What factor within the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria is most strongly correlated with trauma induced DIC? A retrospective study using thromboelastometry in a single center in Japan.

PURPOSE: The diagnostic criteria for disseminated intravascular coagulation (DIC) established by the Japanese Association for Acute Medicine (JAAM) is able to diagnose DIC accurately and promptly. The aim of this retrospective study is to evaluate the degree of association between each parameter of JAAM DIC criteria and the diagnosis of trauma induced DIC (T-DIC) utilizing thromboelastometry (ROTEM). METHODS: Trauma patients transported to our hospital with ROTEM performed in the emergency department between January 2013 and December 2015 were enrolled in this study. We evaluated (1) the characteristics of T-DIC, (2) the relationships between T-DIC and each parameter of the JAAM DIC criteria and (3) the diagnostic accuracies of each parameter for T-DIC by statistical measurement. RESULTS: All 72 patients (21 T-DIC and 51 control) were included in primary analysis. T-DIC was significantly related to younger age, more severe trauma scores, more cases of massive transfusions, and remarkable coagulation abnormality detected by standard coagulation tests. In the cases of T-DIC, ROTEM showed longer clotting time, lower acceleration, lower clot firmness, and inhibited fibrinolysis in EXTEM/INTEM. Within the JAAM DIC score, PT-INR ≥1.2 was the most accurate factor for T-DIC diagnosis; sensitivity 60.0%, specificity 100.0%, and accuracy 88.7%. PT-INR ≥1.2 was statistically correlated with the JAAM DIC score (p < 0.001, r = 0.709). The univariate analysis based on 1.2 of PT-INR indicated statistical differences in most categories of ROTEM, which is similar to analysis performed for the presence and absence of T-DIC. CONCLUSIONS: Among JAAM DIC criteria, the PT-INR ≥1.2 was the most accurate factor for both the diagnosis of T-DIC and the evaluation of its severity.

Genome-wide DNA methylation profile implicates potential cartilage regeneration at the late stage of knee osteoarthritis.

OBJECTIVE: The aim of this work was to characterize the genome-wide DNA methylation profile of cartilage from three regions of tibial plateau isolated from patients with primary knee osteoarthritis (OA), providing the first DNA methylation study that reflects OA progression. METHODS: The unique model system was used to section three regions of tibial plateau: the outer lateral tibial plateau (oLT), the inner lateral tibial plateau (iLT) and the inner medial tibial plateau (iMT) regions which represented the early, intermediate and late stages of OA, respectively. Genome-wide DNA methylation profile was examined using Illumina Infinium HumanMethylation450 BeadChip array. Comparisons of the iLT/oLT and iMT/oLT groups were carried out to identify differentially methylated (DM) probes (DMPs) associated with OA progression. DM genes were analyzed to identify the gene ontologies (GO), pathways, upstream regulators and networks. RESULTS: No significant DMPs were identified in iLT/oLT group, while 519 DMPs were identified in iMT/oLT group. Over half of them (68.2%) were hypo-methylated and enriched in enhancers and OpenSea. Upstream regulator analysis identified many microRNAs. DM genes were enriched in transcription factors, especially homeobox genes and in Wnt/ß-catenin signaling pathway. These genes also showed changes in expression when analyzed with expression profiles generated from previous studies. CONCLUSION: Our data suggested the changes in DNA methylation occurred at the late stage of OA. Pathways and networks enriched in identified DM genes highlighted potential etiologic mechanism and implicated the potential cartilage regeneration in the late stage of knee OA.

Impact of pre-emptive contact precautions for outborn neonates on the incidence of healthcare-associated meticillin-resistant Staphylococcus aureus transmission in a Japanese neonatal intensive care unit.

BACKGROUND: The neonatal intensive care unit (NICU) is a high-risk setting for transmission of meticillin-resistant Staphylococcus aureus (MRSA). Very few studies have investigated the impact of pre-emptive contact precautions applied to outborn neonates transferred to an NICU on the incidence of healthcare-associated (HA)-MRSA transmission. AIM: To assess the efficacy of pre-emptive contact precautions for outborn neonates implemented in an NICU. METHODS: A before-and-after intervention study was conducted in the NICU of Kobe University Hospital. Pre-emptive contact precautions for outborn neonates were introduced in September 2008. The period before the introduction of pre-emptive contact precautions (January 2007-August 2008) was compared with the period after the introduction of pre-emptive contact precautions (September 2008-December 2010). Data for all admitted neonates, neonates who stayed in the NICU for more than three days, length of NICU stay, incidence of MRSA-positive outborn neonates on admission, hand hygiene compliance and incidence of HA-MRSA transmission were compared between the two periods. FINDINGS: There were no significant differences in the percentage of outborn patients admitted to the NICU, percentage of patients who stayed in the NICU for more than three days, length of NICU stay, and incidence of MRSA-positive outborn patients at NICU admission between the groups enrolled before and after the introduction of pre-emptive contact precautions. However, hand hygiene compliance increased, and the incidence of HA-MRSA transmission reduced significantly from 3.5/1000 to 1.3/1000 patient-days after the introduction of pre-emptive contact precautions (P < 0.0001). CONCLUSION: Pre-emptive contact precautions for outborn neonates were effective in reducing the incidence of HA-MRSA transmission in a Japanese NICU.

Systemic non-amyloidotic fibril deposition disease: a probable variant form of fibrillary glomerulonephritis.

Fibrillary glomerulonephritis (FGN) is characterized by deposition of non-amyloidotic fibrillary material in glomeruli, and most patients with the disease show heavy proteinuria and hematuria, and progress into end-stage renal failure. We report a 62-year-old woman with FGN who showed mild proteinuria without hematuria and developed rapidly progressive renal failure requiring hemodialysis. Renal biopsy showed severe tubulointerstitial injury associated with non-amyloidotic fibrillary deposits in the tubular basement membrane, interstitium and vessel walls, in addition to glomeruli. The patient died from liver abscess 1 year after the introduction of hemodialysis. Postmortem examination showed the presence of non-amyloidotic fibrillary deposits arranged in tightly packed electron-dense and bundle-shaped structures in many organs. These findings suggest systemic non-amyloidotic fibril deposition in FGN.

Classic polyarteritis nodosa presenting with rapidly progressive renal insufficiency.

Rapidly progressive renal insufficiency is rare in patients with classic polyarteritis nodosa (cPAN). We describe two cases of cPAN who presented with rapid and progressive deterioration of renal function. Renal biopsies showed severe necrotizing vasculitis in medium-sized arteries but no changes in glomeruli. Combination therapy of corticosteroid and cyclophosphamide resulted in marked improvement of clinical symptoms, amelioration of renal function and lack of subsequent relapse of vasculitis. These findings suggest good prognosis of patients with cPAN who show rapid and progressive deterioration of renal function who respond to immunosuppressive therapy.

Production of intergeneric somatic hybrids between round kumquat (Fortunella japonica Swingle) and 'Morita navel' orange (Citrus sinensis Osbeck).

Intergeneric somatic hybrids between embryogenic callus-derived protoplasts of round kumquat (Fortunella japonica Swingle) and 'Morita navel' orange (Citrus sinensis Osbeck) were produced by electrofusion. Among the eight different fusion strains obtained, six showed normal morphology, whereas the remaining two showed malformation. All the regenerated plants were intermediate in leaf morphology and had thick and round leaves, which are typical characteristics of polyploids. Ploidy analyses by flow cytometry and chromosome counting in root-tip cells revealed that these plants are amphidiploid (2n=4x=36). Hybridity of the fusion products was confirmed by random amplified polymorphic DNA and cleaved amplified polymorphic sequence (CAPS) analyses. Furthermore, analyses of chloroplast (cp) and mitochondrial (mt) DNA by CAPS showed that these somatic hybrids contained cp- and mt-DNA of round kumquat without recombination in the regions analyzed.

NAD-specific 6-phosphogluconate dehydrogenase in lactic acid bacteria.

6-Phosphogluconate dehydrogenase was screened in for cell-free extracts from seventeen strains of lactic acid bacteria. Three types of the enzyme could be classified according to the coenzyme specificity: NAD-specific, NADP-specific, and non-specific types. The two strains that had a heterofermentative pathways had an NAD-specific 6-phosphogluconate dehydrogenase. This type had higher enzyme activity per proteins in the cell-free extracts, and more specificity to NAD compared to the other types of the enzyme in the lactic acid bacteria studied.

A solid phase fluoroimmunoassay of serum cortisol.

Direct solid phase fluoroimmunoassay of serum cortisol was established by using fluorescein isothiocyanate labelled anti-cortisol antibody and cortisol conjugated polyacrylamide beads. Sodium salicylate was used as a blocking agent for cortisol binding proteins. The sensitivity of this assay was 0.2 ng/assay tube and the measurable range was from 2 to 100 micrograms/dl using 10 microliters of serum. Intra- and inter-assay coefficients of variation were 11.6% (mean +/- SD 19.8 +/- 2.3 micrograms/dl, n = 5): and 12.1% (mean +/- SD 22.8 +/- 2.8 micrograms/dl, n = 5), respectively. THe accuracy was estimated from recovery study and the average recovery was 100.2%. Cortisol values determined by the present method correlated well with those determined by radioimmunoassay (r = 0.98, y = 0.98 x + 0.04, n = 35). The proposed assay satisfied the standard criteria of dilution, accuracy, and precision, and is applicable to routine measurement of serum cortisol.