Cholinergic crisis caused by ingesting topical carpronium chloride solution: A case report.

A cholinergic crisiss is a state characterized by excess acetylcholine owing to the ingestion of cholinesterase inhibitors or cholinergic agonists. We report the first case of a cholinergic crisis after the ingestion of a carpronium chloride solution, a topical solution used to treat alopecia, seborrhea sicca, and vitiligo. An 81-year-old woman with no prior medical history was transported to our emergency department because the patient had disturbance of consciousness after ingesting three bottles of FUROZIN® solution (90 mL, 4500 mg as carpronium chloride). A family member who found the patient called for emergency medical services (EMS) personnel, who contacted the patient ten minutes after ingestion. The patient's Glasgow Coma Scale score was 12 (E4V3M5), and vital signs were as follows: blood pressure, 80/40 mmHg; heart rate, 40 beats/min. The patient vomited repeatedly in the ambulance. On arrival to the ED, the patient's systolic blood pressure and heart rate temporarily decreased to 80 mmHg and 40 beats/min, respectively. Seventy-eight minutes after ingestion, gastric lavage was performed. The patient's symptoms, which included excess salivation, sweating, and hot flush, improved 24 h after ingestion, and the patient's vital signs stabilized without atropine or vasopressors. On the second day of admission, the patient was examined by a psychiatrist and discharged without suicidal ideation. Carpronium chloride has a chemical structure similar to that of acetylcholine; therefore, it exhibits both cholinergic and local vasodilatory activities. There is limited information on the pharmacokinetics of ingested carpronium chloride; therefore, physicians should be made aware that ingesting a carpronium chloride solution may cause a cholinergic crisis.

Correction: Validation of Skeletal Muscle Volume as a Nutritional Assessment in Patients With Gastric or Colorectal Cancer Before Radical Surgery.

[This corrects the article DOI: 10.14740/jocmr3129w.].

Validation of Skeletal Muscle Volume as a Nutritional Assessment in Patients With Gastric or Colorectal Cancer Before Radical Surgery.

BACKGROUND: Recently, some studies have reported the importance of sarcopenia as a prognostic factor in patients with gastrointestinal cancer who have undergone surgery. We aimed to examine skeletal muscle volume for use in nutritional assessment of preoperative patients, and to compare the results with those of other conventional methods of nutritional assessment, such as biochemical or body composition values. METHODS: This was an open cohort study which examined skeletal muscle volume for use in nutritional assessment of preoperative patients. A total of 121 patients with gastrointestinal cancer who underwent radical surgery were enrolled in this study between June 1, 2008 and December 31, 2012. There were 39 and 82 patients with gastric and colorectal cancer, respectively. The primary outcome of this study was postoperative overall survival. The secondary outcomes were postoperative survival from cancer-related deaths, recurrences of cancer after surgery, postoperative complications, and postoperative hospital inpatient stay (measured in days). Univariate and multivariate analyses were used to identify the relevant factors for postoperative outcomes mentioned above. RESULTS: Skeletal muscle volume was a significant (hazard ratio (HR): 3.34, 95% confidence interval (CI): 1.21 - 9.17, P = 0.020) independent prognostic factor for cancer-related deaths in patients with gastric or colorectal cancer who had undergone surgery, and a marginally independent (HR: 2.48, 95% CI: 0.91 - 6.81, P = 0.077) factor that negatively contributed to overall survival in these patients. In contrast, the preoperative skeletal muscle volume was not correlated with the recurrence of cancer, and was not significantly correlated with the occurrence of severe complications after surgery or prolongation of hospitalization. CONCLUSIONS: The preoperative skeletal muscle volume was a significant prognostic factor in patients with gastric or colorectal cancers. Therefore, the estimation of skeletal muscle volume may be important for stable, long-term nutritional assessment in patients with gastrointestinal cancers.

A novel method for systematic analysis of rigidity in Parkinson's disease.

We propose a novel system that analyzes the components of rigidity in Parkinson's disease (PD) usually perceived by physicians, in a very simple and systematic way for routine clinical practice. Our system is composed of two compact force sensors, a gyroscope, and EMG surface electrodes. Muscle tone was assessed in 24 healthy elderly subjects and 27 PD patients by passive extension and flexion of the elbow joint with ramp-and-hold trajectory. Torque and angle data in the dynamic phase were used to calculate "elastic coefficients" in extension and flexion, and the mean value of torque in each dynamic phase at each joint angle (defined as "Bias") was also calculated. The muscle activity index in the static phase (EMG Index) was obtained for both biceps brachii (BB) and triceps brachii (TB) muscles. "Elastic coefficients," sum of the "difference of Bias" and "EMG Index" for BB all correlated well with UPDRS score. Based on our results, Parkinsonian rigidity consists of both an "elastic" component and a "difference of Bias" component, and neurologists may assess greater rigidity when either one or both components are high in value. The EMG index was useful for differentiating PD patients with slight rigidity from healthy elderly adults.

Effect of weight reduction with dietary intervention on arterial distensibility and endothelial function in obese men.

Obesity and reduction in central arterial distensibility, respectively, have been identified as powerful and independent risk factors for cardiovascular disease. However, the effect of weight reduction on central arterial function in obese subjects has not yet been clarified. We investigated whether low-calorie diet-induced weight reduction affects central arterial distensibility and endothelial function in middle-aged obese men. Twelve obese men (age: 45+2 yrs, BMI: 30+1 kg/m 2) completed a 12-week dietary intervention. Caloric restriction induced significantly weight loss and decrease in BMI. After the program, carotid arterial compliance significantly increased and b-stiffness index and aortic pulse-wave velocity remarkably decreased. Concentrations of plasma endothelin-1 (ET-1) significantly decreased and plasma nitric oxide (NO) markedly increased after the program. Weight reduction by low-calorie diet in obese men increases central arterial distensibility, which may contribute to the improvement in endothelial function, as noted by a decrease in ET-1 and an increase in NO.

Changes in the homeostatic mechanism of dental pulp with age: expression of the core-binding factor alpha-1, dentin sialoprotein, vascular endothelial growth factor, and heat shock protein 27 messenger RNAs.

Dental pulp has various characteristics in the pulp chamber, but only a few biological evaluations about the effect of age on dental pulp tissue have been reported. The purpose of this study was to compare dental pulp from young and adult rats to characterize the homeostatic mechanism. Dental pulp cells (DPCs) were obtained from the first molar of rats, weighing 150 g each for the young group and 350 g each for the adult group. The expression of core-binding factor alpha-1 (Cbfa-1), vascular endothelial growth factor (VEGF), or heat shock protein (HSP) 27 messenger RNAs (mRNAs) by cultured pulp cells was determined by using a quantitative real-time PCR system after 3, 7, or 14 days. The expression of Cbfa-1 mRNA in the young group was higher than in the adult group. Expression of VEGF and HSP27 mRNAs in the adult group was higher than in the young group. The self-defense system in young DPCs is undertaken by calcification, but in adult DPCs it is carried out by the expression of self-defense proteins and the regeneration of vessels.

Age-related differences in expression of vascular endothelial growth factor by periodontal ligament cells in vitro.

The purpose of this study was to evaluate age-related differences in expression of vascular endothelial growth factor (VEGF) by periodontal ligament (PDL) cells. PDL cells were obtained from Wistar male rats weighing approximately 150 g each in the young group and 350 g each in the old group. PDL cells derived from upper and lower incisors were seeded in 35-mm culture dishes after primary culture. For cell proliferation assays, cells were detached and counted at 1, 3, 5, 7, 11 and 14 days after culture. VEGF mRNA expression was analyzed with TaqMan. The number of cells in both groups increased day by day, but the rate of increase in the young group was higher than that in the old group. VEGF mRNA expression in the young group increased from 3 to 14 days, but in the old group increased only slightly over the same time period. Expression ratios in the young group were higher than those in the old group, and there were significant differences between the young and old groups at 7 and 14 days of culture. In conclusion, the data revealed that PDL cells varied with age, and suggest that in view of such changes in cell proliferation and VEGF mRNA expression, age should be taken into consideration in periodontal treatment.

Characteristics and epidemiologic genotyping of Staphylococcus aureus isolates from bovine mastitic milk in Hokkaido, Japan.

Two hundred thirty one Staphylococcus aureus isolates from bovine mastitic milk were discriminated into 60 patterns and 16 lineages by pulsed-field gel electrophoresis (PFGE). The tested isolates were also investigated using coagulase and capsule serotyping and PCR for possession of genes that encode staphylococcal enterotoxins (sea to sei), enterotoxin-like toxins (selj to selr), and toxic shock syndrome toxin (tst). One hundred seventy three of the isolates (74.9%) possessed one or more toxin genes, while no egg-yolk factor was detected in most of them. The most common combinations of toxin genes possessed by the tested isolates were sec, seg, sei, sell, and tst, or seg and sei, or sec, seg, sei, sell, seln, and tst. Two hundred and ten of the isolates (91.0%) serotyped coagulase VI, and 207 of the isolates (89.6%) expressed serotype 5 or 8 capsules. These results suggested that isolates belonging to two major lineages have spread all over Hokkaido as bovine mastitic isolates. Additionally, no remarkable difference was recognized in the identification ratio of the isolates that belonged to the two major lineages between mastitis of subclinical origin and mastitis of clinical origin.

Prevalence and characteristics of eae-positive Escherichia coli from healthy cattle in Japan.

The prevalence of eae-positive Escherichia coli (eaeEC) in Japan was examined using rectal stool samples taken from 35 calves less than 1 month old, 107 calves more than 1 to 3 months old, 88 heifers more than 3 to 6 months old, 214 heifers over 6 months old, and cows from 95 farms. Screening with eae PCR revealed the prevalence to be, with increasing age, 31.4, 8.4, 26.1, and 14.5%, respectively. Of 51 selected eaeEC strains, more than 40% were serotyped as O26, O103, O111, O145, or O157, which are frequently detected as enterohemorrhagic E. coli types. Four strains were identified as recently reported intimin types eta, iota, and kappa.

Marinobacterium sp. strain DMS-S1 uses dimethyl sulphide as a sulphur source after light-dependent transformation by excreted flavins.

Marinobacterium sp. strain DMS-S1 is a unique marine bacterium that can use dimethyl sulphide (DMS) as a sulphur source only in the presence of light. High-performance liquid chromatography (HPLC) analyses of the culture supernatant revealed that excreted factors, which could transform DMS to dimethyl sulphoxide (DMSO) under light, are FAD and riboflavin. In addition, FAD appeared to catalyse the photolysis of DMS to not only DMSO but also methanesulphonate (MSA), formate, formaldehyde and sulphate. As strain DMS-S1 can use sulphate and MSA as a sole sulphur source independently of light, the excretion of flavins appeared to support the growth on DMS under light. Furthermore, three out of 12 marine bacteria from IAM culture collection were found to be able to grow on DMS with the aid of photolysis by the flavins excreted. This is the first report that bacteria can use light to assimilate oceanic organic sulphur compounds outside the cells by excreting flavins as photosensitizers.