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The effectiveness of a previously developed unsintered hydroxyapatite (uHA) and poly(L-lactic acid) (PLLA) hydrophilic membrane as a resorbable barrier for guided bone regeneration (GBR) was evaluated. Critical-size 8-mm diameter bone defects were surgically generated in the parietal bones of 24 12-week-old male Wistar rats, which were then divided into three groups in which either a uHA/PLLA or a collagen membrane or no membrane (control) was placed onto the bone defect. Following sacrifice of the animals 2 or 4 weeks after surgery, bone defects were examined using microcomputed tomography and histological analysis. Bone mineral density, bone mineral content, and relative bone growth area values 2 or 4 weeks after surgery were highest in the uHA/PLLA group. Four weeks after surgery, the relative bone growth area in the uHA/PLLA group was larger than that in the collagen group. The resorbable uHA/PLLA membrane is thus potentially effective for GBR.

Accurate diagnosis of earlier HIV infection is essential for treatment and prevention. Currently, confirmation tests of HIV infection in Japan are performed using Western blot (WB), but WB has several limitations including low sensitivity and cross-reactivity between HIV-1 and HIV-2 antibodies. To address these problems, a new HIV testing algorithm and a more reliable confirmation and HIV-1/2 differentiation assay are required. The Bio-Rad Geenius HIV-1/2 Confirmatory Assay (Geenius) has recently been approved and recommended for use in the revised guidelines for diagnosis of HIV infection by the Center for Disease Control and Prevention (USA). We made comprehensive comparison of the performance of Geenius and the Bio-Rad NEW LAV BLOT 1 and 2 (NLB 1 and 2) which are WB kits for HIV-1 and HIV-2, respectively, to examine if Geenius is a suitable alternative to these WB assays which are now being used in HIV testing in Japan. A total of 166 HIV-1 positive samples (146 from patients with established HIV-1 infection and 20 from patients with acute infection), five HIV-1 seroconversion panels containing 21 samples and 30 HIV-2 positive samples were used. In addition, a total of 140 HIV negative samples containing 10 false-positives on screening tests were examined. The sensitivity of Geenius and NLB 1 for HIV-1 positive samples was 99.3% and 98.6%, respectively. Geenius provided more positive results in the samples from acute infections and detected positivity 0 to 32 days earlier in seroconversion panels than NLB 1. NLB 2 gave positive results in 12.3% of HIV-1 positive samples. The sensitivity of both Geenius and NLB 2 for HIV-2 positive samples was 100%. The specificity of Geenius, NLB 1 and NLB 2 was 98.5%, 81.5% and 90.0%, respectively. Geenius is an attractive alternative to WB for confirmation and differentiation of HIV-1 and HIV-2 infections. The adaptation of Geenius to the HIV testing algorithm may be advantageous for rapid diagnosis and the reduction of testing costs., Competing Interests: The authors have declared that no competing interests exist.

Background: Recently, the occurrence of peri-implantitis has been increasing. However, a suitable method to debride the contaminated surface of titanium implants has not been established. The aim of this study was to investigate the morphologic changes of the microstructured fixture surface after erbium laser irradiation, and to clarify the effects of the erbium lasers when used to remove calcified deposits from implant fixture surfaces., Methods: In experiment 1, sandblasted, large grit, acid etched surface implants were treated with Er:YAG laser or Er,Cr:YSGG laser at 30 to 60 mJ/pulse and 20 Hz with water spray. In experiments 2 and 3, the effects of erbium lasers used to remove calcified deposits (artificially prepared deposits on virgin implants and natural calculus on failed implants) were investigated and compared with mechanical debridement using either a titanium curette or cotton pellets. After the various debridement methods, all specimens were analyzed by stereomicroscopy (SM), scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS)., Results: Stereomicroscopy and SEM showed that erbium lasers with optimal irradiation parameters did not influence titanium microstructures. Compared with mechanical debridement, erbium lasers were more capable of removing calcified deposits on the microstructured surface without surface alteration using a noncontact sweeping irradiation at 40 mJ/pulse (ED 14.2 J/cm 2 /pulse) and 20 Hz with water spray., Conclusion: These results indicate that Er:YAG and Er,Cr:YSGG lasers are more advantageous in removing calcified deposits on the microstructured surface of titanium implants without inducing damage, compared to mechanical therapy by cotton pellet or titanium curette., (© 2018 American Academy of Periodontology.)

Background: The metabolism of many proton pump inhibitors is influenced by CYP2C19 genotype, which is a limitation of their use., Objectives: To determine the efficacy and safety profile of Z-215 (azeloprazole sodium) as initial treatment for reflux esophagitis (RE), dose response, and optimal dose compared with rabeprazole sodium (RPZ)., Methods: We conducted an exploratory, multicenter, randomized, double-blind, parallel-group study in Japan. Patients with RE aged ≥20 years were enrolled and randomly assigned to receive 10, 20, or 40 mg Z-215 or 10 mg RPZ (1:1:1:1), and orally administered the respective drug for 8 weeks. The primary efficacy end point was the endoscopic healing rate after 8 weeks of treatment (at Week 8). We also assessed the effects of CYP2C19 genotype. Safety end points were the incidence of adverse events and adverse drug reactions., Results: Five hundred three patients received the study drugs (10 mg Z-215: 125 patients, 20 mg Z-215: 126 patients, 40 mg Z-215: 126 patients, and 10 mg RPZ: 126 patients). The endoscopic healing rate at Week 8 was above 95% in all groups (10 mg Z-215: 95.2%, 20 mg Z-215: 96.8%, 40 mg Z-215: 95.2%, and 10 mg RPZ: 96.8%). The endoscopic healing rate and serum gastrin levels of the Z-215 groups were not influenced by CYP2C19 genotype. In patients with Grade C/D, the endoscopic healing rate at Week 4 was slightly higher in the 40-mg Z-215 group compared with the other groups. Incidences of adverse events/adverse drug reactions did not markedly differ between the Z-215 and 10-mg RPZ groups., Conclusions: Z-215 was as effective and well tolerated as 10 mg RPZ in the treatment of RE in this selected population. CYP2C19 genotype status may not influence the efficacy and safety of Z-215. There were no clear dose-response effects between Z-215 doses in the endoscopic healing of RE. These findings suggest that Z-215 may be 1 option for the initial treatment of RE. ClinicalTrials.gov identifier: NCT 02463643.

Objective: This aim of this study was to investigate the differences between patients with and without a treatment history of dental implants by use of a questionnaire survey in order to determine the information that is required for patients undergoing dental implants., Materials and Methods: The questionnaires were given to 4512 patients who visited the Tokyo Medical and Dental University Hospital for oral implants between January 2012 and December 2014, and 2972 (66%) valid questionnaires were collected., Results: There were 857 patients with a treatment history of dental implants and 2115 patients without. "Preservation of an adjacent tooth" was the reason that 32% of these patients chose implant therapy, and the patients without treatment history were significantly higher than the patients with one. Significantly, more patients without a treatment history of dental implants selected the after-effects of surgery and pain after surgery as their main concerns for implant therapy compared to those with a treatment history. In the question "Pain after surgery," the patients without treatment history did not know significantly lower than the patients with one., Conclusions: Patients without a treatment history of dental implants placed more importance on the preservation of healthy teeth. Because patients, in particular those without a treatment history of dental implants, are anxious about surgery, we should provide them with more information on treatment than we already do and explain the risks of treatment to them. To keep the credence between doctors and patients, informed consent and patient education on treatment are six important concerns., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A 69-year-old man presented to our hospital because of epigastric pain. A type 2 lesion was seen in the lesser curvature of the antrum of the stomach. A moderately differentiated adenocarcinoma(human epidermal growth factor receptor 2-negative) was diagnosed by biopsy. Abdominal computed tomography showed a mass shadow 52mm in diameter in the pyloric region invading the surrounding organs, but no evidence of distant metastasis. Chemotherapy with S-1 and cisplatin(SP therapy)was initiated because of a diagnosis of locally advanced gastric cancer. After 2 courses of chemotherapy, the tumor shrinkage rate was 70%, confirming that treatment was effective. However, severe skin disorders developed, precluding the continuation of chemotherapy. Staging laparoscopy showed no evidence of peritoneal dissemination, but invasion into the superior mesenteric vein was noted. The tumor was resected by pancreaticoduodenectomy with partial resection of the venous wall. Pathological examination of the resected specimens provided a definite diagnosis of neuroendocrine cell carcinoma. As of 1 year and 7 months after surgery, there has been no observation of metastasis or recurrence. SP therapy was suggested to be a useful regimen for preoperative chemotherapy in patients with locally advanced neuroendocrine cell carcinoma.

The trigger for bone remodeling is bone resorption by osteoclasts. Osteoclast differentiation only occurs on the old bone, which needs to be repaired under physiological conditions. However, uncontrolled bone resorption is often observed in pro-inflammatory bone diseases, such as rheumatoid arthritis. Mature osteoclasts are multinuclear cells that differentiate from monocyte/macrophage lineage cells by cell fusion. Although Osteoclast precursors should migrate across osteoblast layer to reach bone matrix before maturation, the underlying mechanisms have not yet been elucidated in detail. We herein found that osteoclast precursors utilize two routes to migrate across osteoblast layer by confocal- and electro-microscopic observations. The osteoclast supporting activity of osteoblasts inversely correlated with osteoblast density and was positively related to the number of osteoclast precursors under the osteoblast layer. Osteoclast differentiation was induced by IL-1ß, but not by PGE 2 in high-density osteoblasts. Osteoblasts and osteoclast precursors expressed CX3CL1 and CX3CR1, respectively, and the expression of CX3CL1 increased in response to interleukin-1ß. An anti-CX3CL1-neutralizing antibody inhibited the migration of osteoclast precursors and osteoclast differentiation. These results strongly suggest the involvement of CX3CL1 in the migration of osteoclast precursors and osteoclastogenesis, and will contribute to the development of new therapies for bone diseases. J. Cell. Physiol. 232: 1739-1745, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Introduction: We have recently used highly pure β-TCP (beta-tricalcium phosphate) as the bone grafting material to avoid highly invasive autogenous bone grafting. We evaluated the osseoconduction potential of highly pure β-TCP in sinus augmentation surgery treatment., Materials and Methods: The study group comprised 13 patients who underwent maxillary sinus floor augmentation with β-TCP alone. Seven patients underwent sinus augmentation and implant placement simultaneously. Six patients were treated with a staged approach. Six months after surgery, specimens were obtained from 7 patients (for lateral biopsy) and 6 patients (for vertical biopsy)., Results: Histological and histomorphometrical analysis showed a mean bone proportion of 30.8% (vertical) and 12.0% (lateral) for new bone formation and good integration of the β-TCP. New bone formation was lower in the lateral biopsy specimens than in the vertical., Conclusion: Highly pure β-TCP is a safe bone-grafting material with superior osteoconductive properties. Histologic and radiographic examinations indicate that β-TCP is slowly resorbed, which results in unresorbed graft material remaining even 6 months after the procedure, and that new bone replacement occurs slowly for approximately 1 year.

The newly developed rapid diagnostic test (RDT, DK14-CA1, Denka Seiken Co., Ltd.) to detect Campylobacter antigen was evaluated using fecal specimens of patients with enteritis. The RDT is an immunochromatographic assay using colored latex and can detect Campylobacter antigen (C. jejuni and C. coli) from patients' stool samples within 15 minutes. A total of 227 stool samples obtained from patients with enteritis were examined and the results were compared with conventional culture methods. Overall sensitivity, specificity, accuracy and positive predictive value (PPV) were 75.6%, 98.6%, 89.9% and 97.0% respectively. Among 53 severe cases defined with their clinical findings, sensitivity, specificity, accuracy and PPV were 82.1%, 100%, 90.6% and 100% respectively. Mean time to obtain the result with the RDT was 7 minutes whereas the culture method took 2.2 days. This study revealed the usefulness of the newly developed RDT as a rapid detection tool for Campylobacter antigen. Although the RDT has a little lower sensitivity compared with culture method, the simple and rapid test can contribute to treatment decisions for patients with enteritis and can be used at the patient's bedside and in outpatient clinics.

Objectives: The objective of this study was to examine peri-implant mucosal thickness at different sites of peri-implant crevice around 70 implants placed in 35 patients., Material and Methods: The peri-implant mucosal thickness was defined as distance of the peri-implant mucosal margin and the coronal edge of bone/implant contact and measured using the cast models and dental radiography., Results: The overall mean peri-implant mucosal thickness was 3.6 ± 1.4 mm, wherein maxillary anterior implants, maxillary posterior implants and mandibular posterior implants had significantly different dimensions of median thickness of 4.25, 3.75 and 3.0 mm, respectively. Furthermore, the mesial and distal sites of those positioned implants measured unevenness in the thickness especially in the maxillary posterior region with statistical significance., Conclusion: The proposed methodology to evaluate peri-implant mucosal thickness measured with a big variation from overall 3.6 mm with a big variation from 1.6 to 7.0 mm in healthy volunteers. And significant difference was found in the depth among the three regions and, statistically, dispersion of individual peri-implant mucosal thickness resulted in lack of consistency. Although dental implants have been well developed, predictable and prevailing prosthetics, onset of peri-implantitis might be inevitable in some cases. Therefore, establishment of a standardized dimensional diagnosis of peri-implant tissues followed by pathologic ascertainment could be taken into account for the prevention or curing of peri-implantitis., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The number of patients returning from or staying abroad is likely to increase in the future. We performed a retrospective study of patients returning from abroad in our travel clinic in Japan. All patients presenting within 6 months of traveling abroad between 2004 and 2014 were included in the present study. A total of 2374 (mean age, 35 years) patients were seen by doctors specializing in treating infectious diseases. Of these, 918 were females and 87 of them lived abroad. Diagnoses and exposure regions were recorded for all patients. The most frequent region visited before attending our clinic was Southeast Asia (n = 1050, 44%), with a median duration for staying abroad of 8 days. The major purposes for overseas travel were tourism (n = 1302, 55%) and business (n = 684, 29%). Of the 2399 individual diagnoses made, the most frequent were diseases of the gastrointestinal system (n = 1083, 45%), skin and soft tissue (n = 440, 18%), systemic febrile disease without specific systems (419, 18%), and the respiratory system (353, 15%). The relative incidences of specific diseases changed drastically due to significant disease outbreaks, such as pandemic influenza in 2009. Exposure regions remained relatively constant throughout the study period, except for Japan. Vaccine-preventable diseases accounted for 5.3% of all the diseases, and 402 (26%) patients received pre-travel consultation and prophylaxis with vaccines and/or anti-malarial drug. We should make an effort to make more people notice the risk of travel and properly perform prophylaxis., (Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: The long-term stability of maxillary sinus floor augmentation with β-TCP remains largely unknown. We report the long-term assessment of volumetric changes in maxillary sinus floor augmentation with β-TCP by cone-beam computed tomography (CBCT)., Methods: The subjects included 30 patients who underwent maxillary sinus floor augmentation using β-TCP and 58 implant placement for unilateral maxillary defect, simultaneously. Volumetric changes in β-TCP and the height of peri-implant bone were analyzed by CBCT., Results: In all patients, the mean volume of the grafted bone decreased from immediately after implant placement to 6 months after implant placement (75.6 % reduction rate); it decreased further at 2.5 years after implant placement (54.9 % reduction rate). The mean of the height from the implant tip to the maxillary sinus floor was 2.00 ± 1.51 mm, 0.73 ± 1.33 mm, and -0.72 ± 1.11 mm immediately, 6 months, and 2.5 years after implant placement, respectively. The implant tip protruded beyond the maxillary sinus floor in approximately 70 % of the implants (41/58 implants) at 2.5 years after surgery. During the observation period, the implant survival rate was 100 %., Conclusions: The radiographic analysis by CBCT is considerably more advanced than previous radiographic examinations. Although maxillary sinus pneumatization continues to progress ≥1 year after maxillary sinus floor augmentation with β-TCP, it stabilizes 3 years after surgery.

Purpose: Ceftriaxone has been recognized as a well-tolerated drug; however, in some instances, liver dysfunction occurs after using high-dose ceftriaxone. We aimed to assess the incidence of liver injury due to high-dose ceftriaxone and to determine whether there is a dose-dependent risk of liver injury with this drug., Methods: We conducted a retrospective cohort study of hospitalized adult patients treated with ceftriaxone at a tertiary care hospital from January 2012 to October 2013. We collected demographic and clinical data by reviewing their medical records. The incidence of liver injury based on biochemical criteria, defined as a primary outcome, was compared between patients treated with high-dose ceftriaxone (4 g/day) and those treated with a normal dose of ceftriaxone (2 g/day) for ≥5 consecutive days. A propensity score for the use of high-dose ceftriaxone was calculated from five factors., Results: We identified 37 patients treated with high-dose ceftriaxone and 434 patients treated with a normal dose of ceftriaxone. Among these 471 patients, 15 patients (3.2 %) experienced liver injury, of whom six patients (6/37, 16.2 %) had received high-dose ceftriaxone and nine patients (9/434, 2.1 %) had received normal doses of ceftriaxone. In the multivariate analysis adjusted for the propensity score, high-dose ceftriaxone was independently associated with liver injury (odds ratio, 7.23; 95 % confidence interval, 2.01-26.0)., Conclusions: The present study revealed that high-dose ceftriaxone was associated with a significantly higher incidence of liver injury compared with the normal-dose regimen. Therefore, clinicians should carefully observe for signs of liver injury after high-dose ceftriaxone use.

A 47-year-old man underwent surgical resection and reconstruction with a fibula osteocutaneous flap. After the surgery, a surgical obturator was placed and adjusted. After flap healing, a conventional obturator was fabricated with polymethyl methacrylate resin and retained by the anatomical undercuts around the reconstructed fibula bone flap and the posterior part of the defect. As the defect shape changed with time, a second conventional obturator was fabricated and fitted. No further recurrence of myoepithelioma was observed for 2 years, and the patient was satisfied with the obturator during mastication and speech; however, despite having no major complaints, the patient found it difficult to chew on the right side, and the obturator was displaced slightly downward when the mouth was opened wide and shifted when chewing hard and sticky food. Thus, an implant-retained obturator was suggested to provide better retention and stability. Four dental implants were therefore placed into the fibula bone, although one did not osseointegrate because either primary stability was insufficient or overload was affected in the nonloaded implant environment and was replaced. After fitting custom abutments with a magnet, an implant-retained obturator was placed, and the patient was satisfied with the outcome. During 3 years of follow-up, no issues were noted with the implant bodies, abutments, obturator, or reconstructed site. The conventional obturator was displaced slightly downward when the patient opened his mouth wide, and it shifted when chewing hard and sticky food because there was limited fibula bone at the reconstruction site and more available posteriorly. For better retention and stability, the implant-retained obturator was fabricated with a custom abutment and magnetic retention. The patient was satisfied with the results, as improved implant retention increased the stability of the prosthesis. This clinical report describes the rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap and an implant-retained obturator. The patient's oral functions were improved when the prosthesis was stabilized by means of dental implants and custom abutments., (© 2015 by the American College of Prosthodontists.)

Maxillary sinus floor elevation using autologous or alloplastic bone grafting is often performed for implant treatment of maxillary molars; however, issues related to the donor site and complications such as infection have been reported. We performed maxillary sinus floor elevation using poly-L-lactic acid (PLLA) as a space-making material in patients with an insufficient bone mass (<3 mm) for simultaneous implantation between the alveolar crest and floor of the maxillary sinus and evaluated the newly formed bone. Conventional antrostomy of the maxillary sinus from the lateral wall was performed, and PLLA was placed on the floor of the maxillary sinus after elevating the sinus membrane. Six months after surgery, the bone mass and density were measured using quantitative computed tomography, and histological evaluation was performed. No complications were recorded. Radiological findings showed a bone-like radiopaque appearance, and histological examination revealed new bone formation in all patients. In cases with insufficient bone mass prior to simultaneous implant placement, this method of maxillary sinus augmentation allows for sufficient bone augmentation without bone grafting.

Background: When augmenting the maxillary sinus without grafting material, the method used to cover the bony window is a subject of debate., Purpose: The purpose of this study was to evaluate the poly-L-lactic acid (PLLA) membrane as closing material of the lateral window in a maxillary sinus augmentation without bone grafting., Materials and Methods: Augmentation of the maxillary sinus without grafting material and installation of titanium screws that fix the Schneiderian membrane were performed in 18 Japanese male white rabbits. The bony window was covered with a collagen membrane or PLLA membrane or no membrane. The animals were sacrificed at 4 or 8 weeks. New bone volume was calculated radiologically using microcomputed tomography (micro-CT). The samples were analyzed histologically after toluidine blue staining., Results: No significant differences were observed in the new bone volume, as measured by micro-CT. However, histomorphometric analysis demonstrated the superiority of the PLLA membrane in new bone formation compared with the collagen membrane., Conclusion: The PLLA membrane is a suitable material to be applied for tissue regeneration in this animal model., (© 2015 Wiley Periodicals, Inc.)

Background: It is important to visualize the phenomenon which occurs in actual clinical cases to decide the timing of implant placement subsequently after sinus graft. Although several clinical cases of bone augmentation using xenograft have been evaluated, the number of those reports which have described bone remodeling by alloplasty are not sufficient., Findings: In the present report, to investigate bone remodeling histologically after maxillary sinus augmentation with porous hydroxyapatite alloplast, bone cores from the sinus floor of three female nonsmoking patients (aged 64-73 years) were collected 6 months after sinus lift surgery, embedded in methyl methacrylate resin, and prepared by conventional methods. Bone architecture and graft residues were evaluated by micro-computed tomography of the same specimens. Hematoxylin-eosin and Villanueva-Goldner staining revealed mature osteoblasts and multinucleated osteoclasts on the grafted sinus floor and surface of residual hydroxyapatite particles. The particulate interspace was partially filled with osteoid and calcified tissue and showed active vascularization., Conclusion: The results suggested that bone regeneration and angiogenesis within and between porous hydroxyapatite particles were sufficiently found after 6 month histologically in the grafted sinus floor.

Introduction: The effect of mesalazine in treating active Crohn's disease (CD) remains controversial, possibly due to the various formulae of mesalazine used to treat inflammation located in different regions of the digestive tract., Methods: This exploratory, multicenter, uncontrolled, open-label study included 17 patients with active CD. The inclusion criteria were patients with a CD activity index (CDAI) of ≥ 200 and <350, and in whom mucosal lesions were observed in the area from the terminal ileum to the rectum using colonoscopy (CS). Each patient was treated with pH-dependent-release mesalazine at 4.8 g/day. The drug was administered three times daily for 12 weeks. Efficacy was evaluated by the change in CDAI at the time of final observation (at week 12 or at discontinuation), and safety was evaluated by the incidence of adverse events (AEs) and adverse drug reactions (ADRs)., Results: In the full analysis set (n = 17), the change in CDAI at the time of final observation was -67.4, and the mean change in CDAI from baseline was -49.3 at week 2, -61.8 at week 4, -78.3 at week 8, and -101.1 at week 12. A statistically significant improvement was observed from week 2 to week 12 compared with baseline, and the incidences of AEs and ADRs were 94.1 and 58.8%, respectively. All events were known events, as the results suggested, which is in line with the known safety profile of pH-dependent-release mesalazine., Conclusions: The results suggest that the administration of pH-dependent-release mesalazine 4.8 g/day for 12 weeks could be an effective and highly safe treatment option for patients with mild to moderately active CD in whom mucosal lesions were observed in the area from the terminal ileum to the rectum., Trial Registration Number: JapicCTI-111460.

We herein report a case of Penicillium marneffei infection (PMI) in a Japanese man who was infected with human immunodeficiency virus-1 (HIV-1), who was diagnosed on the basis of a bone marrow culture and who was effectively treated with itraconazole. Our review of the PMI cases reported in Japan suggests that increased serum (1→3)-β-D-glucan levels are a useful diagnostic tool in cases of suspected PMI.

While visiting Malaysia, a 22-year-old previously healthy Japanese man developed myalgia, headache, and fever, leading to a diagnosis of classical dengue fever. After improvement and returning to Japan after a five day hospitalization, he developed productive cough several days after defervescing from dengue. Computed tomography (CT) thorax scan showed multiple lung cavities. A sputum smear revealed leukocytes with phagocytized gram-positive cocci in clusters, and grew an isolate Staphylococcus aureus sensitive to semi-synthetic penicillin; he was treated successfully with ceftriaxone and cephalexin. This second reported case of pneumonia due to S. aureus occurring after dengue fever, was associated both with nosocomial exposure and might have been associated with dengue-associated immunosuppression. Clinicians should pay systematic attention to bacterial pneumonia following dengue fever to establish whether such a connection is causally associated., (© The American Society of Tropical Medicine and Hygiene.)

A Japanese female in her 60's on 5 years' treatment with prednisolone 5 mg for ulcetarive colitis developed severe bloody stools and diarrhea and was admitted. A total colectomy was performed because leukocytapheresis with intravenous corticosteroid administration (prednisolone 70 mg/day) relieved her symptoms partially. Pneumocystis pneumonia (PCP) prophylaxis was not introduced then. She developed acute respiratory failure on postoperative day (POD) 8, and was intubated and moved to our intensive care unit. PCP was suspected and sulfamethoxazole/trimethoprim (ST) was started with methylprednisolone 40 mg/day. The pneumonia initially improved but got worse around POD 27 and pulse corticosteroid therapy was administered. Antibiotics were first changed to pentamidine and finally changed to clindamycin/primaquine because of adverse reactions due to both of the medications. She recovered fully and experienced no exacerbation after discontinuation of the secondary prophylaxis. This is the first report of primaquine administration for PCP in Japan. Clindamycin/primaquine are second-line drugs but very important because the first-line medications such as ST and pentamidine cause adverse reactions and frequently result in discontinuation, as was the case in our present patient. Nowadays immunosuppresive therapy for malingnancies and autoimmune diseases has been introduced more frequently than before, PCP has attracted more attention. Therefore primaquine should be approved for appropriate use without delay in Japan.

Objective: A dengue outbreak occurred in Japan 2014. We investigated the characteristics of dengue infection among Japanese., Methods: We investigated the medical charts retrospectively. Patients The study participants are patients who came to our clinic between 2008 and 2014., Results: We investigated 4 domestic cases and 46 imported cases of Japanese with laboratory confirmation of dengue. Major symptoms were fever (100%), rash (86%), fatigue (84%), headache (81%), joint pain (66%), muscle pain (49%), and bleeding (6%). A late rash that appeared near the time of fever resolution was observed in 37 cases (74%). A total of 38/43 (88%) cases had low WBC count (<3,500 /μL) during the febrile period, 42/48 (88%) cases had a low platelet (PLT) count (<130×10(3)/μL), and 44/50 (88%) cases had a C-reactive protein (CRP) <2.0 mg/dL., Conclusion: Patients with a high fever, late rash, fever-associated leukopenia, low PLT count, low CRP, and elevated aminotransferases are generally suspected of having a dengue infection.

Subjective adverse reactions to metronidazole were analyzed in 111 patients with amebiasis. Metronidazole was administered to 36 patients at a daily dose of 2250 mg and 75 patients at daily doses lower than 2250 mg. The reactions reported included nausea without vomiting in 11 (9.9%) patients, nausea with vomiting in 2 (1.8%), dysgeusia in 2 (1.8%), diarrhea in 1 (0.9%), headache in 1 (0.9%), numbness in 1 (0.9%), dizziness in 1 (0.9%), urticaria in 1 (0.9%), exanthema in 1 (0.9%), and discomfort in 1 (0.9%). Nausea was reported by 28% (10/36) of the patients receiving metronidazole at a daily dose of 2250 mg and 4% (3/75) of the patients receiving lower daily doses. The duration of the metronidazole administration in days was not associated with the appearance of nausea. No life-threatening adverse reactions were identified, and good clinical therapeutic effects were observed in 96% (107/111) of the patients. While metronidazole appears to be a safe anti-protozoal agent for patients with amebiasis, our results indicate that a daily metronidazole dose of 2250 mg is excessive for amebiasis, as it often induces nausea., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Maxillary sinus augmentation is used when performing implant treatment in the maxillary molar region with inadequate bone height. Posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and sinus membrane. When performing an osteotomy via lateral approach, however, damage to the PSAA can occur, because it runs inside the lateral wall of the maxillary sinus, causing hemorrhage and hampering surgery. The objective of the present study was to compare the defect patterns with the distances from the alveolar crest and sinus floor to the PSAA., Method and Materials: 280 lateral regions in 235 patients with at least three missing consecutive posterior teeth were measured. Measurement locations were the 1st premolar (P1), the 2nd premolar (P2), the 1st molar (M1), and the 2nd molar (M2)., Results: The detection rate was 29% to 59%, and the longest diameter was between 1.1 mm and 1.3 mm. The average distances between the PSAA and the alveolar crest were 24.1 mm, 21.3 mm, 15.4 mm, and 15.3 mm (P1-M2), with statistically significant differences in all locations except M1 and M2. The average distances between the PSAA and the maxillary sinus floor were 10.4 mm, 10.4 mm, 9.0 mm, and 8.5 mm (P1-M2), with no significant differences. There were no significant differences between different defect patterns in the distance between the PSAA and either the alveolar crest or the maxillary sinus floor. PSAA detection rate and the longest diameter were related to the spatial resolution of the computed tomography (CT) scan., Conclusion: Although the distance between the PSAA and the alveolar crest was significantly shorter in the molar region than in the premolar region, it did not affect the defect pattern.

Objective: Travel overseas has recently been considered a risk factor for colonization with drug-resistant bacteria. The purpose of this study was to establish the epidemiology and risk factors associated with the acquisition of drug-resistant bacteria by Japanese travelers., Methods: Between October 2011 and September 2012, we screened the stools of 68 Japanese returning travelers for extended-spectrum β-lactamase (ESBL) producing Escherichia coli. All specimens were sampled for clinical reasons. Based on the results, the participants were divided into an ESBL-producing E. coli positive group (18 cases; 26%) and an ESBL-producing E. coli negative group (50 cases; 74%), and a case-control study was performed. Microbiological analyses of ESBL-producing strains, including susceptibility tests, screening tests for metallo-β-lactamase, polymerase chain reaction amplification and sequencing of blaCTX-M genes, multilocus sequence typing, and whole genome sequencing, were also conducted., Results: In a univariate comparison, travel to India was a risk factor (Odds Ratio 13.6, 95% Confidence Interval 3.0-75.0, p<0.0001). There were no statistical differences in the characteristics of the travel, such as backpacking, purpose of travel, interval between travel return and sampling stool, and duration of travel. Although 10 of 13 analyzed strains (77%) produced CTX-M-15, no ST131 clone was detected., Conclusion: We must be aware of the possibilities of acquiring ESBL-producing E. coli during travel in order to prevent the spread of these bacteria not only in Japan but globally.

The purpose of this study was to investigate new patients who had already received treatment with dental implants. The subjects were patients who visited the clinic for oral implants at Tokyo Medical and Dental University Hospital from April 1995 to March 2012. The results were as follows: 1) Of the total number of patients, there were 2,419 patients (14.0%) with dental implants. 2) Of the 2,419 patients, 252 patients (10.4%) had been referred from operating doctors or operating clinics. 3) There were 1,516 (62.7%) patients with complaints related to the implant therapy. 4) There were 1,367 (56.5%) patients who had ill feelings toward their attending doctors. 5) There were 1,112 (46.0%) patients with biological complications. 6) Regarding patients with or without a referral from the doctor who had performed their dental implant, those patients who had been referred showed significantly higher occurrence of loss of implants, neurological symptoms, doctor's recommendation, prosthetic problems, and surgical problems. Almost implant therapies were treated with other treatments for natural teeth, including surgical treatment, prosthetic treatment, periodontal treatment and maintenance. These were too complex to enable the results to be forecast before treatment, therefore unpredictable symptoms often occur in patients with implant therapy. Informed consent including patient education is important, but the results of this study suggest that it is insufficient at present.

Thermoelectrochemical cells (TECs) have the potential to offer a continuous renewable electricity supply from a variety of thermal energy sources. Because of the thermal gradient, the device characteristics are a complex function of temperature dependent electrolyte transport properties, electrode electro-catalytic properties and the Seebeck coefficient of the redox couple. Understanding the interplay between these functions is critical to identifying the limiting factors that need to be overcome to produce more advanced devices. Thus, in this work we have developed a theoretical model for TECs and have measured a range of properties required by the model. We focused attention on the Co(n)(bpy)3(NTf2)n in a [C2mim][B(CN)4] ionic liquid electrolyte as one of the optimal systems for >100 °C operation. The exchange current densities on a range of electrode materials were measured in order to explore the role of electrode function in the simulation. Alternatives to platinum electrodes (maximum output power, Pmax = 183 mW m(-2)), including platinized stainless steel, Pt-SS (Pmax = 188 mW m(-2)) and poly(3,4-ethylenedioxythiophene) deposited on stainless steel, PEDOT-SS (Pmax = 179 mW m(-2)), were shown to be viable options. From the simulations we conclude that for further development of ionic liquid TECs, modifications to the redox couple to increase the Seebeck coefficient, and increasing the rate of diffusion of the redox couple to minimize mass transport resistance, will yield the greatest improvements in device performance.

Peripheral blood CD4(+) T cells in HIV-1(+) patients are coated with Ig. However, the causes and consequences of the presence of Ig(+) CD4(+) T cells remain unknown. Previous studies have demonstrated the rapid turnover of viral receptors (VRs) on lymphoma and tumor cells. The present study investigates the turnover of VRs on peripheral quiescent CD4(+) T cells (qCD4s), which are the most abundant peripheral blood CD4(+) T cells. Utilizing pharmacological and immunological approaches, we found that the turnover of VRs on qCD4s is extremely slow. As a result, exposure to gp120 or HIV-1 virions in vitro causes gp120 to remain on the surface for a long period of time. It requires approximately three days for cell-bound gp120 on the surface to be reduced by 50%. In the presence of patient serum, gp120 forms surface immune complexes (ICs) that are also retained for a long time. Indeed, when examining the percentages of Ig(+) CD4(+) T cells at different stages of HIV-1 infection, approximately 70% of peripheral resting CD4(+) T cells (rCD4s) were coated with surface VRs bound to slow-turnover gp120-Ig. The levels of circulating ICs in patient serum were insufficient to form surface ICs on qCD4s, suggesting that surface ICs on qCD4s require much higher concentrations of HIV-1 exposure such as might be found in lymph nodes. In the presence of macrophages, Ig(+) CD4(+) T cells generated in vitro or directly isolated from HIV-1(+) patients were ultimately phagocytosed. Similarly, the frequencies and percentages of Ig(+) rCD4s were significantly increased in an HIV-1(+) patient after splenectomy, indicating that Ig(+) rCD4s might be removed from circulation and that non-neutralizing anti-envelope antibodies could play a detrimental role in HIV-1 pathogenesis. These findings provide novel insights for vaccine development and a rationale for using Ig(+) rCD4 levels as an independent clinical marker.

The performance of a new version of the HIV p24 antigen and antibody combination assays (Genscreen Ultra HIV Ag-Ab) was evaluated by comparing it with three other fourth-generation enzyme immunoassays (Architect HIV Ag/Ab Combo assay, VIDAS HIV DUO Quick and Genscreen Plus HIV Ag-Ab). The assays were examined with 200 HIV positive samples, 1,000 HIV negative samples, 30 samples (28 positives including 24 samples of subtype A, B, B', C, D, F, G, B/D, CRF01&#95;AE in HIV-1 group M, one sample of HIV-1 group O, three samples of HIV-2 and two negatives) of one worldwide HIV performance panel, 59 samples of ten HIV-1 seroconversion panels and the WHO international standard HIV-1 p24 antigen. Both the sensitivity and specificity of Genscreen Ultra HIV Ag-Ab were 100%. All of the 28 positive samples in the worldwide HIV performance panel were positive. The days of the earliest detection in the ten seroconversion panels were the same in three assays (Genscreen Ultra HIV Ag-Ab, Architect HIV Ag/Ab combo assay and VIDAS HIV DUO Quick). Genscreen Plus HIV Ag-Ab which is a former version of the Genscreen Ultra HIV Ag-Ab detected the earliest positive sample one bleed slower than the other three assays in 5 of 10 seroconversion panels. The p24 antigen limit of detection was determined in two ways, using the WHO international standard and three samples from HIV-1 antigen panels; the values obtained were 1IU/mL and 3.5-9.9 pg/mL for Genscreen Ultra HIV Ag-Ab, 1U/mL and 7.1-9.9 pg/mL for Architect HIV Ag/Ab combo assay, 0.5IU/mL and 4.0-7.1 pg/mL for VIDAS HIV DUO Quick, and 32.0-56.5 pg/mL for Genscreen Plus HIV Ag-Ab. In this study, we have shown that Genscreen Ultra HIV Ag-Ab has the sensitivity, specificity and p24 antigen limit of detection that is equal to those of two typical fourth-generation assays. This assay can be considered useful and reliable for HIV screening.

A 41-year-old woman became ill with acute hepatitis B after gynecological surgery performed by a surgeon who was hepatitis B surface antigen positive. The surgeon was positive for hepatitis B e antigen, and HBV DNA concentrations in the serum, saliva, and sweat of the surgeon were very high. HBV genotype and partial HBV DNA sequences from the HBV-infected surgeon were identical to those in the HBV-infected patient. Extensive research by the committee including infection control and prevention specialists judged the source of infection to be a surgeon infected with HBV. Transmission of HBV from a healthcare worker to patients who are not immune to HBV can actually happen. This case report illustrates the importance of a stringent policy of a nationwide HBV universal vaccination program.

Fibroblast growth factor (FGF) signaling is involved in skeletal development. Among total 22 FGFs, it is suggested that FGF18 functions in promotion of osteoblast differentiation. In order to elucidate the mechanism of FGF18-dependent acceleration of osteogenesis, we implanted rhFGF18 soaked beads over mouse fetal coronal sutures using ex-utero surgery. The coronal suture area comprises the peripheries of the developing frontal and parietal bones, separated by the sutural mesenchyme. rhFGF18 accelerated osteogenesis by promoting connection of the frontal and parietal bone domains, resulting in elimination of the sutural mesenchyme. Expression of Fgf receptors, Fgfr1, -2 and -3 involved in skeletal development, was maintained or upregulated in the developing bone domains, consistent with enhanced osteogenesis. Bone morphogenetic protein (Bmp) 2 was specifically upregulated in the skeletogenic layer and the application of Bmp antagonist, rmNoggin, inhibited rhFGF18-dependent upregulation of osteoblast markers. These results suggest that FGF18 accelerates osteogenesis by upregulation of Bmp2 as well as maintenance or upregulation of Fgfr1, -2 and -3 expression in osteoblasts., (© 2013 The Authors. Congenital Anomalies © 2013 Japanese Teratology Society.)

A survey of HIV-1 strains circulating in the Tokyo-Kanagawa metropolitan area of Japan during 2004 to 2011 (n = 477) identified six Japanese males (patients 1 to 6), who harbored viruses with genome segments derived from a distinct CRF01&#95;AE variant uniquely found among men who have sex with men (MSM) in China (designated CN.MSM.01-1). These six HIV infections were diagnosed in 2010 and 2011 among MSM (3 of 75) and men with unknown risk factors (3 of 63) and differed from the vast majority of HIV infections among MSM in Japan, which are overwhelmingly characterized by subtype B (239 of 246 [97.2%]). Approximately one-third (91 of 239 [38.1%]) of subtype B strains from MSM in Japan belong to a large monophyletic cluster (designated JP.MSM.B-1). In addition, we identified a smaller subtype B cluster (n = 8) (designated JP.MSM.B-2) that also contains strains from two Chinese MSM living in Japan. Interestingly, patients 5 and 6 were found to be coinfected with CRF01&#95;AE (CN.MSM.01-1) and subtype B (JP.MSM.B-2 or JP.MSM.B-1) variants that are unique to the HIV-1 epidemics among MSM in China and Japan, respectively. Our study demonstrates for the first time the effect of the expanding HIV epidemic among MSM in China on transmission in neighboring countries and shows the ongoing mixing of CRF01&#95;AE and subtype B lineages unique to HIV-1 that cocirculate in MSM populations in East Asia. This finding highlights the importance of strengthening epidemiological surveillance in the region and the need for effective measures to limit transmission among MSM in East Asia.

Cytomegalovirus (CMV) retinitis with idiopathic CD4(+) T lymphocytopenia (ICL) is rare and difficult to control. We report a first case for long-term control of CMV retinitis with ICL using interleukin-2 (IL-2) therapy and succeeded in discontinuation of anti-CMV therapy. A 49-year-old Japanese woman was diagnosed with ICL based on low CD4(+) count (72/μl), negative for HIV-1 and -2 antibodies, and absence of any defined immunodeficiency diseases or immunosuppressive therapy. PCR test of the aqueous humor in the right eye was suggestive of CMV retinitis. She was treated with systemic ganciclovir, but after several relapses of CMV retinitis, rhegmatogenous retinal detachment appeared in the right eye and she became blind in that eye. Three years later, she developed CMV retinitis in the left eye. Although she received systemic and focal anti-CMV treatments, the retinitis showed no improvement. Finally, retinal detachment occurred, and she underwent vitrectomy. IL-2 was injected to increase CD4(+) counts. Because of hyperpyrexia, blepharedema, central scotoma, and color anomaly, we changed to low-dose IL-2 therapy with no side effects. Finally, we succeeded in increasing the CD4(+) count to more than 200/μl after discontinuation of low-dose IL-2 therapy. CMV retinitis never recurred after discontinuation of anti-CMV therapy, with good visual acuity of 20/20 in the left eye. She developed blindness of the first affected right eye, whereas the visual acuity of the left eye remains excellent more than 12 years after the onset of CMV retinitis through the combined use of anti-CMV therapy, IL-2 therapy, and vitrectomy.

Objective: To compare the efficacy and safety of fixed-dose abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC) with ritonavir-boosted atazanavir (ATV/r) in treatment-naïve Japanese patients with HIV-1 infection., Methods: A 96-week multicenter, randomized, open-label, parallel group pilot study was conducted. The endpoints were times to virologic failure, safety event and regimen modification., Results: 109 patients were enrolled and randomly allocated (54 patients received ABC/3TC and 55 patients received TDF/FTC). All randomized subjects were analyzed. The time to virologic failure was not significantly different between the two arms by 96 weeks (HR, 2.09; 95% CI, 0.72-6.13; p=0.178). Both regimens showed favorable viral efficacy, as in the intention-to-treat population, 72.2% (ABC/3TC) and 78.2% (TDF/FTC) of the patients had an HIV-1 viral load <50 copies/mL at 96 weeks. The time to the first grade 3 or 4 adverse event and the time to the first regimen modification were not significantly different between the two arms (adverse event: HR 0.66; 95% CI, 0.25-1.75, p=0.407) (regimen modification: HR 1.03; 95% CI, 0.33-3.19, p=0.964). Both regimens were also well-tolerated, as only 11.1% (ABC/3TC) and 10.9% (TDF/FTC) of the patients discontinued the allocated regimen by 96 weeks. Clinically suspected abacavir-associated hypersensitivity reactions occurred in only one (1.9%) patient in the ABC/3TC arm., Conclusion: Although insufficiently powered to show non-inferiority of viral efficacy of ABC/3TC relative to TDF/FTC, this pilot trial suggested that ABC/3TC with ATV/r is a safe and efficacious initial regimen for HLA-B*5701-negative patients, such as the Japanese population.

To demonstrate a new family of ionic liquids (ILs), i.e., "solvate" ionic liquids, the properties (thermal, transport, and electrochemical properties, Lewis basicity, and ionicity) of equimolar molten mixtures of glymes (triglyme (G3) and tetraglyme (G4)) and nine different lithium salts (LiX) were investigated. By exploring the anion-dependent properties and comparing them with the reported data on common aprotic ILs, two different classes of liquid regimes, i.e., ordinary concentrated solutions and "solvate" ILs, were found in the glyme-Li salt equimolar mixtures ([Li(glyme)]X) depending on the anionic structures. The class a given [Li(glyme)]X belonged to was governed by competitive interactions between the glymes and Li cations and between the counteranions (X) and Li cations. [Li(glyme)]X with weakly Lewis basic anions can form long-lived [Li(glyme)](+) complex cations. Thus, they behaved as typical ionic liquids. The lithium "solvate" ILs based on [Li(glyme)]X have many desirable properties for lithium-conducting electrolytes, including high ionicity, a high lithium transference number, high Li cation concentration, and high oxidative stability, in addition to the common properties of ionic liquids. The concept of "solvate" ionic liquids can be utilized in an unlimited number of combinations of other metal salts and ligands, and will thus open a new field of research on ionic liquids.

Paracoccidioidomycosis (PCM) is the most common systemic fungal disease in central-south America, but is rare in Japan. We experiensed a case of PCM in a patient, who came from Bolivia and presented with mouth pain and reduced dietary intake but no fever. Adrenal insufficiency was diagnosed with extremely high serum adrenocorticotropic hormone (ACTH) and was resolved with hormone supplementation. The PCM was treated with trimethoprim-sulfamethoxazole which was switched to itraconazole and improvement was achieved.

These are six different classes of antiretroviral drugs that are nucleoside/nucleotide reverse transcriptase inhibitors(NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 inhibitors and integrase inhibitors. NRTIs are thought as backbone of HAART(highly active antiretroviral therapy) and tenofovir/emtricitabine is one of the most important combinations in NRTIs. Efavirenz has been one of the most effective key drugs of HAART but rilpivirine and etravirine have been options recently. PIs have been also effective key drugs. Lopinavir/ritonavir (LPV/RTV) had been a last option to virological failures but adverse events such as diarrhea, nausea and hypertriglycemia of these drugs were severe. Darunavir/ritonavir is more virologically effective PIs with milder adverse events than LPV/RTV.

The oxidative stability of glyme molecules is enhanced by the complex formation with alkali metal cations. Clear liquid can be obtained by simply mixing glyme (triglyme or tetraglyme) with lithium bis(trifluoromethylsulfonyl)amide (Li[TFSA]) in a molar ratio of 1:1. The equimolar complex [Li(triglyme or tetraglyme)(1)][TFSA] maintains a stable liquid state over a wide temperature range and can be regarded as a room-temperature ionic liquid consisting of a [Li(glyme)(1)](+) complex cation and a [TFSA](-) anion, exhibiting high self-dissociativity (ionicity) at room temperature. The electrochemical oxidation of [Li(glyme)(1)][TFSA] takes place at the electrode potential of ~5 V vs Li/Li(+), while the oxidation of solutions containing excess glyme molecules ([Li(glyme)(x)][TFSA], x > 1) occurs at around 4 V vs Li/Li(+). This enhancement of oxidative stability is due to the donation of lone pairs of ether oxygen atoms to the Li(+) cation, resulting in the highest occupied molecular orbital (HOMO) energy level lowering of a glyme molecule, which is confirmed by ab initio molecular orbital calculations. The solvation state of a Li(+) cation and ion conduction mechanism in the [Li(glyme)(x)][TFSA] solutions is elucidated by means of nuclear magnetic resonance (NMR) and electrochemical methods. The experimental results strongly suggest that Li(+) cation conduction in the equimolar complex takes place by the migration of [Li(glyme)(1)](+) cations, whereas the ligand exchange mechanism is overlapped when interfacial electrochemical reactions of [Li(glyme)(1)](+) cations occur. The ligand exchange conduction mode is typically seen in a lithium battery with a configuration of [Li anode|[Li(glyme)(1)][TFSA]|LiCoO(2) cathode] when the discharge reaction of a LiCoO(2) cathode, that is, desolvation of [Li(glyme)(1)](+) and insertion of the resultant Li(+) into the cathode, occurs at the electrode-electrolyte interface. The battery can be operated for more than 200 charge-discharge cycles in the cell voltage range of 3.0-4.2 V, regardless of the use of ether-based electrolyte, because the ligand exchange rate is much faster than the electrode reaction rate.

Electrochemical reactions of sulfur supported on three-dimensionally ordered macroporous carbon in glyme-Li salt molten complex electrolytes exhibit good reversibility and large capacity based on the mass of sulfur, which suggests that glyme-Li salt molten complexes are suitable electrolytes for Li-S batteries.

Background: Although almost all human immunodeficiency virus (HIV)-infected Japanese hemophiliacs are coinfected with hepatitis C virus (HCV), the outcome of living donor liver transplantation (LDLT) in such patients in terms of survival rate, perioperative complications, and recovery of coagulation activity is poorly understood., Patients and Methods: Six HIV-positive hemophiliacs underwent LDLT for HCV-associated advanced cirrhosis. The mean CD4 T-cell count at transplantation was 376±227/μL., Results: The 1-, 3-, and 5-year survival rates were 66%, 66%, and 50%, respectively. Fatal perioperative bleeding related to hemophilia was not observed. Two patients died within 6 months after transplantation due to graft failure. HIV infection was well controlled in all patients who survived longer than 6 months. Two patients (genotype 2a and 2+3a) achieved a sustained viral response and both of them were alive at the end of follow-up period, whereas one patient (genotype 1a+1b) died of decompensated cirrhosis 4 years after transplantation due to recurrent HCV infection., Conclusions: HIV/HCV-coinfected hemophiliacs can safely undergo LDLT. Hemophilia was clinically cured after successful transplantation. A good outcome can be expected as long as postoperative hepatitis C is controlled with interferon/ribavirin combination therapy.

A 70-year-old woman admitted for nausea and diarrhea was diagnosed with Legionella pneumonia based on chest X-ray and urinary antigen testing. Despite severe complications, she recovered thanks to ciprofloxacin administration. On hospital day 8, she went into hypovolemic shock necessitating emergency gastrointestinal (GI) fiberscopy, which showed active lower gastric bleeding. The exposed artery was clipped endoscopically and proton pump inhibitor was started. At hospital day 16, the woman's active GI bleeding recurred, requiring further endoscopic clipping. On hospital day 20, oozing occurred in the middle gastric body. To prevent recurrent bleeding, extensive gastrectomy was done on hospital day 28. Legionella pneumonia is common pneumonia, as are GI symptoms in Legionella pneumonia, but GI bleeding is rare. Only cases of GI bleeding secondary to Legionella pneumonia have been reported in Japan, in addition to our case, and four of the 5 died after GI bleeding, indicating the dismal prognosis. The relationship between Legionella pneumonia and GI bleeding, although uncertain and rare, requires especially close observation.

A 38-year-old man was admitted to our hospital because of continuous fever and right facial palsy. He was diagnosed as HIV positive. Abdominal CT scan showed a large mass in the ascending colon. Gallium scintigraphy demonstrated increased uptake in the ascending colon. Colonoscopy was performed and histological examination of the colon tumor revealed Burkitt's lymphoma (BL). He received highly active anti-retroviral therapy (HAART) and his facial palsy improved. Because CD4 count was significantly low at 31/microl, he was treated with dose-adjusted EPOCH (DA-EPOCH) combined with HAART. Although the tumor was decreased in size by DA-EPOCH, we changed to the combination of hyper-CVAD/MTX-Ara-C alternating therapy with HAART in order to increase dose intensity. Six cycles of hyper-CVAD/MTX-Ara-C were performed and complete remission was obtained. In the HAART era, the survival of patients with AIDS-related diffuse large cell lymphoma (DLCL) improved dramatically, whereas the survival of similarly treated patients with AIDS-related BL remained poor. Our case suggests that intensive chemotherapy with hyper-CVAD/MTX-Ara-C combined with HAART may be well tolerated and effective in AIDS-related BL.