A case of milk allergy that presented anaphylaxis after cutaneous contact with allergen

ABSTRACTMilk allergy in a 1-year and 8-month-old boy is reported. At 1 year and 1 month of age, the patient presented with anaphylaxis, including erythema, which was initially localized to the contact site of the anterior chest, and wheezing accompanied by dyspnea, 5 min after contact with milk allergen through his atopic skin. These symptoms continued for 50 min. Seventy minutes after the disappearance of the initial erythema, the patient developed subsequent erythematous lesions distributed throughout the neck and head area that persisted for as long as 24 h. On another occasion, he also exhibited a pale face and generalized erythema immediately after an accidental oral ingestion of milk at the age of 1 year and 8 months. He had been unsettled for several hours when an intravenous steroid was administered. His serum IgE was 590 IU/mL and the radioallergosorbent test (RAST) scores against milk, α-lactoalbumin, β-lactoglobulin, casein and cheese were 5, 2, 3, 5 and 5, respectively. This is a rare case of a patient with milk allergy who fell into anaphylaxis following both cutaneous contact with and oral ingestion of the offending milk protein. Care should be taken with patients with food allergies because cutaneous contact with the offending food may cause adverse reactions, including anaphylaxis

The resting microstate networks (RMN): cortical distributions, dynamics, and frequency specific information flow

A brain microstate is characterized by a unique, fixed spatial distribution of electrically active neurons with time varying amplitude. It is hypothesized that a microstate implements a functional/physiological state of the brain during which specific neural computations are performed. Based on this hypothesis, brain electrical activity is modeled as a time sequence of non-overlapping microstates with variable, finite durations (Lehmann and Skrandies 1980, 1984; Lehmann et al 1987). In this study, EEG recordings from 109 participants during eyes closed resting condition are modeled with four microstates. In a first part, a new confirmatory statistics method is introduced for the determination of the cortical distributions of electric neuronal activity that generate each microstate. All microstates have common posterior cingulate generators, while three microstates additionally include activity in the left occipital/parietal, right occipital/parietal, and anterior cingulate cortices. This appears to be a fragmented version of the metabolically (PET/fMRI) computed default mode network (DMN), supporting the notion that these four regions activate sequentially at high time resolution, and that slow metabolic imaging corresponds to a low-pass filtered version. In the second part of this study, the microstate amplitude time series are used as the basis for estimating the strength, directionality, and spectral characteristics (i.e., which oscillations are preferentially transmitted) of the connections that are mediated by the microstate transitions. The results show that the posterior cingulate is an important hub, sending alpha and beta oscillatory information to all other microstate generator regions. Interestingly, beyond alpha, beta oscillations are essential in the maintenance of the brain during resting state.Comment: pre-print, technical report, The KEY Institute for Brain-Mind Research (Zurich), Kansai Medical University (Osaka

Innovations orthogonalization: a solution to the major pitfalls of EEG/MEG "leakage correction"

The problem of interest here is the study of brain functional and effective connectivity based on non-invasive EEG-MEG inverse solution time series. These signals generally have low spatial resolution, such that an estimated signal at any one site is an instantaneous linear mixture of the true, actual, unobserved signals across all cortical sites. False connectivity can result from analysis of these low-resolution signals. Recent efforts toward "unmixing" have been developed, under the name of "leakage correction". One recent noteworthy approach is that by Colclough et al (2015 NeuroImage, 117:439-448), which forces the inverse solution signals to have zero cross-correlation at lag zero. One goal is to show that Colclough's method produces false human connectomes under very broad conditions. The second major goal is to develop a new solution, that appropriately "unmixes" the inverse solution signals, based on innovations orthogonalization. The new method first fits a multivariate autoregression to the inverse solution signals, giving the mixed innovations. Second, the mixed innovations are orthogonalized. Third, the mixed and orthogonalized innovations allow the estimation of the "unmixing" matrix, which is then finally used to "unmix" the inverse solution signals. It is shown that under very broad conditions, the new method produces proper human connectomes, even when the signals are not generated by an autoregressive model.Comment: preprint, technical report, under license "Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)", https://creativecommons.org/licenses/by-nc-nd/4.0

Biomechanical Study of Cervical Posterior Decompression

Study Design Biomechanical study. Purpose We examined the dynamic characteristics of different operative procedures using three-dimensional finite-element models. Overview of Literature Cervical laminoplasty is often selected for patients requiring multilevel spinal decompression. Many laminoplasty techniques have been developed and are continually being improved. Methods Images were extracted for the two intervertebral joints between C3 and C5 in domestic rabbits. The following models were created: preoperative, laminectomy, Z-plasty, open door laminoplasty, French open door laminoplasty, en-bloc laminoplasty, and double-door laminoplasty. The loads required for sagittal rotation of 2.5°, 5°, and 7.5° were measured in vitro and respectively placed at the bottom of the C5 model. Displacement of the plate in the X, Y, and Z coordinates was measured and the rotational angles of the plate were determined. Results The sagittal rotation angle was greater in the laminectomy model than in the preoperative model, but was almost the same in the preoperative and Z-plasty models. Compared with the preoperative model, sagittal rotation angles were smaller in the French open door, open door, en-bloc, and double-door laminoplasty models. Conclusions Laminectomy and various types of laminoplasty are associated with different mechanical features, such as stability and mobility, allowing for selection of the most appropriate surgical procedure for each case

Use of the ICU Nurse-Physician Questionnaire (ICU N-P-Q): Testing reliability and validity in neonatal intensive care units in Japan

Objective: Although communication among health providers has become a critical part of improving quality of care, few studies on this topic have been conducted in Japan. This study aimed to examine the reliability and validity of the Intensive Care Unit Nurse-Physician Questionnaire (ICU N-P-Q) for use among nurses and physicians in neonatal ICUs (NICUs) in Japan. Methods: A Japanese translation of the ICU N-P-Q was administered to physicians and nurses working at 40 NICUs across Japan, which were participating in the Improvement of NICU Practice and Team Approach Cluster randomized controlled trial (INTACT). We used the principal components analysis to evaluate the factor structure of the instruments. Convergent validity was assessed by examining correlations between the subscales of Communication and Conflict Management of the ICU N-P-Q and the subscales and total score of the Nurse-Physician Collaboration Scale (NPCS). Correlations between the subscales of Communication and Conflict Management by correlation with scales that refer to performance, including Job Satisfaction and Unit Effectiveness, were calculated to test the criterion validity. Results: In total, 2006 questionnaires were completed by 316 physicians and 1690 nurses. The exploratory factor analysis revealed 15 factors in the physicians' questionnaire and 12 in the nurses' questionnaire. Convergent validity was confirmed, except for 'Between-group Accuracy' and 'Cooperativeness' in the physicians' scale, and for 'Between-group Accuracy' and 'Sharing of Patient Information' in the nurses' scale. Correlations between the subscales of communication and outcomes were confirmed in the nurses' questionnaire but were not fully supported in the physicians' questionnaire. Conclusions: Although the psychometric property behaved somewhat differently by occupation, the present findings provide preliminary support for the utility of the common item structure with the original scale, to measure the degree and quality of communication and collaboration among staff at NICUs and similar healthcare settings in Japan. Trial registration number: UMIN000007064; Pre-results

Lamivudine treatment in patients with HBV-related hepatocellular carcinoma--using an untreated, matched control cohort.

Lamivudine is widely used to treat patients with hepatitis B. However, the outcomes in patients with hepatocellular carcinoma (HCC) treated with lamivudine have not been established. This study was conducted to evaluate the outcomes of lamivudine treatment for patients with HCC using an untreated, matched control group. Thirty patients with controlled HCC orally received lamivudine. As controls, 40 patients with HCC who were not treated with lamivudine and matched for clinical features were selected. The lamivudine-treated and untreated groups were compared with respect to changes in liver function, HCC recurrence, survival, and cause of death. In the lamivudine-treated group, there was significant improvement in the Child-Pugh score at 24 months after starting treatment, while no improvement was observed in the untreated group. There was no significant difference in the cumulative incidence of HCC recurrence and survival between the groups. However, there was a significant difference in the cumulative incidence of death due to liver failure (P= 0.043). A significant improvement in liver function was achieved by lamivudine treatment, even in patients with HCC. These results suggest that lamivudine treatment for patients with HCC may prevent death due to liver failure. Further prospective randomized studies using a larger number of patients are required.</p

Protocol of a Prospective Observational Study on the Relationship Between Glucose Fluctuation and Cardiovascular Events in Patients with Type 2 Diabetes

IntroductionA recent study demonstrated that large glucose fluctuations were associated with an increased incidence of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) and acute myocardial infarction. However, it is unknown whether glucose fluctuations are related to the incidence of CVD or the progression of atherosclerosis in patients with T2DM with no apparent history of CVD. In this protocol, we will be investigating the relationships of glucose fluctuations evaluated by continuous glucose monitoring (CGM) to the incidence of composite cardiovascular events and the progression of atherosclerosis in patients with T2DM who had no apparent history of CVD.MethodsThis is a prospective, multicenter, 5-year follow-up observational study. Between April 2018 and October 2019, 1000 participants are expected to be recruited at 34 medical institutions. CGM using FreeStyle Libre Pro is useful for evaluating glucose fluctuations by continuously monitoring glucose levels in interstitial fluid for up to 14 days. The primary study outcome is the relationship between fluctuations in glucose levels evaluated by CGM and the incidence of composite cardiovascular events. Secondary outcomes include the relationships of fluctuations in glucose levels evaluated by CGM to changes in carotid intima media thickness evaluated by echography or grayscale median (an index of tissue characteristics of the carotid wall), brachial–ankle pulse wave velocity, development or progression of diabetic retinopathy or nephropathy, quality-of-life-related diabetes therapy, quality of sleep, development of dementia, and autonomic nerve function.Planned OutcomeThis protocol is designed to investigate the relationship between glucose fluctuations and the incidence of composite cardiovascular events. We completed the registration of 1000 participants in March 2019. Thus, results will be available in 2024. We expect that evaluating glucose fluctuations will aid the identification of patients with a high probability of developing CVD.Trial RegistrationClinicalTrials.gov identifier, UMIN000032325

Graphene oxide scaffold accelerates cellular proliferative response and alveolar bone healing of tooth extraction socket

Graphene oxide (GO) consisting of a carbon monolayer has been widely investigated for tissue engineering platforms because of its unique properties. For this study, we fabricated a GO-applied scaffold and assessed the cellular and tissue behaviors in the scaffold. A preclinical test was conducted to ascertain whether the GO scaffold promoted bone induction in dog tooth extraction sockets. For this study, GO scaffolds were prepared by coating the surface of a collagen sponge scaffold with 0.1 and 1 μg/mL GO dispersion. Scaffolds were characterized using scanning electron microscopy (SEM), physical testing, cell seeding, and rat subcutaneous implant testing. Then a GO scaffold was implanted into a dog tooth extraction socket. Histological observations were made at 2 weeks postsurgery. SEM observations show that GO attached to the surface of collagen scaffold struts. The GO scaffold exhibited an interconnected structure resembling that of control subjects. GO application improved the physical strength, enzyme resistance, and adsorption of calcium and proteins. Cytocompatibility tests showed that GO application significantly increased osteoblastic MC3T3-E1 cell proliferation. In addition, an assessment of rat subcutaneous tissue response revealed that implantation of 1 μg/mL GO scaffold stimulated cellular ingrowth behavior, suggesting that the GO scaffold exhibited good biocompatibility. The tissue ingrowth area and DNA contents of 1 μg/mL GO scaffold were, respectively, approximately 2.5-fold and 1.4-fold greater than those of the control. Particularly, the infiltration of ED2-positive (M2) macrophages and blood vessels were prominent in the GO scaffold. Dog bone-formation tests showed that 1 μg/mL GO scaffold implantation enhanced bone formation. New bone formation following GO scaffold implantation was enhanced fivefold compared to that in control subjects. These results suggest that GO was biocompatible and had high bone-formation capability for the scaffold. The GO scaffold is expected to be beneficial for bone tissue engineering therapy