Background: Some patients with immunoglobulin A (IgA) vasculitis develop severe disease, with severe abdominal symptoms that necessitate prolonged fasting. Moreover, no biomarkers that can predict severe disease have been clearly established.

Methods: We analyzed the data of 65 children with IgA vasculitis who were admitted to our department between 2010 and 2015. Seven patients with severe abdominal symptoms who required fasting for at least one week were classified into the fasting group, and the remaining 58 patients were classified into the non-fasting group. The clinicopathological factors were compared between the two groups.

Results: Significant differences in peripheral blood neutrophil-to-lymphocyte ratio (NLR), plasma D-dimer levels, and coagulation factor XIII activity at admission were observed between the two groups. Logistic regression analysis revealed that the NLR showed the highest odds ratio for severe abdominal symptoms (odds ratio, OR: 1.67; 95% confidence interval, CI: 1.14-2.45). The results of receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.89 for the NLR, and an optimum cutoff value of 2.8 was associated with a sensitivity of 100% and specificity of 72.5%.

Conclusion: The NLR at diagnosis is a useful marker for predicting the severity of abdominal symptoms in patients with IgA vasculitis.

Background: Acinetobacter species are environmental microorganisms that inhabit the skin and can become opportunistic pathogens in immunocompromised hosts. This study investigated the pathogenicity of proteins released extracellularly by Acinetobacter radioresistens (A. radioresistens), isolated from the small intestine of two patients with severe Kawasaki disease, in a mouse model.

Methods: The sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of culture supernatants derived from Acinetobacter species showed large variations in protein compositions among species and strains. The biological effects of soluble proteins secreted by A. radioresistens were evaluated in mice by intraperitoneal injection of culture supernatants.

Results: The administration of culture supernatant derived from A. radioresistens caused weight loss, electrolyte imbalance, and decreased aldosterone levels. The sustained infiltration of the inflammatory mononuclear cells was observed in the liver of mice 6 weeks after the last administration.

Conclusions: A. radioresistens expressed virulence through its extracellular proteins, leading to acute adrenal gland insufficiency and chronic inflammation of the livers.

Background: The head-down position used in laparoscopic surgery considerably influences cardiac function. However, few studies have examined systolic and diastolic functions, such as the ejection fraction (EF), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and early diastole/atrial kick ratio, in the head-down position.

Methods: This study was registered at the University Hospital Medical Information Network (UMIN; Registration No.: 46067; Date: November 13, 2021). We used transthoracic echocardiography to examine the systolic and diastolic functions of the left and right ventricles after maintaining first horizontally and next head-down positions (30°) for 5 min in 31 adult volunteers.

Results: Mean blood pressure increased by 6.4%, while left ventricular EF decreased from 70% to 63%. Similarly, MAPSE, which is strongly correlated with left ventricular EF, decreased by 11.3%. TAPSE, which correlated with right ventricular EF, increased by 8.7%. No change was observed in the early diastole/atrial kick ratio or E/E´, which reflects left ventricular diastolic function.

Conclusions: In the head-down position, the EF, percentage fractional shortening, and MAPSE, which reflect contractility, decreased, whereas TAPSE increased. No significant differences were found in the measurement items reflecting diastolic capacity.