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We compared the short-term outcomes of 50 total hip arthroplasties performed through a mini-incision posterior approach with those of 42 arthroplasties performed through a conventional posterior approach. There were no significant differences in age, gender, and bodymass index between groups. The mean operative time was shorter (99±26 versus 123±30 min), and the per-operative mean blood loss was smaller with the mini-incision (339±210 versus 422±177 ml). There was no significant difference between groups in post-operative mean blood loss, mean inclination angle of acetabular components, percentage of hips with good inclination angle, and mean hip score at 6 months after surgery. There was one infection in the conventional group but none in the mini group. There were no dislocations or symptomatic pulmonary embolism in either group. With the mini-incision posterior approach, surgical invasion was reduced, and short-term outcome was as good as with a conventional posterior approach. [ABSTRACT FROM AUTHOR]

Background: Depression is frequently associated with unsuccessful smoking cessation., Objective: In this study, we investigated the impact of depression history on smoking cessation success in a clinical setting., Methods: This retrospective study included 726 patients who visited our smoking cessation clinic between January 1, 2001, and December 31, 2018. Kaplan-Meier analyses and Cox proportional hazards regression models were used to perform univariate and multivariate analyses of smoking cessation success factors., Results: Among the 726 patients, 76 had a history of depression and demonstrated significantly lower 12-week quit rate compared to those without (33.6% vs. 69.6%, p < .001). Multivariate Cox analysis revealed a significant association between abstinence rate and history of depression (hazard ratio 2.251, 95% CI 1.505-3.315, p < .001), history of schizophrenia (hazard ratio 2.716, 95% CI 1.427-4.840, p = .003), and Fagerström Nicotine Dependence Test scores (hazard ratio 1.519, 95% CI 1.053-2.197, p = .025)., Conclusions: Our findings suggested that a history of depression is a significant prognostic factor for smoking cessation, underscoring the need for targeted interventions for patients with a history of depression. The findings of this study are subject to potential selection bias due to recruitment from a single hospital, which may limit the generalizability of our results. This study highlights the necessity for novel, specialized smoking cessation therapies to support patients with a history of depression in their cessation journey.

Immune thrombocytopenia (ITP) and chronic myeloid leukemia (CML) are rarely observed concurrently. Here we report the case of a patient with ITP who developed CML that has been well controlled with tyrosine kinase inhibitor (TKI) therapy. A 55-year-old man was diagnosed with ITP. No cytogenetic abnormalities were found at the time of initial diagnosis. Four years later, he began corticosteroid therapy for progression of thrombocytopenia. At that time, the Philadelphia (Ph) chromosome was observed in 7 of 20 bone marrow (BM) cells, suggesting concurrent CML in the subclinical stage. Prednisolone resulted in a partial response. Seven months after starting prednisolone, he exhibited hematological features of CML with an increase in Ph-positive cells. TKI therapy with imatinib mesylate was started to treat CML and maintained at a daily dose of 400 mg. The patient achieved and sustained a major molecular response. His platelet count also increased, enabling discontinuation of corticosteroid therapy. TKIs have been reported to show various immunological off-target effects. In this case, off-target effects of TKI might have improved ITP by suppressing the autoimmune response. Alternatively, reconstitution of immune systems by Ph-negative cells or cancellation of immunoreaction against CML could have exerted favorable effects on ITP., (© 2022. The Author(s).)

Cardiac bradyarrhythmia and conduction disorder may be rare, but recurrent adverse events caused by bortezomib. Here we report a case with POEMS syndrome presenting severe heart block after bortezomib plus dexamethasone therapy. After permanent pacemaker implantation, bortezomib was restarted and maintained, resulting in sustained complete response for POEMS syndrome., Competing Interests: The authors declare no conflicts of interest associated with this manuscript., (© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

We assessed the efficacy and safety of weekly cyclophosphamide-bortezomib-dexamethasone (CBD) induction prior to autologous stem cell transplantation (ASCT) in newly diagnosed Japanese patients with multiple myeloma (MM). This regimen consisted of four 28-day cycles of once-weekly oral cyclophosphamide (300 mg/m2), subcutaneous bortezomib (1.3 mg/m2), and oral dexamethasone (40 mg). Responding patients underwent stem cell collection followed by ASCT. The primary endpoint was the postinduction rate of achieving a near complete response (nCR) or better. Among the 38 enrolled patients, a complete response (CR), an nCR, a very good partial response (VGPR), and a partial response (PR) were achieved in 10.5, 2.6, 23.7, and 36.8% of cases, respectively. A grade 4 hematological adverse event (AE) was observed in 1 patient. Grade 3-4 infection, including febrile neutropenia, was observed in 4 patients (10.5%). Although 2 patients dropped out due to AE, 94.7% of the patients completed the induction phase. However, because of a poor response to induction chemotherapy (

Objective: To determine the causative factor behind the formation of membranous substances in the mouths of elderly patients requiring nursing care., Background: Membranous substances are sometimes observed in the mouths of elderly persons requiring nursing care, and these can lead to bleeding, infection and asphyxiation., Materials and Methods: In April 2007, samples were collected from 70 patients at C Hospital, Aichi Prefecture, Japan, who were 65 years or older (median age, 81.1 ± 7.7 years). Sixteen of the subjects were confirmed to have a membranous substance containing a keratin degeneration product that had been derived from stratified squamous epithelium. The samples were examined microscopically, and the presence of epithelial components was confirmed through immunohistochemical staining with anti-cytokeratin-1 antibodies., Results: Decision tree analysis and logistic regression suggest that the leading contributors to the formation of the membranous substances were the method of ingesting nutrients, dryness of the tongue dorsum and open mouth. These three factors are related to elderly persons requiring nursing care with impaired oral cavity function, and it was suggested that dryness of the oral mucosa was the major factor behind the membrane formation., (© 2012 The Gerodontology Society and John Wiley & Sons A/S.)

Objectives: Rubber dams increase the quality and safety of dental treatment. However, the condition of a rubber dam over an open mouth may also obstruct the route for respiration. We tested whether an open mouth with or without a rubber dam would affect upper airway patency and breathing pattern., Materials and Methods: Twenty young healthy volunteers were imaged with a magnetic resonance (MR) system under three conditions: mouth closed, mouth open, and rubber dam with mouth open. Respiration was concurrently monitored with plethysmography. MRI slices of the upper airway were obtained at 5-mm thicknesses, and the size of the cross-sectional area of the upper airway was measured by image analysis software. Respiratory cycle duration and tidal volume were also measured with digital signal analysis software., Results: The volume of the upper airway became significantly decreased with the mouth open. Analysis of each cross-sectional area of the upper airway revealed that while the oropharyngeal area was significantly narrower with an open mouth, the retropalatal and hypopharyngeal areas were not affected. Placing a rubber dam had no additional influence on upper airway patency but was seen to significantly shorten mean respiratory duration and decrease tidal volume., Conclusions: Open mouth position plays the largest role in decreased upper airway patency, and open mouth position with a rubber dam may further disrupt breathing pattern., Clinical Relevance: Breathing pattern may become deteriorated by airway obstruction during dental treatments requiring a rubber dam.

When eating food containing both liquid and solid phases (two-phase food), the liquid component frequently enters the hypopharynx before swallowing, which may increase the risk of aspiration. We therefore tested whether preswallow bolus transport and swallow initiation would change as the viscosity of two-phase food was increased. Fiberoptic endoscopy was recorded while 18 adult subjects ate 5 g of steamed rice with 3 ml of blue-dye water. Liquid viscosity was set at four levels by adding a thickening agent (0, 1, 2, and 4 wt%, respectively). We measured the timing of the leading edge of the food reaching the base of the epiglottis, as well as the location of the leading edge at swallow initiation. As viscosity increased, the leading edge of the food reached the epiglottis significantly later during chewing and was higher in the pharynx at swallow onset. The time after the leading edge reached the epiglottis did not vary among the viscosities of the two-phase food. This study found that the initial viscosity of two-phase food significantly altered oropharyngeal bolus flow and the timing of swallow initiation. Accordingly, increased two-phase food viscosity may delay food entry into the pharynx and be of use in dysphagic diets.

19-nor-14-epi-23-yne-1,25(OH)(2) D(3) (inecalcitol) is a unique vitamin D(3) analog. We evaluated the activity of inecalcitol in a human prostate cancer model system. The analog was 11-fold more potent than 1,25(OH)(2) D(3) in causing 50% clonal growth inhibition of androgen-sensitive human prostate cancer LNCaP cells. Inecalcitol, more than 1,25(OH)(2) D(3) , reduced in a dose-dependent manner the expression levels of the transcription factor ETS variant 1 and the serine/threonine protein kinase Pim-1, both of which are upregulated in prostate cancer. Remarkably, dose challenge experiments revealed that inecalcitol maximal tolerated dose (MTD) by intraperitoneal (i.p.) administration was 30 μg/mouse (1,300 μg/kg) three times per week, while we previously found that the MTD of 1,25(OH)(2) D(3) is 0.0625 μg/mouse; therefore, inecalcitol is 480 times less hypercalcemic than 1,25(OH)(2) D(3) . Pharmacokinetic studies showed that plasma half-life of inecalcitol were 18.3 min in mice. A xenograft model of LNCaP cells was developed in immunodeficient mice treated with inecalcitol. The tumors of the diluent-treated control mice increased in size but those in the inecalcitol treatment group did not grow. Our data suggest that inecalcitol inhibits androgen-responsive prostate cancer growth in vivo and should be examined either alone or with other chemotherapy in clinical trials in individuals with rising serum prostate-specific antigen after receiving either surgery or irradiation therapy with curative intent., (Copyright © 2011 UICC.)

A 37-year-old female who presented with pancytopenia in April 2008 was diagnosed with aplastic anemia stage 2 with a normal karyotype. She had a PNH phenotype in her red blood cells (RBC) and granulocytes, and HLA DR15. Her aplastic anemia was deteriorated from stage 2 to stage 3, and she required periodic RBC transfusions. Four months after cyclosporine therapy, the pancytopenia improved and she did not need RBC transfusion. However, three months thereafter, she again required RBC transfusions after developing severe ulcerative colitis. Although mesalazine and steroid pulse therapy improved her ulcerative colitis, her transfusion dependency persisted. Eleven months after the diagnosis of aplastic anemia, equine anti-thymocyte globulin (ATG) and cyclosporine were administered, but no hematological improvement was obtained. Six months after the administration of ATG and cyclosporine, transformation to refractory cytopenia with multilineage dysplasia (RCMD) with 7-monosomy was observed. An allogeneic bone marrow transplant (BMT) from a HLA-identical sibling was performed 23 months after the diagnosis of aplastic anemia. Complete remission of both the aplastic anemia and ulcerative colitis was obtained without medication. Although the relationship between aplastic anemia and ulcerative colitis remains unclear, immunological abnormalities might be involved in the pathogenesis of both disorders because she had PNH phenotype in RBC and HLA DR15 and because allogeneic BMT improved both disorders.

A 71-year-old Japanese male patient infected with HCV was diagnosed with thrombocytopenia. Histological examination of the bone marrow aspirate showed numerous lymphoid aggregates with Russell bodies. Immunohistochemistry and flow cytometric analysis demonstrated clonal expansion of CD5+ CD23+ B cells. Russell bodies were positive for IgM and lambda immunoglobulin light chain. The patient also underwent gastric biopsy, which revealed Helicobacter pylori (HP) infection. Subsequent eradication of the bacteria resulted in improvement of his thrombocytopenia. The clinical course remained uneventful at 15-month follow-up, consistent with monoclonal B-cell lymphocytosis. The observed clonal expansion with plasmacytic differentiation may have occurred under the influence of HCV with HP infection.

We report a patient with hairy cell leukemia Japanese variant (HCL-Jv) that developed after radiotherapy for orbital adnexal MALT lymphoma. A 78-year-old man was diagnosed as having MALT lymphoma in the left conjunctiva in December 2003. The patient was treated by local radiotherapy and the tumor disappeared. Thereafter, he gradually developed leukocytosis and mild splenomegaly. In May 2009, the leukocyte count was 34,300 with 80% lymphoid cells. A diagnosis of HCL-Jv was made since the lymphoid cells showed a hairy morphology with round nuclei and indistinct nucleoli. These cells expressed CD11c, CD19, CD20, CD103 and showed weak reaction for tartrate-resistant acid phosphatase (TRAP). Bone marrow was infiltrated by atypical cells with an intrasinusoidal pattern. No treatment was needed as the patient was asymptomatic without anemia, thrombocytopenia or lymphadenopathy. Results of the immunoglobulin light chain expression and the heavy chain rearrangement in the tumor cells indicated that the two mature B-lymphoid neoplasms, MALT lymphoma and HCL-Jv, in this patient were derived from independent clones. This appears to be the first reported case of HCL-Jv associated with other lymphoid tumor. Further analysis is needed to clarify the risk of secondary malignancy in HCL-Jv.

Glioblastoma Multiforme (GBM) is almost inevitably a fatal tumor of the brain with most individuals dying within 1 year of diagnosis. It is the most frequent brain tumor in adults. Dose-response studies showed that Cucurbitacin B inhibited 50% growth (ED(50)) of 5 human GBM cell lines in liquid culture at approximately 10(-7) M. Soft-gel assays demonstrated that nearly all of the GBM clonogenic cells were inhibited at 10(-8) M of Cucurbitacin B. FACS analysis found that the compound (10(-7) M, 24 hr) caused G2/M arrest. The GBM cells underwent profound morphologic changes within 15-30 min after exposure to Cucurbitacin B (10(-7) M), rounding up and losing their pseudopodia associated with disruption of actin and microtubules, as observed by immunoflourescence. Cucurbitacin B (10(-7) M) caused prominent multinucleation of the cells after they were pulse-exposed (48 hr) to the drug, washed and cultured in normal medium for an additional 2 days. The drug (10(-7) M, 3-24 hr) increased levels of p-p38, p-JNK and p-JUN in U87 and T98G GBM cell lines as seen by Western blot. Interestingly, alterations in cell morphology caused by Cucurbitacin B (10(-7) M) were blocked by the JNK inhibitor SP600125. In summary, Cucurbitacin B has a prominent anti-proliferative activity on GBM cells; and at least in part, the mode of action is by affecting the cytoskeleton, as well as, the JNK pathway. Clinical trails of this drug should be pursued in GBM., (Copyright 2008 Wiley-Liss, Inc.)

Studies have conjectured that nonsteroidal anti-inflammatory drugs (NSAID) inhibit growth of various malignancies by inhibiting cyclooxygenase-2 (COX-2) enzyme activity. Yet, several lines of evidence indicate that a COX-2-independent mechanism may also be involved in their antitumor effects. Here, we report that NSAIDs may inhibit the growth of glioblastoma multiforme (GBM) cells through COX-2-independent mechanisms, including up-regulation of both 15-hydroxyprostaglandin dehydrogenase (15-PGDH, the key prostaglandin catabolic enzyme) and the cell cycle inhibitor p21. Using Western blot and real-time PCR analysis in various GBM cell lines, we observed up-regulation of 15-PGDH and p21 after NSAIDs treatment. To elucidate the role of 15-PGDH in GBM, transfection assays were conducted using the T98G GBM cell line. Overexpression of 15-PGDH suppressed cell growth and was associated with increased expression of p21. In an attempt to investigate the roles of COX-2, 15-PGDH, and p21 in the inhibition of growth of GBM, small interfering RNA (siRNA) against each of these proteins was transfected into T98G cells. Inhibition of growth mediated by NSAIDs was partially reversed after knockdown of either 15-PGDH or p21, but not after COX-2 knockdown. Moreover, expression level of p21 was not affected in COX-2 siRNA transfected cells. Our studies provide evidence that the up-regulation of 15-PGDH induced by NSAIDs has the potential to inhibit growth of GBM, in part, by up-regulation of p21 possibly independent from COX-2 enzymatic function.

Cucurbitacins are a group of diverse triterpenoid substances isolated from plants with medicinal properties. One particularly potent family member is cucurbitacin B (CuB). The antiproliferative effects of CuB against human breast cancer cells were tested. Six human breast cancer cell lines were examined because they represent a diverse mix of breast cancer subtypes varying in expression of estrogen receptor (ER), Her2/neu, and p53 mutation. The antiproliferative effect of CuB were also studied in vivo. The effective dose inhibiting 50% growth (ED(50)) was between 10(-8) M and 10(-7) M for this collection of breast cancer cell lines. These cells underwent rapid morphologic changes after 15-20 min exposure to CuB (5 x 10(-7) M), which was associated with disruption of the microtubules and F-actin, as observed by confocal microscopy. Human MDA-MB-231 (ER-, p53 mutated) breast cancer cells were orthotopically implanted into the breasts of nude mice who intraperitoneally received either CuB 1.0 mg/kg or vehicle. Tumor volume was reduced by 55% in the group that received CuB for 6 weeks compared with vehicle controls. No apparent organ tissue damage was observed by pathological assessment. Interestingly, the experimental mice had lower serum glucose levels, consistent with use of CuB as an antidiabetic drug in China. This drug appears to be a third in a family of drugs targeting the microtubules (taxanes [e.g. taxol], vinca alkaloid [e.g. vincristine], and now CuB). Our in vitro and in vivo results suggest that CuB may be an effective, new approach for the treatment of ER-, Her2/neu amplified, and p53 mutant breast cancers.

Chondroblastoma located in the femoral head is one of the locations accounting for frequent recurrence. One of the reasons for this is the difficulty in obtaining appropriate surgical access to it for adequate removal of tumors. The authors present and illustrate a trapdoor procedure for the surgical treatment of chodroblastoma in the epiphysis of the femoral head. The surgical approach was made over the great trochanter and a trochanteric osteotomy was performed. The capsulotomy was made anteriorly and posteriorly, and the hip was dislocated anteriorly. Using a scalpel and an osteotome, the edges of a trapdoor segment were sharply dissected and the rectangular segment was lifted back to reveal an underlying subchondral tumor. The tumor tissue was thoroughly curetted and autologous cancellous bone was grafted. The trapdoor was replaced without any additional fixation, and the femoral head was reduced. The patient recovered good hip function without pain, and showed no recurrence of chondroblastoma at 5 years after surgery. The trapdoor procedure enabled sufficient access to complete curettage and autologous cancellous bone grafting for the chondroblastoma of the femoral head. This procedure proved to be a useful surgical approach for the treatment of chodroblastoma in the epiphysis of the femoral head in this case.

Rheumatoid arthritis (RA) patients requiring total joint arthroplasties under administration of infliximab, which may remain in donated blood if preoperative autologous blood donation (PABD) is undertaken for the surgery, may risk infection. We clarified infliximab hemokinetics in blood stored for such patients. A 20-ml blood sample was obtained from each of the ten RA patients receiving infliximab at just after administration and at 2 and 4 weeks following the administration of infliximab, mixed with 2.8 ml citrate-phosphate-dextrose-adenine (CPDA-1) and stored at 4-6 degrees C. Plasma levels of infliximab in the stored blood were measured just after-mixture with CPDA-1, and at 2 and 4 weeks following the start of storage. Serum levels were also measured just before infliximab administration and at each phlebotomy. The plasma infliximab levels in the stored blood remained close to their original serum levels at the time of each corresponding phlebotomy, only somewhat influenced by dilution of CPDA-1, and sustained for 4 weeks following the start of storage, unlike in vivo, where levels decreased. This suggests that in order to prevent side effects, the later after infusion of infliximab the phlebotomy occurs, the better, and that the amount of stored blood transfusion should be consistent with that of blood loss.

Tumor suppressor genes are often silenced in human cancer; this can occur by transcriptional repression by deacetylation in the promoter regions, mediated by histone deacetylase (HDAC). HDAC inhibitors can block cancer cell growth by restoring expression of tumor suppressor genes. In this study, we investigated the effects of a HDAC inhibitor, suberoylanilide hydroxamic acid (SAHA) on pancreatic cancer cells. SAHA inhibited the growth of 6 pancreatic cancer cell lines in a dose-dependent manner as measured by MTT and clonogenic assays (ED(50) approximately 10(-6) M) associated with induction of apoptosis, G2 cell cycle arrest and also induced differentiation as indicated by morphology and increased expression of cytokeratin 7. It increased expression of p21(WAF1) (independent of the mutational status of p53), C/EBPalpha, RARalpha and E-cadherin; these genes have been associated with decreased proliferation in other cancers. SAHA decreased cyclin B1 expression; this cyclin normally promotes progression through G2 of the cell cycle. SAHA mediated acetylation of histone H3 globally, as well as, associated with the p21(WAF1) promoter, as measured by chromatin immunoprecipitation. SAHA also decreased levels of c-myc and cyclin D1, independent of an active beta-catenin pathway. In further studies, the combination of SAHA and an inhibitor of DNA methylation, 5-Aza-2'-deoxycytidine, had an enhanced antiproliferative effect on pancreatic cancer cells. In summary, SAHA inhibited the growth of human pancreatic cancer cells by inducing apoptosis, differentiation and cell cycle arrest, as well as increase in the expression of several tumor suppressor genes. SAHA is a novel, promising therapeutic agent for human pancreatic cancers., (Copyright (c) 2007 Wiley-Liss, Inc.)

Honokiol (HNK), a naturally occurring biphenyl, possesses potent antineoplastic and antiangiogenic properties. We investigated the in vitro and in vivo activity of HNK against breast cancer. HNK exhibited potent anti-proliferative activity against breast cancer cell lines and enhanced the activity of other drugs used for the treatment of breast cancer. In vivo, HNK was highly effective against breast cancer in nude mice. We identified two different effects of HNK on breast cancer cells: cell cycle inhibition, observed at lower doses of HNK, and induction of apoptosis, observed at higher doses of the compound. Our data suggest that HNK is a systemically available, non-toxic inhibitor of breast cancer growth and should be examined for clinical applications.

We performed a prospective randomized controlled study to determine whether drainage increased the degree of anemia after primary cementless total hip arthroplasty. After implanting the components, we randomly divided 40 patients (40 hips) into a group who had drains (20 patients, 20 hips) and a group without drains (20 patients, 20 hips). There were no differences in the mean preoperative hemoglobin or hematocrit values, length of skin incision, operative time, intraoperative blood loss, or the donated and transfused volumes of autologous blood between the two groups. There were also no differences in decreased hemoglobin or hematocrit values 3 days postoperatively compared with preoperative values (hemoglobin, 0.7 g/dL versus 0.7 g/dL; hematocrit, 2.2% versus 2.4%). Drainage did not increase the degree of postoperative anemia after cementless total hip arthroplasty.

Background: To reduce variations of cup inclination after total hip arthroplasty using the mini-incision posterior approach, we introduced two techniques, one at a time. The first technique is measuring a pelvic tilt angle in the frontal plane in the initial lateral position in the operating room. The second technique is using a tilt-meter to adjust the direction of a cup holder. The purpose of this study was to evaluate the usefulness of these techniques., Methods: For 106 hips operated on, the cementless acetabular component was impacted using a cup holder targeting 45 degrees in inclination and 20 degrees in anteversion. These hips were divided into three consecutive groups. For the first group (30 hips), no radiograph in the lateral position was obtained, and the alignment frame of the cup holder was aligned parallel to the floor by eye measurement. For the second group (56 hips), we measured the pelvic tilt angle, and tilted the alignment frame by eye measurement. For the third group (20 hips), we measured the pelvic tilt angle and tilted the alignment frame using the tilt meter. Inclination and anteversion angles were measured on postoperative radiographs. The absolute value of the difference between the measured angle and the target angle was defined as the inclination error or anteversion error, respectively., Results: The inclination error was more than 5 degrees for 33% in the first group, 20% in the second group, and 0% in the third group (P = 0.015, chi-squared test). There was a significant difference between the first group and the third group (P = 0.0039). For the anteversion error, there were no significant differences among the three groups., Conclusions: Adjustment using a tilt-meter after measuring a pelvic tilt angle is a useful method to reduce the rate of large inclination error.

Enteroaggregative Escherichia coli (EAEC) is an emerging enteric pathogen in both developing and industrialized countries. AatA, an outer-membrane protein that is a homolog of E. coli TolC, facilitates the export of the dispersin protein Aap across the outer membrane in EAEC. To identify which amino acids are important for this export activity, site-directed mutagenesis of the carboxy terminus was performed. An insertional mutant of aatA was complemented with each of several deletion mutants, and was examined for Aap secretion. The results showed that three nonpolar amino acids at positions 381-383 (Phe-Leu-Leu) were required for the activity, and these residues were located at the base of carboxy-terminal elongation in the equatorial domain of AatA.

The association between biofilm formation and the accessory gene regulator (agr) types of methicillin-resistant Staphylococcus aureus (MRSA) strains in our hospital were investigated. The biofilm index and the incidence of MRSA strains carrying agr-2 in the infection group (n=91) were significantly higher than were those in the carrier group (n=225), suggesting that biofilm formation and agr type are associated with nosocomial MRSA infections.

A 61-year-old man with primary macroglobulinemia (PMG) had been followed without any treatment as he had no apparent manifestations. After 1 year and 3 months, he was admitted to our hospital with a fever. No signs or symptoms of infection and no progressive increase of serum IgM levels was observed. Non-Hodgkin's lymphoma was not additionally found. Fever without infection, elevated serum LDH level and further enlargement of the spleen compelled us to diagnose his condition as deterioration of the PMG. An immediate fall in his temperature and serum IgM levels was observed after CHOP therapy. Effective therapy must be discussed in the deterioration of this type of disease.

A 62-year-old woman was admitted to our hospital because of gastric mucosal bleeding. Gastroendoscopy revealed a gastric tumor which was diagnosed from the biopsied specimen as diffuse large B-cell lymphoma (DLBCL). Lymphoma cells had infiltrated the bone marrow showed morphological features resembling Burkitt lymphoma (BL). Nearly 100% of the cells in the bone marrow were positive for MIB-1 immunostaining. The chromosomal study was normal. Surface marker analysis disclosed that the cells were positive for CD10, CD19, CD20 and CD25. As lymphoma cells had infiltrated the central nervous system, combined chemotherapy was performed accompanied with intrathecal administration of anticancer drugs. Although transient improvement was observed, the patient died of the advanced disease three months after admission. As we have shown here, there are some cases of DLBCL with immunohistochemical features resembling BL. Further consideration about the appropriate chemotherapy program for this type of disease might be necessary.

Preoperative autologous blood donation (PABD) with no risk of blood-borne infection transmission has been considered the supreme blood transfusion therapy, and it has been reported to decrease incidence of postoperative deep-vein thrombosis. However, the need for PABD has decreased in the USA, because 1) risk of blood-borne infection transmission through allogeneic blood transfusion (ABT) has decreased after introduction of nucleic acid amplification test (NAT), and 2) blood collection-induced anemia has been found in many cases due to inapplicability of erythropoietin (rEPO). ABT risks are decreasing in Japan as in the USA, however, ABT has several issues proper to Japan, such as, outpacing of blood demand over supply in the near future and increase of HIV positive donors. Also, as rEPO can be used in Japan, PABD-induced anemia risks are low. Accordingly, necessity of PABD should increase in Japan. However, as those who usually perform PABD in Japan are surgeons, big issues arise such as bacterial contamination during blood collection and ABO incompatibility during transfusion. Underutilization of PABD in gastrointestinal cancer surgery should also be addressed. Appropriate technique and methodology must be established to increase the safety of PABD and to spread PABD in cancer surgery.

The gold standard for identification of Enteroaggregative Escherichia coli (EAEC) remains the HEp-2 cell adherence test, which is time-consuming and requires specialized facilities. We evaluated the usefulness of a quantitative biofilm assay to screen for EAEC from a total of 1,042 E. coli strains from children with diarrhea. Bacteria were incubated overnight in high-glucose Dulbecco's modified Eagle's medium using a polystyrene microtiter plate. The plate was stained with crystal violet after washing, and the biofilm was quantified using an enzyme-linked immunosorbent assay plate reader. The aggR gene was evaluated by a polymerase chain reaction. Forty-eight (77.4%) of 62 strains with an optical density at 570 nm (OD(570)) > 0.2 were identified as EAEC by the HEp-2 adherence test, while no EAEC was found in strains with an OD(570) < or = 0.2. Twenty-one aggR+ and 27 aggR - EAEC strains could be screened by an OD(570) > 0.2 using this assay. Although confirmation by a HEp-2 cell adherence test is needed, this biofilm assay is convenient and useful in screening for EAEC.

We compared the short-term outcomes of 50 total hip arthroplasties performed through a mini-incision posterior approach with those of 42 arthroplasties performed through a conventional posterior approach. There were no significant differences in age, gender, and bodymass index between groups. The mean operative time was shorter (99+/-26 versus 123+/-30 min), and the peroperative mean blood loss was smaller with the mini-incision (339+/-210 versus 422+/-177 ml). There was no significant difference between groups in post-operative mean blood loss, mean inclination angle of acetabular components, percentage of hips with good inclination angle, and mean hip score at 6 months after surgery. There was one infection in the conventional group but none in the mini group. There were no dislocations or symptomatic pulmonary embolism in either group. With the mini-incision posterior approach, surgical invasion was reduced, and short-term outcome was as good as with a conventional posterior approach.