New evaluation method for postoperative scar redness

Even after successful operations, ugly postoperative skin scars are often distressing to patients and their parents. To judge the success of surgical methods and postoperative treatment, postoperative scars should be evaluated using a quantitative system. Height and width are easily measured, but scar redness is not. We have developed a simple and effective method for evaluating scar redness. According to the color definitions employed in computer graphics, each color can be expressed as RGB (red, green or blue) coordinates (r, g, b): 0 &#8806; r, g, b &#8806; 10. The degree of scar redness is defined by the following formula: redness score (RS) = (r1 - r0)2 + (g1 - g0)2 + (b1 - b0)2. Here, (R1, g1, b1) = coordinates of the scar color and (r0, g0, b0) = coordinates of the surrounding skin color. RS was evaluated in 59 children (35 males, 24 females; ages 1 month to 12 years old) who had scar redness after congenital cardiac surgery. For each patient, scar color and surrounding skin color was identified on the color sample table. Scar redness was also evaluated by the conventional grading method: 1 = mild, 2 = moderate and 3 = severe. The RS of the colored scars ranged from 4 to 100 (38 ± 27). By the conventional grading method, 44 scars were grade 1, 15 grade 2 and none grade 3. RS was significantly higher among grade 2 than grade 1 patients, 52 ± 25 and 33 ± 27, respectively (P &#60; 0.05). Given its subjectivity, the conventional grading method yields variable data; surrounding skin color, moreover, is not considered. Our new evaluation method using RS effectively and accurately defines scar and skin colors, and allows quantitative studies of these factors.</p

Molecularly Engineered “Janus GroEL”: Application to Supramolecular Copolymerization with a Higher Level of Sequence Control

Herein we report the synthesis and isolation of a shape-persistent Janus protein nanoparticle derived from the biomolecular machine chaperonin GroEL (^AGroEL^B) and its application to DNA-mediated ternary supramolecular copolymerization. To synthesize ^AGroEL^B with two different DNA strands A and B at its opposite apical domains, we utilized the unique biological property of GroEL, i.e., Mg²⁺/ATP-mediated ring exchange between ^AGroEL^A and ^BGroEL^B with their hollow cylindrical double-decker architectures. This exchange event was reported more than 24 years ago but has never been utilized for molecular engineering of GroEL. We leveraged DNA nanotechnology to purely isolate Janus ^AGroEL^B and succeeded in its precision ternary supramolecular copolymerization with two DNA comonomers, A** and B*, that are partially complementary to A and B in ^AGroEL^B, respectively, and programmed to self-dimerize on the other side. Transmission electron microscopy allowed us to confirm the formation of the expected dual-periodic copolymer sequence −(^(B*/B)GroEL^(A/A**/A**/A)GroEL^(B/B*))– in the form of a laterally connected lamellar assembly rather than a single-chain copolymer

Heat shock protein 72 expression in the right ventricle of patients undergoing congenital cardiac surgery.

While heat shock protein (HSP) 72 is known as a stress protein, there have been no reports of HSP 72 expression in patients who have undergone surgery for congenital heart disease. Fourteen patients (7 males and 7 females) who had undergone surgery for congenital heart disease were studied. The ages of the patients ranged from 2 months to 43 years old (mean 6.5 +/- 10.8 years old; median 3.0 years old). The diagnoses were Tetralogy of Fallot in seven, pulmonary atresia with ventricular septal defect (VSD) in three, complex anomalies in three, and VSD in one patient. Histological study and HSP analysis using Western blots and immunostaining with anti-HSP 72 monoclonal antibody were performed for right ventricular muscle samples resected during the surgery. The histological findings showed hypertrophic changes of ventricular cardiomyocytes in all samples studied. Western blots detected HSP 72 expression of various degrees in all specimens. Immunostaining using monoclonal antibody against HSP 72 showed that the protein was present in the nuclei and cytoplasm of cardiomyocytes. In conclusion, although it is difficult to determine the cause of the &#34;stress&#34; that triggers HSP 72 expression in cardiomyocytes, low O2 saturation and pressure overload might act as a &#34;stress&#34;, and the only common factor that induced HSP 72 in every sample was hypertrophy.</p

Dynamic Trend of Myocardial Edema in Takotsubo Syndrome: A Serial Cardiac Magnetic Resonance Study

BACKGROUND The wall motion abnormalities of the left ventricle (LV) in takotsubo syndrome (TTS) are known to be transient and completely recover within a few weeks. However, there is little information about the relationship between functional recovery and tissue characteristics. The aim of this study was to investigate the recovery process of TTS using cardiovascular magnetic resonance (CMR). METHODS Consecutive patients with TTS were prospectively enrolled. We performed serial CMR in the acute phase (<72 h after admission), the subacute phase (7-10 days after admission) and the chronic phase (3 months later). To assess the degree of myocardial edema quantitatively, we evaluated the signal intensity of myocardium on T2-weighted images and calculated the signal intensity ratio compared with the skeletal muscle. RESULTS Fifteen patients with TTS were enrolled. CMR demonstrated reduced LV ejection fraction in the acute phase, and it recovered almost completely by the subacute phase. On the other hand, severe myocardial edema was still observed in the subacute phase, associated with increased LV mass. The highest signal intensity ratio in the subacute phase was correlated with the maximum voltage of negative T wave on electrocardiogram (r = 0.57, p = 0.03). CONCLUSIONS In patients with TTS, myocardial edema associated with increased LV mass still remained in the subacute phase despite functional recovery of the LV. Electrocardiogram may be useful to assess the degree of myocardial edema in the subacute phase. Our study suggests that myocardial ischemia might have a central role in developing TTS

COPD 急性増悪後1 年間における再入院に関連する入院中の因子

研究論文Original Articles【目的】本研究の目的は，COPD 急性増悪患者を対象に，退院後1 年間の再入院に関連する因子を明らかにすることであった．【方法】対象は2014 年4 月から2016 年9 月にCOPD 急性増悪の診断で入院し，退院後1 年間の追跡が可能な46 例（平均年齢78.0 ± 8.0 歳）であった．退院後1 年間の再入院の有無で2 群に分け，入院時のデータを電子カルテより収集し，分析を行った．【結果】再入院群は15 例，非再入院群は31 例であった．2 群間の比較では過去の増悪歴（60% vs 29%,p=0.04）に有意差があり，理学療法開始までの日数（5.0 ± 3.0 日vs 3.4 ± 1.7 日，p=0.07）は有意差がなかった．多重ロジスティック回帰分析の結果，過去の増悪歴（OR：4.45，95%CI：1.09-18.2）と理学療法開始までの日数（OR：1.41，95%CI：1.03-1.93）が退院後1 年間の再入院と関連していた．【結論】本研究の結果，急性増悪後の理学療法介入開始の遅延は，退院後1 年間の再入院リスクを増加させる可能性が示唆された．急性増悪後早期の理学療法介入は，再入院の予防に有効である可能性がある．Purpose　The purpose of this study was to clarify the factors related to readmission for one year after discharge in patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease（ COPD）.Method　Among patients who were admitted with a diagnosis of acute exacerbation of COPD between April 2014 and September 2016, 46 patients （mean age 78.0 ± 8.0 years old） who could be followed-up for one year after discharge were evaluated. The subjects were divided into two groups based on whether or not they were re-hospitalized within one year after being discharged, and data from the time of the first admission was collected from their electronic medical records and analyzed.Result　15 patients were included in the readmission group and 31 patients in the non-readmission group. There was a significant difference in previous history of exacerbations （60% vs. 29%, p = 0.04） between the two groups, and a borderline difference in the number of days to commencement of physical therapy （5.0 ± 3.0 days vs. 3.4 ± 1.7, p = 0.07）. Multiple logistic regression analysis revealed that previous history of exacerbations（ OR: 4.45, 95% CI: 1.09 - 18.2） and the number of days to commencing physical therapy （OR: 1.41, 95% CI: 1.03 - 1.93） were related to readmission rate.Conclusion　The findings of this study suggest that a delay in the start of physical therapy after acute exacerbation of COPD might increase the risk of readmission for one year after discharge of the patient from the hospital. Early physical therapy intervention after acute exacerbation of COPD might be effective in preventing readmission due to further exacerbations

Potential use of COX-2–aromatase inhibitor combinations in breast cancer

Cyclooxygenase-2 (COX-2) is overexpressed in several epithelial tumours, including breast cancer. Cyclooxygenase-2-positive tumours tend to be larger, higher grade, node-positive and HER-2/neu-positive. High COX-2 expression is associated with poor prognosis. Cyclooxygenase-2 inhibition reduces the incidence of tumours in animal models, inhibits the development of invasive cancer in colorectal cancer and reduces the frequency of polyps in familial adenomatous polyposis (FAP). These effects may be as a result of increased apoptosis, reduced angiogenesis and/or proliferation. Studies of COX-2 inhibitors in breast cancer are underway both alone and in combination with other agents. There is evidence to suggest that combining COX-2 inhibitors with aromatase inhibitors, growth factor receptor blockers, or chemo- or radiotherapy may be particularly effective. Preliminary results from combination therapy with celecoxib and exemestane in postmenopausal women with advanced breast cancer showed that the combination increased the time to recurrence. Up to 80% of ductal carcinomas in situ (DCISs) express COX-2, therefore COX-2 inhibition may be of particular use in this situation. Cyclooxygenase-2 expression correlates strongly with expression of HER-2/neu. As aromatase inhibitors appear particularly effective in patients with HER-2/neu-positive tumours, the combination of aromatase inhibitors and COX-2 inhibitors may be particularly useful in both DCIS and invasive cancer