Evaluation of the Association Between Hearing Aids and Reduced Cognitive Decline in Older Adults with Hearing Impairment.

OBJECTIVE: We investigated whether hearing aids (HAs) for hearing impairment may reduce cognitive decline in older adults. STUDY DESIGN: Retrospective cohort. SETTING: Ambulatory for medical checkup. PATIENTS: Comprised 1,453 older adults aged 65 to 90 years. INTERVENTION: HAs were recommended for hearing impairment with thresholds of ≥40 dB. MAIN OUTCOME MEASURES: The Mini-Mental State Examination (MMSE) and pure-tone audiometry were performed. Over 2 years, multivariate logistic regression analysis was used to assess the effects of sex, age, hearing, HAs, hypertension, diabetes, cerebrovascular disease, smoking, and drinking on MMSE scores. RESULTS: Of 1,453 participants who underwent MMSE, 1,320 who underwent audiometry in the first-year included 99 HA users. Of the 1,320 participants, 858 (89 HA users) were followed longitudinally for 1 year and 672 (66 HA users) for 2 years. In the first-year cross-sectional study, the risk ratios (RRs) for hearing impairment (≥25 dB) when the MMSE scores were ≤23 and ≤27 points were 2.97 (1.40-6.28) and 1.34 (1.01-1.79), respectively. For moderate (40-<70 dB) and moderate to severe (≥40 dB) hearing impairment, the RRs for HA use were 0.30 (0.11-0.86) and 0.50 (0.22-1.13), respectively, when the MMSE scores were ≤23. A 2-year follow-up of participants with moderate hearing impairment yielded hazard ratios for MMSE score decrease of 0.30 (0.11-0.82) after 1 year and 0.16 (0.04-0.64) after 2 years in HA users. CONCLUSIONS: HA use may be associated with reducing MMSE score decrease in older adults with moderate hearing impairment.

Brief report on similar mutational changes in neurofibromatosis type 2 gene in minute pulmonary meningothelial-like nodule and meningioma of the central nervous system.

INTRODUCTION: Minute Pulmonary Meningothelial-like Nodules (MPMNs) are usually detected incidentally adjacent to lung cancer tissue. The pathogenesis is unknown. MPMNs reportedly share the status of neurofibromatosis (NF)-2 gene with meningiomas of the central nervous system. RESULTS: Immunohistochemical staining of two MPMNs revealed they were positive for epithelial membrane antigen (EMA), vimentin, CD56, and progesterone. We identified deletion of the NF-2 gene in two MPMNs and one CNS meningioma. CONCLUSIONS: MPMN and CNS meningioma may develop via the same mechanism through NF-2 translocation. Further studies are required to elucidate the genetic similarities between these entities. METHODS: We used fluorescence in situ hybridization to explore the status of the NF-2 gene in MPMNs and compare it with that of CNS meningiomas. We used a commercially available locus-specific probe for the NF-2 region to analyze whole tissue sections of two MPMNs and two CNS meningiomas by fluorescence in situ hybridization.

Lung parenchymal involvement of primary bone marrow follicular lymphoma: a rare case study.

A 76-year-old man presented with shortness of breath. Computed tomography revealed ground-glass opacity and interlobular thickening in the right lower lobe. Blood examination showed elevated levels of white blood cell count and lymphocytes. Bone marrow aspiration revealed low-grade follicular lymphoma. Histopathological examination of the surgical lung biopsy from the right lower lobe demonstrated usual interstitial pneumonia and scattered aggregation of lymphocytes with poorly formed non-necrotizing granuloma. An 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) did not show intense uptake in areas other than the right lower lobe. We concluded that the granuloma in the lung was presumed to be a sarcoid reaction associated with bone marrow follicular lymphoma, and the intense 18F-FDG uptake in the right lower lobe might have been due to a sarcoid reaction. Immunohistochemistry or other genetic examinations are important even if 18F-FDG uptake on PET-CT seems to be a false-positive because of the possibility of a sarcoid reaction.

[Identification of mycobacteria by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry--using reference strains and clinical isolates of Mycobacterium].

PURPOSE AND METHODS: Matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) method is being played an important role for the inspection of clinical microorganism as a rapid and the price reduction. Mass spectra obtained by measuring become points of identification whether the peak pattern match any species mass spectral pattern. We currently use MALDI-TOF MS for rapid and accurate diagnosis of inactivated reference and clinical isolates of Mycobacterium because of the improved pretreatment techniques compared with former inspection methods that pose a higher risk of infection to the operator. The identification matching rate of score value (SV) peak pattern spectra was compared with that of conventional methods such as strain diffusion/amplification. Also, cultures were examined after a fixed number of days. Compared with the initial inspection technique, the pretreatment stage of current MALDI-TOF MS inspection techniques can improve the analysis of inactivated acid-fast bacteria that are often used as inspection criteria strains of clinical isolates. Next, we compared the concordance rate for identification between MALDI-TOF MS and conventional methods such as diffusion/amplification by comparison of peak pattern spectra and evaluated SV spectra to identify differences in the culture media after the retention period. RESULTS AND DISCUSSION: In examination of 158 strains of clinical isolated Mycobacterium tuberculosis complex (MTC), the identification coincidence rate in the genus level in a matching pattern was 99.4%, when the species level was included 94.9%. About 37 strains of nontuberculous mycobacteria (NTM), the identification coincidence rate in the genus level was 94.6%. M. bovis BCG (Tokyo strain) in the reference strain was judged by the matching pattern to be MTC, and it suggested that they are M. tuberculosis and affinity species with high DNA homology. Nontuberculous mycobacterial M. gordonae strain JATA 33-01 shared peak pattern spectra, excluding the isolates, with each clinically isolated strain. However, the mass spectra of six M. gordonae clinical isolates suggested polymorphisms with similar mass-to-charge ratios compared with those of the reference strains. The peak pattern spectra of the clinical isolates and reference strains, excluding the NTM M. gordonae strain JATA33-01, were consistent with the peak pattern characteristics of each isolate. However, a comparison between the peak patterns of the reference strains and those of the six clinically isolated M. gordonae strains revealed a similar mass-to-charge ratio, which may indicate few polymorphisms. The SV spectrum of the improved inspection technique showed no fidelity, but it was acceptable after days of culture as indicated by the decrease in SV (0.3 degree). Also, the reproducibility of this method was good, but no difference was observed from the SV of the improved inspection technique, which decreased by approximately 0.3 because of the number of days of culture storage. In addition, expansion of the database and dissemination of regional specificity by genotype analysis of clinical isolates was relevant to the accumulated data, as expected. In future studies, the relevance and regional specificity of clinical isolates by genotype analysis can be determined by stacking the solid media and database penetration.

Nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy in 2008: general view of the pathogens' antibacterial susceptibility.

For the purpose of nationwide surveillance of the antimicrobial susceptibility of bacterial respiratory pathogens collected from patients in Japan, the Japanese Society of Chemotherapy conducted a third year of nationwide surveillance during the period from January to April 2008. A total of 1,097 strains were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections. Susceptibility testing was evaluable with 987 strains (189 Staphylococcus aureus, 211 Streptococcus pneumoniae, 6 Streptococcus pyogenes, 187 Haemophilus influenzae, 106 Moraxella catarrhalis, 126 Klebsiella pneumoniae, and 162 Pseudomonas aeruginosa). A total of 44 antibacterial agents, including 26 ß-lactams (four penicillins, three penicillins in combination with ß-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), three aminoglycosides, four macrolides (including a ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standard Institute (CLSI). The incidence of methicillin-resistant S. aureus (MRSA) was as high as 59.8%, and those of penicillin-intermediate and penicillin-resistant S. pneumoniae (PISP and PRSP) were 35.5 and 11.8%, respectively. Among H. influenzae, 13.9% of them were found to be ß-lactamase-non-producing ampicillin (ABPC)-intermediately resistant (BLNAI), 26.7% to be ß-lactamase-non-producing ABPC-resistant (BLNAR), and 5.3% to be ß-lactamase-producing ABPC-resistant (BLPAR) strains. A high frequency (76.5%) of ß-lactamase-producing strains was suspected in Moraxella catarrhalis isolates. Four (3.2%) extended-spectrum ß-lactamase-producing K. pneumoniae were found among 126 strains. Four isolates (2.5%) of P. aeruginosa were found to be metallo ß-lactamase-producing strains, including three (1.9%) suspected multidrug-resistant strains showing resistance to imipenem, amikacin, and ciprofloxacin. Continual national surveillance of the antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.

[Comparison of radial two-dimensional strain and regional wall motion abnormalities in the patients undergoing off-pump coronary artery bypass grafting].

BACKGROUND: Measurement of myocardial strain by echocardiogram is a novel approach in quantitatively assessing regional ventricular function. We investigated the relationship between left ventricular radial strain and traditional visual assessment of regional wall motion abnormalities. METHODS: We obtained midesophageal short-axis view of the left ventricle at the level of papillary muscles with a transesophageal echocardiography in 32 patients before and after off-pump coronary artery bypass grafting. Off-line analysis of echocardiogram was performed by the two independent observers. A total of 241 segments were divided into 5 grades (normal, mild hypokinesis, severe hypokinesis, akinesis, dyskinesis) according to the grading scale of ASE/SCA recommendations. A peak systolic radial strain was determined for each segment with a two-dimensional tissue-tracking method. RESULTS: The average peak systolic strain was significantly different among normal (38.4 +/- 16.1%), mild hypokinetic (30.8 +/- 14%), and severe hypokinetic (17 +/- 13.1%) segments, while no significant difference was observed between severe hypokinetic and akinetic segments. CONCLUSIONS: Our results suggest that intraoperative strain measurement by transesophageal echocardiography has a good reproducibility and allows quantitative assessment of regional ventricular function during cardiac surgery. However, the peak systolic radial strain may is less capable of differentiating segments with severely impaired wall motion.

Combined spinal-epidural analgesia for labor pain: best timing of epidural infusion following spinal dose.

OBJECTIVES: The combined spinal-epidural analgesia (CSEA) technique for labor pain has attained wide spread popularity in obstetric anesthesia. The onset of analgesia is rapid and reliable, and maternal satisfaction is very high. However, the best timing of an epidural infusion following the spinal dose and its effect on the total local anesthetics consumption has not been well determined. METHODS: A total of 144 consenting healthy nulliparous parturients whose labor was induced and who labored under regional analgesia were enrolled in this study. Following induction of the CSEA with intrathecal injection of bupivacaine, 2.5 mg and fentanyl, 25 microg, the patients were randomized into one of four groups to receive a subsequent continuous epidural infusion [E (3), E (30), E (60) and E (90)], depending on the timing of the initiation of epidural infusion of 0.1% ropivacaine, 0.0002% fentanyl and 1:500,000 epinephrine at the rate of 10 ml/h. In study Groups E (3), E (30), E (60) and E (90), epidural infusion was initiated 3, 30, 60 and 90 min, respectively following spinal induction dose. Patients requesting additional labor analgesia were given an epidural bolus (8 ml) of ropivacaine, 0.2%. The number of parturients requesting additional boluses of ropivacaine and the total dose of ropivacaine required for labor analgesia were registered. RESULTS: The numbers of patients who required additional boluses of ropivacaine in Group E (3) and Group E (30) were significantly less than those in Group E (60) and Group E (90). The total dose of ropivacaine required for labor pain in Group E (3) and Group E (30) was insignificantly smaller than the total dose required in Group E (60) and Group E (90). CONCLUSION: Our results suggest that the best timing of epidural infusion following spinal dose was within 30 min of spinal induction dose.

[Case report of tuberculous retropharyngeal abscess].

We report a case of tuberculous retropharyngeal abscess. The case reported was an 89 year old female. She visited our hospital with a complaint of swelling in the neck, a feeling of choking and a feeling of dysphagia. With a test puncture to the neck tumor, acid-fast stained bacilli were detected from punctured pus and the patient was hospitalized immediately due to a suspicion of tuberculous retropharyngeal abscess. As present illnesses, mucosal retraction and protrusion were found in the area from the right pharyngeal back to the oral cavity. Palpation revealed soft tumors of a ping-pong ball size without tenderness nor febrile sensation in the right submandibular region and left supraclavicular fossa in the neck. In the cervical contrast enhanced CT images, an abscess was found in the hypopharyngeal posterior gap and was shown as LDA (low density area) surrounded by strongly contrasting walls. The tumor was divided horizontally at the second cervical vertebra and shown strongly at the left cervical region as it goes downward, and in the region from the 6th cervical vertebra to the second thoracic vertebra, vertebral body destruction and numerous small abscesses in the vertebral anterior gap were found. Chest images revealed infiltration (r III 2) in the right lung, but the sputum smear was negative (-) for tubercle bacilli. As the abscess punctured fluid was TB-PCR (+), she was diagnosed as tuberculous retropharyngeal abscess, and a treatment was started with HRS (combination of isoniazid, rifampicin and streptomycin). Due to elevated feeling of suffocation and feeling of dysphagia during hospitalization, CT-guided cervical abscess puncture (using a 21G puncture needle) was performed twice to drain 100 ml and 80 ml pus. Subsequently, since the symptoms have improved and retention of abscesses was not found, the patient was discharged from the hospital. After the treatment for 9 months, no recurrence was reported.

A case of proteinase 3-antineutrophil cytoplasmic antibody-positive Sjögren's syndrome complicated with interstitial nephritis.

A 65-year-old woman who had fever was admitted. Laboratory data showed renal tubular dysfunction, elevated C-reactive protein, soluble interleukin-2 receptor (sIL-2R), and IgG. Her blood showed proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) as well as antinuclear antibody and anti-Ro/SS-A antibody. Salivary gland and renal biopsy showed inflammatory infiltration of lymphocytes. A diagnosis of Sjögren's syndrome (SS) and interstitial nephritis was made. beta(2)-microglobulin, sIL-2R, IgG, and PR3-ANCA were decreased in response to medium-dose oral prednisolone. Antineutrophil cytoplasmic antibody could be a new marker for extraglandular features of SS. It would be beneficial for SS patients who have positive ANCA to investigate extraglandular lesions such as interstitial nephritis.

CD40-CD40 ligand signal induces the intercellular adhesion molecule-1 expression through nuclear factor-kappa B p50 in cultured salivary gland epithelial cells from patients with Sjögren's syndrome.

The purpose of this study is to clarify signal transduction of expression of the intercellular adhesion molecule-1 (ICAM-1) via CD40-CD40 ligand in salivary glands of patients with Sjögren's syndrome (SS). We used cultured salivary gland epithelial cells (SG cells) from 15 SS patients and 8 controls obtained by labial minor salivary gland biopsy. First, ICAM-1 expression was determined with reverse transcriptase-polymerase chain reaction and flow cytometry in the presence or absence of soluble CD40L (sCD40L). Next, SG cells were transfected with plasmids of pGL1.3-Luc inserted with promoter region of ICAM-1, pGL1.3kB(-)-Luc mutated in nuclear factor kappa-B (NF-kappaB) binding site of pGL1.3-Luc and pNF-kappaB-Luc by lipofection method. Luciferase activity of the cells was measured in the presence or absence of sCD40L or sCD40L and an NF-kappaB inhibitor, pyrrolidine dithiocarbamate (PDTC). Finally NF-kappaB family proteins of cell nuclear extracts were determined. ICAM-1 expression was significantly enhanced with sCD40L at the mRNA and protein level. Activity of pNF-kappaB-Luc and pGL1.3-Luc was significantly elevated by stimulation with sCD40L and suppressed by PDTC. NF-kappaB p50 protein level was elevated by stimulation with sCD40L and suppressed by PDTC. Our results suggest that sCD40L enhances the ICAM-1 expression by activation of NF-kappaB p50 in the SS SG cells.

Spinal anesthesia using a continuous spinal catheter for cesarean section in a parturient with prior surgical correction of scoliosis.

This case report demonstrates the successful anesthetic management of cesarean section for a 29-year-old primiparous parturient with a past history of a scoliosis operation at 13 years of age. An Isola hook and screw-rod system had been implanted as posterior spinal instrumentation at the level of T3-L3. We titrated hyperbaric bupivacaine 7 mg combined with fentanyl 15 microg through a continuous spinal catheter, placed with a catheter-over-needle technique in order to avoid unintentional wide spread of anesthetic agents. The anesthetic level was T4 at the start of the operation. Her surgery was carried out without any problems. Headache, as a dural tap-related complication, was not observed. Spinal anesthesia with the titration of anesthetic agents for cesarean section is considered to be one of the choices for a parturient who has had spinal instrumentation.

Activities of rat cytochrome P450 3A and 2C isoforms are increased in vivo by magnesium sulfate as evidenced by enhanced oxidation of bupivacaine and testosterone in liver microsomes.

We previously reported that magnesium sulfate (MgSO(4)) increases the threshold dose of bupivacaine in inducing seizure in rats. Cytochrome P450 (P450) isoforms involved in the biotransformation of bupivacaine to three oxidative metabolites and the effects of MgSO(4) in vivo on the P450 activities in rats were investigated. Of six cDNA-expressed rat P450 isoforms tested, CYP3A2 and CYP2C11 had high rates for N-debutlylation and 3'-hydroxylation of bupivacaine, respectively. The liver microsomes prepared from male rats pretreated with intravenous administration of MgSO(4) (a bolus dose of 25 mg/kg, followed by infusion of 2.0 mg/kg/min for 6 h) showed increased V(max) values for N-debutylation and 3'-hydroxylaiton of bupivacaine compared to the liver microsomes from control rats. Administration of MgSO(4) also increased the activities of testosterone 6beta- and 16alpha-hydroxylation. Although the level of expression of CYP3A and CYP2C isoforms in the liver microsomes were unchanged, NADPH-P450 reductase and cytochrome b(5) were found to be induced by intravenous administration of MgSO(4). These results suggest that CYP3A and CYP2C isoforms are activated by MgSO(4) in vivo as a consequence of enhanced microsomal electron transfer due to induction of NADPH-P450 reductase and cytochrome b(5), leading to the increased metabolism and clearance of bupivacaine.

Subcutaneous sumatriptan for refractory trigeminal neuralgia.

BACKGROUND: Mechanical compression of the trigeminal root by an artery is thought to cause trigeminal neuralgia. The 5-HT(1B/1D) receptor agonist may inhibit neurogenic inflammation and vasodilation near the irritated trigeminal root. OBJECTIVE: To examine the effectiveness of a 5-HT(1B/1D) receptor agonist, sumatriptan, on a paroxysmal pain in trigeminal neuralgia. METHODS: Twenty-four patients with trigeminal neuralgia refractory to previous treatment were randomized to receive subcutaneously either 3 mg (1 mL) of sumatriptan or 1 mL of saline placebo. Following a 7-day period, patients crossed over to receive the alternative treatment. Paroxysmal pain triggered by touching or moving the face was assessed with VAS before and 15 minutes after the treatment. Patients used a descriptive scale to pain-grade outcome, and asked to note whether the pain returned and how long after therapy it recurred. RESULTS: Subcutaneous sumatriptan, but not placebo, significantly decreased VAS from 8.3 +/- 2.1 to 2.4 +/- 3.0 cm (mean +/- SD). The number of patients who described their pain as moderately or slightly better was 20 in the sumatriptan group and 1 in the placebo group. The effect of subcutaneous sumatriptan persisted for a median period of 7.9 hours (range: 1-20 hours). CONCLUSIONS: Subcutaneous sumatriptan produced prompt analgesia without serious adverse reactions in patients with trigeminal neuralgia refractory to previous treatment.

Patient-controlled epidural analgesia during labor using ropivacaine and fentanyl provides better maternal satisfaction with less local anesthetic requirement.

PURPOSE: To test the hypothesis that patient-controlled epidural analgesia (PCEA) using ropivacaine and fentanyl provides better maternal satisfaction and less anesthetic requirement than conventional continuous epidural infusion (CEI) during labor, we studied 58 uncomplicated parturients (singleton, vertex presentation). METHODS: After establishing effective epidural analgesia with 11 ml of 0.2% ropivacaine, all parturients were randomly divided into one of two groups: the PCEA group (n = 29) or the CEI group (n = 29). In the PCEA group, the pump was initiated to deliver a basal infusion at 6 ml x h(-1) and a demand dose of 5 ml; the lockout interval was 10 min, and there was a 31 ml x h(-1) limit. The drugs used were 0.1% ropivacaine + fentanyl 2 microg x ml(-1). In the CEI group, epidural analgesia was maintained with the same solution as the PCEA group at a constant rate of 10 ml x h(-1). If parturients requested additional analgesia in the CEI group, we added 8 ml of epidural 0.2% ropivacaine without fentanyl. RESULTS: Parturients' demographic data, such as duration of labor, mode of delivery, Apgar score, and umbilical arterial pH did not differ between the two groups. However, the hourly requirement of ropivacaine was significantly less in the PCEA group than in the CEI group (9.3 +/- 2.5 vs. 17.6 +/- 7.6 mg x h(-1); P < 0.05). Parturients' satisfaction assessed by the Visual Analogue Scale tended to be higher in the PCEA group than in the CEI group. Side effects such as nausea, hypotension, and itching were similar for the two groups. CONCLUSION: We found that PCEA was an effective means of providing optimal analgesia, with better satisfaction during labor and less local anesthetic requirement.

Labour analgesia guided by echocardiography in a parturient with primary dilated cardiomyopathy.

PURPOSE: To evaluate the effects of intrathecal analgesics on cardiac function during labour analgesia using echocardiography in a parturient with idiopathic dilated cardiomyopathy (DCM). CLINICAL FEATURES: Induction of labour was planned in a 35-yr-old primiparous woman suffering from DCM. In order to stabilize hemodynamics in this patient, we induced continuous spinal analgesia with an infusion of fentanyl and epinephrine. Although her analgesia was well maintained for three hours during the first stage of labour, the patient complained of pain towards the second stage of labour. At this point, we administered bupivacaine intrathecally to alleviate her pain. Transthoracic echocardiography showed that the left ventricular end-diastolic and systolic dimensions, as well as the ejection fraction were not impaired by use of these analgesic medications. CONCLUSION: Measurement of left ventricular dimensions by echocardiography allowed us to monitor the patient's response to intrathecal analgesic medications. In this patient with DCM, analgesia with intrathecal fentanyl and bupivacaine was well tolerated.

Epithelial Metaplasia Induced Amnionic Ectoderm by the Dermis of Chicken Embryos1 : (mesenchymal-epithelial interaction/feather/scale/skin/keratin).

Amnionic ectoderm of 6.8-day chicken embryos was associated with 6.8-day dorsal dermis or 13-15-day scale dermis and cultured on host chorio-allantoic membrane for 8 days. The amnionic ectoderm, recombined and cultured with the dorsal dermis, developed feather filaments consisted of a feather root, a horny sheath, and barb ridges. With several feather keratin-specific monoclonal antibodies (4E12 and 1F3), these structures in the induced feather filaments were shown to express feather-specific keratin antigens. The amnionic ectoderm, recombined and cultured with the shank dermis, became stratified squamous and developed scales. The scales were keratinized and their surface reacted only weakly with the monoclonal antibodies specific for the feather keratins. However, 1F3 reacted with two polypeptides in the cytoskeletal fraction of the scales, but not of the feather filaments. The results confirm our previous findings from in vitro experiments with the proamnionic ectoderm (Mizuno, 1970, 1972).