Kobe Journal of Medical Sciences最新文献

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy. Some studies have reported that FPIES was associated with elevated C-reactive protein (CRP). However, the number of reports on the relationship between FPIES and procalcitonin (PCT) is limited. This case report highlights the fact that PCT levels can be markedly elevated in patients with acute FPIES. An 11-month-old girl previously diagnosed with FPIES underwent an oral food challenge test (OFC). Her serum PCT levels were measured after she developed severe symptoms including fever and shock following administration of 100mL of formula milk. The PCT levels were extremely elevated but improved without antibiotics the next day. The fact that serum PCT levels may be significantly elevated in FPIES means that differentiating severe FPIES from sepsis could be more challenging than was previously thought.

We investigated the effect of lactic acid bacteria-containing beverage intake on the level of resilience against stress in male university students. Forty male university students were recruited into the study and randomly assigned into two groups. They were instructed to consume lactic acid bacteria-containing beverage or water twice a day for 28 days. The level of stress resilience, stress reaction, and anxiety were evaluated by a series of questionnaires conducted at three time points (T1: day 0, T2: day 14, and T3: day 28). The stress response was also assessed by measuring their salivary amylase levels. The variance analysis of each group showed a significant increase in stress resilience at T3 compared with T1 in the group of participants who consumed the lactic acid bacteria-containing beverage. Our results suggest that lactic acid bacteria-containing beverage intake could affect resilience against stress positively.

The purpose of this study was to evaluate the usefulness of adding Waters' projection to panoramic imaging compared with panoramic imaging or Waters' projection alone. Maxillary sinusitis in 106 patients (206 sinuses) was retrospectively assessed with panoramic imaging, Waters' projection, and computed tomography imaging by two oral radiologists. The diagnostic performance was assessed with computed tomography imaging as the gold standard. Receiver operating characteristic curves and area under the curve values were obtained. Inter- and intra-observer agreement was quantified using weighted kappa coefficients. Observer A performed the same procedure twice (A1 and A2 for the first and second observations, respectively). The accuracies of observers A1, B, and A2 with combination imaging were 0.699, 0.636, and 0.718, respectively. Their area under the curve values with combination imaging were 0.746, 0.640, and 0.771, respectively. Inter-observer agreement was good for Waters' projection (κ, 0.650), and poor for panoramic imaging (κ, 0281). Intra-observer agreement was good for Waters' projection (κ, 0.752), and moderate for panoramic imaging (κ, 0.597). Panoramic imaging was equivalent to Waters' projection for diagnosing maxillary sinusitis. Combination imaging comprising panoramic imaging and Waters' projection can contribute to the diagnosis of odontogenic maxillary sinusitis because of its high sensitivity.

Background: The number of newly diagnosed human immunodeficiency virus (HIV) infections and acquired immune deficiency syndrome (AIDS) patients in Japan appears to be decreasing. However, whether these new infections cease to occur in the future in Japan, similar to abroad, is unclear. To evaluate the feasibility of this achievement, we conducted a time series analysis using Bayesian local linear trend model to evaluate the possibility of zero new infection of HIV/AIDS in Japan.

Methods: We used quarterly data on HIV/AIDS from the first quarter, 2001 to the second quarter, 2020. Bayesian analyses were conducted using Markov chain Monte Carlo (MCMC) method, and a local linear trend model was constructed for number of newly diagnosed HIV infection without AIDS diagnosis, AIDS cases, and their aggregate. Predictions for the following 60 quarters until the second quarter of 2035 were also made for all models.

Results: The mean aggregate cases of HIV/AIDS patients became 0 by the fourth quarter of 2031 (90% credible interval 0-535). For HIV infections alone, mean cases became 0 by the second quarter of 2030 (90%CrI 0-472). For AIDS alone mean cases were 9 at the second quarter of 2035 (90%CrI 0-231).

Conclusion: Our local linear trend model suggested that number of HIV/AIDS cases in Japan could decrease to zero by the first quarter of 2031, if the trend of the infections followed the local linear trend model, yet with rather wide credible interval. Achieving zero new transmission of HIV in Japan is a realistic goal but measures to make it faster may be needed.

It has already been reported that HbA1c levels measured by immunoassay (IA) (IA-HbA1c) during off-site health checkups present falsely lower results. We also reported that HbA1c levels measured by enzymatic assay (EA) (EA-HbA1c) during off-site health checkups are lower. In the present study, we compared IA-HbA1c levels or EA-HbA1c levels during off-site health checkups with on-site high-performance liquid chromatography (HPLC)-HbA1c levels using the same samples. Subjects were 88 non-diabetic individuals who had health checkups in Nishinomiya Municipal Central Hospital. Subjects with a history of diabetes mellitus and those with HPLC-HbA1c ≥ 6.5% were excluded. IA-HbA1c levels (Study 1) or EA-HbA1c levels (Study 2) in the health checkups were compared with on-site HPLC-HbA1c levels using the same samples. Both IA-HbA1c levels and EA-HbA1c levels had positive correlations with HPLC-HbA1c levels (p <0.0001 for both), although both were significantly lower than HPLC-HbA1c levels (p <0.0001 for both). The degrees of reductions in the IA-HbA1c levels and EA-HbA1c levels compared with HPLC-HbA1c levels were almost same to each other. Similarly to IA-HbA1c levels, EA-HbA1c levels during the health checkups were lower than HPLC-HbA1c levels. It was demonstrated that HbA1c levels decrease similarly if measured by either EA or IA during off-site health checkups.

Objective: Acute pulmonary edema associated with ritodrine hydrochloride is a rare, life-threatening complication, and dose and duration of ritodrine use are closely associated with this pathology. We report a case of acute pulmonary edema associated with short-duration infusion of ritodrine hydrochloride in a patient with pectus excavatum as an underlying factor.

Case report: A 30-year-old healthy pregnant woman was treated with oral ritodrine for tocolysis between 31 and 35 weeks of pregnancy. At 36 weeks of gestation, she went into preterm labor, with premature rupture of the membrane and breech presentation, and received an infusion of ritodrine hydrochloride for a few hours. Although she was normotensive until labor onset, mild hypertension and proteinuria were recognized. Intraoperatively, a funnel-chest deformity was observed, and she developed postoperative pulmonary edema associated with dyspnea and wet cough and confirmed on chest radiography and arterial gas analysis, and recovered with supportive care.

Conclusion: Small-dose infusion of ritodrine hydrochloride might cause pulmonary edema in patients with underlying medical problems, including pectus excavatum.

Familial Mediterranean Fever (FMF) is an autosomal recessive disorder, characterized by recurrent attacks of fever, serositis and articular pain. Mutations in the MEFV gene causes inflammation that may trigger cognitive impairment in FMF patients. The objectives were to identify the effect of anti-inflammatory diet containing curcumin, flaxseed and vitamin D supplementation on the clinical presentation and cognitive functions of FMF patients. The study included 73 FMF patients, that followed in addition to their regular colchicine doses an anti-inflammatory diet (rich in fresh vegetables and fruits, low in saturated and unsaturated fats and carbohydrates, low in food additives, sugar, fast foods and processed foods). In addition, to dietary supplementation with vitamin D, curcumin and flax seeds. Results: Statistically significant improvement was observed regarding clinical presentation, cognitive functions, CRP and subjective wellbeing. Conclusion: Our study highlights the importance of anti-inflammatory diet in the amelioration of the clinical presentation, cognitive functions and general wellbeing of FMF patients. We recommend that our findings would be confirmed by a randomized controlled trial.

Triiodothyronine (T3)-predominant Graves' disease is characterized by increased serum free T3 (FT3) levels after free thyroxine (FT4) levels become normal or even low during antithyroid drug treatment. We encountered a 34-year-old pregnant woman, gravida 5 para 4, who was complicated by T3-predominant Graves' disease. She was diagnosed with Graves' disease at 20 years old, and had received methimazole. Methimazole was changed to potassium iodide to reduce the risk of congenital anomalies during the first trimester. The dose of antithyroid drugs was adjusted based on maternal FT4 levels, so that maternal Graves' disease deteriorated and fetal goitrous hyperthyroidism appeared during the second trimester. Since the fetus presented goiter and tachycardia at 27-28 gestational weeks, doses of methimazole and potassium iodide were increased. A male newborn weighing 2604 g was delivered by a cesarean section at 35 gestational weeks. The newborn was diagnosed with neonatal hyperthyroidism, and received methimazole for six months. He developed normally with normal thyroid function at 1 year old. In pregnancies complicated by T3-predominant Graves' disease, the kinds and doses of antithyroid drugs have to be carefully selected to maintain maternal levels of FT4 as well as FT3 within the normal range, considering trimesters of pregnancy, teratogenicity of medication, and maternal levels of thyroid-stimulating hormone receptor antibody.

Daikenchuto (TU-100) is herbal medicine which predominantly contains ginger, Japanese pepper, and ginseng. We investigated whether TU-100 can affect the composition of gut flora and intestinal tumor development using Apc^Min/+ mice, a murine model of intestinal tumor. Bacterial 16S rRNA sequencing and short-chain fatty acid analysis were performed on faecal samples. Tumor number and size were analysed. Any change in gene expression of the tumor tissues was assessed by real-time PCR. Principal coordinate analysis (PCoA) showed that the faecal microbiota cluster of TU-100-fed mice was different from the microbiota of control mice. However, no significant difference was observed in the concentration of short-chain fatty acids, tumor number, and gene expression levels between the two groups. Our data showed that TU-100 can affect the intestinal environment; however, it does not contribute in tumor progression or inhibition in our setting.

We treated an 85-year-old man with an abscess perforating into the retroperitoneal space from the sigmoid colon, with retroperitoneal drainage combined with antibiotics. CT showed no abscess formation in the intraperitoneal space. The patient consulted a doctor with a chief complaint of left-side low back pain and fever. He was first diagnosed with bacteremia due to Escherichia coli and close examination by CT revealed a retroperitoneal abscess. On referral to our hospital, we determined by CT that the cause of abscess formation was perforation of the intestine into the retroperitoneal space and spreading into the psoas muscle compartment. We then performed colostomy and abscess drainage through the retroperitoneal space to prevent the abscess disseminating into the intraperitoneal space. The abscess and necrotic tissue cultures were polymicrobial, including Enterobacteriaceae and Bacteroides spp. The abscess almost disappeared after drainage, and the patient's general condition gradually improved. The retroperitoneal abscess did not relapse by follow-up CT. In conclusion, this rare case presented with perforation of the intestine (Sigmoid colon) disseminated only to the retroperitoneal space without no intraperitoneal space abscess formation. We performed drainage only by a retroperitoneal approach without entering the intraperitoneal space.