Evaluating the impact of de-escalating antimicrobial therapy in burn patients: a retrospective cohort study.

Antimicrobials should be used appropriately to minimise the risk of resistant strains arising in association with overuse. De-escalation of antimicrobial therapy is one strategy used to ensure appropriate use, but its safety and efficacy in burn patients are unclear. The aim of this study was to evaluate the safety and efficacy of de-escalation therapy for treating infections in burn patients. This retrospective cohort study investigated patients admitted to our intensive care unit with burns and treated for infection between October 1, 2013, and September 30, 2020. Patients were classified into a de-escalation group (Group D) comprising patients treated with empiric antimicrobial therapy followed by de-escalation and a non-de-escalation group (Group ND) comprising patients who did not undergo de-escalation. Characteristics and outcomes were compared between groups. Forty-three patients met the inclusion criteria, including 15 patients in Group D and 28 patients in Group ND. Bacterial species commonly detected in these patients were Corynebacterium spp. (17.3%), Pseudomonas aeruginosa (16.1%), and Staphylococcus aureus (9.6%) . No inter-group difference was seen in 28-day mortality (6.7% vs 21.4%, p =0.391). Multidrug-resistant strains were detected significantly less frequently in Group D (13.0%) than in Group ND (26.1%, p =0.003). De-escalation was associated with use of two or more antimicrobials as empiric antimicrobial therapy. As the use of de-escalation in infection treatment did not impact 28-day mortality, de-escalation might be safe for treating infections in burn patients.

Efficacy of folinic acid in preventing oral mucositis in allogeneic hematopoietic stem cell transplant patients receiving MTX as prophylaxis for GVHD.

As the safety of folinic acid administration and its efficacy for reducing the toxicity of MTX remain controversial, we assessed the effect of folinic acid administration after MTX treatment for GVHD prophylaxis on the incidence of oral mucositis and acute GVHD. We retrospectively analyzed data for 118 patients who had undergone allogeneic hematopoietic SCT and had received MTX for GVHD prophylaxis. Multivariate analysis showed that systemic folinic acid administration significantly reduced the incidence of severe oral mucositis (odds ratio (OR)=0.13, 95% confidence interval (CI) 0.04-0.73, P=0.014). There was also a tendency for a lower incidence of severe oral mucositis in patients who received folinic acid mouthwash (OR=0.39, 95%CI 0.15-1.00, P=0.051). No significant difference was observed in the incidence of acute GVHD between patients who received systemic folinic acid administration and those who did not (P=0.88). Systemic folinic acid administration and mouthwash appear to be useful for reducing the incidence of severe oral mucositis in patients who have received allogeneic hematopoietic SCT using MTX as GVHD prophylaxis.

Mizoroki-Heck type reaction of organoboron reagents with alkenes and alkynes. A Pd(II)-catalyzed pathway with Cu(OAc)2 as an oxidant.

[reaction: see text]. In contrast to the Pd(0)-catalyzed mechanism by Uemura, Mizoroki-Heck type reaction of boronic acids is found to proceed under a Pd(II)-mediated pathway using a catalytic amount of Pd(OAc)2 in the presence of Cu(OAc)2 as an oxidant. Treatment of a variety of alkenes with boronic acids, boronates, and sodium tetraphenylborate furnishes beta-arylated and alkenylated products in good to excellent yields. The reactions with norbornene, norbornadiene, and diphenylacetylene are also performed to give 1:2 or 2:1 coupling products.

Enzymatic synthesis of sulfated disaccharides using beta-D-galactosidase-catalyzed transglycosylation.

We have established a unique enzymatic approach for obtaining sulfated disaccharides using Bacillus circulans beta-D-galactosidase-catalyzed 6-sulfo galactosylation. When 4-methyl umbelliferyl 6-sulfo beta-D-galactopyranoside (S6Gal beta-4MU) was used as a donor, the enzyme induced transfer of 6-sulfo galactosyl residue to GlcNAc acceptor. As a result, the desired compound 6'-sulfo N-acetyllactosamine (S6Gal beta1-4GlcNAc) and its positional isomer 6'-sulfo N-acetylisolactosamine (S6Gal beta1-6GlcNAc) were observed by HPAEC-PAD, in 49% total yield based on the donor added, and in a molar ratio of 1:3.5. With a glucose acceptor, the regioselectivity was substantially changed and S6Gal beta1-2Glc was mainly produced along with beta-(1-1)alpha, beta-(1-3), beta-(1-6) isomers in 74% total yield. When methyl alpha-D-glucopyranoside (Glc alpha-OMe) was an acceptor, the enzyme also formed mainly S6Gal beta1-2Glc alpha-OMe with its beta-(1-6)-linked isomer in 41% total yield based on the donor added. In both cases, it led to the predominant formation of beta-(1-2)-linked disaccharides. In contrast, with the corresponding methyl beta-D-glucopyranoside (Glc beta-OMe) acceptor, S6Gal beta1-3Glc beta-OMe and S6Gal beta1-6Glc beta-OMe were formed in a low total yield of 12%. These results indicate that the regioselectivity and efficiency on the beta-D-galactosidase-mediated transfer reaction significantly depend on the anomeric configuration in the glucosyl acceptors.

[A case of metanephric adenoma treated with partial nephrectomy].

A 32-year-old female presented with a right renal mass detected by abdominal ultrasound examination at a routine medical check up. Computed tomography scans and magnetic resonance images revealed a solid tumor in the upper pole of the right kidney measuring 1.5 cm in diameter. Partial nephrectomy was performed on suspicion of the renal cell carcinoma. Histologically, the tumor is composed of small, uniform, epithelial cells with scant cytoplasm and hyperchromatic round nuclei that formed a tubular or glomerular-like structure. The histological diagnosis was metanephric adenoma.

Relationships between the onset of pustulosis palmaris et plantaris, periodontitis and bacterial heat shock proteins.

Relationships between the onset of pustulosis palmaris et plantaris, periodontitis and heat shock proteins were studied by using enzyme-linked immunosorbent assay to examine levels of immunoglobulin G (IgG) against Escherichia coli GroEL, a recombinant DnaJ of Actinobacillus actinomycetemcomitans heat shock protein, a synthetic peptide made from the 180th to the 188th amino acids of Mycobacterium bovis BCG Hsp65, and a recombinant human Hsp60, in sera obtained from 43 pustulosis palmaris et plantaris patients judged to have chronic infectious diseases of the oral cavity. We found that the titers of IgG against E. coli GroEL and A. actinomycetemcomitans DnaJ in the sera from pustulosis palmaris et plantaris patients were significantly higher than those in the control group, whereas the titers of IgG against the synthetic M. bovis Hsp65 and the recombinant Hsp60 did not differ significantly. Periodontal therapy and extraction of teeth with periapical infectious resulted in remission of pustulosis palmaris et plantaris and a statistically significant reduction in the levels of IgG against E. coli GroEL in 9 of the 22 patients (41%) examined. We also found that the IgG levels against A. actinomycetemcomitans DnaJ in 6 serum samples of 16 (37%) were reduced, but not significantly, after the treatment. These results suggest that the IgG responses to heat shock proteins partially induced by oral bacteria may be related to the onset of pustulosis palmaris et plantaris in some patients.

[A case of urothelial carcinoma associated with penile metastasis].

A 71-year-old man, who had been treated with continuous ambulatory peritoneal dialysis due to chronic renal failure for 5 months, visited our hospital with a complaint of penile induration in April, 1998. He underwent wedge biopsy of the penis. On the day after the biopsy, he had an episode of gross hematuria. Cystoscopy revealed a papillary tumor that seemed to have arisen from the right ureteral orifice and another in the trigone. Computed tomographic scan revealed the bladder tumors and swelling of the internal iliac lymph nodes. The bladder tumors were resected transurethrally. The pathological diagnosis of the specimen from the penile induration was metastatic transitional cell carcinoma.

New rubber-band loader to facilitate use of hemorrhoid ligator.

The placement of rubber bands on a ligator is often difficult and frustrating, especially when the operator is wearing gloves. A newly designed rubber-band loader with grooves and a pusher places the bands on the ligator easily, simultaneously, and quickly even under these conditions.

[General trust and judgments of trustworthiness].

Contrary to the common sense idea that trustful people are gullible and easily believe whatever other people may say, past research reviewed by Rotter (1980a) indicated the idea was not necessarily valid. Two experiments of this paper further demonstrated that trustful people are more sensitive to information that indicates lack of trustworthiness in other people. In the experiments, subjects read a series of stories in which a person was about to make a choice between a trustworthy action and an untrustworthy one. Some of them were also given pieces of information regarding trustworthiness of the person. They were then asked to predict the likelihood of the person taking a trustworthy action. When no information was given, high trusters predicted with higher probability than low trusters that the person would take a trustworthy action. On the other hand, the high trusters lowered the predicted likelihood more steeply than the low when negative information was provided.

Thyroid nodules: evaluation with US-guided core biopsy with an automated biopsy gun.

To evaluate the efficacy of ultrasound (US)-guided automated core biopsy of thyroid nodules, 74 biopsies were performed in 61 consecutive patients with an 18-gauge short-throw (1.1-cm excursion) biopsy gun. Results were correlated with diagnoses made at surgery (n = 38) or at sonographic follow-up of at least 6 months (n = 36). Sensitivity, specificity, and accuracy of diagnoses made with automated core biopsy were 84%, 95%, and 91%, respectively. US-guided biopsy with an automated biopsy gun allowed accurate assessment of thyroid nodules.

[US-guided core biopsy of the breast with an automated biopsy gun: comparison with an aspiration core needle device].

To evaluate the efficacy of an automated Tru-cut type of biopsy gun in US-guided breast biopsy, we performed 162 breast biopsies in 148 patients using an 18 gauge short-throw (1.1cm excursion) Tru-cut-type biopsy gun (Ace-cut needle). The results of the series were compared with another series of aspiration core biopsies, which were performed on 113 breast lesions in 112 patients using an 18 gauge Sure-cut needle. The results of the two series were correlated with the diagnoses made at surgery or clinical follow-up. Sensitivity, specificity, and accuracy for the automated biopsy gun were 89.2%, 94.9%, and 92.7%, and for the Sure-cut needle, 75.0%, 78.6%, and 77.5%, respectively (p < 0.01 for specificity and accuracy, by chi 2 test). There were no serious complications. The diagnostic surgical biopsy to operated cancer ratios in 1991 (without core biopsy), 1993 (with aspiration core biopsy), and 1995 (with automated core biopsy) were 2.9 (46/10), 2.0 (30/17), and 0.5 (12/24), respectively. We concluded that US-guided breast biopsy with an automated biopsy gun is a safe and highly accurate method, and could replace the diagnostic surgical biopsy.

[A case of completion pneumonectomy with carinal wedge resection after sleeve upper lobectomy for right lung cancer].

A 58-year-old man underwent sleeve upper lobectomy for squamous cell carcinoma of the right lung in April 1993. Eleven months after the operation, local recurrence at the bronchial suture line was detected by bronchoscopy. As the patient declined our proposal for performing reoperation, the recurrent tumor was treated with concurrent radiotherapy and chemotherapy, which resulted in only minimal response. After these treatment, the tumor was still localized at the right pulmonary hilus with no distant metastasis, and patient's pulmonary function was preserved good enough to undergo reoperation. Therefore, with a patient's consent to reoperation, we performed completion pneumonectomy with carinal wedge resection in September 1994. Pedicled serratus anterior muscle flap was applied to the suture line in order to prevent anastomotic complications. Postoperative course was uneventful except for pneumonia, and the anastomosis had healed well. As of March 1997 the patient is alive with no evidence of tumor recurrence. Completion pneumonectomy with carinal resection carries a high risk of operative morbidity and is seldom indicated. We reported a patient underwent this procedure for recurrent lung cancer and discussed about its indication and procedure.

[Effective administration of recombinant granulocyte colony-stimulating factor to prevent granulocytopenia due to combination chemotherapy for testicular germ cell tumors].

A prospective randomized study on the administration of recombinant granulocyte colony stimulating factor (rG-CSF) was conducted on 15 patients with testicular germ cell tumors. The clinical stagings of all patients except one were minimal to moderate extent according to the Indiana University staging system. Combination chemotherapy using bleomycin, etoposide and cisplatinum (BEP) was performed as the initial treatment on the eligible patients. rG-CSF was administered by two different methods; 1) routine administration on the 6th day after BEP chemotherapy (group A), and 2) the same method, but after granulocytopenia of 1,500/mm3 had developed (group B). The administration of rG-CSF in group A significantly reduced the severity of leucocytopenia and also the incidence of stomatitis compared with group B. Although rG-CSF produced no significant side effects, the thrombocytopenia was prominent in the group A patients (not significant). BEP chemotherapy itself is an easily-tolerable and well established method for treating young adult patients. The method used in group B seems to be suitable in situations where thrombocytopenia and cost effectiveness.