Corynebacterium simulans was first reported in 2000. Although it is a member of the normal skin flora, some cases of C. simulans infection have been reported. Other Corynebacterium spp. rarely cause ...chronic pyogenic spondylitis, and pyogenic spondylitis caused by C. simulans has not been reported at all. Here we report a case of acute pyogenic spondylitis due to C. simulans. A 78-year-old man with diabetes mellitus visited our hospital with a 3-day history of lower back pain and fever. Blood culture revealed C. simulans and magnetic resonance images of lumbar vertebrae showed pyogenic spondylitis. He recovered after treatment by vancomycin for 9 weeks and was discharged home. No recurrence has been observed for half a year. This is likely the first reported case of pyogenic spondylitis by C. simulans. In general, Corynebacterium spp. cause chronic pyogenic spondylitis, but this case showed an acute course.
Background: The purpose of this study was to report the pharmacokinetics (PK) and tolerance profile of intraoperative intraperitoneal chemo-hyperthermia (IPCH) with oxaliplatin and irinotecan. ...Patients and methods: Thirty-nine patients with peritoneal carcinomatosis (PC) of either gastrointestinal or peritoneal origin underwent complete cytoreductive surgery followed by IPCH with a stable dose of oxaliplatin (460 mg/m2), plus one among seven escalating doses of irinotecan (from 300 to 700 mg/m2). IPCH was carried out with the abdomen open, for 30 min at 43°C, with 2 l/m2 of a 5% dextrose instillation in a closed continuous circuit. Patients received intravenous leucovorin (20 mg/m2) and 5-fluorouracil (400 mg/m2) just before IPCH to maximize the effect of oxaliplatin and irinotecan. Results: Irinotecan concentration in tumoral tissue increased until 400 mg/m2 and then remained stable despite dose escalations. It was 16–23 times higher than in non-bathed tissues. Increasing doses of intraperitoneal irinotecan did not modify the PK of intraperitoneal oxaliplatin, and the drug concentration ratio was 17.8 higher in tumoral tissue (bathed) than in non-bathed tissues. The hospital mortality rate was 2.5% and the non-hematological complication rate was 25%. However, grade 3–4 hematological toxicity rate was 58%. Conclusion: Intraperitoneal heated oxaliplatin (460 mg/m2) plus irinotecan (400 mg/m2) presented an advantageous PK profile and was tolerated by patients, despite a high hematological toxicity rate.
The purpose of this paper is to investigate the relationship between clinical outcome and the intactness of cagPAI in Helicobacter pylori strains from Vietnam. The presence or absence of 30 cagPAI ...genes was investigated by polymerase chain reaction (PCR) and dot-blotting. H. pylori-induced interleukin-8 secretion and hummingbird phenotype, and H. pylori adhesion to gastric epithelial cells were examined. The serum concentration of pepsinogen 1, pepsinogen 2, and gastrin was also measured in all patients. cagPAI was present in all 103 Vietnamese H. pylori isolates, of which 91 had intact cagPAI and 12 contained only a part of cagPAI. Infection with the partial cagPAI strains was less likely to be associated with peptic ulcer and chronic gastric mucosal inflammation than infection with strains possessing intact cagPAI. The partial cagPAI strains lacked almost all ability to induce interleukin-8 secretion and the hummingbird phenotype in gastric cells. Their adhesion to epithelial cells was significantly decreased in comparison with intact cagPAI strains. Moreover, for the first time, we found an association between cagPAI status and the serum concentration of pepsinogens 1 and 2 in infected patients. H. pylori strains with internal deletion within cagPAI are less virulent and, thus, less likely to be associated with severe clinical outcomes.
Summary
Background : Gastric cancer incidence in men is almost double that in women. We investigated mucosal responses in the stomach against Helicobacter pylori (H. pylori) infections to elucidate ...the interindividual or sex‐related differences, which may in turn be associated with gastric cancer incidence, mucosal changes of stomach as measured by the Sydney System, and interleukin‐8, cyclooxygenase‐2 and trefoil factor family 1 (TFF1) gene expression.
Methods : An age‐, sex‐, H. pylori status‐ and disease‐matched case−control study was performed in 574 H. pylori‐positive and 225 H. pylori‐negative patients selected from 4125 patients with a diagnosis of benign disease of the stomach. Levels of acute and chronic inflammations, atrophy and intestinal metaplasia scored according to the Sydney System were compared by stomach site and by sex. Two biopsy specimens (antral and corpus gastric mucosa) from patients with benign gastric diseases (142 patients; 72 men, 70 women) were analysed for interleukin‐8, cyclooxygenase‐2 and TFF1 mRNA expression as measured by real‐time PCR.
Results : Inflammation and activity scores in antrum with H. pylori infection were higher in men, but scores declined according to age. Atrophy and intestinal metaplasia scores in corpus with H. pylori infection appeared more severe in men than in women, especially in older patients. In women, atrophy score increased with increasing age, particularly in postmenopausal H. pylori‐negative patients. Interleukin‐8 mRNA induction was detected in both antrum and corpus mucosa in H. pylori infection, but sex differences were not found. Response of cyclooxygenase‐2 mRNA expression against H. pylori infection in the mucosa was higher in men than women. In H. pylori‐negative patients, TFF1 mRNA levels in women were significantly higher than in men, and TFF1 mRNA was significantly lower in positive than negative women.
Conclusions : Sex differences in mucosal responses to H. pylori infection in the stomach may be correlated with sex differences in the incidence of stomach cancer.
The purpose of this study is to clarify whether gross total tumor resection can prolong the survival in adult patients with supratentorial glioblastoma multiforme (GBM), and to clarify what subset of ...these patients obtains a survival advantage by gross total tumor resection without postoperative neurological deterioration. Eighty-two adult patients with supratentorial GBM were retrospectively reviewed. Overall, the median survival time was 13 months, and the 1- and 2-year survival rates were 53.7% and 14.6%, respectively. In a univariate analysis for survival rate by log-rank test, age (< 40 years), Karnofsky performance scale (KPS) score (70-100%) and extent of surgery (gross total resection) were revealed to be significant good prognostic factors. A Cox proportional hazard multivariate regression analysis confirmed that the KPS and extent of surgery were independent, significant good prognostic factors. Nine patients (11%) suffered postoperative neurological deterioration. A topographical GBM staging system (Stages I, II and III) with the integration of tumor location, size and eloquence of adjacent brain based on MRI (for explanation of Stages see text) was originally proposed. In Stage I, gross total resection had a strong tendency toward a better prognostic factor in a univariate analysis and was revealed to be a significant independent good prognostic factor in a multivariate analysis. In also Stage II, the survival of patients who underwent gross total resection was better than that of patients with less than gross total resection, although not significant. In Stage III, there were no patients who underwent gross total tumor resection. Risk probabilities of postoperative neurological deterioration, overall, were 0%, 22.2%, and 20% in Stages I, II, and III, respectively, and those after gross total resection were 0% and 16.7% in Stages I and II, respectively. Although gross total tumor resection is associated with prolongation of the survival time of patients with GBM, the risk of postoperative neurological deficit increases with radical tumor resection. To select an eligible subset of patients that benefit in survival from gross total tumor resection without postoperative risk, the following surgical policy for GBM resection is suggested. GBM in Stage I should be resected as radically as possible. Regarding Stage II, risky surgical resection extending to the area adjacent to the critical zone should be avoided and more meticulous and careful surgical planning is needed than that in Stage I. In Stage III, radical gross total tumor resection is not recommended at present.
Summary
Aim
To systematically determine the usefulness of Helicobacter pylori IgG antibody titer decline as a predictor of treatment success after H. pylori eradication in large patient samples.
...Patients and Methods
Serum samples from 258 H. pylori positive patients (52.8 yrs, 65% males) were retrospectively collected from five medical centers, and H. pylori titers were quantitatively determined by ELISA. Serial serum samples were collected at baseline and for up to 4.9 years after treatment. 169 patients underwent successful eradication while 89 remained infected. The median total observation period was 635 days (range, 51 to 1,800 days). Chronological changes in H. pylori titers were analyzed and compared between cured and infection persistent subjects.
Results
The proportion of infection persistent patients who developed negative H. pylori IgG antibody titers was below 5%. A receiver operating characteristic (ROC) curve for the confirmation of successful eradication according to the percent decline over baseline at each time‐point showed that a 60% decline at 1 year or more after eradication treatment strongly correlated with successful eradication (sensitivity = 90% and specificity = 87%).
Conclusion
A 60% decline in H. pylori IgG titers (HEL‐p kit) from baseline to one year or greater is a reliable predictor of successful H. pylori eradication.
The mechanism of the distant metastasis of echinococcosis was investigated using jirds (Meriones unguiculatus) by inoculation of fractions obtained from echinococcal lesions formed in the peritoneal ...cavity of cotton rats (Sigmoid hispidus). Protoscoleces, cysts, and germinal cells were fractionated from the peritoneal lesions of the cotton rats injected peritoneally with echinococcal germinal cells. Each fraction (protoscoleces; 500 pieces, cysts; 50 pieces, germinal cells; 2 x 10(7) cells) suspended in 0.2 ml of PBS was injected into either the left inguinal vein (IV group) or the mesenteric vein (MV group) of seven week-old jirds. Eight weeks after the injection, the jirds were sacrificed and examined macroscopically and microscopically. In IV group, one of 10 jirds had echinococcal lesions in lung, bilateral adrenal, brain, para-aortic lymph node and left inguinal lymph node by inoculation of only germinal cells. Another one had lung lesions formed by cysts inoculated. In MV group, both intrahepatic and pulmonary echinococcal lesions by inoculation of germinal cells were observed in 3 out of 5 jirds. Cysts inoculated formed intrahepatic lesions in all 5 jirds. However, protoscoleces inoculated through both routes never formed echinococcal lesions in any organs. The typical lesions of echinococcosis were observed in all lesions without protoscoleces and calcification. These results indicate that germinal cells in intrahepatic echinococcal lesions might invade into the intrahepatic vein and metastasize to other organs.
I examined the characteristics of Helicobacter pylori (H. pylori) infection in elderly patients with peptic ulcer and its relation to the endoscopic appearance of the gastric mucosa. 1) Infection ...with H. pylori was more common in middle-aged patients (those over 40 and younger than 59 years old, 80.4%) than in younger patients (those less than 39 years old, 63.0%). Elderly patients were less likely than younger patients to be infected (60's: 77.7%, 70's: 70.8%, over 80 years old: 65.8%). The percentage was higher in men than in women, in all age groups. 2) Oshima's classification was used to divide the patients into 5 groups, according to the endoscopic appearance of blood vessels of the gastric mucosa. Infection was found in 71.7% of the patients without atrophy, in 86.3% of those with mild atrophy, and in 88.9% of those with moderate atrophy. In contrast, infection was found in only 78.4% of the patients with severe atrophy. Similar results were found in patients with peptic ulcer and in subjects with no lesion except atrophic gastritis. 4) The percentage of patients with gastric ulcer disease who had atrophic gastric mucosa was higher in those with ulcers above the middle of the stomach (46.3%) than in those with ulcers in the antrum (30.2%, p < 0.05). Almost all patients with gastric ulcers in the lower part of the stomach and in the angulus were found to be infected with H. pylori (93.3% and 94.0%, respectively). The percentage of patients with ulcers low in the stomach who were infected was lower (59.4%). All of the location-related differences in infection were significant (p < 0.001).
This paper investigates the role of communication among the principal and agents under uncertainty. We treat the problem: How epistemic conditions of communication will be able to settle a moral ...hazard in team in the principal-agent model under uncertainty. We shall propose a communication process to resolve the moral hazard in the principal-agent model by communication. We assume that the agents have the knowledge structure induced from a binary relation associated with the multi-modal logic bf S4n. We show that the moral hazard can be resolved if the principal and each agent communicate their expected marginal costs according to the acyclic communication graph.
The indications and results of intraoperative radiofrequency ablation (RFA) of liver metastases (LMs) are not well defined in the literature and have never been compared with those of hepatectomy. ...The aim of the study was to appreciate the local recurrence rate of RFA in comparison with anatomic and wedge resection.
Eighty-eight patients with technically unresectable LMs were treated with curative intent. The LMs were treated by anatomic resection (40 patients, 213 LMs) when large, by wedge resection (64 patients, 99 LMs) when peripheral and small, and by RFA (88 patients, 227 LMs) when central and small. The median follow-up was 27.6 months (range, 15-74 months), and a total of 539 LMs were treated (median of 5 per patient).
The local recurrence rates were 5.7% for the 227 RFAs, 7.1% for the 99 wedge resections, and 12.5% for the 40 anatomic resections (P =.216). Local recurrence rates after RFA were correlated with LMs larger than 30 mm (P <.001) and with LMs in direct contact with large vessels (P <.001).
RFA is as efficient and safe as wedge or anatomic resections in terms of local control.
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