Classification of Primary Hepatolithiasis According to Morphology of the Liver, Especially Atrophy of Hepatic Parenchyma

One hundred twenty one patients with primary hepatolithiasis (PHL) was encountered for the last 7 years. In order to elucidate how to follow and treat PHL, PHL was classified into five types (I-V) on the basis of morphological findings obtained by CT. It depends mainly on the presence of atrophy of hepatic parenchyma (AHP) and dilatation of intrahepatic bile ducts (DIBD). Methods of treatment were selected for each patient according to the classification. Type I patients comprised of 43.8% in observation group. These patient were asymptomatic and just followed since neither APH nor DIBD were observed. The remaining patients in the observation group, operation was refused or contraindicated. Most of them were asymptomatic. Surgical treatments were done on 47 patients (hepatic resection in 32 patients, surgical lithotomy in 10 and others in 5). In Type III, IV and V, hepatic resection was often performed to remove all of stones and bile stasis since improvement in hepatic function could not be expected in view of AHP. All patients were followed-up 79 months or less. In the surgically terated patients, recurrence was not observed. In observation group, no new symptome developed during the follow-up period. It was suggested, therefore, that the present classification of PHL was helpful in determining therapeutic strategy for PHL

Effects of 6-month eicosapentaenoic acid treatment on postprandial hyperglycemia, hyperlipidemia, insulin secretion ability, and concomitant endothelial dysfunction among newly-diagnosed impaired glucose metabolism patients with coronary artery disease. An open label, single blinded, prospective randomized controlled trial

Additional file 2: Table S2. Comparison of cookie meal test data between baseline and 6 months, and comparison of absolute change from baseline among patients with baseline plasma glucose <110 mg/dL

Transmission dynamics of seasonal influenza in a remote island population.

Seasonal influenza outbreaks remain an important public health concern, causing large numbers of hospitalizations and deaths among high-risk groups. Understanding the dynamics of individual transmission is crucial to design effective control measures and ultimately reduce the burden caused by influenza outbreaks. In this study, we analyzed surveillance data from Kamigoto Island, Japan, a semi-isolated island population, to identify the drivers of influenza transmission during outbreaks. We used rapid influenza diagnostic test (RDT)-confirmed surveillance data from Kamigoto island, Japan and estimated age-specific influenza relative illness ratios (RIRs) over eight epidemic seasons (2010/11 to 2017/18). We reconstructed the probabilistic transmission trees (i.e., a network of who-infected-whom) using Bayesian inference with Markov-chain Monte Carlo method and then performed a negative binomial regression on the inferred transmission trees to identify the factors associated with onwards transmission risk. Pre-school and school-aged children were most at risk of getting infected with influenza, with RIRs values consistently above one. The maximal RIR values were 5.99 (95% CI 5.23, 6.78) in the 7-12 aged-group and 5.68 (95%CI 4.59, 6.99) in the 4-6 aged-group in 2011/12. The transmission tree reconstruction suggested that the number of imported cases were consistently higher in the most populated and busy districts (Tainoura-go and Arikawa-go) ranged from 10-20 to 30-36 imported cases per season. The number of secondary cases generated by each case were also higher in these districts, which had the highest individual reproduction number (Reff: 1.2-1.7) across the seasons. Across all inferred transmission trees, the regression analysis showed that cases reported in districts with lower local vaccination coverage (incidence rate ratio IRR = 1.45 (95% CI 1.02, 2.05)) or higher number of inhabitants (IRR = 2.00 (95% CI 1.89, 2.12)) caused more secondary transmissions. Being younger than 18 years old (IRR = 1.38 (95%CI 1.21, 1.57) among 4-6 years old and 1.45 (95% CI 1.33, 1.59) 7-12 years old) and infection with influenza type A (type B IRR = 0.83 (95% CI 0.77, 0.90)) were also associated with higher numbers of onwards transmissions. However, conditional on being infected, we did not find any association between individual vaccination status and onwards transmissibility. Our study showed the importance of focusing public health efforts on achieving high vaccine coverage throughout the island, especially in more populated districts. The strong association between local vaccine coverage (including neighboring regions), and the risk of transmission indicate the importance of achieving homogeneously high vaccine coverage. The individual vaccine status may not prevent onwards transmission, though it may reduce the severity of infection

Visualization of the radiofrequency lesion after pulmonary vein isolation using delayed enhancement magnetic resonance imaging fused with magnetic resonance angiography

AbstractBackgroundThe radiofrequency (RF) lesions for atrial fibrillation (AF) ablation can be visualized by delayed enhancement magnetic resonance imaging (DE-MRI). However, the quality of anatomical information provided by DE-MRI is not adequate due to its spatial resolution. In contrast, magnetic resonance angiography (MRA) provides similar information regarding the left atrium (LA) and pulmonary veins (PVs) as computed tomography angiography. We hypothesized that DE-MRI fused with MRA will compensate for the inadequate image quality provided by DE-MRI.MethodsDE-MRI and MRA were performed in 18 patients who underwent AF ablation (age, 60±9 years; LA diameter, 42±6mm). Two observers independently assessed the DE-MRI and DE-MRI fused with MRA for visualization of the RF lesion (score 0–2; where 0: not visualized and 2: excellent in all 14 segments of the circular RF lesion).ResultsDE-MRI fused with MRA was successfully performed in all patients. The image quality score was significantly higher in DE-MRI fused with MRA compared to DE-MRI alone (observer 1: 22 (18, 25) vs 28 (28, 28), p<0.001; observer 2: 24 (23, 25) vs 28 (28, 28), p<0.001).ConclusionsDE-MRI fused with MRA was superior to DE-MRI for visualization of the RF lesion owing to the precise information on LA and PV anatomy provided by DE-MRI