Mizushima Central Hospital

Medial meniscus posterior root tears (MMPRTs) with focal cartilage defects present a therapeutic challenge, even in neutral-to-mild varus knees. Although transtibial pullout repair is standard for MMPRTs without advanced osteoarthritis, coexisting cartilage lesions may compromise outcomes and prompt unicompartmental knee arthroplasty (UKA). Combining pullout repair with osteochondral autograft transplantation (OAT) may offer a joint-preserving alternative by restoring meniscal hoop stress and reconstructing focal osteochondral defects. However, supporting evidence is limited. We retrospectively analyzed 150 patients treated surgically for MMPRT between 2015 and 2019, divided into three groups: pullout repair with OAT (Group O, n = 6), pullout repair alone (Group P, n = 120), and UKA (Group U, n = 24), with OAT being applied only in carefully selected patients based on strict clinical and radiographic indications. Clinical outcomes were assessed preoperatively, at 1 year, and at final follow-up (mean, 4.2-5.8 years). The primary outcome was the final clinical score, and secondary outcomes were changes from baseline. All groups improved postoperatively. Group O showed marked improvement in Knee Injury and Osteoarthritis Outcome Score-Symptom and Visual Analogue Scale-Pain score, achieving outcomes comparable to Group U at final follow-up. Group P showed consistent improvement from baseline. Radiographically, mild osteoarthritis progression was observed in Group O. Given the small sample size in Group O and the retrospective design, the findings are exploratory and warrant confirmation in larger prospective studies.

It is challenging to isolate Escherichia albertii from clinical specimens. Therefore, a medium that can selectively grow E. albertii and differentiate it from E. coli is earnestly desired. Here, we describe the evaluation of a recently developed selective differential medium, called cefixime-tellurite-phosphate-xylose-rhamnose-MacConkey (CT-PS-XR-MacConkey) medium, which enables the specific growth of E. albertii and differentiation of E. albertii (colorless) from E. coli (red) based on colony color and thus, facilitating the efficient isolation of E. albertii from diarrheal stool. When three E. albertii negative diarrheal stools were inoculated onto CT-PS-XR-MacConkey and xylose-rhamnose-melibiose (XRM) containing MacConkey agars, no colorless colonies were observed on both the media. However, when E. albertii was spiked into these three diarrheal stools, the ratio of colorless colonies to red colonies was higher on CT-PS-XR-MacConkey agar compared to XRM-MacConkey agar in all three samples. Notably, out of 105 Eacdt-gene PCR negative diarrheal stools 56 yielded colorless colonies on MacConkey agar while out of these 56 diarrheal stools, nine yielded colorless colonies on XRM-MacConkey but no colorless colonies were observed on CT-PS-XR-MacConkey agar. Furthermore, evaluation of these two media with five E. albertii positive-stool specimens revealed that the number of red colonies were constantly less, whereas that of colorless colonies were constantly more on CT-PS-XR-MacConkey agar, thus aiding in efficient isolation. Altogether, these results suggest that the CT-PS-XR-MacConkey agar could be a useful selective differential medium for isolation of E. albertii from diarrheal stool specimens.

Approach 51 cases we investigate WBC count and Lymphocyte Monocyte percentage, TH1/TH2 ratio, Treg cell count (normal value 8.0 ~34.0%) and the presence of recurrence every year for 10 years later.

Our aim was to examine whether serum levels of placental growth factor (PlGF) and soluble endoglin (sEng) at 19-25 and 26-31 weeks of gestation were associated with the occurrence of the 9-block categorization of placenta weight (PW) and fetal/placenta ratio (F/P ratio). We performed a retrospective cohort study in 1391 women with singleton pregnancy. Serum levels of PlGF and sEng were measured by enzyme immunosorbent assay. A light placenta was defined as PW ZS < -1.28 SD. Based on the PW (light, normal, and heavy) and F/P ratio (relatively heavy, balanced growth, and relatively small), 9-block categorization were performed. Multivariable logistic regression analyses were performed. Low PlGF at 26-31 weeks was an independent risk factor for the birth of infants belonging to Block A (light placenta and relatively heavy infant), after adjusting for prepregnancy body mass index and serum levels of sEng. High sEng at 26-31 weeks was an independent risk factor for the birth of infants belonging to Block D (light placenta and balanced growth of infant), after adjusting for past history of either preeclampsia or gestational hypertension, high pulsatility index of uterine artery flow velocity waveforms in the second trimester, and serum level of PlGF. Low PlGF levels at 26-31 weeks of gestation may precede a light placenta and relatively heavy infant (Block A), and high sEng levels at 26-31 weeks of gestation may precede a light placenta and balanced growth of infant (Block D).

Objective: To investigate the extent of asbestos exposure among patients with primary lung cancer in Japan. Methods: A retrospective estimation of potential asbestos-exposed individuals, as determined by the presence of pleural plaques identified on chest computed tomography (CT), was conducted on 885 pathologically confirmed primary lung cancer patients (mean age 71.3 years, 641 males). All patients were diagnosed at 29 hospitals across Japan between 2006 and 2007. Since these hospitals belong to the Japan Federation of Democratic Medical Institutions (MIN-IREN), an organization of medical institutions for workers, the study subjects may contain a higher proportion of workers than the general population. Results: Pleural plaques were identified in 12.8% of subjects (15.8% in males and 4.9% in females), consisting exclusively of cases older than 50 years. They were found most frequently on the chest wall pleura (96.5%), followed by the diaphragm (23.9%) and mediastinum (9.7%). Calcifications were seen in 47 cases (41.6%). The highest prevalence of pleural plaques was seen among workers from construction-related fields (37.7%). No distinct lung cancer histology was observed in patients with pleural plaques. Coexistence of pleural plaques and small irregular opacities was observed in 2.5% of subjects. Conclusion: In a Japanese population representing more workers than general Japanese, 12.8% of patients with primary lung cancer may have experienced asbestos exposure at some time in the past. Special medical attention should be paid to individuals with a history of employment in construction-related occupations, as workers in this sector showed the highest prevalence of pleural plaques.

A female was admitted presenting with melaena. She had previously been diagnosed with deep vein thrombosis which was being treated with Warfarin. Esophagogastroduodenoscopy revealed a symptomatic submucosal pedunculated tumor located in the second portion of the duodenum. The tumor showed a thick stalk, yellow in color, and measuring 20 mm at its base. Definitive diagnosis of a duodenal lipoma located in the submucosal layer was supported by histological examination. During endoscopic examination blood was discovered issuing from a mucosal break in the stalk. Hemostasis was achieved via hemostatic clips that were administered endoscopically. Eighteen days after undergoing endoscopic hemostasis the patient had melaena again. After the melaena, removal of the duodenal lipoma via endoscopic polypectomy using a detachable snare was determined the choice treatment. After seventeen days the patient showed no postoperative complications and was subsequently discharged. In this case, the use of a detachable snare was determined an effective technique in performing endoscopic polypectomy in the removal of the symptomatic duodenal lipoma.

The Japanese government recommended in 2000 that women planning pregnancy should take 400 μg of folic acid daily to decrease the risk of having an infant with spina bifida. We aimed to identify risk factors for the occurrence of spina bifida and to evaluate how the prevalence rate has altered over the past 3 decades. Subjects comprised 360 women who gave birth to spina bifida-affected offspring and 2333 women who gave birth to offspring without spina bifida between 2001 and 2012. A self-administered questionnaire was used to collect data, which were analyzed by multiple logistic regression models. The prevalence rate of spina bifida was obtained through data provided by international and domestic organizations. Four variables were significantly associated with the increased risk of having newborns afflicted with spina bifida: not taking folic acid supplements (odds ratios [OR], 2.50; 95% confidence interval [CI], 1.72-3.64), presence of spina bifida patients within third-degree relatives (OR, 4.26; 95% CI, 1.12-16.19), taking anti-epileptic drugs without folic acid (OR, 20·20; 95% CI, 2.06-198.17), and low birth weight in the newborns ≤ 2500 g (OR, 4.21; 95% CI, 3.18-5.59). The prevalence rate of spina bifida has remained 5 to 6 per 10,000 total births and has not shown any decreasing trend over the past 11 years. Four risk factors were identified among Japanese women. Because recommendations and information have not decreased the occurrence of spina bifida, the Japanese government should implement mandatory food fortification.

Cytolethal distending toxins (CDTs), which block eukaryotic cell proliferation by acting as inhibitory cyclomodulins, are produced by diverse groups of Gram-negative bacteria. Active CDT is composed of three polypeptides--CdtA, CdtB, and CdtC--encoded by the genes cdtA, cdtB, and cdtC, respectively. We developed a PCR-restriction fragment length polymorphism assay for the detection and differentiation of five alleles of cdtB (Cdt-I through Cdt-V) in Escherichia coli and used the assay to investigate the prevalence and characteristic of CDT-producing E. coli in children with diarrhea (A. Hinenoya et al., Microbiol. Immunol. 53:206-215, 2009). In these assays, two untypable cdtB genes were detected and the organisms harboring the cdtB gene were identified as Providencia alcalifaciens (strains AH-31 and AS-1). Nucleotide sequence analysis of the cdt gene cluster revealed that the cdtA, cdtB, and cdtC genes of P. alcalifaciens are of 750, 810, and 549 bp, respectively. To understand the possible horizontal transfer of the cdt genes among closely related species, the presence of cdt genes was screened in various Providencia spp. by colony hybridization assay, and the cdt gene cluster was found in only limited strains of P. alcalifaciens. Genome walking revealed that the cdt gene cluster of P. alcalifaciens is located adjacent to a putative transposase gene, suggesting the locus might be horizontally transferable. Interestingly, the CDT of P. alcalifaciens (PaCDT) showed some homology with the CDT of Shigella boydii. Whereas filter-sterilized lysates of strains AH-31 and AS-1 showed distention of CHO but not of HeLa cells, E. coli CDT-I exhibited distention of both cells. This activity of PaCDT was confirmed by generating recombinant PaCDT protein, which could also be neutralized by rabbit anti-PaCdtB antibody. Furthermore, recombinant PaCDT was found to induce G(2)/M cell cycle arrest and phosphorylation of host histone H2AX, a sensitive marker of DNA double-strand breaks. To our knowledge, this is the first report showing that certain clinical P. alcalifaciens strains could produce variants of the CDTs compared.