Electrical muscle stimulation on upper and lower limb muscles in critically ill patients

Objectives: Electrical muscle stimulation (EMS) is widely used to enhance lower limb mobilization. Although upper limb muscle atrophy is common in critically ill patients, EMS application for the upper limbs has been rarely reported. The purpose of this study was to investigate whether EMS prevents upper and lower limb muscle atrophy and improves physical function. Design: Randomized controlled trial. Setting: Two-center, mixed medical/surgical intensive care unit (ICU). Patients: Adult patients who were expected to be mechanically ventilated for >48 h and stay in the ICU for >5 days. Interventions: Forty-two patients were randomly assigned to the EMS (n = 17) or control group (n = 19). Measurements and Main Results: Primary outcomes were change in muscle thickness and cross-sectional area of the biceps brachii and rectus femoris from day 1 to 5. Secondary outcomes included incidence of ICU-acquired weakness (ICU-AW), ICU mobility scale (IMS), length of hospitalization, and amino acid levels. The change in biceps brachii muscle thickness was −1.9% vs. −11.2% in the EMS and control (p = 0.007) groups, and the change in cross-sectional area was −2.7% vs. −10.0% (p = 0.03). The change in rectus femoris muscle thickness was −0.9% vs. −14.7% (p = 0.003) and cross-sectional area was −1.7% vs. −10.4% (p = 0.04). No significant difference was found in ICU-AW (13% vs. 40%; p = 0.20) and IMS (3 vs. 2; p = 0.42) between the groups. The length of hospitalization was shorter in the EMS group (23 [19–34] vs. 40 [26–64] days) (p = 0.04). On day 3, the change in the branched-chain amino acid level was lower in the EMS group (40.5% vs. 71.5%; p = 0.04). Conclusion: In critically ill patients, EMS prevented upper and lower limb muscle atrophy and attenuated proteolysis and decreased the length of hospitalization

Cystoid Macular Edema following Treatment with Nanoparticle Albumin-Bound Paclitaxel and Atezolizumab for Metastatic Breast Cancer

Cystoid macular edema (CME) is a rare side effect associated with chemotherapy. Although the development of CME has been reported to occur following treatment with taxane drugs, such as nanoparticle albumin-bound paclitaxel (Nab-PTX), the occurrence of CME with treatment with atezolizumab has not yet been reported. Here, we report the case of a 49-year-old woman who developed CME 19 months into chemotherapy with Nab-PTX and atezolizumab. Improvement was not achieved with steroid injections into the Tenon’s sac, and Nab-PTX and atezolizumab treatments were ceased. One month later, there was subjective improvement in her symptoms. Although many reports have indicated that cessation of chemotherapy has successfully improved CME, a specific treatment for CME has not yet been established. Clinicians should be aware of the ophthalmologic side effects and offer immediate treatment if symptoms develop

中国における地域文化の観光学及び博物館学的研究―雲南省大理を事例として―

本稿は2016～2017年度の2年度に亘り実施した、板垣・落合・三浦の共同研究第2回目、大理市の調査結果をもとに考察を試みたものである。雲南省を代表する2大観光地となった麗江市と大理市は、そのまま野外博物館としての存在感を示し、また世界遺産登録の有無に関わらず世界各地から多くの観光客を集める中国有数の観光地として脚光を浴び続けている。今回の調査では、いにしえ隆盛を極めた大理市古城地区が、古鎮として当時をしのぶ姿を今日にとどめている現状、世界遺産登録が日本人観光客の観光目的化に及ぼす影響、地元民の文化としての「食」が、観光のまなざしを受ける中でどの様に変容したのかや持続的な「食」の伝統保持等の視点をもとに論究したものである

Rab11A Functions as a Negative Regulator of Osteoclastogenesis through Dictating Lysosome-Induced Proteolysis of c-fms and RANK Surface Receptors

Osteoclast differentiation and activity are controlled by two essential cytokines, macrophage colony-stimulating factor (M-CSF) and the receptor activator of nuclear factor-kappa B ligand (RANKL). Rab11A GTPase, belonging to Rab11 subfamily representing the largest branch of Ras superfamily of small GTPases, has been identified as one of the crucial regulators of cell surface receptor recycling. Nevertheless, the regulatory role of Rab11A in osteoclast differentiation has been completely unknown. In this study, we found that Rab11A was strongly upregulated at a late stage of osteoclast differentiation derived from bone marrow-derived macrophages (BMMs) or RAW-D murine osteoclast precursor cells. Rab11A silencing promoted osteoclast formation and significantly increased the surface levels of c-fms and receptor activator of nuclear factor-kappa B (RANK) while its overexpression attenuated osteoclast formation and the surface levels of c-fms and RANK. Using immunocytochemical staining for tracking Rab11A vesicular localization, we observed that Rab11A was localized in early and late endosomes, but not lysosomes. Intriguingly, Rab11A overexpression caused the enhancement of fluorescent intensity and size-based enlargement of early endosomes. Besides, Rab11A overexpression promoted lysosomal activity via elevating the endogenous levels of a specific lysosomal protein, LAMP1, and two key lysosomal enzymes, cathepsins B and D in osteoclasts. More importantly, inhibition of the lysosomal activity by chloroquine, we found that the endogenous levels of c-fms and RANK proteins were enhanced in osteoclasts. From these observations, we suggest a novel function of Rab11A as a negative regulator of osteoclastogenesis mainly through (i) abolishing the surface abundance of c-fms and RANK receptors, and (ii) upregulating lysosomal activity, subsequently augmenting the degradation of c-fms and RANK receptors, probably via the axis of early endosomes-late endosomes-lysosomes in osteoclasts

Characterization of Acinetobacter clinical isolates

Members of the genus Acinetobacter are typical opportunistic bacterial pathogens that can survive for a long term even on inanimate surfaces. Acinetobacter species have natural and acquired antibiotic resistance mechanisms that provide resistance against a broad range of antimicrobial agents. Between April 2010 and March 2011, 6 clinical Acinetobacter sp. strains were isolated from expectoration or aspiration sputum samples in a local medical treatment-type hospital in Osaka prefecture. The antibiotic susceptibility breakpoint test showed that all the 6 isolates were ciprofloxacin-resistant. Strain AHU-70, which was identified as A.baumannii by 16S rRNA sequencing and polymerase chain reaction detection of the blaOXA-51-like gene, showed high levels of resistance to ciprofloxacin by the minimum inhibitory concentration (MIC) test. Preliminary research in Japan, based on nationwide susceptibility surveillance of ciprofloxacin against A.baumannii isolates showed that approximately 90% of the isolates were ciprofloxacin-susceptible. Given these results, further strain level identification of isolates is required to determine whether resistance to ciprofloxacin is an overall trait of these bacteria in the sampled local area or is restricted to a specific strain within particular hospitals