Dynamic changes in clinical characteristics and serotype distribution of invasive pneumococcal disease among adults in Japan after introduction of the pediatric 13-valent pneumococcal conjugate vaccine in 2013–2019

Nationwide population-based surveillance for invasive pneumococcal disease (IPD) is being conducted in few Asian countries. We aimed to evaluate the clinical characteristics and serotype distribution among Japanese adult patients with IPD after introduction of the pediatric 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. IPD surveillance was conducted among adults between 2013 and 2019, and 1,995 patients were analyzed by time period (early, 2013–2015; middle, 2016–2017; late, 2018–2019). We found that the period of 2018–2019 was independently associated with a lower risk of fatal outcome, compared with the period of 2013–2015. The proportion of those with serotype PCV13-nonPCV7 decreased significantly in patients aged 15–64 years and in those aged ≥ 65 years within 3 years after the introduction of pediatric PCV13. By contrast, the proportion of those with nonvaccine serotype increased significantly in those aged ≥ 65 years, but not in those aged 15–64 years. No significant change was found in the proportion of 23-valent polysaccharide pneumococcal vaccine (PPSV23)-nonPCV13 in both of adults aged 15–64 years and ≥ 65 years. The proportions of PCV15-, PCV20- and PCV24-covered serotypes were 38%, 56% and 58% in adult patients with IPD aged ≥ 65 years during the late period. Our data on the serotype distribution support an indirect effect from pediatric PCV13 use among adults, and afford a basis for estimates of protection against IPD by vaccination with newly developed PCVs in older adults in Japan.     

Enhanced neurogenesis after transient global ischemia in the dentate gyrus of the rat

The dentate gyrus is one of the few areas of the mammalian brain where new neurons are continuously produced in adulthood. Certain insults such as epileptic seizures and ischemia are known to enhance the rate of neuronal production. We analyzed this phenomenon using the temporary occlusion of the two carotid arteries combined with arterial hypotension as a method to induce ischemia in rats. We measured the rate of cell production and their state of differentiation with a mitotic indicator, bromodeoxyuridine (BrdU), in combination with the immunohistochemical detection of neuronal markers. One week after the ischemic episode, the cell production in dentate gyrus was increased two- to threefold more than the basal level seen in control animals. Two weeks after ischemia, over 60% of these cells became young neurons as determined by colabeling with BrdU and a cytoplasmic protein (CRMP-4) involved in axonal guidance during development. Five weeks after the ischemia, over 60% of new neurons expressed calbindin, a calcium-binding protein normally expressed in mature granule neurons. In addition to more cells being generated, a greater proportion of all new cells remained in the differentiated but not fully mature state during the 2- to 5-week period after ischemia. The maturation rate of neurons as determined by the calbindin labeling and by the rate of migration from a proliferative zone into the granule cell layer was not changed when examined 5 weeks after ischemia. The results support the hypothesis that survival of dentate gyrus after ischemia is linked with enhanced neurogenesis. Additional physiological stimulation after ischemia may be exploited to stimulate maturation of new neurons and to offer new therapeutic strategies for promoting recovery of neuronal circuitry in the injured brain.     

白细胞在油酸引起的急性肺损伤中的作用

以0.1ml/kg油酸静脉注入复制大鼠急性肺损伤模型。实验动物出现呼吸困难、低氧血症和白细胞减少。注油酸二小时后,肺指数、血清及BALF中β-葡萄糖醛酸酶(β-g)活力明显增高。组织学检查可看到肺微血管内有白细胞聚集,间质有白细胞浸润,间质和肺泡内水肿,出血和充血。以抗多形核白细胞抗体造成白细胞减少的大鼠,肺损伤就没有正常大鼠那样严重。结果表明白细胞参与油酸引起的急性肺损伤。     

Morphine antinociception elicited from the ventrolateral periaqueductal gray is sensitive to sex and gonadectomy differences in rats

Sex differences have been observed in antinociception following central administration of morphine into either the lateral ventricles or rostral ventromedial medulla (RVM) such that male rats exhibit significantly greater antinociception than female rats. The present study examined whether sex and adult gonadectomy differences were observed in morphine-induced (1-10 micrograms) antinociception elicited from the ventrolateral periaqueductal gray (vlPAG) on two nociceptive measures. Both sham-operated (ED50=1.20-1.60 microgram) and castrated (ED50=1.08-1.09 micrograms) male rats displayed significantly greater magnitudes and potencies of morphine-induced antinociception on both tests than female rats. Sham-operated female rats tested during the estrous phase (ED50=>50 micrograms) were significantly less sensitive to morphine than ovariectomized female rats (ED50=1.98-2. 51 micrograms). Thus, the vlPAG, a site sensitive to interactions between estradiol-containing hypothalamic loci and opioid peptides, elicits morphine-induced antinociception which is sensitive to sex differences and adult gonadectomy.     

Idiopathic sciatic mononeuropathy

Sciatic nerve lesions are usually painful and secondary to compression, trauma, infarction or part of a systemic illness. The etiology is usually defined by radiographic or blood studies, or by exploratory surgery. In rare cases, as the one being presented, there is clear clinical and electrophysiological evidence for a lesion of the sciatic nerve, but no morphological correlate or defined etiology. These idiopathic sciatic mononeuropathies seem to occur in the nerves of the legs in young adults.     

Conservative treatment of neurogenic bladder dysfunction

Summary In neurogenic bladder dysfunction conservative treatment is preferred whenever possible and preservation of renal function remains the main topic. Additionally, a patient-related form of bladder management with decreased intravesical pressure and social dryness is needed. Therefore many strategies are available and after evaluation of the underlying neurogenic bladder dysfunction an individual kind of treatment can be used. Possible options are the clean intermittent catherization, anticholinergic drugs, detrusor triggering, electrical stimulation and bladder emptying by Valsalva's manouvre.      

超声引导下成人与儿童肾活检术的评价

目的评价经超声引导成人与儿童肾活检术的方法和安全性。方法83例肾脏病患者超声引导下经皮穿刺活检,经右肾或左肾下极进针,方向自外下向内上,沿肾下极皮质取材。结果68例获取足够肾组织,总成功率及3针以内成功率分别为82%、53%,成人与儿童间无差异(P>0.05)。肾活检并发症儿童以疼痛为主,成人以血尿为主。结论超声引导下成人与儿童肾活检术是安全可靠的,其病理诊断对临床治疗具有明确的指导意义。     

Outcome of congenital adrenal hyperplasia

In congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, affected girls are born with ambiguous genitalia due to increased secretion of androgens in utero by the defective adrenal gland. Even though it is generally accepted that there are differences between male and female brain development, determining factors have been difficult to identify. Girls with CAH have frequently been studied to evaluate the impact of prenatal androgen exposure on psychological, psychosocial, and psychosexual development, and impairments in various areas have been identified. However, there is no comprehensive study available regarding the outcome of this chronic disorder in adult life. We studied the quality of life in women with CAH, with particular emphasis on how they cope with genital malformations, genital operations, and chronic disease as well as lifelong medication. The patients filled out questionnaires covering their physical state, psychological well-being, social relationships, and functional capacity, as well as questionnaires on psychosexual identification and psychosocial integration. The results were evaluated using a computerized statistical program for social studies. Out of a total of 94 patients above 18 years of age, 45 agreed to participate and were compared to 46 healthy, age-matched controls. Age at diagnosis was 2.31 ± 1.55 years and 38% suffered from the simple-virilizing, 45% from the salt-wasting, and 17.0% from the late-onset form of CAH. About one-third of patients had Prader stage 3 or 4 genital virilization. While the overall quality of life did not differ significantly, CAH patients were more often single (47.8% vs. 66.7%) and fewer of them had children (22.2% vs. 38.6%) compared to controls. Significant impairments were found in regard to body image and attitudes toward sexuality, but there was no increased homosexual preference. The women were successful in adjusting to illness and receiving social support. It is speculated that improved psychosocial adaptation is part of a coping mechanism that helps to maintain a high level of well-being despite impairment. Coping mechanisms should be identified and strengthened in order to help patients cope with their chronic illness.