Acute Hydrocephalus Associated with Streptococcus anginosus Meningitis

Introduction: Meningitis-related acute hydrocephalus is rare, challenging to diagnose, and has a high mortality rate.  Case description: Here we describe the case of a 76-year-old patient diagnosed with bacterial meningitis who developed acute hydrocephalus and subsequently died.  Discussion: Although meningitis-related acute hydrocephalus is usually non-occlusive, occlusive hydrocephalus may also occur. Moreover, worsening hydrocephalus despite cerebrospinal fluid drainage should prompt a diagnosis of obstructive hydrocephalus. In such conditions, potential management strategies include ventriculoperitoneal shunt and endoscopic third ventriculostomy. Conclusion: In patients with meningitis-related hydrocephalus, worsening despite appropriate antibiotic administration, treatment may be complicated by ventriculitis and obstructive hydrocephalus, which can be fatal. If intracranial pressure is not medically controlled, bilateral decompression craniectomy should be considered as a potential management strategy

Heme Orientation of Cavity Mutant Hemoglobins (His F8 → Gly) in Either α or β Subunits: Circular Dichroism, 1H NMR, and Resonance Raman Studies

Native human adult hemoglobin (Hb A) has mostly normal orientation of heme, whereas recombinant Hb A (rHb A) expressed in E. coli contains both normal and reversed orientations of heme. Hb A with the normal heme exhibits positive circular dichroism (CD) bands at both the Soret and 260-nm regions, while rHb A with the reversed heme shows a negative Soret and decreased 260-nm CD bands. In order to examine involvement of the proximal histidine (His F8) of either α or β subunits in determining the heme orientation, we prepared two cavity mutant Hbs, rHb(αH87G) and rHb(βH92G), with substitution of glycine for His F8 in the presence of imidazole. CD spectra of both cavity mutant Hbs did not show a negative Soret band, but instead exhibited positive bands with strong intensity at the both Soret and 260-nm regions, suggesting that the reversed heme scarcely exists in the cavity mutant Hbs. We confirmed by 1H NMR and resonance Raman (RR) spectroscopies that the cavity mutant Hbs have mainly the normal heme orientation in both the mutated and native subunits. These results indicate that the heme Fe-His F8 linkage in both α and β subunits influences the heme orientation, and that the heme orientation of one type of subunit is related to the heme orientation of the complementary subunits to be the same. The present study showed that CD and RR spectroscopies also provided powerful tools for the examination of the heme rotational disorder of Hb A, in addition to the usual 1H NMR technique. Chirality 28:585–592, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.Embargo Period 24 month

血清ペプシノゲン検査に基づく胃がん発生率と有効性に関する15年間のコホート研究

Objectives : The incidence of and mortality from gastric cancer in Japan have remained high and prophylaxis is important. However, the number of the individuals undergoing gastric mass radiography has decreased in recent years because the examination has a big burden at the time of the consultation. Many studies have reported the ease and effectiveness of the pepsinogen test and a higher incidence of gastric cancer in positive groups. However, the longest survey period was 10 years. Therefore, we conducted a 15-year cohort study to examine the validity of the testing period and the incidence of gastric cancer in serum pepsinogen positive and negative groups at a private company utilizing pepsinogen test. Methods : Subjects were 4383 employees who received a pepsinogen test. Subjects were followed for 15 years. For the purpose of examining the three periods over five-, 10-, and 15-year periods, we analyzed the validity of testing during each period, carried out a log-rank test, and analyzed hazard ratio in the Cox proportional hazard model. Results : The number of individuals who developed gastric cancer during the survey was nine in the five-year negative group, 18 in the five-year positive group, 16 in the 10-year negative group, 27 in the 10-year positive group, 31 in the 15-year negative group, and 29 in the 15-year positive group. The sensitivity of testing was 0.667 over the first five years, 0.628 over 10 years, and 0.483 over 15 years, and the specificity was 0.744 over the first five years, 0.745 over 10 years, and 0.745 over 15 years. The five-year incidence of gastric cancer was 57 per 100,000 person years in the negative group and 350 per 100,000 person years in the positive group. The ten-year incidences were 53 per 100,000 person years in the negative group and 279 per 100,000 person years in the positive group. The 15-year incidence was 75 per 100,000 person years in the negative group and 231 per 100,000 person years in the positive group. The hazard ratio of the positive group toward the negative group was 4.98 over the first five years, 4.71 over 10 years, and 2.76 over 15 years (p＜0.001). Conclusions : This study clarified that the first five years after the testing showed the highest hazard ratio and validity, therefore, the validity of testing was approximately 10 years. 【目的】我が国の胃がんの死亡率及び罹患率は現在も上位であり、その予防対策は重要で ある。けれども、近年X線の胃集団検診の受診者は、受診時の負担が大きいことから減少 している。一方職域の胃がん予防対策は、法的義務が無いため、企業により様々であるが 地域同様減少している。多くの先行研究では、血清ペプシノゲン検査法が簡便で有益とし ており、陽性群に発症率が高いとしているが、調査期間は最長10年であり、15年間の調査 はなかった。そこで、一企業において15年間の“陽性群”と“陰性群”での発症率の違い と検査の有効性の期間を検討することを目的にコホート調査を行った。 【方法】ペプシノゲン検査を受診した4,383名を15年間追跡した。５年間、10年間、15年間の ３期間に区切って各期間の検査の有効性を算出し、発症率をLog-rankで検定し、発症危険 度をCox比例ハザードで分析した。 【結果】追跡期間中に陰性群と陽性群のそれぞれの胃がん発症数は、５年間で９人と18人、 10年間で16人と27人、15年間で31人と29人であった。検査の感度は５年間で0.667、10年間 で0.628、15年間で0.483であり、特異度は、５年間で0.744、10年間で0.745，15年間で0.745 であった。発症率では、５年間の陰性群と陽性群で57、350per 100,000 person yearsであり、 10年では53、279 per 100,000 person years であり、15年では 75、231 per 100,000 person yearsであった。陰性群に対する陽性群の発生危険度は、５年間4.98、10年間4.71、15年間 2.76であった (p＜0.001)。 【結論】胃がんの発症率及び発症危険度や検査の有効性が最も高かったのは、2000年まで の５年間であり、検査の有効性は、約10年であることが明らかになった。Thesis of Takami Okuno / 奥野 敬生 博士論文 金沢大学医薬保健学総合研究科（保健学専攻

Proton beam therapy with concurrent chemotherapy is feasible in children with newly diagnosed rhabdomyosarcoma

BACKGROUND: The optimal treatment for rhabdomyosarcoma (RMS) requires multidisciplinary treatment with chemotherapy, surgery, and radiotherapy. Surgery and radiotherapy are integral to the local control (LC) of RMS. However, postsurgical and radiotherapy-related complications could develop according to the local therapy and tumor location. In this study, we conducted a single-center analysis of the outcomes and toxicity of multidisciplinary treatment using proton beam therapy (PBT) for pediatric RMS. MATERIALS AND METHODS: RMS patients aged younger than 20 years whose RMS was newly diagnosed and who underwent PBT at University of Tsukuba Hospital (UTH) during the period from 2009 to 2019 were enrolled in this study. The patients’ clinical information was collected by retrospective medical record review. RESULTS: Forty-eight patients were included. The 3-year progression-free survival (PFS) and overall survival (OS) rates of all the patients were 68.8% and 94.2%, respectively. The 3-year PFS rates achieved with radical resection, conservative resection, and biopsy only were 65.3%, 83.3%, and 67.6%, respectively (p = 0.721). The 3-year LC rates achieved with radical resection, conservative resection, and biopsy only were 90.9%, 83.3%, and 72.9%, respectively (p = 0.548). Grade 3 or higher mucositis/dermatitis occurred in 14 patients. Although the days of opioid use due to mucositis/dermatitis during the chemotherapy with PBT were longer than those during the chemotherapy without PBT [6.1 and 1.6 (mean), respectively, p = 0.001], the frequencies of fever and elevation of C-reactive protein were equivalent. CONCLUSIONS: Multidisciplinary therapy containing PBT was feasible and provided a relatively fair 3-year PFS, even in children with newly diagnosed RMS without severe toxicity