Reactivation of cyprinid herpesvirus 2 (CyHV-2) in asymptomatic surviving goldfish Carassius auratus (L.) under immunosuppression.

Cyprinid herpesvirus 2 (CyHV-2) is a highly contagious pathogen of goldfish (Carassius auratus) and Prussian carp (Carassius auratus gibelio) causing herpesviral hematopoietic necrosis. Our previous study revealed that CyHV-2 can persistently infect the kidney and spleen of goldfish that recovered from a primary infection. In this study, we tried to identify the cells persistently infected with the virus in surviving fish and investigated virus reactivation in the survivors injected with immunosuppressants, namely dexamethasone (Dex) and cyclosporine A (CsA). Virus DNA was detected from the monocytes that were isolated from the trunk kidney of the asymptomatic survivors, suggesting that monocytes/macrophages are major cells that may be persistently infected with CyHV-2. A significant increase of virus DNA levels was detected in the group injected with Dex at 10 and 21 days post-injection (dpi). In the fish group injected with CsA, the virus DNA level was the same as that in the control group at 10 dpi but increased in some organs at 21 dpi. Compared with Dex-injected fish at 10 dpi, the group injected with both Dex and CsA showed a greater increase in virus DNA levels. The gene expression of phagocytosis-associated genes, major histocompatibility complex (MHC) class II and p47phox, and anti-virus antibody levels increased in the CsA group due to virus reactivation in the infected cells but not in the Dex and Dex & CsA groups, indicating that Dex effectively suppressed monocyte/macrophage function and antibody production. In addition, recombinant interferon γ (IFNγ) supplementation in the kidney leukocyte culture that was isolated from survivors showed a reduction of virus DNA. CsA may inhibit T-helper 1 (Th1) cells and consequently IFNγ production, causing a synergetic effect with Dex on virus reactivation. The results suggest that the activity of monocytes/macrophages stimulated by IFNγ can relate to virus latency and reactivation in asymptomatic virus carriers.

Successful management of preoperatively diagnosed torsion of a subserosal uterine fibroid by pneumoperitoneum laparoscopic single-port surgery.

OBJECTIVE: Preoperative diagnosis and successful management of acute torsion of a subserosal fibroid by using appropriate imaging modalities and single-port laparoscopic surgery. CASE REPORT: A 44-year-old nulliparous woman presented with lower abdominal pain. Computed tomography and magnetic resonance imaging with contrast enhancement revealed a tumor in the pouch of Douglas with a low contrast at the center and thin-rim enhancement. Torsion of a uterine subserosal fibroid was diagnosed preoperatively. Laparoscopic single-port surgery by pneumoperitoneum was performed. Torsion of the pedicle attached to the uterine wall was excised by bipolar coagulation and cut with scissors. The extirpated fibroid was extracted from the umbilical wound. The pneumoperitoneum single-port laparoscopic surgery was completed as a gynecologic emergency operation. CONCLUSION: Torsional uterine fibroids are difficult to diagnose preoperatively as symptoms are nonspecific and need emergent surgical management as an acute abdomen. Preoperative diagnosis using appropriate imaging modalities is important to perform single-port laparoscopic surgery.

Persistence of cyprinid herpesvirus 2 in asymptomatic goldfish Carassius auratus (L.) that survived an experimental infection.

Cyprinid herpesvirus 2 (CyHV-2) is the causative agent of herpesviral haematopoietic necrosis (HVHN) in goldfish, Carassius auratus, and Prussian carp, C. auratus gibelio. In this study, we investigated virus persistence in goldfish experimentally infected with CyHV-2. Virus DNA presence in organs was monitored in survivors reared at a virus permissive temperature and also in survivors treated with a non-permissive temperature for 4 days, initiated at three different time points post-infection in order to obtain fish with different virus loads. We detected virus DNA in all organs tested at 51 days post-infection (dpi) and in the spleen, trunk kidney and gills of survivors at 81 dpi, although the virus load in fish influenced the subsequent number of organs that tested positive for virus DNA. In addition, some organs dissected from four out of five asymptomatic survivors tested positive by PCR following incubation in vitro in a medium for 5 days. Following inoculation with the homogenate of PCR-positive kidney incubated in vitro, one of the three inoculated fish died, showing that the detected virus by PCR produced infectious particles. This study suggests that CyHV-2 can establish a persistent infection in some organs, especially the spleen and trunk kidney, and that asymptomatic surviving fish can be a source of infection.

Influence of antiplatelet therapy on postoperative recurrence of chronic subdural hematoma: a multicenter retrospective study in 719 patients.

OBJECTIVE: The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. METHOD: We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study. RESULTS: Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% (p value<0.0001; odds ratio, 3.77; 95% confidence interval, 1.72-8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased. CONCLUSION: Antiplatelet therapy significantly influences the recurrence of CSDH.

Full mini nutritional assessment and prognosis in elderly patients with pulmonary tuberculosis.

OBJECTIVE: Malnutrition is observed frequently in elderly patients with pulmonary tuberculosis (TB). Full Mini Nutritional Assessment (full MNA) is a useful method of measuring nutrition status for elderly person. The objective of this study is to examine the relationship between full MNA and the mortality of elderly patients with pulmonary TB. METHODS: We evaluated 53 elderly patients with pulmonary TB. The nutrition risk assessment was carried out using full MNA. RESULTS: A receiver operating characteristic (ROC) curve was generated for further analysis of the prognostic value of full MNA score. The area under the curve was 0.856 (95% confidence interval [CI], 0.751-0.961). We used the maximum Youden index to obtain optimal cutoff values for full MNA score for prognostic assessment in elderly patients with pulmonary TB. For predicting the risk of mortality, the optimal cutoff value for full MNA score was 13.75. Based on this cutoff value, the Cox proportional hazard model was applied to assess the ability of full MNA score < 14 to predict the prognosis of elderly patients with pulmonary TB. Multivariate analysis identified age (hazard ratio [HR] = 1.114, 95% CI, 1.018-1.219, p = 0.019) and full MNA score < 14 (HR = 9.038, 95% CI, 1.064-76.768, p = 0.044) to be significant independent prognostic factors for survival. CONCLUSION: Severe malnutrition, as defined by full MNA score < 14, was a predictor of high mortality.

The prognostic significance of nutritional status using malnutrition universal screening tool in patients with pulmonary tuberculosis.

BACKGROUND: Malnutrition is frequently observed in patients with pulmonary tuberculosis (TB). The present study aimed to examine the relationship between nutritional status using Malnutrition Universal Screening Tool (MUST) and the mortality of patients with pulmonary TB. METHODS: Fifty-seven patients with pulmonary TB were analyzed. Nutrition assessment was carried out using MUST. The Cox proportional hazard model was applied to assess the ability of MUST to predict prognosis. Receiver operating characteristic curve analysis was used to assess MUST score as a prognostic indicator in pulmonary TB patients. To obtain optimal cut-off values for MUST score for prognostic assessment in TB patients, we used the maximum Youden Index. RESULTS: For predicting the risk of mortality, the optimal cut-off value for MUST score was 3.5. Univariate and multivariate analyses identified age and MUST score ≥ 4 as significant independent prognostic factors for survival. The patients with MUST score ≤ 3 had a median survival of 481 days (95% CI: 453 to 510) and that for the patients with MUST score ≥ 4 was 304 days (95% CI: 214 to 394); the difference was statistically significant (P = 0.001). CONCLUSION: MUST appears to be a reliable tool for nutritional risk assessment of patients with pulmonary TB. In addition, MUST may be a useful prognostic indicator of survival in patients with pulmonary TB.

Usefulness of the Malnutrition Screening Tool in patients with pulmonary tuberculosis.

OBJECTIVE: To examine the relation between the Malnutrition Screening Tool (MST) and the mortality of patients with pulmonary tuberculosis (TB). METHODS: Fifty-two patients with pulmonary TB were analyzed. Nutritional assessment was carried out using the MST. The MST incorporates three components: presence of weight loss (score 0 or 2), amount of weight lost (score 1-4), and poor food intake or poor appetite (score 0 or 1). A score ≥2 means that the patient is at risk for malnutrition. The Cox proportional hazard model was applied to assess the ability of the MST to predict prognosis. Receiver operating characteristic curve analysis was used to assess the MST score as a prognostic indicator in patients with pulmonary TB. To obtain optimal cutoff values for the MST score for the prognostic assessment in patients with TB, the maximum Youden index was used. RESULTS: For predicting the risk of mortality, the optimal cutoff value for the MST score was 2.5. Univariate and multivariate analyses identified age and a MST score ≥3 as significant independent prognostic factors for survival. The patients with a MST score <3 had a median survival of 453 d and those with a MST score ≥3 had a median survival of 242 d; the difference was statistically significant (P = 0.001). CONCLUSION: The MST appears to be a reliable tool for the nutritional risk assessment of patients with pulmonary TB. This risk assessment tool can play a valuable role in quickly identifying patients at an increased risk of death and providing adequate nutritional support.

Subjective global assessment in patients with pulmonary tuberculosis.

BACKGROUND: Malnutrition is observed frequently in patients with pulmonary tuberculosis (TB). Subjective global assessment (SGA) is a subjective method of measuring nutrition status. Few studies have investigated the prognostic role of SGA in patients with pulmonary TB. METHODS: The authors evaluated 39 patients with pulmonary TB. The SGA classification technique was performed; patients were classified as well nourished (A), moderately malnourished (B), or severely malnourished (C). RESULTS: The mean patient age was 67.7 ± 19.0 years, and the majority of patients were male (64.1% ). Twelve patients (30.1% ) were categorized as SGA class A, 14 patients (35.9% ) as class B, and 13 patients (33.3% ) as class C. The SGA-A group had a median survival of 438 days (95% confidence interval, 366-509), the median survival of the SGA-B group was 344 days (251-436), and the median survival of the SGA-C group was 118 days (37-198); these survival rates were significantly different (P < .001). CONCLUSION: SGA appears to be a useful tool for nutrition assessment of patients with pulmonary TB. In addition, SGA may be a prognostic indicator of survival in patients with pulmonary TB.

The importance of preferential solvation of the CN ligands in electron- and proton-transfers observed for cis-[Ru(CN)2(bpy)2] under ion bombardment.

Liquid secondary ion mass spectrometry (LSIMS) mass spectra of cis-[Ru(CN)2(bpy)2] with a strong hydrogen-bonding-induced solvatochromism were measured using 3-nitrobenzyl alcohol (NBA) (oxidizing agent) and glycerol (reducing agent), and mixtures of these solvents. The formation of M+ (oxidized molecule) correlated closely to the extent of preferential solvation by NBA (preferential solvation-shell) around the cyanide ligands as observed from changes in the energy of the maximum metal-to-ligand charge transfer absorption. (M + H)+ is caused mainly by the preferential orientation of OH groups with protons in the NBA molecules toward the cyanide ligands in the disrupted region of the solvent structure as observed from the variation in the peak position of the stretching vibration of (OH) in the solvents. Large decreases in (M + 2H)+ and (M + 3H)+ (reduced molecules) resulted from the large decrease in the interaction between the cyanide ligands and glycerol owing to the preferential solvation by NBA. The LSIMS mass spectra clearly showed the electron- and proton-transfer processes along with the change in the hydrogen-bonding interaction between the acceptor (NBA and glycerol) and donor (the cyanide ligands), and in the solvent structure of the preferential solvation-shell. These results indicate that the composition of solvent molecules around the cyanide ligands at the surface of the solvents in LSIMS still holds the composition in the preferential solvation around the ligands in the primary solvation-shell.

Epidemiological correlation between chromium content in gallstones and cholesterol in blood.

The authors measured the chromium in gallstones and bile from patients in three areas (Kawasaki (a city adjacent to Tokyo) in Japan, Chiang Mai and Bangkok in Thailand) by means of neutron activation analysis. The chromium in three types of gallstones (cholesterol, pigment, and rare stones) and bile from patients living in Bangkok were evidently larger than those from patients living in Kawasaki and Chiang Mai. The high chromium intake by Bangkok patients continued from the start of gallstone formation until the time the stones were removed. The total-cholesterol, triglyceride, and hemoglobin A(1C) levels in the blood from Bangkok residents with high chromium intake over a long period were clearly lower than those of Japanese and Chiang Mai residents. The authors showed that the high dietary intake of chromium over a long period may play a role in the lowering of total-cholesterol, triglyceride, and hemoglobin A(1C) in blood.