detailed operative techniques including the practice of proper technique by the surgeon and surgical team

Isotopic analysis of Ni, Cu, and Zn in freshwater for source identification

Nickel (Ni), copper (Cu), and zinc (Zn) are commonly used in human activities and pollute aquatic environments including rivers and oceans. Recently, Ni, Cu, and Zn isotope ratios have been measured to identify their sources and cycles in environments. We precisely determined the Ni, Cu, and Zn isotope ratios in rain, snow, and rime collected from Uji City and Mt. Kajigamori in Japan, and investigated the potential of isotopic ratios as tracers of anthropogenic materials. The isotope and elemental ratios suggested that road dust is the main source of Cu in most rain, snow, and rime samples and that some of the Cu may originate from fossil fuel combustion. Zinc in the rain, snow, and rime samples may be partially attributed to Zn in road dust. Zinc isotope ratios in the Uji rain samples are lower than those in the road dust, which would be emitted via high temperature processes. Nickel isotope ratios are correlated with V/Ni ratios in the rain, snow, and rime samples, suggesting that their main source is heavy oil combustion. Furthermore, we analyzed water samples from the Uji and Tawara Rivers and the Kakita River spring in Japan. Nickel and Cu isotope ratios in the river water samples were significantly heavier than those in rain, snow, and rime samples, while Zn isotope ratios were similar. This is attributed to isotopic fractionation of Cu and Ni between particulate-dissolved phases in river water or soil

A Disseminated Fusarium fujikuroi Species Complex Infection Prior to Allogeneic Hematopoietic Stem Cell Transplantation

A 53-year-old man was diagnosed with acute myeloid leukemia, which was refractory to chemotherapies. Systemic papules appeared afterward. The skin biopsies revealed filamentous fungal infection including fusariosis. Despite antifungal therapy, the infection did not resolve, because neutropenia persisted with the leukemia. He underwent hematopoietic stem cell transplantation (HSCT) to overcome the leukemia and restore normal hematopoiesis but died from fusariosis just before engraftment. Fusarium fujikuroi species complex was detected in blood cultures with poor antifungal susceptibility. Because restoring normal hematopoiesis is important in the treatment of fusariosis, HSCT might be considered for patients with persistent pancytopenia

Numerical study on effect of member length error on structural properties of single layer pin-joined grid dome composed of wooden truss system

p. 444-455This study examines a single layer three-way pin-jointed grid dome constructed from of wooden truss system. We show the effect of the member length error on the initial imperfection and nodal buckling behavior by the numerical analysis results considering geometrical nonlinearity. In numerical calculation, the member length errors are assumed to be a normal distribution. The distribution and magnitude of the initial axial force and displacement are evaluated with respect to the mean and SD (standard deviation) of the member length errors. The range of the initial imperfection and the tolerance of manufactured member length are also predicted by the mean and SD of the numerical results. The properties of nodal buckling load and buckling mode are also discussed. The nodal buckling load is mainly affected by the SD of member length error and the effect of mean of member length error on the buckling is secondary. When SD of member length error changes from zero to 0.10 cm, the mean of the nodal buckling load decreases by about 50 % and the area of nodal buckling mode changes from the overall dome to the inner region.Fujimoto, M.; Katayama, S.; Kaname, T.; Imai, K.; Machinaga, T. (2009). Numerical study on effect of member length error on structural properties of single layer pin-joined grid dome composed of wooden truss system. Editorial Universitat Politècnica de València. http://hdl.handle.net/10251/653

Examination of the Effective Utilization of the CARELINK® Remote Monitoring System after its Introduction

AbstractBackground: Japan started using the CARELINK® (Medtronic, Inc, Minneapolis, MN, USA) remote monitoring system in April 2009. However, in some cases, the device failed to transmit a message after registration or according to schedule. We investigated the difference between patients who could make effective use of CARELINK® system and those who could not.Subjects and Method: Sixty patients who had registered until December 2009 at our institution were analyzed. These patients were divided into two groups: those who were able to use the device effectively (group G, n = 49) and those who were not (group F = 11). Patient background, automatic or manual telemetries, new or existing implant patient, presence of adverse events, and the use or non-use of a checklist at the time of introduction were compared between the two groups.Results: In group G, more patients used a checklist at the time of introduction than that in group F (use of checklist/total, 31/49 in group G vs. 3/11 in group F; P, 0.029). No significant difference was observed in other factors between the two groups.Conclusion: We consider that the method used to explain the system are important to make the patients understand handling methods of CARELINK® system. The number of patients introduced to remote monitoring of implantable devices will continue to increase in the future; therefore, we must continue to develop innovative approaches for their effective us

Trans-vertebral Regional Cooling for Spinal Cord Protection during Thoracoabdominal Aortic Surgery : An Experimental Study

We developed a simple cooling method for spinal cord protection against ischemic injury during aortic surgery. The neuroprotective effects of our method were investigated using an animal study. Selective spinal hypothermia was produced by means of originally-designed cooling pads placed over the lower thoracic and lumbar vertebral column. Spinal cord ischemia was induced by cross-clamping the thoracic aorta for 60 min in beagle dogs. The neuroprotective effects were evaluated by a multi-modal study. The motor-evoked potentials of the spinal cord resulting from transcranial electric stimulation (MEPs) were recorded during both the ischemic and reperfusion periods. Hindlimb motor function was graded with the Tarlov score, and a histologic examination of the spinal cord injury was performed, at 24 hours after ischemia in animals undergoing hypothermia (hypothermia group: n = 7) or a sham (control group: n = 7). The spinal cord temperatures at the lower thoracic (T10) and lumbar (L3) levels decreased by -9.1°C per hour and -8.1°C per hour, respectively. The amplitude of the MEPs decreased during ischemia in both groups of animals, and significantly recovered during the early phase of aortic reperfusion in the hypothermia group. The Tarlov scores in the hypothermia and control groups were 3.3 ± 1.0 and 1.1 ± 1.5 (mean ± SD, p = 0.015), respectively. Histopathologic study revealed that ischemic injury of the lumbar cord was reduced in the animals undergoing hypothermia. Trans-vertebral regional cooling reduced ischemic spinal cord injury in a canine study. The current method is potentially feasible for clinical use, especially in view of its technical simplicity and few procedure-related complications

Canonical versus non-canonical transsynaptic signaling of neuroligin 3 tunes development of sociality in mice

社会性の発達を調節する新たな機構を発見. 京都大学プレスリリース. 2021-03-26.Neuroligin 3 (NLGN3) and neurexins (NRXNs) constitute a canonical transsynaptic cell-adhesion pair, which has been implicated in autism. In autism spectrum disorder (ASD) development of sociality can be impaired. However, the molecular mechanism underlying NLGN3-mediated social development is unclear. Here, we identify non-canonical interactions between NLGN3 and protein tyrosine phosphatase δ (PTPδ) splice variants, competing with NRXN binding. NLGN3-PTPδ complex structure revealed a splicing-dependent interaction mode and competition mechanism between PTPδ and NRXNs. Mice carrying a NLGN3 mutation that selectively impairs NLGN3-NRXN interaction show increased sociability, whereas mice where the NLGN3-PTPδ interaction is impaired exhibit impaired social behavior and enhanced motor learning, with imbalance in excitatory/inhibitory synaptic protein expressions, as reported in the Nlgn3 R451C autism model. At neuronal level, the autism-related Nlgn3 R451C mutation causes selective impairment in the non-canonical pathway. Our findings suggest that canonical and non-canonical NLGN3 pathways compete and regulate the development of sociality

Phase I/II study of alectinib in lung cancer with RET fusion gene : study protocol

Background : The rearranged during transfection (RET) fusion gene was discovered as a driver oncogene in 1-2% of non-small cell lung cancers (NSCLCs). Alectinib is an approved anaplastic lymphoma kinase (ALK) inhibitor that may also be effective for RET fusion-positive NSCLC. Methods/Design : RET fusion-positive NSCLC patients treated with at least one regimen of chemotherapy are being recruited. In step 1, alectinib (600 or 450 mg, twice daily) will be administered following a 3+3 design. The primary endpoint is safety. In step 2, alectinib will be administered at the recommended dose (RD) defined by step 1. The primary endpoint is the response rate of RET inhibitor treatment-naïve patients. Conclusion : This is the first study to investigate the safety and preliminary efficacy of alectinib in RET fusion-positive NSCLC patients. If successful, alectinib treatment may lead to substantial and important changes in the management of NSCLC with RET fusion genes

Immunological profile in a family with nephrogenic diabetes insipidus with a novel 11 kb deletion in AVPR2 and ARHGAP4 genes

<p>Abstract</p> <p>Background</p> <p>Congenital nephrogenic diabetes insipidus (NDI) is characterised by an inability to concentrate urine despite normal or elevated plasma levels of the antidiuretic hormone arginine vasopressin. We report a Japanese extended family with NDI caused by an 11.2-kb deletion that includes the entire <it>AVPR2 </it>locus and approximately half of the <it>Rho GTPase-activating protein 4 </it>(<it>ARHGAP4</it>) locus. ARHGAP4 belongs to the RhoGAP family, Rho GTPases are critical regulators of many cellular activities, such as motility and proliferation which enhances intrinsic GTPase activity.</p> <p>ARHGAP4 is expressed at high levels in hematopoietic cells, and it has been reported that an NDI patient lacking <it>AVPR2 </it>and all of <it>ARHGAP4 </it>showed immunodeficiency characterised by a marked reduction in the number of circulating CD3+ cells and almost complete absence of CD8+ cells.</p> <p>Methods</p> <p>PCR and sequencing were performed to identify the deleted region in the Japanese NDI patients. Immunological profiles of the NDI patients were analysed by flow cytometry. We also investigated the gene expression profiles of peripheral blood mononuclear cells (PBMC) from NDI patients and healthy controls in microarray technique.</p> <p>Results</p> <p>We evaluated subjects (one child and two adults) with 11.2-kb deletion that includes the entire <it>AVPR2 </it>locus and approximately half of the <it>ARHGAP4</it>. Hematologic tests showed a reduction of CD4+ cells in one adult patient, a reduction in CD8+ cells in the paediatric patient, and a slight reduction in the serum IgG levels in the adult patients, but none of them showed susceptibility to infection. Gene expression profiling of PBMC lacking <it>ARHGAP4 </it>revealed that expression of RhoGAP family genes was not influenced greatly by the lack of <it>ARHGAP4</it>.</p> <p>Conclusion</p> <p>These results suggest that loss of <it>ARHGAP4 </it>expression is not compensated for by other family members. ARHGAP4 may play some role in lymphocyte differentiation but partial loss of <it>ARHGAP4 </it>does not result in clinical immunodeficiency.</p