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To investigate the relationship between quantitative tracheal geometry and clinical course among various types of vascular ring and to identify factors correlating with symptom presentation. Patients with vascular ring diagnosed between April 2010 and December 2022 were included. All the patients were classified as type 1 (complete double aortic arch); type 2 (incomplete double aortic arch); type 3 (circumflex aorta); type 4 (right aortic arch and aberrant left subclavian artery with a left retroesophageal diverticulum of Kommerell); or type 5 (mirror-imaged right aortic arch with retroesophageal aortic diverticulum). Their clinical characteristics and quantitative variables on computed tomography (CT) were compared. Of the 50 patients enrolled, those with type 1 tended to have a smaller luminal tracheal diameter at the level of the ring. The median symptom-free survival time was shortest in this group (16.0 days [95% confidence interval (CI): 9.4-51.0]), followed by type 3 (138.0 days [95% CI: 0.0-851.4]). Type 1 (hazard ratio [HR]: 9.0; 95% CI: 2.3-35.0; P = 0.001), type 3 (HR: 4.2; 95% CI: 1.4-13.2; P = 0.013), and the percentage of tracheal narrowing in the anteroposterior projection (HR: 0.87; 95% CI: 0.78-0.96; P = 0.008) were significantly associated with symptom presentation in the time-dependent course. The aortic arch encircling the entire circumference in type 1 and high-pressure vasculature in front of the vertebral body in types 1 and 3 may contribute to raising the risk of symptom presentation., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Self-adhesive resin cements contain functional monomers that enable them to adhere to the tooth structure without a separate adhesive or etchant. One of the most stable functional monomers used for chemical bonding to calcium in hydroxyapatite is 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP). The aim of this study was to evaluate the influence of the10-MDP concentration on the bond strength and physical properties of self-adhesive resin cements., Materials and Methods: We used experimental resin cements containing 3 different concentrations of 10-MDP: 3.3 wt% (RC1), 6.6 wt% (RC2), or 9.9 wt% (RC3). The micro-tensile bond strength of each resin cement to dentin and a hybrid resin block (Estenia C&B, Kuraray Noritake Dental) was measured, and the fractured surface morphology was analyzed. Further, the flexural strength of the resin cements was measured using the three-point bending test. The water sorption and solubility of the cements following 30 days of immersion in water were measured., Results: The bond strength of RC2 was significantly higher than that of RC1. There was no significant difference between the bond strength of RC2 and that of RC3. The water sorption of RC3 was higher than that of any other cement. There were no significant differences in the three-point bending strength or water solubility among all three types of cements., Conclusions: Within the limitations of this study, it is suggested that 6.6 wt% 10-MDP showed superior properties than 3.3 wt% or 9.9 wt% 10-MDP in self-adhesive resin cement., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2019. The Korean Academy of Conservative Dentistry.)

Photochemical oxidation of aromatic hydrocarbons leads to tropospheric ozone and secondary organic aerosol (SOA) formation, with profound implications for air quality, human health, and climate. Toluene is the most abundant aromatic compound under urban environments, but its detailed chemical oxidation mechanism remains uncertain. From combined laboratory experiments and quantum chemical calculations, we show a toluene oxidation mechanism that is different from the one adopted in current atmospheric models. Our experimental work indicates a larger-than-expected branching ratio for cresols, but a negligible formation of ring-opening products (e.g., methylglyoxal). Quantum chemical calculations also demonstrate that cresols are much more stable than their corresponding peroxy radicals, and, for the most favorable OH ( ortho ) addition, the pathway of H extraction by O 2 to form the cresol proceeds with a smaller barrier than O 2 addition to form the peroxy radical. Our results reveal that phenolic (rather than peroxy radical) formation represents the dominant pathway for toluene oxidation, highlighting the necessity to reassess its role in ozone and SOA formation in the atmosphere., Competing Interests: The authors declare no conflict of interest.

Neonatal lupus (NL), a passively-acquired autoimmune disease associated with maternal anti-SSA antibody, presents both cardiac manifestations such as cardiac NL and non-cardiac manifestations including rashes, cytopenia, and hepatic abnormalities. Cardiac NL, occurring in 1-2% of anti-SS-A antibody-positive mothers, is a life-threatening complication with a mortality rate of 20% and a pacemaker implantation rate of 70%. In contrast, cutaneous NL, which is more common than cardiac NL, usually resolves in six months. Since half of NL cases occur in asymptomatic mothers, if an infant presents characteristic cutaneous or cardiac manifestations of NL, the mother should be tested for anti-SS-A antibody. In mothers positive for anti-SS-A antibody, the risk of having a child with cardiac NL increases ten-fold and five-fold for a previous child with cardiac NL and cutaneous NL, respectively. A joint American, British, and French retrospective study of NL registries showed that hydroxychloroquine (HCQ) reduced the cardiac NL risk in subsequent pregnancies in mothers who previously had a child with cardiac NL. A prospective open-label study to confirm this effect is being undertaken in the USA. A similar prospective multi-center study will be undertaken in Japan. Establishing a Japanese registry of children with NL and subsequent pregnancies of their mothers will help promote clinical research in NL in Japan.

Addition reaction of a radical to the double bond of a monomer, which is important at early stage of photopolymerization, has been studied by time-resolved (TR-) and pulsed electron paramagnetic resonance (EPR) spectroscopic methods. Reactions of one phosphorus-centered and three carbon-centered radicals attacking to several monomers have been employed. Intermediate radicals were identified by analyzing the recorded TR-EPR spectra, and the reaction rate constants were determined by the electron spin-echo detection method proposed by Weber and Turro [J. Phys. Chem. A, 2003, 107 (18), 3326 - 3334]. The quantum chemical calculation shows that the rate constants for the addition reactions are well-explained by introducing two factors of "enthalpy effect" and "polar effect" to control the activation barrier height. It was observed that the rate constants of the phosphorus-centered radical were larger than those of carbon-centered radicals for some monomers. The difference in the rate constants was argued on the basis of frequency factor and activation barrier both of which are influenced by an atom of radical center.

Previously, we found that the injection of zoledronic acid (ZOL) into mice bearing tumor induced changes of the vascular structure in the tumor. In this study, we examined whether ZOL treatment could decrease interstitial fluid pressure (IFP) via change of tumor vasculature, and enhance the antitumor efficacy of liposomal doxorubicin (Doxil®). When ZOL solution was injected at 40 µg/mouse per day for three consecutive days into mice bearing murine Lewis lung carcinoma LLC tumor, depletion of macrophages in tumor tissue and decreased density of tumor vasculature were observed. Furthermore, ZOL treatments induced inflammatory cytokines such as interleukin (IL)-10 and -12, granulocyte-macrophage colony-stimulating factor (GM-CSF) and tumor necrosis factor (TNF)-α in serum of LLC tumor-bearing mice, but not in normal mice, indicating that ZOL treatments might induce an inflammatory response in tumor tissue. Furthermore, ZOL treatments increased antitumor activity by Doxil in mice bearing a subcutaneous LLC tumor, although they did not significantly increase the tumor accumulation of doxorubicin (DXR). These results suggest that ZOL treatments might increase the therapeutic efficacy of Doxil via improvement of DXR distribution in a tumor by changing the tumor vasculature. ZOL treatment can be an alternative approach to increase the antitumor effect of liposomal drugs.

Kawasaki disease (KD), an acute vasculitis that preferentially affects coronary arteries, is still the leading cause of acquired heart disease in children. Although the involvement of immune system malfunction in the onset of KD is suggested, its etiology still remains to be clarified. We investigated autoantibodies in KD patients, which are frequently found in sera from patients with autoimmune diseases, vasculitides and arteritides. We performed two-dimensional western blotting and LC-MS/MS to analyze the antigens of autoantibodies, detected two protein spots with 4 out of 24 sera from KD patients but not with 6 control sera, and identified the antigens as 4-trimethylaminobutyraldehyde dehydrogenase (TMABA-DH). A slot blot analysis with TMABA-DH as an antigen also revealed higher reactivities of patients' sera than control sera (positive rates: 18/43 vs 3/41). Using an enzyme-linked immunosorbent assay (ELISA), we found that the reactivity of anti-TMABA-DH antibodies in sera from KD patients was significantly higher than that in sera from age-matched controls. The optimal cut-off value of 0.043 had a sensitivity of 83.7% and a specificity of 80.0% in detecting KD patients (positive rates: 37/43 for KD patients, 9/41 for controls). Immunohistochemistry performed on thin sections of rat heart revealed that TMABA-DH colocalized with myosin light chains in cardiac myocytes. Patient sera with high reactivity gave similar immunostaining pattern. These results suggest that the detection of anti-TMABA-DH autoantibody could be a potential strategy for a diagnosis of KD.

Several protic ionic liquids (PILs) with a wide range of pK(a) differences (ΔpK(a)) between the parent acid and base molecules were thermally evaporated in vacuum, trapped on a CsI plate by a cryogenic neon matrix-isolation method, and studied by Fourier transform infrared spectroscopy and density functional theory calculations. The parent neutral molecules and proton-transferred cation-anion pair species were identified as chemical components evaporated from the PILs with lower and higher ΔpK(a) values, respectively. The ΔpK(a)-dependent vaporization mechanism is discussed in terms of thermodynamic equilibrium between acid-base and anion-cation systems in the liquid phase.

The photochemistry of ozone-water complexes and the wavelength dependence of the reactions were studied by matrix isolation FTIR spectrometry in neon, argon, and krypton matrixes. Hydrogen peroxide was formed upon the irradiation of UV light below 355 nm. Quantitative analyses of the reactant and product were performed to evaluate the matrix cage effect of the photoreaction. In argon and krypton matrixes, a bimolecular O((1)D) + H2O → H2O2 reaction was found to occur to form hydrogen peroxide, where the O((1)D) atom generated by the photolysis of ozone diffused in the cryogenic solids to encounter water. In a neon matrix, hydrogen peroxide was generated through intracage photoreaction of the ozone-water complex, indicating that a neon matrix medium is most appropriate to study the photochemistry of the ozone-water complex.

The charge-transfer (CT) absorption bands of ion pairs composed of 1-ethylpyridinium (Epy(+)) and halogen anions (X(-): Cl, Br, or I) were measured in dichloromethane solutions of EpyX. The CT band of the Epy(+)I(-) ion pair shows clear splitting because of spin-orbit interaction in the excited state. The CT transition energy of an Epy(+)X(-) ion pair in a dichloromethane solution is related to electron affinity of X, which is in accordance with the Mulliken theory for CT bands. Extinction coefficients for the CT bands of the Epy(+)X(-) ion pairs in dichloromethane were determined using the measured absorbance, and the ion-pair concentration was estimated on the basis of electroconductivity. Structures of Epy(+)X(-) ion pairs were also evaluated on the basis of both quantum-chemical calculations and NMR spectroscopy. In addition, in the absorption spectrum measured for neat EpyI liquid, a broad band appeared at a longer wavelength side of the S1(ππ*) band. This new band has been assigned to the CT band of the Epy(+)I(-) ion pair formed in neat EpyI liquid.

The np gerade Rydberg states of acetylene were analyzed using two-photon resonance fluorescence excitation spectroscopy in the 72,000-93,000 cm(-1) energy region. The npπ(1)Σ(g)(+) and npπ(1)Δ(g) Rydberg series (n = 3-5) were identified in the fluorescence excitation spectrum measured by monitoring the C(2) d(3)Π(g)-a(3)Π(u) Swan system. Some vibronic bands were assigned to the npπ(1)Δ(g)-X̃(1)Σ(g)(+) transition on the basis of rotational analysis. The 5pσ(1)Π(g) state was observed, which is the first such observation in an npσ(1)Π(g) series. Rotational analysis of the 5pσ(1)Π(g)-X̃(1)Σ(g)(+) transition showed e/f-symmetry dependent predissociation of acetylene in the 5pσ(1)Π(g) state. The 0(0)(0) band of the deuterated acetylene (C(2)D(2)) 4pπ(1)Σ(g)(+)-X̃(1)Σ(g)(+) transition exhibits an atypical structure, which was satisfactorily reproduced by a simple model of quantum interference between the discrete and quasi-continuum states. The predissociative lifetimes of the npπgerade Rydberg states were estimated from the spectral profiles. The predissociation mechanism of acetylene in the Rydberg states is discussed.

Collision-induced near-IR emission of O(2) a(1)Δ(g) was investigated in O(2)/M (M = Ar, Kr, Xe, N(2), or CO(2)) gas mixtures, where the total pressure ranged from 10 to 100 atm, and gaseous O(2) dimol was excited with a pulsed dye laser at 630 nm through the simultaneous two-electron transition to prepare O(2) in the a(1)Δ(g) state. The a(1)Δ(g) → X(3)Σ(g)(-) emission intensity around 1270 nm increased with the number density of foreign gas (M) under constant O(2) number density. Emission enhancement efficiencies were in the order Xe > CO(2) > O(2) > Kr > N(2) > Ar; they are controlled by collisional enhancement during the near-IR emission at 1270 nm but not during photoabsorption at 630 nm. Efficiencies were converted into bimolecular rate constants to enhance the radiative a → X transition for the added gases. The rate constants were estimated as quadratically dependent on the molar refraction (or polarizability) of collision gas. The self-quenching rate constant was determined from the Stern-Volmer plot of the emission lifetimes measured in pure O(2).

Rotational motion of a nitroxide radical, peroxylamine disulfonate (PADS), dissolved in room temperature ionic liquids (RTILs) was studied by analyzing electron paramagnetic resonance spectra of PADS in various RTILs. We determined physical properties of PADS such as the hyperfine coupling constant (A), the temperature dependence of anisotropic rotational correlation times (τ(∥) and τ(⊥)), and rotational anisotropy (N). We observed that the A values remain unchanged for various RTILs, which indicates negligible interaction between the N-O PADS group and the cation of RTIL. Large N values suggest strong interaction of the negative sulfonyl parts of PADS with the cations of RTILs. Most of the τ(∥), τ(⊥), and (τ(∥)τ(⊥))(1/2) values are within the range calculated on the basis of a hydrodynamic theory with stick and slip boundary conditions. It was deduced that this theory could not adequately explain the measured results in some RTILs with smaller BF(4) and PF(6) anions.

The matrix-isolation infrared spectrum of a thermally evaporated ionic liquid, 1-ethyl-3-methylimidazolium trifluoromethanesulfonate ([Emim][OTf]), was measured by FTIR spectroscopy and analyzed with the aid of DFT calculations. The main chemical species in the observed IR spectrum was mainly identified as the 1:1 cation-anion pair, which corresponds to the second stable ion-pair structure bonded through five hydrogen bonds between three O atoms of the anion side and four H atoms of the cation.

Infrared spectra of OH-(H2O)n (n = 1, 2) isolated in solid Ne were measured by FT-IR spectroscopy. Complexes of OH-(H2O)n were prepared by vacuum ultraviolet (VUV) photolysis of water clusters, and the OH radical stretch and HOH bending vibrations of OH-H2O and OH-(H2O)2 complexes were identified with the aid of quantum chemical calculations. Observation of the recombination reaction OH-H2O + H --> (H2O)2 under dark conditions provides undisputed evidence for our spectroscopic assignment. Quantum chemical calculations predict the cyclic structure to be the most stable for OH-(H2O)2 and OH-(H2O)3. The strength of the hydrogen bond within OH-(H2O)n depends on cluster size.

Low-temperature infrared spectra of thermally evaporated ionic liquids, 1-ethyl- and 1-butyl-3-methylimidazolium bis(trifluoromethanesulfonyl)imide and bis(trifluoromethanesulfonyl)amide have been measured in a cryogenic Ne matrix. The experimental IR spectrum of bis(trifluoromethanesulfonyl)amide can be reproduced theoretically by not B3LYP/6-31G* but MP2/6-31G* calculation, which suggests that the vibrational analysis for ionic liquids composed of bis(trifluoromethanesulfonyl)imide anion would be more successfully performed using the MP2 calculation. By comparison of the matrix-isolation spectra of the ionic liquids with the MP2 calculation, their geometrical structures in the gas phase are determined to be of C(2-position)-H(+)...N(-) interaction structure, which corresponds to the geometry of the energetically second-lowest ion-pair structure. The present study may provide a valuable clue to understand a vaporization mechanism of ionic liquid.

The exchange interaction, J, producing quartet and doublet energy separation in radical-triplet excited molecule encounter pairs, was investigated in solution by measuring chemically induced dynamic electron polarization (CIDEP) created through the radical-triplet pair mechanism. A time-resolved FT-EPR method was utilized to measure CIDEP of galvinoxyl radical by recording FID signals and an absolute magnitude of CIDEP, P(n), was determined for each radical-triplet system by detailed analysis of the time evolution curves of CIDEP. A transient FT-EPR signal phase remarkably depends on the triplet molecule. The signal phase is related to the sign of J value, which is responsible for the radical-triplet pair interaction. Most of galvinoxyl-triplet systems showed normal negative sign. An unusual positive sign was found in some systems characterized by a small energy gap, DeltaG, between the radical-triplet pair and intermolecular charge transfer (CT) states. A theoretical calculation of J value for radical-triplet encounter pairs was carried out by considering exchange integral and intermolecular CT interaction. According to the calculated J value and the diffusion theory for CIDEP magnitude, experimental Pn values were theoretically reproduced as a function of DeltaG. The present results confirm our previously reported CT model explaining the complicated nature of the sign of J value in the galvinoxyl-triplet encounter pairs. According to the proposed model for CT effect on J value and CIDEP results, nature of J value in radical-triplet pairs is discussed.

Matrix isolation infrared spectroscopy has been applied to study an ozone-water complex of atmospheric interest. The complex was identified in the spectral region of three normal modes of ozone and water. Ab initio calculation at MP4(SDQ), QCISD, and CCSD(T) levels indicates the existence of only one stable conformer, which accords with the present experimental result. This conformer belongs to the Cs symmetry group where two molecular planes of ozone and water are perpendicular to the Cs symmetry plane. The binding energy was calculated to be 1.89 kcal/mol at the CCSD(T)/6-311++G(3df,3pd)//CCSD(T)/6-311++G(d,p) level of theory. The formation constant and atmospheric abundance of the ozone-water complex are estimated using the thermodynamic and spectroscopic data obtained.

The D(1)-D(0) transitions of diphenylmethyl (DPM) and chlorodiphenylmethyl (CDPM) radicals were studied by laser induced fluorescence (LIF) spectroscopy in a supersonic jet. Laser induced fluorescence excitation and dispersed fluorescence (DF) spectra were obtained for DPM and CDPM radicals produced by ArF excimer laser (193 nm) photolyses of their chlorides. With the aid of the density functional theory (DFT) calculation, vibronic bands are assigned by comparing the observed LIF excitation spectra of the jet-cooled radicals with the single vibronic level DF spectra. Low-frequency vibrations of 55 and 53 cm(-1) in the ground and excited states, respectively, are assigned to the symmetric phenyl torsional mode of the DPM radical. The geometries of DPM in the ground and excited states are discussed with regards to observed spectra and DFT calculations. Similarly for the CDPM radical, symmetric phenyl torsional and Ph-C-Ph bending modes are assigned and the halogen-substitution effect in equilibrium geometry is discussed.

Formation of the ground-state nitrogen atom, N((4)S), following 193.3-nm ArF laser irradiation of NO and NO(2) was detected directly by a technique of laser-induced fluorescence (LIF) spectroscopy at 120.07 nm. Tunable vacuum ultraviolet (VUV) laser radiation around 120.07 nm was generated by two-photon resonance four-wave sum frequency mixing in Hg vapor. Photoexcitation processes of NO and NO(2) giving rise to the N((4)S) formation are discussed on the basis of the Doppler profiles of the nascent N((4)S) atoms produced from the photolysis of NO and NO(2) and the photolysis laser-power dependence of the N((4)S) signal intensities. Using laser flash photolysis and vacuum ultraviolet laser-induced fluorescence detection, the kinetics of the reactions of N((4)S) with NO and NO(2) have been investigated at 295 +/- 2 K. The rate constants for the reactions of N((4)S) with NO and NO(2) were determined to be (3.8 +/- 0.2) x 10(-11) and (7.3 +/- 0.9) x 10(-12) cm(3) molecule(-1) s(-1), respectively, where the quoted uncertainties are 2sigma statistical uncertainty including estimated systematic error.

The authors report a case of laryngeal atresia (congenital high airway obstruction syndrome [CHAOS]) that was diagnosed prenatally. The patient underwent successfully tracheostomy by ex utero intrapartum treatment (EXIT). The fetal ultrasonography and magnetic resonance imaging MRI showed a typical CHAOS pattern with expanded hyperechogenic lungs, inverted diaphragms, and a dilated trachea. Recently, 3 cases of prenatally diagnosed CHAOS were reported to be treated successfully by EXIT. The clinical manifestation and course of this case was not similar to these 3 cases. The 3 previous patients did not fare as well during gestation and were delivered earlier than that in our case. In our case, fetal hydrops was seen at 23 gestational weeks, but it gradually subsided and disappeared at 30 gestational weeks. The fetus was stable and well. After delivery at 39 weeks, the baby received respiratory assistance by ventilator assistance. After 3 days, she could breath well on her own. The patient also had chromosome 5p deletion syndrome and perineal groove. More experience in treating CHAOS cases with EXIT to fully estimate its clinical course and prognosis is needed.

Introduction: Macrophages are considered to play an essential role in the events leading to systemic inflammatory response. Some are known to reside in the peritoneal cavity but there are no reports defining the participation of peritoneal macrophages (PMs) in the progression of acute pancreatitis., Aim: To clarify the role of PMs in the progression of acute pancreatitis., Methodology: Acute pancreatitis was induced in rats from which macrophages other than PMs were greatly depleted, and in rats greatly depleted of macrophages including PMs. Macrophages were depleted by the injection of liposome encapsulated dichloromethylene bisphosphonate. After the induction of acute pancreatitis, local pancreatic inflammation, intraperitoneal inflammation and lung injury were compared between the 2 groups., Results: Local pancreatic inflammation did not differ between the 2 groups. However, intraperitoneal inflammation was clearly improved by the depletion of PMs. Serum cytokine level and lung injury were also improved by the depletion of PMs., Conclusion: Peritoneal macrophages extend inflammation from the pancreas to the peritoneal cavity and subsequently induce lung injury in acute pancreatitis. Peritoneal macrophages play an essential role in the systemic inflammatory response and the progression of acute pancreatitis in the rat.

Although patients with unresectable pancreatic tumors have been treated with 5-fluorouracil (5FU)-based combination chemotherapy, the drug resistance of cancer cells presents a crucial therapeutic problem. It was reported that UPRT overcomes 5FU resistance. UPRT catalyzes the synthesis of 5-fluorouridine monophosphate (FUMP) from Uracil and phosphoribosylpyrophosphate (PRPP). The antitumor effect of 5FU is enhanced by augmenting 5-fluorodeoxyuridine monophosphate (FdUMP) converted from FUMP, which inhibits thymidylate synthetase (TS). We first demonstrated that injecting an E1-deficient adenoviral vector (Adv) expressing UPRT (AxCAUPRT) followed by 5-FU treatment resulted in a volume reduction of xenotransplanted human tumors. In examining the therapeutic effect of AxCAUPRT/5-FU against peritoneal dissemination, we found that non-selective gene transduction of AxCAUPRT caused severe adverse effects arising from the increase of F-dUMP in normal intestine. Because the therapeutic gene delivered by a restricted replication-competent Adv lacking 55 kDa E1B protein (AxE1AdB) is speculated to be expressed selectively in tumors, mice with established tumors were injected with AxE1AdB and E1-deleted Adv expressing the lacZ reporter gene (AxCAlacZ). The expression of the reporter gene (lacZ) was selectively enhanced in disseminated tumors. The therapeutic advantage of restricted replication competent Adv that expresses UPRT (AxE1AdB-UPRT) was evaluated in an intraperitoneal disseminated tumor model. To study the anti-tumor effect of AxE1AdB-UPRT/5FU, mice with disseminated AsPC-1 tumors were administered the Adv, followed by the 5FU treatment. It was shown that the treatment with AxE1AdB-UPRT/5FU caused a dramatic reduction of the disseminated tumor burden without toxicity in normal tissues. Our results showed that the AxE1AdB-UPRT/5FU system is a promising tool for intraperitoneal disseminated pancreatic cancer., (Copyright 2002 Wiley-Liss, Inc.)

Introduction: The mortality associated with severe acute pancreatitis is still high, and death in the later stage of the disease is chiefly due to bacterial infection and sepsis. However, objective parameters for the risk of sepsis in acute pancreatitis have not been established., Aim: To investigate the value of human leukocyte antigen-DR (HLA-DR) on peripheral monocytes for predicting the development of sepsis during acute pancreatitis., Methodology: The expression of HLA-DR on peripheral monocytes was measured in 64 patients by flow cytometry at admission and 7 and 14 days after the onset of acute pancreatitis. Twenty-eight patients with severe acute pancreatitis and 36 with mild acute pancreatitis, as determined by the Atlanta classification, were enrolled., Results: Six patients had sepsis, and two of them died during the hospital stay. At admission, the percentage of HLA-DR-expressing cells in the monocyte population was significantly lower in the patients who had sepsis in the later course than in the patients who did not have sepsis. A percentage lower than 80% at admission was observed in 17 patients, and the patients who had persistently low percentages of HLA-DR-expressing monocytes throughout the observation period had sepsis in the later clinical course, whereas the patients in whom expression recovered to the normal range were spared the development of sepsis., Conclusion: In acute pancreatitis, the low percentage of HLA-DR-expressing cells in the monocyte population is a reliable predictor of the development of sepsis. Monitoring of monocyte HLA-DR expression may be a useful marker for identifying the patients who are at high risk of sepsis in acute pancreatitis.

Objective: Kawasaki disease (KD) was first reported by Tomisaku Kawasaki in 1967 in Japan. Large-scale nationwide epidemiologic surveys have been conducted continuously by the Japan Kawasaki Disease Research Committee; however, there were very few reports of KD before 1967. This study was performed to clarify when KD appeared in Japan., Design: We investigated the medical charts of patients who had been hospitalized at Tokyo University Hospital between 1940 and 1965., Results: We identified 10 patients whose clinical signs fulfilled the criteria for KD. The ages of the patients ranged from 8 months to 5 years, and their final diagnoses were Stevens-Johnson syndrome, allergic toxic erythema, Izumi fever, scarlet fever, and cervical lymphadenitis. These 10 patients presented between 1950 and 1964, and no confirmed cases were seen between 1940 and 1949., Conclusions: Our findings suggested that KD patients were rare before 1950 in Japan.

Background: The purpose of this study was to clarify the still poorly understood dynamics of peritoneal inflammatory cells (PICs) in acute pancreatitis., Methods: Acute pancreatitis of 3 different degrees of severity was induced in male Wistar rats. Peritoneal lavage was performed at 1, 6, 12, and 24 hours after the induction, and the fluids collected were analyzed for the number and subpopulation of PICs. The levels of apoptosis and necrosis, cytokines, and bacterial infection were also investigated., Results: The number of PICs was increased in mild and moderate pancreatitis, and the infiltration of inflammatory cells had occurred. In severe pancreatitis, the number of PICs increased until 6 hours after the induction, but thereafter the number decreased. Infiltration of neutrophils occurred 6 hours after the induction, but it was not sustained thereafter and infiltration of peritoneal macrophages did not occur. Cytokines in the lavage fluid increased in all 3 models during the first 6 hours after the induction. Subsequently, cytokines were reduced in mild and moderate pancreatitis but significantly increased in severe pancreatitis. The level of bacterial infection increased according to the severity., Conclusions: The relationship between the PIC dynamics and cytokine levels in severe pancreatitis is very different from that observed in mild or moderate pancreatitis.

Background/purpose: To provide a framework for clinicians to manage acute pancreatitis, evidence-based guidelines have been developed by the Japanese Society of Abdominal Emergency Medicine., Methods: Evidence was collected by a systematic search of MEDLINE and Japana Centra Revuo Medicina. A total of 1348 papers were reviewed and levels of evidence were assessed. Practical recommendations were also graded., Results: The present guidelines consist of introductions, a summary of recommendations, practice algorithms, definitions, epidemiology, diagnosis, severity assessment, and therapy. The main points of recommendation in these guidelines are: (1) measuring lipase for the diagnosis of acute pancreatitis (recommendation grade [RG], A). (2) The Severity of acute pancreatitis should be assessed using a scoring system, such as that of the Japanese Ministry of Health and Welfare or Acute Physiology and Chronic Health Evaluation (APACHE) II (RG, A). (3) Enhanced computed tomography (CT) should be used for assessment of degree of pancreatic necrosis and inflammation (RG, B). (4) Prophylactic antibiotic administration should be used for severe pancreatitis (RG, A), but not for mild to moderate pancreatitis (RG, D). (5) Gabexate mesilate should be used for severe pancreatitis (RG, B). (6) Enteral feeding should be used for all pancreatitis (RG, B). (7) Continuous hemodiafiltration and continuous arterial infusion of proteinase inhibitor and antibiotics may be of benefit (RG, C). (8) Fine-needle aspiration should be done for the diagnosis of infectious pancreatic necrosis, and if positive, necrosectomy is indicated (RG, A)., Conclusions: These guidelines provide useful information for physicians to manage this troublesome disease.

On March 1, 1999, a 71-year-old woman was diagnosed as having cholecystolithiasis, for which she underwent laparoscopic cholecystectomy at a local hospital. Intraoperative cholangiography was not performed. No malignant lesion was detected in the gallbladder. In March 2000, a subcutaneous tumor was pointed out at the port site in her abdomen, and resected. Histological examination revealed metastatic adenocarcinoma. On detailed examination, endoscopic retrograde cholangiopancreatography (ERCP) revealed a tumor, about 2 cm in diameter, in the lower bile duct. On June 1, she underwent pylorus-preserving pancreatoduodenectomy at our institute, and several disseminated lesions were detected at the port site and in the abdominal cavity. There have been few reports of bile duct carcinoma that developed peritoneal dissemination caused by leakage of bile during cholecystectomy. Leakage of bile should be prevented during laparoscopic cholecystectomy, even in patients not diagnosed as having cancer preoperatively.

Normal values in adults for ultrasonic tissue characterization by integrated backscatter have been reported previously and subsequently applied to patients with specific diseases. Factors influencing integrated backscatter values in a pediatric population are not clearly defined. To obtain normal values for myocardial ultrasonic integrated backscatter in a pediatric population, we studied 72 children with normal cardiac anatomy using an ultrasonic integrated backscatter imaging system. The parameters measured were at peak, nadir, and end-diastole in eight different regions with two different settings: fixed and variable. We subsequently calculated cyclic variation, the ratios of cyclic variation to end-diastole and to peak. Age ranged from 1 day to 17.4 years (median 4.4 years). More than 90% of data curves from the two regions in the left ventricular posterior wall in long-axis view had normal patterns, whereas more than 50% of curves for the other regions had abnormal patterns. Comparing the two posterior wall positions, there were no differences in cyclic variation between the two regions, with little effect of setting. Less effect of regions and settings was noted for the ratios of cyclic variation to end-diastole or peak. There was no relation between backscatter variables and age, gender, or height, and some variables correlated weakly with body surface area. The assessment of integrated backscatter in children is optimal with interrogation of the left ventricular posterior wall imaged in the long-axis view. More stable estimates are obtained when the cyclic variation is related to the peak or end-diastolic value.

Ultrasonic tissue characterization by integrated backscatter is a sensitive tool to detect myocardial changes related to specific diseases. Cardiotoxicity related to doxorubicin use is well known and remains a major concern. To determine if ultrasonic tissue characterization of the myocardium is abnormal in patients receiving doxorubicin, we studied the myocardium of pediatric patients receiving doxorubicin by a real-time integrated backscatter (IB) imaging system. Three values of IB parameters were averaged from the left ventricular posterior wall at the level of the tip of the mitral valve. In addition to standard echo parameters, we obtained the following IB parameters: peak, nadir, cyclic variation (CV), end-diastole, heart-rate corrected delay of nadir (Delay(c)), and the ratio of CV over end-diastole. IB parameters were normalized as Z scores from multiple linear regression equations including echo wall thickness and functional indices from a normal control group of 72 children. We evaluated 27 patients at a median age of 11.6 years (1.6 years to 20.3 years) and median time of 1.7 m (2 days to 7.2 years) after a mean cumulative dose of doxorubicin of 188 +/- 120 mg/m(2) for treatment of neoplasm. Mean (+/-SD) Z scores for IB variables were as follows: zPeak 0.15 +/- 1.07, P = 0.47; zNadir 0.41 +/- 1.16, P = 0.08; zCV -0.49 +/- 0.95, P = 0.01; zEnd-diastole 0.17 +/- 0.94, P = 0.38; zDelay(c) 0.33 +/- 0.80, P = 0.06, and zCV/Peak -0.59 +/- 1.06, P = 0.009. This study shows that ultrasonic IB of the myocardium of children receiving doxorubicin is abnormal and is independent of the cumulative dosage of doxorubicin or the amount of time since the last dose.