Pleural effusions after the Fontan procedure contribute to morbidity, prolonged hospital stay, increased risk of infection, and may necessitate a pleurodesis procedure. Although the exact pathophysiological pathways are not fully understood, diuretics are generally used for the treatment of pleural effusions. On the other hand, postoperative elevation in antidiuretic hormone and decrease in atrial natriuretic peptide have been proven, indicating an effect of resistance to diuretic therapy. This paper reports on the efficacy of a high-dose diuretics regimen to prevent pleural effusions in the early postoperative period after the Fontan procedure. From June 1997 to November 2012, 36 cases underwent the Fontan procedure. From August 2008, a new regimen using high-dose diuretics has been adopted and applied to 15 patients. Four out of 15 patients were excluded from this study due to early death or serious complications, so 11 patients were defined as the high-dose group. Before August 2008, 3 out of 21 patients were excluded for a similar reason, with 18 patients being defined as the control group. The high-dose group received a high-dose diuretic regimen that consisted of 20 mg of furosemide and 20 mg of spironolactone, three times a day after every meal. Perioperative data and postoperative course were compared between the two groups retrospectively. Patient characteristics were not significantly different between the two groups. However, preoperative body weight was lower in the high-dose group(10.3±1.12 vs. 11.8±2.34kg, p<0.05). The average amount of urine from postoperative day 1 to day 3 was significantly higher in the high-dose group(49.2±10.7 vs. 40.0±14.6ml /kg/day, p<0.05). The amount of chest drainage was significantly lower in the high-dose group(486±182 vs. 870±635ml , p<0.05). No patients received drip infusions of albumin preparation in the high-dose group, while 6 out of 18 patients received it in the control group. Further pleural drainage after the removal of chest tubes was performed on eight patients in the control group, but it was performed only twice on one patient in the high-dose group(p<0.05). No patient showed serious complications, such as renal failure, thrombus formation, arrhythmias, reintubation, the need for increasing inotropic support, or the need for pleural sclerosis. The high-dose diuretics regimen using furosemide and spironolactone after the Fontan procedure increased urine in the early postoperative period, reduced overall pleural effusions, and minimized the need for additional treatment.
Objective: The present study examined whether Objective Structured Clinical Examination (OSCE) scores are related to Computer-Based Test (CBT) and graduation examination scores, and considered the OSCE’s application to undergraduate medical education. Study design: The subjects were 282 students who underwent a common achievement examination and a graduation examination at Juntendo University. The subjects were divided into four (A to D) groups according to their ranking on academic-year-specific CBT and graduation examination scores. Correct answer rates and global rating scores were compared among the four ranks. Results: The correct answer rate on the OSCE was 89.06±3.86, and the global rating score was 4.67±0.36. The correct answer rate on the Advanced OSCE was 80.13±9.85, and the global rating score was 4.50±0.74. The top-ranked group also scored highest on the OSCE and Advanced OSCE. The correct answer rates and global rating scores of both OSCE and Advanced OSCE decreased as rank decreased from Rank A to Rank D. Conclusions: The correct answer rates for the OSCE and Advanced OSCE in students who received low CBT and graduation examination scores were lower than those of the high-score group. It is necessary to encourage students to develop and improve their skills based on knowledge that will facilitate smooth postgraduate clinical training.
Objective: Sall1 is a zinc finger containing transcription factor that is highly expressed during mammalian embryogenesis and known as the initial key step for matenephros development. Sall1-deficient animals die at birth due to kidney deficits. However, its function in mature podocytes and/or injured podocytes has not been characterized. The present study indicated the role of Sall1 in mature podocytes as well as in injured podocytes. Materials and Methods: To clarify the role of Sall1 in mature podocytes, we generated podocyte-specific Sall1 KO (pSall1 KO) mice. To clarify the role of Sall1 in injured podocytes, we used Lipopolysaccharide (LPS) -injected mice as a minimal-change disease (MCD) model and ADR-injected mice as a nephrosis and glomerulosclerosis model. Results: We observed that the pSall1 KO mice showed no obvious phenotype under physiological conditions. There was no significant difference in the level of urinary protein among WT mice and pSall1 KO mice groups 48 hours after the injection of LPS. The level of urinary protein was significantly increased in pSall1 KO mice on day 28 after ADR injection. Sall1 affected the localization of the slit diaphragm protein nephrin in ADR-injected pSall1 KO mice. Conclusions: Sall1 may have a crucial renoprotective role in the mechanism of recovery from severe podocyte injury.
Metastasis is a life-threatening disease that accounts for as much as 90% of cancer-related mortality. Carcinoma cells have often spread to distant organs at the time patients present with cancer. Routine clinical examinations have produced significant progress in detecting metastasis but existing methods for screening cancer patients are incapable of detecting micrometastasis and disseminated tumour cells (DTCs) in distant organs. Adjuvant chemotherapy and adjuvant radiotherapy are anticipated to prevent relapse and death. However, over periods of time ranging from years to decades, these metastatic cells residing in distant organs often relapse, corrupt the local microenvironment and acquire the ability to develop into macrometastases. Metastatic nodules are known to be formed by carcinoma cells harboring increased numbers of epi/genetic alterations conferring aggressive and drug-resistant propensities. In addition, more recently emerging evidence supports the notion that the tumour-associated stroma, consisting of endothelial cells, leukocytes, macrophages, myofibroblasts, bone marrow-derived progenitors and abundant extracellular matrix (ECM), significantly facilitates tumour metastasis. The molecular signalling underlying the complexity of heterogeneous stromal-tumour interactions that is relevant to tumour metastasis is the subject of intensive research. The tumour-associated stroma, in addition to tumour cell-autonomous alterations plays significant roles to instigate and support progression of the multi-step processes of tumour metastasis.
A bacterial genome is characteristic to its circular chromosomal DNA most of which consist of coding sequences, showing clear contrast to eukaryotic cells carrying multiple numbers of linear chromosomes with lower ratio of the coding sequences than bacteria. The genes involved in a common biochemical pathway often form a polycistronic unit called operon, which is not seen in the eukaryotic cells. By knowing such unique characters of a bacterial genome, we can infer physiological features of a bacterium from its genome sequence, and the work is probably much simpler than that for eukaryotic cells. The department of Bacteriology of the Juntendo Univ. determined the whole genome sequence of Staphylococcal aureus, a causative microorganism of nosocomial infections, for the first time in the world in collaboration with other domestic groups. By employing the obtained genome information, we performed comparative analyses with genomes of other S. aureus strains as well as those of related species of staphylococci. We thereby found that (i) a S. aureus genome carries its unique domains designated genomic islands that has been presumably acquired horizontally and are often accompanied with virulence or drug-resistant genes, in addition, (ii) the genomic islands show polymorphism among S. aureus strains, leading to carriage of different sets of the virulence determinants, indicating the toxicity of a S. aureus strain upon infection differs form the others.