High Levels of Tetrodotoxin in the Flesh, Usually an Edible Part of the Pufferfish Takifugu flavipterus, Caused by Migration from the Skin and the Regional Characteristics of Toxin Accumulation

The consumption of a pufferfish, Takifugu flavipterus or komonfugu in Japanese, formerly known as Takifugu poecilonotus, is popular in Japan. However, T. flavipterus is frequently involved in cases of tetrodotoxin (TTX) poisoning in Japan. Although victims have usually consumed inedible parts, some cases are related to consumption of flesh. To improve the risk management of pufferfish poisoning, we studied TTX level in the flesh and skin of T. flavipterus. Ninety-seven specimens obtained from the Seto Inland Sea and landed in Fukuoka Prefecture were analyzed by liquid chromatography-tandem mass spectrometry. The flesh from six specimens was toxic (>10 MU/g = 2.2 mg/kg): one was in poor condition (not freeze–thawed); three were freeze–thawed before sample preparation; and two freshly prepared and in good condition (not freeze–thawed). The fillets were divided into outer and inner portions; the TTX levels in the outer portions were notably higher. The skin of the six specimens was moderately to extremely toxic: 165 MU/g (36.3 mg/kg) in the fresh specimen not in good condition, 600–950 MU/g (132–200 mg/kg) in freeze–thawed specimens, and 4500 and 6000 MU/g (990 and 1320 mg/kg) in the two fresh specimens. We concluded that TTX in the flesh migrated from the highly toxic skin. In addition, TTX levels in the skin appeared to be regionally specific. We recommend that toxic portions of T. flavipterus are removed as soon as possible after individuals are caught, and that fish from known highly toxic areas are not consumed

Clinical studies of 20-year graft survivals of kidney transplantations

【Objective】Good long-term kidney graft function and graft survival depend on multiple factors. This study aimed to assess the impact of donor and recipient clinical factors on 20-year graft survival after kidney transplantation (KT). 【Material and Methods】From 1987-1994, twenty-five KTs (14 living and 11 deceased donors) were performed at Ryukyu University Hospital, and 24 of these cases were followed for more than 20 years after the KTs and reviewed. Ten patients had 20 years of graft survival, and 14 experienced graft failure for some reason within 20 years after KTs. Retrospective analyses were performed to elucidate the difference in donor and recipient factors among these patients. 【Results】The death censored graft survival rates at 5, 10, 15, and 20 years were 92.0%, 83.0%, 67.0%, and 67.0% in living-donor KTs and 73.0%, 62.0%, 62.0%, and 31.0% in deceased-donor KTs, respectively. The overall graft survival rates at 5, 10, 15, and 20 years were 85.0%, 77.0%, 62.0%, and 54.0% in living-donor KTs and 63.0%, 55.0%, 45.0%, and 27.0% in deceased-donor KTs, respectively. Comparison of clinical factors between the ≥ 20-year graft survivor group (10 cases) and <20-year graft survivor group (14 cases) revealed no differences in, for example, recipient age, duration of dialysis, donor age, donor type, number of human leukocyte antigen mismatches, and occurrence of acute rejections within 1 year of KTs. However, among 13 cases of living-donor KTs, the overall graft survivals after KTs from donors older than 50 years were worse than those after KTs from donors younger than 50 years. Also, the death-censored graft survivals after KTs from donors older than 60 years were worse than those after KTs from donors younger than 60 years. Moreover, graft survivals after KTs from maternal donors were worse than those after KTs from nonmaternal living donors, and there were no 20-year graft survivors after KTs from maternal donors. 【Conclusion】Our results suggest that the principal risk factors associated with <20-year graft survival after living-donor KTs are the presence of donors older than 50 or 60 years and a maternal donor

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

Risk Profile and 1-Year Outcome of Newly Diagnosed Atrial Fibrillation in Japan - Insights From GARFIELD-AF -

Background: Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective non-interventional study of stroke prevention in patients with newly diagnosed non-valvular AF (NAVF) that is being conducted in 35 countries