Successful treatment of ascites accumulation and diarrhea associated with protein-losing enteropathy with oral equine placenta extract supplementation in a dog: A case report

Background: Protein-losing enteropathy (PLE) is characterized by leakage of serum proteins into the intestinal lumen, indicating hypoproteinemia. Immunosuppressive agents are the mainstay of treatment, but in many cases, patients are forced to taper off early owing to the induction of liver damage. Case Description: An 8-year-old, non-spayed female Chihuahua presented with diarrhea and ascites effusion lasting 2 weeks. Based on the results of radiography and blood tests, a diagnosis of PLE was made. Prednisolone (3 mg/kg semel in die [SID]) and MitoMax (200 mg/day) were administered, but ascites accumulation and diarrhea did not improve. Thus, azathioprine (2 mg/kg/day) was added, but there was no improvement, and liver damage developed. The liver injury did not improve immediately, but diarrhea and ascites effusion improved after serum total protein and serum albumin levels increased after they had decreased. Subsequent tapering of prednisolone from 3 mg/kg SID to 1 mg/kg SID, combined with MitoMax (200 mg/day) and equine placenta extract (eqPE) (2 ml/day), resulted in no recurrence of ascites or diarrhea. Conclusion: In canine PLE with prolonged diarrhea and ascites effusion, supplementation with eqPE may be considered a reasonable additional therapeutic strategy

Effect of Keishi-bukuryo-gan on autonomic nervous activity

桂枝茯苓丸の自律神経活動に対する効果を明らかとするために,レーザードプラ血流計,R-R間隔および収縮期血圧のスペクトル解析を用いて検討した。健常者8名を対象とし,自律神経活動の変化を桂枝茯苓丸料と微温湯において統計学的に解析した。桂枝茯苓丸により,皮膚血流量(SBF)は前値に比較して一旦15分後に減少し,90分後に有意に増加した。収縮期血圧低周波成分(SBP-LF)・収縮期血圧成分比(SBP-L/H)は前値に比較して一旦15分後に増加し,60及び90分後に有意に減少した。微温湯では有意な変化はみられなかった。SBFは交感神経活動にともない変化し,SBP-LF及びSBP-L/Hは交感神経活動と関連するとされている。今回の結果は,桂枝茯苓丸が交感神経活動に対する作用を有していることを示唆するものである。 In order to confirm any effects of Keishi-bukuryo-gan (KBG) on the autonomic nervous system, 8 healthy volunteers were evaluated with laser Doppler flowmetry and spectral analysis of the R-R intervals (RR) and systolic blood pressure (SBP). After evaluation of the "oketsu" score and measurement of the electrophysiological parameters (PRE), each subject was administered KBG or hot water. The same parameters were re-measured at 15, 30, 45, 60 and 90 minutes after their administration to each subject. Changes in the parameters after the administration of KBG or hot water were investigated compared with PRE. In the experiment with KBG, skin blood flow (SBF) was increased at 90 min, although it had been significantly decreased at 15 min. By spectral analysis, SBP-low frequency (LF) and SBP-low to high frequency ratio (L/H) were initially increased at 15 min, and then were significantly decreased at 60 and 90 min. As for hot water, there were no significant changes in any of the parameters. It is known that SBF changes with sympathetic nervous activity, and SBP-LF and SBP-L/H reflect sympathetic nervous activity. These results suggest that KBG has certain effects on sympathetic nervous activity

Immunological analysis into Kl-disorder based on traditional Japanese Oriental diagnostic system

漢方医学での病態を把握し有効方剤を選択するためには,伝統医学的手法を応用することが,現在でも最も客観的な方法であると考えられる。しかしながら,伝統医学的手法は心身・如を助炭とし,きわめて全人的な指標を中心としているが故に,西洋医学的な客観性,すなわち要素還元性に乏しいと指摘されている。この研究では気の異常を臨床免疫学的手法で客観化することを目的とした。22名の関節リウマ患者の気虚,気鬱,気逆の病態と末梢血リンパ球のサブセット(CD3, CD19, CD4,CD8, CD16, CD56, CD158a, CD158b)の関連を検討した。その結果,気虚とCD16+CD158b+cellのpopulationが有意な負の相関を示し,気虚を伴う患者群ではCD16+CD158b+cellのpopulationが少ない傾向にあった。この逆相関の関係は4名の3ヶ月の追跡研究でも観察された。このことから活性化したXK細胞の減少は,気虚の病態を呈した患者の一つの特徴と考えられる。このような検討から気虚など複雑な要素が関与する病態の一部を客観化して同一症例での経過観察などに応用可能と考えられる。ただし複雑性の科学の観点から診断への応用に関しては制限される必要がある。 Although traditional medicine is an all-around medical service, it has been pointed out that traditional medical procedures are not objective, and are independent of reductionism. The aim of this study was to determine the immune status of the patients with Kl-disorder. We assessed the association between Kl-disorder and the population of peripheral lymphocytes (CD3, CD19, CD4, CD8, CD16, CD56, CD158a/b:killer cells immunoglobulin-like receptors) in 22 patients with rheumatoid arthritis. The results showed a negative correlation between the score of Kl-deficiency and the population of the CD16+CD158b+cells, and also showed that patients with Kl-deficiency have a tendency to have a reduced population of CD16+CD158b+cells. The inverse relationship between these was also observed in a 3-month follow-up study. Thus, it is possible, in part, to assess the condition of Kl-deficiency objectively using the population of CD16+CD158b+cells. However, the diagnostic utility of CD158b+expressing cells is expected to be limited from the viewpoints of complexity

Phase I clinical trial of the vaccination for the patients with metastatic melanoma using gp100-derived epitope peptide restricted to HLA-A*2402

<p>Abstract</p> <p>Background</p> <p>The tumor associated antigen (TAA) gp100 was one of the first identified and has been used in clinical trials to treat melanoma patients. However, the gp100 epitope peptide restricted to HLA-A*2402 has not been extensively examined clinically due to the ethnic variations. Since it is the most common HLA Class I allele in the Japanese population, we performed a phase I clinical trial of cancer vaccination using the HLA-A*2402 gp100 peptide to treat patients with metastatic melanoma.</p> <p>Methods</p> <p>The phase I clinical protocol to test a HLA-A*2402 gp100 peptide-based cancer vaccine was designed to evaluate safety as the primary endpoint and was approved by The University of Tokyo Institutional Review Board. Information related to the immunologic and antitumor responses were also collected as secondary endpoints. Patients that were HLA-A*2402 positive with stage IV melanoma were enrolled according to the criteria set by the protocol and immunized with a vaccine consisting of epitope peptide (VYFFLPDHL, gp100-in4) emulsified with incomplete Freund's adjuvant (IFA) for the total of 4 times with two week intervals. Prior to each vaccination, peripheral blood mononuclear cells (PBMCs) were separated from the blood and stored at -80°C. The stored PBMCs were thawed and examined for the frequency of the peptide specific T lymphocytes by IFN-γ- ELISPOT and MHC-Dextramer assays.</p> <p>Results</p> <p>No related adverse events greater than grade I were observed in the six patients enrolled in this study. No clinical responses were observed in the enrolled patients although vitiligo was observed after the vaccination in two patients. Promotion of peptide specific immune responses was observed in four patients with ELISPOT assay. Furthermore, a significant increase of CD8⁺gp100-in4⁺CTLs was observed in all patients using the MHC-Dextramer assay. Cytotoxic T lymphocytes (CTLs) clones specific to gp100-in4 were successfully established from the PBMC of some patients and these CTL clones were capable of lysing the melanoma cell line, 888 mel, which endogenously expresses HLA-restricted gp100-in4.</p> <p>Conclusion</p> <p>Our results suggest this HLA-restricted gp100-in4 peptide vaccination protocol was well-tolerated and can induce antigen-specific T-cell responses in multiple patients. Although no objective anti-tumor effects were observed, the effectiveness of this approach can be enhanced with the appropriate modifications.</p

Geographical Differences and the National Meeting Effect in Patients with Out-of-Hospital Cardiac Arrests: A JCS-ReSS Study Report

The "national meeting effect" refers to worse patient outcomes when medical professionals attend academic meetings and hospitals have reduced staffing. The aim of this study was to examine differences in outcomes of patients with out-of-hospital cardiac arrest (OHCA) admitted during, before, and after meeting days according to meeting location and considering regional variation of outcomes, which has not been investigated in previous studies. Using data from a nationwide, prospective, population-based, observational study in Japan, we analyzed adult OHCA patients who underwent resuscitation attempts between 2011 and 2015. Favorable one-month neurological outcomes were compared among patients admitted during the relevant annual meeting dates of three national scientific societies, those admitted on identical days the week before, and those one week after the meeting dates. We developed a multivariate logistic regression model after adjusting for confounding factors, including meeting location and regional variation (better vs. worse outcome areas), using the "during meeting days" group as the reference. A total of 40,849 patients were included in the study, with 14,490, 13,518, and 12,841 patients hospitalized during, before, and after meeting days, respectively. The rates of favorable neurological outcomes during, before, and after meeting days was 1.7, 1.6, and 1.8%, respectively. After adjusting for covariates, favorable neurological outcomes did not differ among the three groups (adjusted OR (95% CI) of the before and after meeting dates groups was 1.03 (0.83-1.28) and 1.01 (0.81-1.26), respectively. The "national meeting effect" did not exist in OHCA patients in Japan, even after comparing data during, before, and after meeting dates and considering meeting location and regional variation

Improved outcomes for out-of-hospital cardiac arrest patients treated by emergency life-saving technicians compared with basic emergency medical technicians: A JCS-ReSS study report

Background Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs’ effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes. Methods In a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs. Results Included were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17–1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22–1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72–2.11) compared with the BEMT group. However, ELSTs’ limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes. Conclusions Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA

Prehospital predicting factors using a decision tree model for patients with witnessed out-of-hospital cardiac arrest and an initial shockable rhythm

The effect of prehospital factors on favorable neurological outcomes remains unclear in patients with witnessed out-of-hospital cardiac arrest (OHCA) and a shockable rhythm. We developed a decision tree model for these patients by using prehospital factors. Using a nationwide OHCA registry database between 2005 and 2020, we retrospectively analyzed a cohort of 1,930,273 patients, of whom 86,495 with witnessed OHCA and an initial shockable rhythm were included. The primary endpoint was defined as favorable neurological survival (cerebral performance category score of 1 or 2 at 1 month). A decision tree model was developed from randomly selected 77,845 patients (development cohort) and validated in 8650 patients (validation cohort). In the development cohort, the presence of prehospital return of spontaneous circulation was the best predictor of favorable neurological survival, followed by the absence of adrenaline administration and age. The patients were categorized into 9 groups with probabilities of favorable neurological survival ranging from 5.7 to 70.8% (areas under the receiver operating characteristic curve of 0.851 and 0.844 in the development and validation cohorts, respectively). Our model is potentially helpful in stratifying the probability of favorable neurological survival in patients with witnessed OHCA and an initial shockable rhythm.Tateishi K., Saito Y., Yasufuku Y., et al. Prehospital predicting factors using a decision tree model for patients with witnessed out-of-hospital cardiac arrest and an initial shockable rhythm. Scientific Reports 13, 16180 (2023); https://doi.org/10.1038/s41598-023-43106-w

炭素窒素安定同位体比を用いた広島湾の海産生物24種の栄養段階の推定

本研究は広島湾に生息する魚類や頭足類などの栄養段階を炭素・窒素安定同位体分析を用いて明らかにした。分析した魚類の中で最もδ15N値が低かったのはカタクチイワシとサヨリの14.4‰で，逆に高かったのはカサゴの16.8‰であった。δ13C 値が低かったのはサヨリとスズメダイの-17.6‰で，高かったのはマダイとシロギスの-15.3‰であった。頭足類を加えると，アオリイカのδ15N 値とδ13C 値は最も高く，それぞれ17.3‰と-14.8‰であった。このような種間の栄養段階の違いは，食性や栄養源の違いを反映していると考えられた。本研究結果は，瀬戸内海でも屈指の漁場として知られている広島湾において，魚類資源の持続的利用を行うために有益な知見となるであろう。Stable isotopes can provide useful knowledge about sources and processes within an ecosystem. The stable isotopes of carbon (δ13C) and nitrogen (δ15N) were used to investigate trophic relationships of relatively commercially important 21 finfish species, cephalopods in Hiroshima Bay. Among 21 finfish species, the lowest mean δ15N of 14.4‰ was recorded for Engraulis japonicus and Hyporhamphus sajori while the highest mean δ15N of 16.8‰ was recorded for Sebasticus marmoratus. The lowest and highest mean δ13C were noted -17.6‰ for Chromis notata and H. sajori, and -15.3‰ for Pagrus major and Sillago japonica, respectively. Including with cephalopods, the highest mean δ13C and δ15N noted at -14.8‰ and 17.3‰ for Sepioteuthis lessoniana. Information of stable isotope variation and trophic level in aquatic species of Hiroshima Bay can be used for monitoring and managing sustainable fisheries