Detection and molecular phylogenetic analysis of chicken astrovirus in Saga prefecture, Japan.

We detected three chicken astrovirus strains in 4-day-old broiler chickens with high mortality and visceral gout and one strain from 150-day-old hens without clinical symptoms in Saga prefecture, Japan. Phylogenetic analysis based on ORF2 amino acid sequences revealed that the strains from the visceral gout cases belonged to subgroup Bi, and the strain from hens without clinical symptoms belonged to subgroup Aiii. Our study showed that CAstV had infiltrated into Saga prefecture, Japan. This is the first report of CAstV in Japan.

Scald Burns While Bathing Among Elderly People in Japan.

Night baths are an essential and beloved tradition in Japanese households. The main purpose of taking a bath at the end of the day, besides hygiene, is relaxation. The aging population is rapidly growing in Japan, as one in three people are approaching the age of 65 years or older. Furthermore, with the progress of nuclear families, the number of households with only elderly people and the need for elderly care is increasing. In recent years, elderly people experienced burns caused by hot water during bathing. We report two cases of water bath burns experienced by elderly people. The first is a case of a 68-year-old woman who presented with a history of type 2 diabetes and osteoarthritis in both knees. She did not notice that the bath stopper was unplugged while she was taking a bath, and she added hot water at around 44°C. She was exposed to hot fluid on the right foot and suffered deep dermal burns. However, due to knee osteoarthritis, it became difficult for her to move. Two hours after taking a bath, she was removed from the bathtub. The second is a case of a 71-year-old woman who presented with a history of type 2 diabetes and osteoarthritis in both knees. Because the temperature of the bath was approximately 44°C, she tried to cool down the water, but it was difficult for her to move because of knee osteoarthritis. She called out for help from her family living in the neighborhood, but she could not get out. She was sitting for about 2 hours before being noticed by her family. As a result, she suffered second-degree burns on both the buttocks and soles of her feet. Prolonged exposure to thermal liquids and burns such as low-temperature burns are caused by individual factors, such as decreased perception, orthopedic disease, and difficulty in moving due to fainting, and social factors such as delay in discovery in elderly people living alone. These factors lead to an increased depth of the burn.

A clinical and statistical analysis of abscess in cellulitis.

The features of abscess that forms in cellulitis patients were investigated. Among 449 cellulitis cases, about 15% developed abscess, and about 70% of teenaged patients were abscess cases. Furthermore, abscess in the younger age group occurred almost exclusively among male patients. The lesion was predominantly concentric at all ages in the abscess group and in teenagers in the non-abscess group. In contrast, it was diffuse in patients ≥20 years old in the non-abscess group. The clinical symptoms and laboratory values in the abscess group were generally more severe than those in the non-abscess group, especially in the older age group. The abscess sizes increased with the initial area of the lesions. Most abscess cases received incision, and post-incision ulcers were mostly conservatively treated. The duration required for treatment termination was >30 days longer in the abscess group than in the non-abscess group. When post-incision ulcers were conservatively treated, the duration until healing increased with abscess size. However, the durations did not significantly differ between the conservatively and surgically treated groups. When surgically treated, many ulcers healed within 19 days after operation and the outpatient follow-up period tended to be relatively short. Most teenaged patients were student athletes, and thus needed an early return to competition. The main cause in these patients was bruising during sports, with rugby football the most common causative sport. Ulcer closure by operation was suggested to be preferable for shortening the outpatient follow-up period, especially for student athlete patients.

Statistical analysis of anti-mamushi venom serum injection time and clinical course.

AIM: Early injection of anti-mamushi venom serum (antiserum) is believed to be effective for the treatment of patients with mamushi bites. However, there is no firm information that indicates the time range constituting "early" injection. We tried to quantify the cut-off time of antiserum injection that brings favorable clinical courses by clarifying the relationship between the injection time and clinical outcome. METHODS: We retrospectively analyzed the relationships between the time after bite, injection time of the antiserum, swelling grades, and laboratory values. RESULTS: The injection time of the antiserum in severe cases was significantly delayed as compared with non-severe cases. The best cut-off time of the antiserum injection that could distinguish non-severe and severe cases was 14 h. In the group that received the antiserum within 14 h, the antiserum injection may have successfully arrested the grade progression in a substantial number of cases. In the other group receiving the antiserum beyond 14 h, the grades in many cases possibly may have peaked by the time of antiserum injection. CONCLUSION: The cut-off time of early injection for favorable clinical course was determined to be 14 h. A statistical basis concerning the appropriate antiserum injection time was made to help prevent a severe clinical course due to delayed injection.

Solitary subungual neurofibroma with glomus tumor-like appearance: a case report.

We present a case of subungual neurofibroma which clinically presented a glomus tumor-like appearance. Six months after surgical resection, no clinical recurrence or pain was reported. We herein report the difficulty of its preoperative diagnosis, including literature review.

[A case report of adult-onset IgA vasculitis with repeated migrating abdominal lesions and manifestations].

A 68-year-old woman was referred to our hospital due to widespread purpura on her legs. A diagnosis of IgA vasculitis was made based on the findings of a skin biopsy. However, after being admitted to our hospital, abdominal pain and lower gastrointestinal hemorrhaging developed. The purpura disappeared gradually, whereas the abdominal pain migrated and persisted. Treatment with prednisolone was initiated, and the clinical course improved temporarily. However, her severe abdominal symptoms recurred while, in addition, the intestinal tract lesions migrated after the prednisolone dosage was tapered. Therefore, intravenous high-dose methylprednisolone was administered followed by oral steroids. The dose was thereafter carefully tapered, and the steroid dose reduction was successful with this treatment. We herein report the clinical course of the case along with a review of the relevant literature.

Cochineal dye-induced immediate allergy: Review of Japanese cases and proposed new diagnostic chart.

BACKGROUND: Cochineal dye is used worldwide as a red coloring in foods, drinks, cosmetics, quasi-drugs, and drugs. The main component of the red color is carminic acid (CA). Carmine is an aluminum- or calcium-chelated product of CA. CA and carmine usually contain contaminating proteins, including a 38-kDa protein thought to be the primary allergen. Severe allergic reactions manifest as anaphylaxis. The aim of this study was to review all Japanese reported cases and propose useful diagnostic chart. METHODS: All reported Japanese cases of cochineal dye-induced immediate allergy were reviewed, and newly registered cases were examined by skin prick test (SPT) with cochineal extract (CE) and measurement of CE and carmine-specific serum IgE test. Two-dimensional (2D) western blotting using patient serum was conducted to identify the antigen. RESULTS: Twenty-two Japanese cases have been reported. SPT and the level of specific IgE test indicated that six cases should be newly registered as cochineal dye allergy. All cases were adult females, and all cases except three involved anaphylaxis; 13 cases involved past history of local symptoms associated with cosmetics use. Japanese strawberry juice and fish-meat sausage, and European processed foods (especially macarons made in France) and drinks were recent major sources of allergen. 2D western blotting showed that patient IgE reacted to the 38-kDa protein and other proteins. Serum from healthy controls also weakly reacted with these proteins. CONCLUSIONS: SPT with CE and determination of the level of CE and carmine-specific IgE test are useful methods for the diagnosis of cochineal dye allergy.

A lethal case of mamushi (Gloydius blomhoffii) bite: severe bowel symptoms as a lethal sign.

Case: We report a lethal case of a mamushi (Gloydius blomhoffii) bite. An 84-year-old woman was bitten by a mamushi snake on her right elbow. She was initially treated at another hospital, however, because the swelling expanded and her renal function worsened, she was transferred to our hospital. Compartment syndrome, thrombocytopenia, respiratory arrest, and elevated creatinine kinase and lactose dehydrogenase levels were seen; renal failure progressed, and ileus and peritonitis due to colon perforation occurred. Outcome: The patient died 35 days after the bite. An autopsy revealed widespread necrosis of the ileum, colon, and liver. Conclusion: This report supplies useful clinical information on the treatment of severe mamushi bite cases, and severe abdominal symptoms, such as ileus and melena, may be a lethal sign.

Severe pyoderma gangrenosum in association with a flame burn.

We herein report a severe case of pyoderma gangrenosum occurring in a burn patient and discuss the possibility of occult complications of this pathological state in daily treatment.

Pemetrexed-induced scleroderma-like conditions in the lower legs of a patient with non-small cell lung carcinoma.

Pemetrexed, which is used for the treatment of non-small cell lung carcinoma and malignant mesothelioma, induces cutaneous adverse reactions in approximately 20% of patients. There are also reports of the induction of fibrosing disorders. We describe a case of pemetrexed-induced scleroderma-like conditions in the lower legs of a patient whose pulmonary carcinoma has been relatively well controlled, with prolongation of the dose interval, in spite of the discomfort in both his legs. Skin biopsy revealed dermal fibrosis and dilated lymph vessels in the dermis, but lymphocytic infiltration around the lymph vessels, in contrast to the blood vessels, was minimal. Immunohistochemical staining revealed that the major subsets of T cells that had infiltrated around blood vessels were CD3 and CD45Ro, but no B cells were detected. High serum levels of interleukin (IL)-4 and IL-6 suggested that T cells, which secrete these cytokines, may be involved in the pathogenesis of this condition. Magnetic resonance imaging of the lower extremities revealed muscular and fascial involvement. Several chemotherapeutic agents, such as taxanes, gemcitabine and bleomycin, are known to induce scleroderma-like changes, and we should also keep the side-effects of pemetrexed in mind when we encounter patients with fibrosing conditions.

Comparative analysis of mamushi (Gloydius blomhoffii) bite patients indicates that creatinine kinase levels/white blood cell count trends reflect severity.

Aim: There has been no indicator that allows an early quantitative evaluation of the severity of a mamushi snake (Gloydius blomhoffii) bite. Because the number of severe mamushi bite cases is much fewer than non-severe cases, a formal case-control study is difficult. Therefore, we tried to generate a preliminary quantitative, real-time index for its severity by referring to published reports of severe mamushi bite cases. Methods: We enrolled patients who presented with a mamushi bite and visited our outpatient clinic. Severe cases were collected from published works. Creatinine kinase levels and white blood cell counts of non-severe and severe cases were compared and analyzed. Results: There was a lag time of 10 h before the creatinine kinase level began to rise. The speed of the increase was higher in severe cases than in non-severe cases, and severe cases were recognized as those showing speeds of above 250 IU/L/h. White blood cell counts increased earlier than creatinine kinase levels without any lag time. Severe cases were recognized as those with the counts of over 1,000 × (h) + 6,000 [/µL] before 5 h and 300 × (h) + 10,000 [/µL] after 5 h. Conclusion: We herein present the creatinine kinase level and white blood cell count trends and demonstrate preliminary cut-off equations. The trends for both parameters serve as quantitative indicators of the severity of a mamushi bite until a large scale case-control study is achieved.

Results of second-stage screening for skin cancers in Oita Prefecture, Japan.

We performed skin cancer screenings for 2 or 3 days annually from 2006 through 2013 in Oita Prefecture, Japan. Screening of approximately 3000 people in total allowed us to identify and treat several skin cancers, including five cases of malignant melanoma, four of squamous cell carcinoma, 16 of basal cell carcinoma, 11 of Bowen's disease, 17 of actinic keratosis, one of extramammary Paget's disease and one of metastatic breast carcinoma. The sensitivity and specificity for the category defined by an identified lesion associated with risk of cancer and requiring further examination (category C) were 92.7% and 95%, respectively. We cannot estimate the outcome of our skin cancer screenings in terms of cancer mortality because of the small number of subjects examined and the brief follow-up period. However, we did estimate the effectiveness of these screenings in terms of stages or sizes of cancerous lesions. The relative numbers of subjects with malignant melanoma at various clinical stages, identified during skin cancer screenings and during a routine visit to our hospital, were significantly different. We also compared, statistically, the sizes of lesions in Bowen's disease that were found during cancer screenings and during a direct visit to our hospital. The former lesions were smaller than the latter. Our data suggest the benefits of our skin cancer screenings and the importance of campaigns and education to encourage people to visit dermatologists for the detection of skin cancers at an early stage.

Identification of fibronectin binding sites in dermatopontin and their biological function.

BACKGROUND: Dermatopontin (DP) is a 22kDa acidic extracellular matrix (ECM) protein that plays a critical role in both ECM structure and wound healing. Previously, we demonstrated that DP interacts with fibronectin (Fn) and promotes formation of insoluble Fn fibrils that are called activated Fn (Kato et al., J Biol Chem 2011;286:14861-9). OBJECTIVE: Details of the interaction between DP and Fn are investigated to further examine the biological functions of DP. METHODS: Interactive sites between Fn and DP were examined by a solid-phase assay using Fn, DP, and their respective recombinant proteins and synthetic peptides. The effect of the DP peptides on insoluble Fn fibril formation was examined by both electrophoresis and electron microscopy. RESULTS: A binding site in DP for Fn was identified as the DP-4 (PHGQVVVAVRS) peptide, and the major binding site in Fn for DP was the 14th type III repeat (III14) domain. Further, the major DP binding site in the III14 domain was located around the B- and C-strands and their connecting loop region. A synthetic cyclic peptide mimicking the Fn loop structure enhanced DP binding activity. The DP-4 peptide induced Fn polymerization but the morphology was different from that of Fn fibrils formed by full length DP. The Fn fibrils with DP-4 enhanced integrin α5ß1-mediated cell adhesion and spreading. CONCLUSION: Interactive sites between Fn and DP were identified. The DP-4 peptide activated Fn and enhanced cell adhesion activity. DP-4 has the potential to be used for therapeutic applications, such as a wound treatment.

Functional peptide of dermatopontin produces fibrinogen fibrils and modifies its biological activity.

BACKGROUND: Dermatopontin (DP), a small extracellular matrix protein, interacts with both fibrinogen and fibrin. DP accelerates fibrin fibril formation and enhances cell adhesion to fibrin fibrils but DP does not influence fibrinogen fibril formation. We have previously demonstrated that DP-4 (PHGQVVVAVRS) is a functional dermatopontin peptide (Wu et al., 2014). OBJECTIVE: Identification of biological functions of DP-4. METHODS: Protein-protein interactions were examined by solid-phase assay. The kinetics of fibrinogen/fibrin polymer formation was monitored by turbidity change, SDS-PAGE, and electron microscopy. A cell adhesion assay was performed using human umbilical vein endothelial cells. RESULTS: Although DP promoted fibrin formation, the DP-4 peptide promoted fibrinogen polymerization but did not apparently affect fibrin formation. The polymerized fibrinogen formed straight solid fibrils comparable to the normally formed fibrin fibrils. A minimum functional sequence of the DP-4 peptide was determined to be VVVAVRS. An αC domain in fibrinogen was involved in the fibril formation. Fibrinogen fibrils made by DP-4 enhanced endothelial cell adhesion and spreading in a dose-dependent manner. This cell adhesion was inhibited by heparin and by anti-αvß3 and ß1 integrin antibodies. CONCLUSION: DP-4 did not reproduce the full functional biological activities of DP with fibrin but DP-4 did promote fibrinogen fibril formation. The fibrinogen fibrils produced by DP-4 are useful as a novel synthetic biomaterial for therapeutic applications.