Liposomal amphotericin B (L-AMB) is reported in Japan to be less effective and not as safe for treating severe fungal infections in non-neutropenic patients as in neutropenic patients. Therefore, we evaluated the clinical efficacy and safety of L-AMB as an antifungal agent in non-neutropenic patients. The efficacy of L-AMB administered intravenously in patients with severe fungal infections was retrospectively investigated by reviewing medical records from November 2007 to July 2010. The records of 18 eligible adult patients were analyzed according to the L-AMB dose they received: standard (2.5mg/kg/day; n=5) and high (>2.5mg/kg/day; n=13). The average age of the standard- and high-dosage group was 71.4 and 60.3 years, respectively. The 30-day survival rate in the standard- and high-dosage group was 20% (n=1) and 76.9% (n=10), respectively (P=0.047). A significant antipyretic effect was observed in the high-dosage group (P=0.001). There was no relationship between the dosage of L-AMB and any side effect. By carrying out the treatment according to the information provided at the time of administration, no cases were discontinued because of side effects. A high dosage of L-AMB is more effective than the standard dosage and both dosages are well-tolerated in non-neutropenic patients.

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There is an increasing number of patients with severe liver disease that requires whole organ transplantation or living-related split liver transplantation. This has resulted in a shortage of donor organs, which is particularly problematic and still awaits resolution. Bioartificial liver (BAL) support systems have been developed with the aim of supporting patients with life-threatening liver disease until their liver recovers. Here, we describe a high performance three-dimensional rat hepatocyte culture system using a radial-flow bioreactor (RFB) with a polyvinyl alcohol (PVA) membrane as a small-scale BAL support system. Hepatocytes from male Sprague-Dawley rat livers were isolated and divided into two groups as follows. Group A: isolated hepatocytes were maintained in culture medium as controls; and group B: isolated hepatocytes were injected into the medium chamber of the RFB-PVA culture system. Sampling was carried out every 48 h to analyze the concentrations of ammonia and albumin in the medium. Light and electron microscopic examination of hepatocytes explanted from the PVA membrane was also performed. Albumin production and urea synthesis by cells in group B were both significantly higher than in group A. Hematoxylin-Eosin staining of the cells in group B showed that three-dimensional cell masses were attached to the PVA membrane. It also showed that the cells were stably proliferating in the porous spaces of the PVA. Scanning electron microscopic images of group B also showed clusters of hepatocytes attached to the PVA membrane. Hepatocyte clusters growing in the RFB-PVA culture system retained their biological function and were stable in the porous spaces of the PVA membrane. This cell culture system may be useful for the development of new BAL support systems.

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IgA nephropathy (IgAN) is characterized by mesangial deposition of IgA, C3, and often IgM. We examined the relationship among IgM deposition, clinical features, and renal outcome in IgAN patients who underwent combined treatment of tonsillectomy with steroid pulse therapy (Tx-SP). We retrospectively reviewed 73 IgAN patients treated with Tx-SP from March 2006 to March 2014. The patients were divided into those with moderate (2+) to severe (3+) mesangial IgM deposition (Prominent IgM-positive patients, P-Group) and those with negative (−) to faint (1+) deposition (the “Other” patients, O-Group). Using propensity scores to minimize confounding factors, 11 propensity score-matched patients with O-Group (mO-Group) were compared to 11 P-Group patients. The study outcome was defined as urinary protein grade by urine test strip before Tx-SP and one year after Tx-SP. P-Group patients exhibited an increased severity of proteinuria compared to O-Group (p=0.018) and mO-Group patients (p=0.009) before Tx-SP. After Tx-SP, proteinuria was significantly ameliorated in the P-Group, reaching the same severity recorded in the O-Group (p=0.007) and mO-Group (p=0.021). No significant differences were noted between P-Group and mO-Group in microhematuria, serum creatinine level, and histological severity. Prominent IgM deposition is associated with severe proteinuria in IgAN. However, Tx-SP induces a sufficient reduction in the severity of proteinuria in IgM-positive IgAN.

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In April 2012, the Center of Special Needs Dentistry (SND) was established at Showa University Dental Hospital to provide function training for children with eating and swallowing disorders. A statistical clinical assessment was performed on new patients ≤18 years of age who visited the Center over a 1-year period (April 2012–March 2013) to assess the conditions present at the initial visit. In all, 60 patients (29 boys, 31 girls, mean (± SD) age 4.2±4.1 years, range 0-18 years of age) were included in the study. Most patients were <1 year of age (32%) and most came from one of four cities in the Johnan area (Shinagawa City, Meguro City, Ota City and Setagaya City). The most common primary diseases at the initial visit were cerebral palsy and cleft lip and palate. The third largest patient group was of healthy children with oral function problem. Over 60% of patients attended the Center of SND because of an eating-related complaint. More than 50% of patients were obtaining nutrients via oral intake; the remaining patients were obtaining nutrients via non-oral or a combination of oral and non-oral intake. Because of the young age of the patients and the fact that most were from neighboring areas, it can be inferred that effective community health care is being provided. It is necessary for the Center of SND to continue to provide professional treatment for dysphagia and to contribute to community medicine.

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The use of ultrasonically activated devices (USADs) in hepatic resections may be associated with an increased rate of complications, such as postoperative bile leaks. Nonetheless, the safety of USADs for sealing bile ducts during liver surgery has not yet been established. The purpose of this study was to assess the efficacy of a USAD for sealing bile ducts. In animal experiments, the common bile duct of ten anesthetized dogs was individually occluded using a USAD. Additionally, using the prospective liver surgery database from a single institution, we identified 45 consecutive patients who underwent hepatic resection using a USAD (USAD group) and 45 similar patients who underwent hepatic resection without the use of a USAD (NUSAD group). In the occluded and harvested canine bile ducts, the mean burst pressure was 280mmHg, and the lumen of the bile duct was completely sealed morphologically. In the clinical study, there was no significant difference in postoperative mortality or complications between the two groups, and biliary leakage was observed in only one patient (0.7%) in the USAD group. These data demonstrate that the USAD is a safe, efficient, and practical instrument for use during liver surgery to achieve complete hemobiliary stasis.

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A pterygium is a benign growth that develops on the conjunctiva and, in some cases, extends to the cornea and interferes with vision. Excessive exposure to ultraviolet (UV) light is one of the causes of pterygium development. We previously reported that UV-induced apoptosis is led by production of reactive oxygen species (ROS) that activate p38 mitogen-activated protein kinase (MAPK) in human conjunctival epithelial (HCE) cells. Also, ROS-dependent induction of interleukin-11 (IL-11) has been reported to upregulate MAPK pathways, which results in compensatory proliferation. In this study, we examined the effect of UV exposure on HCE cells, in terms of change in apoptosis, ROS generation, phosphorylation of c-Jun N-terminal kinase (JNK), levels of IL-11 (a key cytokine in tissue repair and compensatory proliferation), production of activator protein 1 (AP-1), and expression of c-myc, c-fos and c-jun (which provides evidence of healthy cell proliferation). Apoptosis in HCE cells was induced by UV light irradiation (312nm, 4.94mW/cm²). Apoptosis was measured using the Muse Annexin V and Dead Cell Assay Kit. ROS generation was measured by using 5-(and 6-) chloromethyl-2'7'-dichlorodihydrofluorescein diacetate, acetyl ester. JNK phosphorylation, IL-11 levels and AP-1 production were measured by enzyme-linked immunosorbent assays (ELISAs). Imnunocytochemical staining was used to measure c-myc, c-fos and c-jun expression. UV irradiation increased ROS generation, phosphorylation of JNK, and apoptotic cell count. IL-11 levels and AP-1 production were significantly increased by UV irradiation. The irradiated cells had increased expression of c-myc, c-fos and c-jun, and treatment of the cells with IL-11 significantly increased expression of c-myc, c-fos and c-jun. These results suggest that the release of IL-11 from UV-induced apoptotic HCE cells and surrounding healthy cells could promote proliferation to maintain homeostasis.

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Prevention of cardiovascular diseases is a top-priority issue in Japan. To this end, we have developed a new screening method for metabolic syndrome (MetS) using chest X-ray. We recruited 200 patients who visited our outpatient cardiology clinic from March 2014 to August 2014. Patients with severe lung disease, acute coronary syndrome, and end-stage renal failure were excluded. We collected data on each patient's medical history, laboratory results, waist circumference (WC), body weight, and height. Additionally, we measured two parameters from the chest X-ray: (A) width at the level of right dome of diaphragm and (B) width between the costophrenic (CP) angles. We classified the CP angles as either inward (A≥B) or outward (A<B). Increased WC was defined as ≥85cm in males and ≥90cm in females. Patients with outward CP angles had a significantly larger WC compared to those with inward CP angles (92.3±8.9 vs. 80.5±7.8cm, P<0.001). In particular, the percentage of male patients with increased WC (≥ 85cm) was significantly higher in patients with outward CP angles than in those with inward CP angles (89.2% vs. 41.3%, P<0.001). Body weight and BMI were both significantly higher in patients with outward CP angles than in those with inward CP angles in both gender groups. When laboratory data and risk factors were compared, patients with outward CP angles and those with positive WC criteria consistently tended toward high morbidity from hypertension, dyslipidemia, and diabetes. The inward/outward CP identified candidates for MetS, especially in the male subjects. Chest X-ray could become a useful screening tool for the detection of increased WC and coronary risk factors.

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Abdominal visceral pseudoaneurysms are rare, but rapid diagnosis is clinically important because of the associated conditions that are often fatal. Multidetector-row computed tomography (MDCT) is important in the diagnosis and treatment of many human conditions. This study thus sought to investigate the usefulness of MDCT for diagnosing abdominal visceral pseudoaneurysms. We retrospectively assessed the MDCT diagnosis of pseudoaneurysms and identification of the responsible vessels or cases diagnosed with an abdominal visceral pseudoaneurysm via angiography. The study comprised 35 patients who underwent MDCT preoperatively and in whom angiography detected an abdominal visceral pseudoaneurysm over a 7-year period. Using the angiography findings as the gold standard, we investigated whether a pseudoaneurysm and the responsible vessel could be diagnosed using preoperatively imaged MDCT findings. For angiography and MDCT, diagnosis was reached on the basis of two radiologists' agreement. Of 35 patients (28 males and 7 females), the median subject age was 67 years (range: 22–84 years). We found that MDCT could preoperatively detect abnormal findings such as hematomas in all patients. MDCT detected the presence of a pseudoaneurysm in 88.6% (31/35) of patients and identified the responsible vessel in 71% (25/35) of patients. In 6 patients, MDCT findings could successfully reveal both the pseudoaneurysm and the extravasation. MDCT was effective for diagnosing abdominal visceral pseudoaneurysms and it could be useful for determining treatment strategies and aiding treatment techniques in such patients.

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The aim of the present study was undertaken to investigate the effects of several surface modification methods applied to lithium disilicate glass ceramics (LDCs) on their bonding durability with resin-based cement. The LDC specimens were sectioned using a low-speed diamond cutting machine, crystallized by heating in a furnace, and then subjected to several surface modification treatments such as acid etching, sandblasting, or silica coating with silane coupling agents. Then, a cylindrical titanium with a sandblasted surface was bonded to the surface-modified LDC specimens using resin-based cement. After being either stored in water at 37°C for 24h or subjected to 10,000 and/or 30,000 thermal cycles, the specimens were subjected to a shear bond strength test using a universal testing machine. The surface-modified LDC specimens obtained by combining blasting and silica coating modification treatments showed excellent durability, similar to that of acid-etched specimens. For safer laboratory practice, we recommend using the silica coating method for LDCs prior to applying silane coupling agents.

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