ABSTRACT
The vacuum packing closure (VPC) is often performed as temporal abdominal closure after damage control surgery (DCS). We occasionally encounter severe trauma patients whose abdomens were unable to be closed after DCS. The bilateral anterior rectus abdominis sheath flap turnover method and component separation (CS) method are one of the options to close the abdomen. However, it can be challenging to close the abdomen in some patients with very severe trauma or obesity by these methods. The open abdomen management (OAM) with a planned ventral hernia can be performed in those patients. The patients with long term OAM occasionally develop persistent enteroatmospheric fistula (EAF). The VPC using absorbable mesh is useful to reduce the likelihood of EAF. The posterior component separation with transversus abdominis release is a useful method for delayed abdominal wall reconstruction following planned VH if bilateral anterior rectus abdominis sheath flap turnover method and CS method are unable to be performed.
ABSTRACT
The vacuum packing closure (VPC) is often performed as temporal abdominal closure after damage control surgery (DCS). We occasionally encounter severe trauma patients whose abdomens were unable to be closed after DCS. The bilateral anterior rectus abdominis sheath flap turnover method and component separation (CS) method are one of the options to close the abdomen. However, it can be challenging to close the abdomen in some patients with very severe trauma or obesity by these methods. The open abdomen management (OAM) with a planned ventral hernia can be performed in those patients. The patients with long term OAM occasionally develop persistent enteroatmospheric fistula (EAF). The VPC using absorbable mesh is useful to reduce the likelihood of EAF. The posterior component separation with transversus abdominis release is a useful method for delayed abdominal wall reconstruction following planned VH if bilateral anterior rectus abdominis sheath flap turnover method and CS method are unable to be performed.
ABSTRACT
Ceftriaxone is one of the easily administrative antibiotics, but little is known about their role in palliative care settings. The aim of this study is to show the effect and the safety of ceftriaxone subcutaneous infusion to infection among advanced cancer patients. Consecutive patients who received ceftriaxone subcutaneous infusion at the Seirei Hospice from January 2013 to January 2014 were enrolled in this retrospective analyses. Primary outcome was the response rate of ceftriaxone, determined by improvement of symptoms within 3 days of ceftriaxone use. Secondary outcomes are inflammatory site reaction, and a comparison of the response rate between ceftriatone and other antibiotics. Among a total of 100 admitted patients, 10 patients used ceftriaxone subcutaneous infusion (4 for urinary tract infection, 4 for pneumonia, 2 for soft tissue infection). The response rate was 70% (95% confidence interval, 39－89). There was no inflammatory symptom at the insertion site observed. For comparisons, 16 patients used other antibiotics with the response rate of 74% (51－88).In conclusion, subcutaneous infusion of ceftriaxone can be useful in the treatment of infections of end－of－life cancer patients, and randomized controlled trial is promising.
ABSTRACT
PURPOSE: It has been reported that the Pulse Contour Cardiac Output (PiCCO) is very useful mainly in the field of intensive care and treatment to grasp the pathophysiological conditions of pulmonary edema because of its capability of obtaining data such as Pulmonary Vascular Permeability Index (PVPI) and Extra Vascular Lung Water (EVLW). Furthermore, a high degree of usability of various markers has been reported for better understanding of the pathological conditions in cases with septicemia. MATERIALS AND METHODS: The correlation between the cardiorespiratory status based upon the PiCCO monitor (EVLW and PVPI) and inflammatory markers including C reactive protein, procalcitonin (PC), and Endotoxin Activity Assay (EAA) were evaluated in 11 severe cases that required treatment with a respirator in an intensive care unit. RESULTS: The EAA values were significantly higher in patients with abnormal EVLW at 0.46+/-0.20 compared to the normal EVLW group at 0.21+/-0.19 (p=0.0064). In a similar fashion, patients with abnormal PVPI values tended to have higher PC levels at 18.9+/-21.8 compared to normal PVPI cases at 2.4+/-2.2 (p=0.0676). On the other hand, PVPI was significantly higher in the abnormal EAA group at 3.55+/-0.48 in comparison with the normal EAA group at 1.99+/-0.68 (p=0.0029). The abnormal EAA group tended to have higher PVPI values than the normal EAA group. CONCLUSION: The EAA is a measurement method designed to estimate the activity of endotoxins in the whole blood. Our results suggest that the EAA value, which had the greatest correlation with lung disorders diagnosed by the PiCCO monitoring, reflects inflammatory reactions predominantly in the lungs.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cardiac Output/physiology , Endotoxins/blood , Lung Injury/blood , Pulmonary Edema/bloodABSTRACT
<b>Purpose and Methods</b>: Infection and neoplastic fever is one of the common complication in patients with advanced cancer. To develop a novel method to differentiate neoplastic fever from infection, we performed a retrospective study of hospitalized terminally ill cancer patients at Seirei Hospice from April 2009 to August 2011. <b>Results</b>: We identified a consecutive sample of 12 patients with neoplastic fever and 12 patients with infection as a control. We extracted demographic data, laboratory data, vital signs and symptoms from medical charts. We found significant differences in difference in C-reacive protein value between afebrile and febrile period (<i>p</i>＜0.001), difference of white blood cell count between afebrile and febrile period (<i>p</i>=0.0017), percentages in neutrophil counts (<i>p</i>=0.023), percentages in lymphocyte counts at base line (<i>p</i>=0.011) and the presence of delirium (<i>p</i>=0.012). <b>Conclusion</b>: These findings suggest that we might differentiate neoplastic fever from infection with common laboratory data and their longitudinal change.
ABSTRACT
PURPOSE: Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC. MATERIALS AND METHODS: A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied. RESULTS: The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients. CONCLUSION: Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Disseminated Intravascular Coagulation/complications , Fibrinolytic Agents/therapeutic use , Sepsis/complications , Time Factors , Treatment OutcomeABSTRACT
The World Health Organization (WHO) standard assay for determining antibody level is the rapid fluorescent focus inhibition test (RFFIT) and is used to determine the degree of immunity after vaccination against rabies.To compare the difference in RFFIT results between the laboratories of The National Institute of Infectious Disease in Japan (NIID) and the Chinese Centre for Disease Control (CCDC) as well the influence of the choice of standard serum (STD) for the detection,the two laboratories detection methods were simultaneously manipulated by RFFIT.The reference serums used in NIID and the WHO standard serum used in CCDC were compared in the same RFFIT detection to determine the titer of four sera samples C1,S1,S2 and S4 in parallel,and the titers of the detected sera samples were calculated using the standard formula for neutralizing antibody titer.No significant difference was found in RFFIT methods from the two laboratories and the RFFIT testing procedures of the two laboratories have good consistency.However,different titers were obtained with the tentative internal standard serum (TI-STD) produced by adjusting to 2.0 IU of WHO standard serum in NIID and the WHO STD.The titer determined with the TI-STD was higher than that determined with WHO STD,This difference appears to be significant and requires further investigation.
ABSTRACT
<p><b>OBJECTIVES</b>Among the complementary and alternative medical services available in Japan, only judo therapists are covered under the national health-insurance program without a referral from a physician. Many orthopedists claim that judo therapists deprive them of potential patients. If such competition exists, fewer patients would be expected to visit orthopedists in areas where many patients visit judo therapists. Therefore, we examined the correlation between the number of patients visiting judo therapists and those visiting physicians for musculoskeletal diseases.</p><p><b>METHODS</b>In a cross-sectional study covering each prefecture in Japan (n = 47), we obtained figures for the numbers of judo therapist facilities and elderly patients (over 70 years old) who visited them and the numbers of orthopedists and patients who visited physicians for musculoskeletal diseases. Correlations between the numbers of practitioners per 100,000 population and the numbers of their patients per 100,000 population were examined by prefecture.</p><p><b>RESULTS</b>There were positive correlations between the numbers of judo therapist facilities and elderly patients who visited them (r = 0.72, P < 0.01, n = 47), and between the numbers of orthopedists and elderly patients who visited physicians for musculoskeletal diseases (r = 0.32, P = 0.03). However, there was no significant correlation between the numbers of elderly patients who visited judo therapist facilities and those who visited physicians (r = 0.06, P = 0.68) for musculoskeletal diseases.</p><p><b>CONCLUSIONS</b>This study did not find a negative correlation between the numbers of patients visiting judo therapists and patients visiting physicians for musculoskeletal diseases. Thus, these results do not support the orthopedists' claim that the two services compete for patients.</p>
ABSTRACT
AIM: To establish a sensitive and efficient reporter gene-based screening model for finding agonists of estrogen receptor beta subtype. METHODS: A recombinant vector pTAL-ERE-SEAP was constructed by inserting a synthetic sequence composed of five estrogen responsive elements in front of promoter of pTAL-SEAP vector. pTAL-ERE-SEAP was then transfected into human embryonic kidney (HEK293) cells. G418 (200 microg x mL(-1)) was added to select positive clones that can be induced by E2 to express reporter gene SEAP. The speciality was tested by several ligands of relative nuclear receptors of the same family. The stability of the model, the time-effect relationship, the dose-response relationship, and the immunocytochemistry staining of ERbeta expression after transfection were observed. 2 622 compounds were screened by using this model. RESULTS: Stably transfected clones were obtained. The expression levels of reporter gene SEAP of positive clones was induced by E2 in a dose-response and time-effect relationship manners. The Z' factor value was 0.7. The expression levels of dexamethasone and other ligands were low. The result of immunocytochemistry staining showed the expression of ERbeta. E2 had no proliferating effects on stably transfected clones. CONCLUSION: Stably transfected positive clones transfected with recombinant vector pTAL-ERE-SEAP were obtained. The positive clones may be used to screen for agonists of estrogen receptor beta subtype by measurement of luminescent value of expressed SEAP in wells of microlitre plate.
Subject(s)
Alkaline Phosphatase/metabolism , Estrogen Receptor beta/agonists , Estrogen Receptor beta/genetics , Recombinant Fusion Proteins/metabolism , Alkaline Phosphatase/genetics , Cell Line , Estradiol/pharmacology , Estrogen Receptor beta/metabolism , Gene Expression Regulation/drug effects , Genetic Vectors , Humans , Immunohistochemistry , Promoter Regions, Genetic/genetics , Recombinant Fusion Proteins/genetics , Response Elements/genetics , TransfectionABSTRACT
PURPOSE: To evaluate the bonding effectiveness of one- and two-step self-etch adhesives in comparison with a total-etch approach. METHODS: From 55 non-carious human third molars, mid-coronal dentin and enamel bur-cut surfaces were prepared. The bonding surfaces were treated strictly following the manufacturers' instructions with three one-step self-etch (all-in-one) adhesives, AQ bond, Reactmer and Xeno CF Bond; two two-step self-etch adhesives, experimental ABF and Clearfil SE Bond, one two-step total-etch adhesive, Prime & Bond NT, and one three-step total-etch adhesive, OptiBond FL. Composite built-ups were made using Z100. After storage overnight in 37 degrees C water, the bonded specimens were sectioned into rectangular slabs of approximately 2x2 mm width and 9 mm length. They were then trimmed into a round cross-sectional shape resulting in an interface area of approximately 1 mm2, and subsequently subjected to microtensile bond strength (microTBS) testing with a cross-head speed of 1 mm/minute. Differences in microTBS were determined for enamel and dentin using the Kruskal-Wallis test at P < 0.05. RESULTS: The microTBS to enamel varied from 10.3 MPa for the one-step self-etch adhesive AQ bond to 49.5 MPa for the total-etch adhesive Prime & Bond NT. The microTBS to dentin varied from 15.5 MPa for the one-step self-etch adhesive Reactmer to 59.6 for the three-step total-etch adhesive OptiBond FL. The microTBS of the total-etch adhesives to enamel was significantly higher than that of the one-step self-etch adhesives. Comparing the dentin microTBS, only OptiBond FL performed significantly better than the one-step self-etch adhesives. Specimen failure during preparation occurred with each one-step adhesive, but more frequently when bonding to enamel than to dentin. Most one-step self-etch adhesives failed predominantly adhesively between the tooth substrate and the bonding layer in contrast to the two- and three-step adhesives that revealed generally more mixed adhesive-cohesive failures.
Subject(s)
Dental Bonding , Dentin-Bonding Agents/chemistry , Glass Ionomer Cements/chemistry , Resin Cements/chemistry , Acid Etching, Dental/methods , Dental Enamel , Dental Stress Analysis , Dentin , Humans , Hydrogen-Ion Concentration , Materials Testing , Microscopy, Electron, Scanning , Molar , Tensile StrengthABSTRACT
A 75-year-old male with an aneurysm in the transverse aortic arch with aberrant right subclavian artery was surgically treated successfully. Preoperative angiograms suggested abnormal expansion of neck vessels but this was not confirmed before operation. At operation, right aberrant subclavian artery was confirmed and the transverse aortic arch was replaced with a 22mm woven Dacron graft and four brachiocephalic vessles were reconstructed by interposition of four 8mm Dacron grafts between those vessels and the arch prosthesis. The postoperative course was uneventful and the postoperative angiograms indicated successful transverse aortic arch reconstruction.
