Traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture: a retrospective multicenter analysis.

BACKGROUND: Retropharyngeal hematoma can be a life-threatening injury due to progressive upper airway obstruction. It is common following spinal cord injury or spinal fracture, and the clinical course and outcome of such patients are determined by their primary injuries. However, the natural clinical course of retropharyngeal hematoma itself remains unclear. In this study, we aimed to examine the clinical characteristics of traumatic retropharyngeal hematoma without spinal cord injury or spinal fracture (TREWISS). METHODS: We performed a multicenter retrospective analysis of patients who were diagnosed in the emergency department with soft tissue swelling of the retropharyngeal space by neck CT, between April 2010 and April 2020. The inclusion criterion was thickness of the retropharyngeal space > 7 mm at C1-C4 or > 22 mm at C5-C7 on a CT image. The exclusion criteria were (1) age < 18 years, (2) cardiopulmonary arrest, (3) other causes of soft tissue swelling besides hematoma, (4) patients with cervical spinal cord injury or spine fractures. Baseline characteristics were compared between intubated and non-intubated patients. RESULTS: Twenty-two patients were included in the analysis. Among them, 16 patients needed intubation. Median patient age was 69 years, and 27% of the patients were on antiplatelet or anticoagulant medications. The width of the hematoma on sagittal CT images was significantly wider in the intubated group [median (interquartile range), 2.5 cm (2.0-3.4) vs. 1.2 cm (0.9-1.7), p = 0.002). More than half the intubated patients needed tracheotomy. Tracheotomy was performed around day 3, and endotracheal tube was placed about 3 weeks. Only 60% of patients were successfully discharged to their homes, and one patient (6.3%) died during hospitalization. CONCLUSION: Early intubation and subsequent intensive care are important for patients with TREWISS. The patients typically require several weeks of hospitalization, although their outcomes are usually poor.

Medical students' perceptions of emergency medical care before and during the coronavirus disease 2019 pandemic.

Aim: Understanding how medical students perceive emergency medical care is important in promoting education and recruitment in the field of emergency medicine. This study aimed to clarify the perceptions of undergraduate medical students on emergency medical care with a focus on comparing their perceptions before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Fourth-year undergraduate medical students were invited to complete a self-administered questionnaire in 2017 and 2020. Free comments on emergency medical care were analyzed via text mining. The relationships among categorical words were evaluated via correlation matrix and correspondence analysis. Results: The number of written words per student were not significantly different between 2017 (4.9 ± 3.4) and 2020 (5.3 ± 4.1). In 2017, the most frequently used word was "busy," and the words "patients," "life," and "care" were not related to each other significantly. In 2020, the frequency of the word "busy" decreased and the word "patients" was related to "life" (P < 0.01) and "care" (P < 0.01). In the correspondence analysis, seven words including "life" and "care" were associated with "patients," which demonstrates that these words tended to occur together. Conclusions: Although the responses of the medical students regarding emergency medical care before and during the COVID-19 pandemic included similar words, their expressions tended to be related to patient care or patient life during the pandemic. This change in perception might cultivate a sense of mission and responsibility and an interest in emergency medical care among medical students.

Blockade of endoplasmic reticulum stress-induced cell death by Ureaplasma parvum vacuolating factor.

Previously, we found that Ureaplasma parvum internalised into HeLa cells and cytosolic accumulation of galectin-3. U. parvum induced the host cellular membrane damage and survived there. Here, we conducted vesicular trafficking inhibitory screening in yeast to identify U. parvum vacuolating factor (UpVF). U. parvum triggered endoplasmic reticulum (ER) stress and upregulated the unfolded protein response-related factors, including BiP, P-eIF2 and IRE1 in the host cells, but it blocked the induction of the downstream apoptotic factors. MicroRNA library screening of U. parvum-infected cells and UpVF-transfected cells identified miR-211 and miR-214 as the negative regulators of the apoptotic cascade under ER stress. Transient expression of UpVF induced HeLa cell death with intracellular vacuolization; however, some stable UpVF transformant survived. U. parvum-infected cervical cell lines showed resistance to actinomycin D, and UpVF stable transformant cell lines exhibited resistance to X-ray irradiation, as well as cisplatin and paclitaxel. UpVF expressing cervical cancer xenografts in nude mice also acquired resistance to cisplatin and paclitaxel. A mycoplasma expression vector based on Mycoplasma mycoides, Syn-MBA (multiple banded antigen)-UpVF, reduced HeLa cell survival compared with that of Syn-MBA after 72 hr of infection. These findings together suggest novel mechanisms for Ureaplasma infection and the possible implications for cervical cancer malignancy. TAKE AWAYS: • Ureaplasmal novel virulence factor, UpVF, was identified. • UpVF triggered ER stress but suppressed apoptotic cascade via miR-211 and -214. • UpVF conferred resistance to anticancer treatments both in vivo and in vitro. • Dual expression of MBA and UpVF in JCVI-syn3B showed host cell damage.

A case series of the dynamics of lipid mediators in patients with sepsis.

BACKGROUND: Bioactive lipid mediators play a crucial role during infection. Previously, we showed the expression level of FAAH mRNA in septic patients was lower than in healthy controls. CASE PRESENTATION: Four patients with a Sequential Organ Failure Assessment (SOFA) score of <7 recovered from sepsis. One patient with SOFA score of 12 on day 7 died on day 21. In the fatal case, eicosapentaenoic acid, docosahexaenoic acid, arachidonic acid, and linoleic acid-derived lipid mediators, including 9-hydroxyoctadecadienoic acid (9-HODE), 13-HODE, 9,10-dihydroxy-12-octadecenoic acid (9,10-DiHOME), and 12,13-DiHOME, were elevated on day 1. Increase in anti-inflammatory prostaglandin E1 ethanolamide together with persistently lower transcription level of FAAH mRNA was detected on day 7 in the fatal case. CONCLUSION: Lipidomic analysis on day 1 revealed elevated linoleic acid metabolites, whereas on day 7, elevated prostaglandin E1 ethanolamide and low level of FAAH mRNA transcription were observed in the fatal case of sepsis.

Structural basis of α-catenin recognition by EspB from enterohaemorrhagic E. coli based on hybrid strategy using low-resolution structural and protein dissection.

Enterohaemorrhagic E. coli (EHEC) induces actin reorganization of host cells by injecting various effectors into host cytosol through type III secretion systems. EspB is the natively partially folded EHEC effector which binds to host α-catenin to promote the actin bundling. However, its structural basis is poorly understood. Here, we characterize the overall structural properties of EspB based on low-resolution structural data in conjunction with protein dissection strategy. EspB showed a unique thermal response involving cold denaturation in the presence of denaturant according to far-UV circular dichroism (CD). Small angle X-ray scattering revealed the formation of a highly extended structure of EspB comparable to the ideal random coil. Various disorder predictions as well as CD spectra of EspB fragments identified the presence of α-helical structures around G41 to Q70. The fragment corresponding to this region indicated the thermal response similar to EspB. Moreover, this fragment showed a high affinity to C-terminal vinculin homology domain of α-catenin. The results clarified the importance of preformed α-helix of EspB for recognition of α-catenin.

Cytoskeleton-modulating effectors of enteropathogenic and enterohemorrhagic Escherichia coli: a case for EspB as an intrinsically less-ordered effector.

Enterohemorrhagic and enteropathogenic Escherichia coli produce various effector proteins that are directly injected into the host-cell cytosol through the type III secretion system. E. coli secreted protein (Esp)B is one such effector protein, and affects host-cell morphology by reorganizing actin networks. Unlike most globular proteins that have well-ordered, rigid structures, the structures of type III secretion system effectors from pathogenic Gram-negative bacteria, including EspB, are often less well-ordered. This minireview focuses on the functional relationship between the structural properties of these proteins and their roles in type III secretion system-associated pathogenesis.

Molecular basis of actin reorganization promoted by binding of enterohaemorrhagic Escherichia coli EspB to alpha-catenin.

EspB is a multifunctional protein associated with the type III secretion system of enterohaemorrhagic Escherichia coli, and interacts with various biomolecules including alpha-catenin in the host cell. The binding of EspB to alpha-catenin is thought be involved in actin reorganization during bacterial infection, although the precise mechanism of this phenomenon is still unclear. Recent research shows that dimerization of alpha-catenin dissociates it from E-cadherin/beta-catenin/alpha-catenin complexes, and that the dimer suppresses Arp2/3-mediated actin branching or polymerization. These results inspired us to evaluate the effect of EspB on the functions of alpha-catenin. Based on a series of in vitro biochemical approaches, including pull-down, co-sedimentation and pyrene-actin polymerization assays combined with transmission electron microscopy, we conclude that EspB promotes all the functions of dimeric alpha-catenin described above. These results clarified the molecular basis of reorganization of actin filaments during infection with enterohaemorrhagic Escherichia coli.

The mRNA expression of fatty acid amide hydrolase in human whole blood correlates with sepsis.

An excessive accumulation of anandamide (N-archidonoylethanolamine, AEA) is associated with septic shock. Results of previous studies have suggested that mRNA coding for the AEA degrading enzyme fatty acid amide hydrolase (FAAH), which converts AEA into arachidonic acid and ethanolamine, might be down-regulated in septic shock. We used real-time reverse transcription PCR assays to measure relative FAAH mRNA concentrations in the whole blood of 30 healthy donors and eight sepsis patients to ascertain whether such down-regulation takes place. Our results suggest that concentrations of FAAH mRNA in male and female samples from healthy donors are similar, but that concentrations are significantly lower in sepsis patients. These findings indicate that mRNA expression of FAAH in human whole blood correlates with sepsis, and may be an interesting biomarker for predicting the onset of septic shock.

Severe acute pancreatitis caused by organophosphate poisoning.

Organophosphate intoxication may be caused pancreatitis, but the role of diagnostic imaging for pancreatitis in these patients has not been well defined. We recently encountered a patient with organophosphate poisoning showing hyperamylasemia who was proven to have severe acute pancreatitis by CT findings. The patient was a 69-year-old woman who presented to a local hospital with disturbance of consciousness. She was initially treated for cerebral infarction, but an extremely low level of ChE was noted on Day 3. The patient was then referred to our institution. Examination of the abdomen revealed weak intestinal peristalsis, blood chemistry showed an increased level of serum amylase, and the urinary organophosphate test was positive. Based on the findings obtained by abdominal CT scanning, severe acute pancreatitis was diagnosed. Clouding of her consciousness resolved on day 21, but a pancreatic pseudocyst was detected on day 41.