Ventriculoperitoneal Shunt Outcomes among Infants

Ventriculoperitoneal shunts (VPSs) are used for the treatment of hydrocephalus. Here we analyzed the outcomes of VPS placements in 24 infants to determine the risk factors for shunt failure. The infants had undergone the initial VPS operation in our hospital between March 2005 and December 2013. They were observed until the end of January 2014. We obtained Kaplan-Meier curves and performed a multivariate Cox regression analysis of shunt failure. Of the 24 cases, the median (range) values for gestational age, birth weight, and birth head circumference (HC) were 37 (27-39) wks, 2,736 (686-3,788) g, and 35.3 (23.0-45.3) cm, respectively. The total number of shunt procedures was 45. Shunt failure rates were 0.51/shunt and 0.0053/shunt/year. Shunt infection rates were 0.13/shunt and 0.0014/shunt/year. The Kaplan-Meier analysis revealed an increased risk for shunt failure in infants ＜1 month old or in the HC ＞90ｵtile. The Cox regression analysis yielded hazard ratios (HRs) of 2.93 (95ｵ confidence interval (CI), 0.96-10.95, p＝0.059) for age ＜1 month, and 4.46 (95ｵCI:1.20-28.91,p＝0.023) for the HC ＞90ｵtile. The multivariate Cox regression analysis showed adjusted HRs of 17.56 (95ｵCI:2.69-202.8, p＝0.001) for age ＜1 month, and 2.95 (95ｵCI:0.52-24.84, p＝0.228) for the HC ＞90ｵtile. Our findings thus revealed that the risk factors for shunt failure in infants include age ＜1 month at the initial VPS placement

Changes in the Features of Invasive Pneumococcal Disease after Introduction of the Seven-valent Pneumococcal Conjugate Vaccine in a Regional Core Hospital of Kochi, Japan

Since the introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) in 2007, invasive pneumococcal disease has declined, but the incidence of Streptococcus pneumoniae serotype 19A has risen worldwide. The present study examined changes in the features of invasive pneumococcal disease since the introduction of the PCV7 in Kochi, Japan. Pediatric cases of invasive pneumococcal disease were investigated before and after vaccine introduction (January 2008 to December 2013). Cases of invasive pneumococcal disease tended to decrease after PCV7 introduction. In addition, before introduction of the vaccine, most serotypes causing invasive pneumococcal disease were those included in the vaccine. However, after the introduction, we found cases infected by serotypes not covered by vaccine. Penicillin-resistant S. pneumoniae was the predominant serotype causing invasive pneumococcal disease before introduction of the PCV7, and the susceptibility of this serotype to antibiotics improved after vaccine introduction. Serotype isolates identified after vaccine introduction were also relatively susceptible to antibiotic therapy, but decreased susceptibility is expected

Long-term efficacy of bevacizumab and irinotecan in recurrent pediatric glioblastoma.

A 5-year-old boy with glioblastoma relapsed soon after postoperative irradiation in combination with temozolomide. Second-line chemotherapy was also ineffective; therefore, the bevacizumab and irinotecan were given after a third gross-total resection of the tumor. Treatment was interrupted for 1 month due to development of posterior reversible encephalopathy syndrome, but was re-initiated at a lower dose of bevacizumab with prolonged intervals between treatments. The patient was alive and disease free 2 years after initial diagnosis. Bevacizumab and irinotecan are a promising regimen for pediatric cases of recurrent glioblastoma after gross-total resection, although the optimal treatment schedule must be determined on a patient-by-patient basis

Long-term efficacy of bevacizumab and irinotecan in recurrent pediatric glioblastoma

A 5-year-old boy with glioblastoma relapsed soon after postoperative irradiation in combination with temozolomide. Second-line chemotherapy was also ineffective; therefore, the bevacizumab and irinotecan were given after a third gross-total resection of the tumor. Treatment was interrupted for 1 month due to development of posterior reversible encephalopathy syndrome, but was re-initiated at a lower dose of bevacizumab with prolonged intervals between treatments. The patient was alive and disease free 2 years after initial diagnosis. Bevacizumab and irinotecan are a promising regimen for pediatric cases of recurrent glioblastoma after gross-total resection, although the optimal treatment schedule must be determined on a patient-by-patient basis

Increased levels of 8-hydroxy-2′-deoxyguanosine in Drosophila larval DNA after irradiation with 364-nm laser light but not with X-rays

Exposure to UVA light causes damage to cellular components such as DNA and membrane lipids. We showed previously that UVA irradiation can induce mutations in Drosophila larvae and that the major lesions responsible for mutations were not thymidine dimers when wavelengths tested became longer. The use of a longer wavelength with UVA laser apparatus (364 nm) has made it possible to test the effects of this powerful light in biological organisms. In the present study, we irradiated third instar larvae of the urate-null Drosophila mutant strain y v ma-l, which is sensitive to oxidative stress, and compared the effects of 364 nm light irradiation with the effects of X-rays. To assay viability, some of the larvae were kept at 25°C until they eclosed in order to obtain a measure of viability. The remaining larvae were used to measure the amount of 8-hydroxydeoxyguanosine (8-OHdG), an indicator of oxidative DNA damage. The amount of 8-OHdG increased and viability decreased in response to increased UV dose in both the y v ma-l and wild-type strains. With irradiation of 600 kJ m-2, 8-OHdG/106dG was 7.2 ± 3.2 and 6.2 ± 2.0 in y v ma-l and wild-type strains, respectively, whereas the respective levels were 2.2 ± 0.6 and 2.3 ± 0.8 without irradiation. Our results indicated that irradiation with a 364-nm laser light caused significant oxidative damage in Drosophila larval DNA; however, induction of the damage was not prohibited by urate. To the best of our knowledge, this is the first report of a study in whole animals that shows increased levels of 8-OHdG in response to 364-nm UVA. X-ray ionizing radiation is also thought to generate reactive oxygen species in irradiated cells. We found that the amount of 8-OHdG in DNA following X-ray radiation remained unchanged in both strains, though survival rates were affected. X-ray-generated oxidative damage in Drosophila cells was followed by cell death but not DNA base oxidation, and the damage was suppressed by urate. The overall results suggest significant differences in the major in vivo oxidative damage caused by 364-nm light and X-rays