Influence of Oral Anaerobic Bacteria on Hematopoietic Stem Cell Transplantation Patients: Oral Mucositis and General Condition.

OBJECTIVE: Oral mucositis (OM) caused by infection facilitated by myelosuppression and immunosuppression can be controlled through oral care. We investigated changes in oral anaerobic bacterial flora during the onset of OM with hematopoietic stem cell transplantation (HSCT). METHODS: This study included 19 patients who underwent HSCT. All received professional oral care before initiating the preparative regimen. We assessed OM, oral health and obtained microbial samples from the oral cavity during 5 assessment points: before initiating the preparative regimen; the day before HSCT (day 1); and at 7, 14, and 30 days after HSCT. Microbial species were identified by using a mass spectrometer. RESULTS: The number of patients with serious OM increased initially after HSCT and decreased thereafter. Many Streptococcus species were identified before HSCT, but these gradually decreased and were replaced by coagulase-negative staphylococci. An increase in Candida species after HSCT and the identification of Enterococcus species were significantly associated with OM. Nutritional status recovery and prognosis were significantly worse in patients who developed OM. CONCLUSIONS: To the best of our knowledge, this study is the first which shows that anaerobic bacteria were identified in patients' oral flora before and after HSCT by using a mass spectrometer. These results indicate that Enterococcus species and Candida species may have been associated with OM. OM affected the patients' improvement in nutritional status and their prognosis. We concluded that it is important to provide more complete oral care instructions and interventions to prevent these bacterial infections.

Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia.

When discussing treatment options for patients with acute leukemia, it is important to acknowledge the impact of allogeneic hematopoietic cell transplantation (allo-HCT) or chemotherapy on quality of life (QOL). We performed a cross-sectional questionnaire study that administered SF-36, FACT-Leukemia and EuroQOL5D to 524 acute leukemia survivors, to compare patient-reported QOL between chemotherapy and allo-HCT, and to elucidate predictors of QOL. Patients who received chemotherapy alone had a better physical QOL than those who received allo-HCT. On the other hand, the allo-HCT group reported a better mental QOL. In the comparison of QOL in the allo-HCT patients according to the presence of GVHD at survey, patients who had GVHD symptoms experienced statistically and clinically significantly worse QOL than those who did not. In the allo-HCT patients without GVHD, the physical QOL was comparable to that in the chemotherapy patients, and they experienced significantly better mental and general QOL than the chemotherapy patients. GVHD and immunosuppressive drugs at survey were strongly associated with worse QOL after allo-HCT. In the chemotherapy group, a shorter time between treatment completion and survey was significantly associated with worse QOL. Further evaluation of QOL by a longitudinal assessment with quantitative and qualitative analyses are warranted.

Intensive glucose control after allogeneic hematopoietic stem cell transplantation: a retrospective matched-cohort study.

Some studies have shown that intensive glucose control (IGC) improves outcome in the intensive care unit setting. However, it is the benefit of IGC in hematopoietic SCT (HSCT) that is not well defined. Between June 2006 and May 2007, IGC was maintained prospectively after allogeneic HSCT and clinical outcomes were compared with a cohort matched for conditioning regimen, source of stem cells, age and relation to donor. A stratified Cox regression model was used. There were no significant differences in baseline clinical characteristics. The median age was 43.5 years in both groups. The primary diagnosis was a hematologic malignancy. Patients in the IGC group had a lower glucose level (least-square mean, 116.4 vs 146.8 mg per 100 ml, P<0.001) compared to the standard glucose control group. The incidences of documented infections and bacteremia were significantly lower in the IGC group (14 vs 46%, P=0.004, 9 vs 39%, P=0.002, respectively). IGC tended to reduce the incidence of renal dysfunction (19 vs 37%, P=0.36) and the elevation of C-reactive protein (18 vs 38%, P=0.13). This study suggests that IGC has may have a beneficial effect after HSCT. IGC should be evaluated further in a large prospective, randomized study.

[A study of BBN induced bladder cancer in mice. The time differences in changes of histopathology and nuclear DNA content].

To evaluate the process of tumor progression in BBN induced bladder cancer, BBN was administered to C57BL/6 mice for 10 weeks. The mice were sacrificed every week from the 5th week to the 22nd week. The urinary bladder was embedded in paraffin block for histopathological examination and was sampled for DNA content analysis by flow cytometry. The results were as follows: 1. In the histopathological findings, the incidence of atypical hyperplasia of the urinary bladder, indicative of a precancerous state, was 29% 7 weeks after the initiation with BBN. And the cancer was found in 74% of the mice 9 weeks after the initiation. 2. In the analysis of nuclear DNA content, the atypical hyperplasia and the incipient cancer of the urinary bladder were all DNA diploid, and the DNA aneuploid was found in 50% of the cancer group 11 weeks after the initiation. 3. These data suggest that the change of nuclear DNA content is an occurrence after the completion of the carcinogenesis in BBN induced bladder cancer of mice.

[A transitional cell carcinoma of the urinary bladder with a high level of serum CA 19-9--a case report].

Reported is the case of a 72 year-old man who was hospitalized because of abdominal pain and gross hematuria. A subsequent laboratory examinations revealed a high level of serum CA 19-9, and abdominal computed tomography showed a mass lesion behind the urinary bladder and multiple lymphadenopathy. Examination of the digestive organs revealed no abnormality, however cystoscopy showed a submucosal a tumor with a partly ruddy surface. Thus, a percutaneous needle biopsy and a transurethral biopsy were performed. The pathological findings indicated a transitional cell carcinoma of the urinary bladder, and ABC-peroxidase staining revealed the presence of CA 19-9 positive cells in a portion of the carcinomatous cells.

[The study of BBN induced bladder cancer in mice. Influence of Freund complete adjuvant and associated immunological reactions in mice].

To evaluate the genetic difference in induction of bladder cancer by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN), BBN was given to two different strains of mice, i.e. A/J (BCG resistant) strains and C57BL/6 (BCG susceptible) strains. The influence of Freund complete adjuvant (FCA), which includes BCG, was similarly examined along with associated cellular immunity as evaluated by footpad reaction (FPR). The results were as follows: 1. The incidence of bladder cancer was significantly higher in C57BL/6 strains (90.0%) than A/J strains (54.5%). 2. FCA reduced the incidence of bladder cancer significantly in C57BL/6 strains. 3. FPR, which reflects the delayed type hypersensitivity, was activated significantly in FCA treated C57BL/6 strains. These data suggest that the strain differences in mice probably explains the inhibition of carcinogenesis by FCA and cellular immunity.

Determination of residual cephalexin in chick tissues by Bacillus stearothermophilus paper disc assay.

A paper disc method is described for determination of residual cephalexin (CEX) in chick tissues. A trichloroacetic acid extract of plasma and tissues is chromatographed on a macroreticular resin (Diaion HP-20) column to remove endogenous antibacterial substances interfering with the assay. The eluate is evaporated to dryness and the residue, dissolved in methanol-water (1 + 2), is subjected to a paper disc assay using Bacillus stearothermophilus var. calido-lactis C953 NIZO as a test organism. The detection limit was 0.0375 ppm in tissue; the average recovery of CEX ranged from 72.4% in skin to 90.4% in plasma. Water containing 200 or 500 mg/L of CEX was given ad libitum to 2-week-old chicks for 10 days; the highest levels of CEX were found in the kidney, and the lowest were found in muscle at 0 h of withdrawal. CEX disappeared from most tissues at 24 h after withdrawal except from skin of chicks given 500 mg/L. However, the drug was not detected in the skin at 48 h after withdrawal.