Nosocomial Infection with Serratia marcescens: Comparison of Bacteriocin Types and Antibiograms between Two University Hospitals

Nosocomial distribution of Serratia marcescens at two university hospitals was studied by bacteriocin typing and antibiogram from January 1981 to July 1983, and the results were compared. The 126 strains isolated from Medical College Hospital of Oita (MCHO) consisted mainly of bacteriocin types 4 (29%), 9 (23%), 52 (19%) and 42 (6%) , and the 86 from Nagasaki University Hospital (NUH) were mainly of types 14 (20%) , 4 (17%), 9 (12%) and 26 (12%); these four types amounted to 77% and 61% respectively. Types 4 and 9 which formed a high proportion of isolates at both hospitals were apparently the most common bacteriocin types. Using 154 strains of the bacteriocin types 4 , 9, 14, 26, 42 and 52 of S. marcescens, antibiogram with 13 antimicrobial agents was tested. The strains isolated from MCHO were found to be more resistant than those from NUH. The isolates of S. marcescens at each hospital showed characteristic , different distribution in bacteriocin type and antibiogram. The close relation was not always observed between antibiograms and bacteriocin types

Clinicopathological Study of 50 Cases of Lung Cancer Associated with Silicosis

To clarify any causal relationship between lung cancer and silicosis, we studied clinicopathological findings in 50 men, mainly tunneling workers, aged from 47 to 85 years with both diseases. The histological types were : squamous cell carcinoma, 29 cases; small cell carcinoma, 10; adenocarcinoma, 6 ; large cell carcinoma, 4 ; and adenosquamous carcinoma, 1. The high frequency of cancer, particularly squamous and small cell cancer, in sites of silicotic fibrosis suggested a causal relationship, perhaps via a carcinogen. If a weak carcinogen accumulastes in fibrotic leasions, its prolonged presence may induce cancer. We believe that silica alone is rarely carcinogenic, but it may interact with polycyclin aromatic hydrocarbons from cigarette smoking or from pyrolysis, or with other substances encountered in occupational environments

Evaluation of an Experimental Animal Model for Estimating the Pathogenicity and the Efficacy of Antibiotic Treatment in Bacterial Infection

An experimental model of intracutaneous infection in the guinea pig, which was based on the study of MILES et al. (Br. J. Exp. Path. 38: 79-96, 1957) :and MASKELL (J. Med. Microbiol. 14: 131-140, 1981), was used to investigate the pathogenicity and the effect of chemotherapy with lincomycin, using 36 strains of the genus Bacteroides. The pathogenicity was estimated by intracutaneous injection of 0.1-ml quantities of bacterial suspension into guinea pigs and the value was expressed as the number of inoculated organisms required to induce a skin lesion 10 mm in diameter 24 hours after injection. Bacteroides fragilis was, on average, three times as pathogenic as non-B. fragilis strains (p<0.1). Two intramuscular injections of lincomycin were more effective than a single one against the intracutaneous infection, and the lower was the MIC value, the greater was the effect (p<0.001). This experimental animal model was simple and convenient for estimating the pathogenicity and efficacy of antimicrobial agents. However, the skin lesions were often not clear if the bacteria with low virulence were inoculated and the induced infection is not natural

A Case of Pulmonary Alveolar Proteinosis associated with Pulmonary Silicosis

A 53 years old man complaining productive cough and dyspnea admitted to a hospital on 8th March, 1982. Chest X-ray showed the fine granular shadow through out lung fields. Arterial blood gas tensions were PO2 31 torr, PCO2 27 torr and AaDO2 86 torr at pH 7.45. Transbronchial lung biopsy was performed and the microscopic findings of which showed eosinophilic, PAS positive granular materials filled in the intraalveolar space and the swelling of the alveolar lining cells. The patient was diagnosed as pulmonary alveolar proteinosis and was saved by bronchoalveolar lavage with the aid of extracorporeal circulation. Histochemical and electron microscopic observation and biochemical analysis were performed, and it was suggested that the materials accumulated in the intraalveolar space were mostly originated from the lung surfactant secreted by the pulmonary alveolar cells type II

Bronchiolitis Obliterans Organizing Pneumonia: Case Report and Review of Literature

A 69-year-old female complaining of fever, cough and dyspnea was admitted to our hospital. Chest X-ray examination showed bilateral infiltration shadows that increased in spite of antibiotics therapy. Broncho-alveolar lavage fluid analysis demonstrated an increased lymphocytes with an inverted CD4/CD8 ratio. Histopathology of lung biopsy specimens showed organizing granulation tissue in the lumens of bronchioles, alveolar ducts, and alveoli, along with mononuclear cell infiltration in the interstitium. A diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP) was thus made. The patient completely recovered by cortico steroid therapy, and is now without any indication of disease

Detection of a Fully-resolved Compton Shoulder of the Iron K-alpha Line in the Chandra X-ray Spectrum of GX 301-2

We report the detection of a fully-resolved, Compton-scattered emission line in the X-ray spectrum of the massive binary GX 301-2 obtained with the High Energy Transmission Grating Spectrometer onboard the Chandra X-ray Observatory. The iron K-alpha fluorescence line complex observed in this system consists of an intense narrow component centered at an energy of E = 6.40 keV and a redward shoulder that extends down to ~6.24 keV, which corresponds to an energy shift of a Compton back-scattered iron K-alpha photon. From detailed Monte Carlo simulations and comparisons with the observed spectra, we are able to directly constrain the physical properties of the scattering medium, including the electron temperature and column density, as well as an estimate for the metal abundance.Comment: 13 pages, 4 figures, 1 table, accepted for publication in ApJ Lette

Pathogenesis and clinical features of chronic pulmonary aspergillosis ? Is it possible to distinguish CNPA and CCPA clinically?

Background: The pathogenesis of chronic pulmonary aspergillosis (CPA) including chronic necrotizing pulmonary aspergillosis (CNPA), chronic cavitary pulmonary aspergillosis (CCPA), and simple aspergilloma (SA) has been poorly investigated. We examined all types of CPA cases with histopathological evidence to clarify the differences in pathogenesis and clinical features. Method: We searched for cases diagnosed as pulmonary aspergillosis by histopathological examination in Nagasaki University Hospital between 1964 and September 2010. All available clinical information including radiological findings were collected and analyzed. Result: We found 7, 5, 8, and 7 cases of proven CNPA, probable CNPA, CCPA, and SA, respectively. The radiograph of proven and probable CNPA was initially infiltrates or nodules that progress to form cavities with or without aspergilloma, whereas the radiograph of CCPA showed pre-existed cavities and pericavitary infiltrates with or without aspergilloma. The patients with proven and probable CNPA exhibited not only respiratory symptoms but also systemic symptoms and malnutrition. Aspergillus fumigatus was the most frequently isolated Aspergillus species (n = 14), however, Aspergillus niger was the predominant isolated species in proven CNPA cases (n = 4). Conclusion: Our data indicate that the cases with chronic infiltration, progressive cavitation, and subsequent aspergilloma formation should be diagnosed as CNPA, and the cases with pre-existed cavities showing peri-cavitary infiltrates with or without aspergilloma would mean CCPA. However, it may be difficult to distinguish the two subtypes if a series of adequate radiography films are not available. We propose the term "chronic progressive pulmonary aspergillosis (CPPA)" for the clinical syndrome including both CNPA and CCPA

Spectral evolution of GRB 060904A observed with Swift and Suzaku -- Possibility of Inefficient Electron Acceleration

We observed an X-ray afterglow of GRB 060904A with the Swift and Suzaku satellites. We found rapid spectral softening during both the prompt tail phase and the decline phase of an X-ray flare in the BAT and XRT data. The observed spectra were fit by power-law photon indices which rapidly changed from $\Gamma = 1.51^{+0.04}_{-0.03}$ to $\Gamma = 5.30^{+0.69}_{-0.59}$ within a few hundred seconds in the prompt tail. This is one of the steepest X-ray spectra ever observed, making it quite difficult to explain by simple electron acceleration and synchrotron radiation. Then, we applied an alternative spectral fitting using a broken power-law with exponential cutoff (BPEC) model. It is valid to consider the situation that the cutoff energy is equivalent to the synchrotron frequency of the maximum energy electrons in their energy distribution. Since the spectral cutoff appears in the soft X-ray band, we conclude the electron acceleration has been inefficient in the internal shocks of GRB 060904A. These cutoff spectra suddenly disappeared at the transition time from the prompt tail phase to the shallow decay one. After that, typical afterglow spectra with the photon indices of 2.0 are continuously and preciously monitored by both XRT and Suzaku/XIS up to 1 day since the burst trigger time. We could successfully trace the temporal history of two characteristic break energies (peak energy and cutoff energy) and they show the time dependence of $\propto t^{-3} \sim t^{-4}$ while the following afterglow spectra are quite stable. This fact indicates that the emitting material of prompt tail is due to completely different dynamics from the shallow decay component. Therefore we conclude the emission sites of two distinct phenomena obviously differ from each other.Comment: 19 pages, 9 figures, accepted for publication in PASJ (Suzaku 2nd Special Issue

Efficacy of Combination Therapy with Oseltamivir Phosphate and Azithromycin for Influenza: A Multicenter, Open-Label, Randomized Study

Background: Macrolides have antibiotic and immunomodulatory activities, which may have a favorable effect on the clinical outcome of patients with infections, including influenza. This study aimed to evaluate the effects of combination therapy with an anti-influenza agent, oseltamivir, and a single-dose formulation of azithromycin (AZM), which has been used for influenza-related secondary pneumonia, on influenza patients. The primary endpoint was a change in the expression levels of inflammatory cytokines. Secondary endpoints were the time required for resolution of influenza-related symptoms, incidence of complications, and adverse reactions. Methods: Patients with seasonal influenza were enrolled in this multicenter, open-label, randomized study. Patients were stratified according to the presence of a high risk factor and were randomized to receive combination therapy with oseltamivir plus an extended-release formulation of AZM (combo-group) or oseltamivir monotherapy (mono-group). Results: We enrolled 107 patients and randomized them into the mono-group (56 patients) or the combo-group (51 patients). All patients were diagnosed with influenza A infection, and none of the patients had comorbid pneumonia. Statistically significant differences were not observed in the expression levels of inflammatory cytokines and chemokines between the 2 groups. The maximum temperature in the combo-group was lower than that in the mono-group on day 3 through day 5 (p = 0.048), particularly on day 4 (p = 0.037). Conclusion: To our knowledge, this is the first prospective, randomized, clinical trial of oseltamivir and AZM combination therapy for influenza. Although the difference in inflammatory cytokine expression level was not statistically significant, combination therapy showed an early resolution of some symptoms. Name of registry: University hospital Medical Information Network (UMIN). Trial Registration no.: UMIN000005371

Probing the Disk-jet Connection of the Radio Galaxy 3C120 Observed with Suzaku

Broad line radio galaxies (BLRGs) are a rare type of radio-loud AGN, in which the broad optical permitted emission lines have been detected in addition to the extended jet emission. Here we report on deep (40ksec x4) observations of the bright BLRG 3C~120 using Suzaku. The observations were spaced a week apart, and sample a range of continuum fluxes. An excellent broadband spectrum was obtained over two decades of frequency (0.6 to 50 keV) within each 40 ksec exposure. We clearly resolved the iron K emission line complex, finding that it consists of a narrow K_a core (sigma ~ 110 eV or an EW of 60 eV), a 6.9 keV line, and an underlying broad iron line. Our confirmation of the broad line contrasts with the XMM-Newton observation in 2003, where the broad line was not required. The most natural interpretation of the broad line is iron K line emission from a face-on accretion disk which is truncated at ~10 r_g. Above 10 keV, a relatively weak Compton hump was detected (reflection fraction of R ~ 0.6), superposed on the primary X-ray continuum of Gamma ~ 1.75. Thanks to the good photon statistics and low background of the Suzaku data, we clearly confirm the spectral evolution of 3C120, whereby the variability amplitude decreases with increasing energy. More strikingly, we discovered that the variability is caused by a steep power-law component of Gamma ~2.7, possibly related to the non-thermal jet emission. We discuss our findings in the context of similarities and differences between radio-loud/quiet objects