新たに開発された高性能紫外線照射システムによる 医療機器表面の細菌制御に関する研究

患者や医療従事者が触れる機会の多い医療機器の表面消毒は非常に重要であり、医療機器表面の汚染の度合いによっては感染の危険性を生じる。しかし、環境表面の殺菌は、清掃スタッフにより手で行われているが、拭き残しの発生や薬剤耐性菌への効果が薄いことが課題とされている。そこで、本研究においては、キセノン紫外線消毒ロボット及び消毒ポッド（LS-DP システム）を導入し、用手清拭後、紫外線照射後の２つのタイミングで各種医療機器における表面採取、培養を行い、菌コロニーの検出数から評価を行った。その結果、全ての機器において、紫外線照射後のコロニー数は清拭後に比べて有意差を持って低かった。用手清拭後に多くの菌が培養、検出され、清掃スタッフにより手で行われる清掃には物理的に清拭できない部位があり、紫外線照射を用手清拭後に行うことで消毒効果が上乗せされ、医療機器を介する院内感染の防止に有用であると示唆された

Preoperative Magnetic Resonance Imaging as a Diagnostic Aid for Hypermobile Lateral Meniscus

Background: Hypermobile lateral meniscus is difficult to diagnose with imaging due to its absence of tears or anomalies. We aimed to clarify the accuracy of the preoperative diagnosis using magnetic resonance imaging (MRI). Methods: The preoperative MRI status of the posterosuperior popliteomeniscal fascicle (sPMF), anteroinferior popliteomeniscal fascicle (iPMF), and popliteal hiatus were examined retrospectively on sagittal images in the hypermobile lateral meniscus group (n = 22) and an age- and gender-matched control group (n = 44). These statuses were evaluated by a logistic regression analysis to assess their degree of diagnostic accuracy. Results: The area under the curve (AUC) of the sPMF, iPMF, popliteal hiatus, and all three criteria combined was 0.66, 0.74, 0.64, and 0.77, respectively (low, moderate, low, and moderate accuracy, respectively). The odds ratios of the most severe type 3 forms of the sPMF, iPMF, and popliteal hiatus for hypermobile lateral meniscus were significantly high (5.50, 12.20, and 5.00, respectively). Although the diagnostic accuracy was not high enough, the significantly higher odds ratio for type 3 may indicate a hypermobile lateral meniscus. Conclusion: a definitive diagnosis of hypermobile lateral meniscus is difficult with MRI findings alone; however, MRI evaluations of the iPMF, sPMF, and the widening of popliteal hiatus can be used as an adjunct to diagnosis

Design and Synthesis of Open-Chain Hosts Having a Partial Structure of <i>p</i>-<i>tert</i>-Butylthiacalixarene

The development of separation materials for hard-to-separate molecular mixtures is highly desired from environmental and economic perspectives. Although the crystal of <i>p</i>-<i>tert</i>-butylthiacalix­[4]­arene exhibits high guest selectivity in inclusion from a mixture of molecules with similar sizes and shapes, it cannot include molecules larger than its calix cavity. To extend its guest inclusivity, we designed and synthesized an open-chain host, [3,3′-thiobis­(5-<i>tert-</i>butyl-2-hydroxybenzene)-1,1′-diyl]­diacetic acid (<b>4</b>). The competitive inclusion among toluidine isomers using compound <b>4</b> gave inclusion crystals containing the <i>p</i>-isomer in 1:1 (host/guest) ratio, with lesser amounts of other isomers and/or solvent molecules. The isomer selectivity varied between 66% and 97% depending on the solvent employed. X-ray analysis of inclusion crystals <b>4</b>·<i>p</i>-toluidine·MeCN and <b>4</b>·<i>p</i>-toluidine·(<i>o</i>-toluidine)_0.5 revealed that compound <b>4</b> includes <i>p</i>-toluidine by forming macrocyclic 2:2 inclusion complex­(es) and that its higher-order structure has vacant spaces, in which molecules other than <i>p</i>-toluidine are included. Compound <b>4</b> was then transformed into monopropyl ester <b>5</b> to fill the vacant spaces with propyl moieties. Compound <b>5</b> included <i>p</i>-toluidine with high selectivity (∼96%) without the coinclusion of other molecules, regardless of the solvent employed

Electrical vagus nerve stimulation attenuates systemic inflammation and improves survival in a rat heatstroke model.

This study was performed to gain insights into novel therapeutic approaches for the treatment of heatstroke. The central nervous system regulates peripheral immune responses via the vagus nerve, the primary neural component of the cholinergic anti-inflammatory pathway. Electrical vagus nerve stimulation (VNS) reportedly suppresses pro-inflammatory cytokine release in several models of inflammatory disease. Here, we evaluated whether electrical VNS attenuates severe heatstroke, which induces a systemic inflammatory response. Anesthetized rats were subjected to heat stress (41.5°C for 30 minutes) with/without electrical VNS. In the VNS-treated group, the cervical vagus nerve was stimulated with constant voltage (10 V, 2 ms, 5 Hz) for 20 minutes immediately after completion of heat stress. Sham-operated animals underwent the same procedure without stimulation under a normothermic condition. Seven-day mortality improved significantly in the VNS-treated group versus control group. Electrical VNS significantly suppressed induction of pro-inflammatory cytokines such as tumor necrosis factor-α and interleukin-6 in the serum 6 hours after heat stress. Simultaneously, the increase of soluble thrombomodulin and E-selectin following heat stress was also suppressed by VNS treatment, suggesting its protective effect on endothelium. Immunohistochemical analysis using tissue preparations obtained 6 hours after heat stress revealed that VNS treatment attenuated infiltration of inflammatory (CD11b-positive) cells in lung and spleen. Interestingly, most cells with increased CD11b positivity in response to heat stress did not express α7 nicotinic acetylcholine receptor in the spleen. These data indicate that electrical VNS modulated cholinergic anti-inflammatory pathway abnormalities induced by heat stress, and this protective effect was associated with improved mortality. These findings may provide a novel therapeutic strategy to combat severe heatstroke in the critical care setting

The Successful Retreatment with Glecaprevir and Pibrentasvir of Genotype 1 or 2 HCV-infected Hemodialysis Patients who Failed to Respond to NS5A and Protease Inhibitor Treatment

Clinical trials and real-world data have proven that hepatitis C virus (HCV) in most infected patients can be eradicated by direct-acting antivirals (DAAs). However, the proper retreatment regimen for hemodialysis patients with HCV infection who have previously failed to respond to DAAs has not been clarified. We herein report, for the first time, the successful retreatment with glecaprevir and pibrentasvir, of three hemodialysis patients with genotype 1 or 2 HCV infection, who had previously failed to respond to combination therapy with an HCV-NA5A inhibitor (daclatasvir) and an HCV protease inhibitor (asunaprevir)

Design and Synthesis of Open-Chain Hosts Having a Partial Structure of <i>p</i>-<i>tert</i>-Butylthiacalixarene

The development of separation materials for hard-to-separate molecular mixtures is highly desired from environmental and economic perspectives. Although the crystal of <i>p</i>-<i>tert</i>-butylthiacalix­[4]­arene exhibits high guest selectivity in inclusion from a mixture of molecules with similar sizes and shapes, it cannot include molecules larger than its calix cavity. To extend its guest inclusivity, we designed and synthesized an open-chain host, [3,3′-thiobis­(5-<i>tert-</i>butyl-2-hydroxybenzene)-1,1′-diyl]­diacetic acid (<b>4</b>). The competitive inclusion among toluidine isomers using compound <b>4</b> gave inclusion crystals containing the <i>p</i>-isomer in 1:1 (host/guest) ratio, with lesser amounts of other isomers and/or solvent molecules. The isomer selectivity varied between 66% and 97% depending on the solvent employed. X-ray analysis of inclusion crystals <b>4</b>·<i>p</i>-toluidine·MeCN and <b>4</b>·<i>p</i>-toluidine·(<i>o</i>-toluidine)_0.5 revealed that compound <b>4</b> includes <i>p</i>-toluidine by forming macrocyclic 2:2 inclusion complex­(es) and that its higher-order structure has vacant spaces, in which molecules other than <i>p</i>-toluidine are included. Compound <b>4</b> was then transformed into monopropyl ester <b>5</b> to fill the vacant spaces with propyl moieties. Compound <b>5</b> included <i>p</i>-toluidine with high selectivity (∼96%) without the coinclusion of other molecules, regardless of the solvent employed

L-Carnitine Suppresses Loss of Skeletal Muscle Mass in Patients With Liver Cirrhosis

Liver cirrhosis (LC) is a major cause of secondary sarcopenia. Sarcopenia makes the prognosis worse; thus, novel therapeutic options for sarcopenia in patients with LC are urgently required as they are currently limited. In this retrospective study, 158 patients with LC were screened, and 35 of those patients who were treated with L-carnitine for more than 6 months and for whom skeletal muscle mass changes could he evaluated by computer tomography were enrolled. Of the 158 patients, 79 patients who did not receive L-carnitine supplementation served as controls. Cases and controls were propensity score matched for age, sex, presence of hepatocellular carcinoma, and branched chain amino acid administration, and changes in skeletal muscle mass and clinical data were compared. The 35 patients who received L-carnitine supplementation and 35 propensity score-matched patients who did not receive carnitine supplementation comprised the final enrollment. Compared with control patients, patients who received L-carnitine had significantly worse liver function, which is associated with rapid progress of skeletal muscle depletion. However, loss of skeletal muscle mass was significantly suppressed in patients receiving L-carnitine, and a significant effect was observed in patient subgroups stratified by age, sex, presence of hepatocellular carcinoma, and branched chain amino acid administration. The change ratios of most laboratory data, including vitamin D and insulin-like growth factor 1 levels, were similar in the two groups, but ammonia levels were significantly less in those receiving L-carnitine. However, even in patients receiving L-carnitine but not showing an ammonia decrease, loss of skeletal muscle was significantly suppressed. Conclusion: L-carnitine suppresses loss of skeletal muscle mass and may therefore be a novel therapeutic option for sarcopenia in patients with LC