Validity of the NAFLD fibrosis score in a Japanese population

Scoring systems for the diagnosis of fibrosis in non-alcoholic fatty liver disease (NAFLD) have been devised all over the world. However, the usefulness of these scoring systems for Japanese populations has not been established. We examined the diagnostic ability of several scoring systems for the diagnosis of advanced fibrosis in NAFLD patients. A total of 52 patients with NAFLD who had undergone liver biopsy were included in this study. The area under the receiver operating characteristic (AUROC) of the scoring system for the advanced fibrosis was greatest for NAFLD fibrosis score (NFS) (0.913). At a cutoff point of -0.876 modified from the original low cutoff point (-1.455), the sensitivity, specificity, and positive and negative predictive values for advanced fibrosis were 100%, 82.5%, 63.2%, and 100%, respectively. Based on these results, we conclude that low cutoff point of NFS should be modified to -0.876 for a Japanese population with a lower BMI than Western populations.     

Perioperative Landiolol Administration reduces Atrial Fibrillation after Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Introduction

Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. Patients who develop POAF have a prolonged stay in the intensive care unit and hospital and an increased risk of postoperative stroke. Many guidelines for the management of cardiac surgery patients, therefore, recommend perioperative administration of beta-blockers to prevent and treat POAF. Landiolol is an ultra-short acting beta-blocker, and some randomized controlled trials of landiolol administration for the prevention of POAF have been conducted in Japan. This meta-analysis evaluated the effectiveness of landiolol administration for the prevention of POAF after cardiac surgery.

Methods

The Medline/PubMed and BioMed Central databases were searched for randomized controlled trials comparing cardiac surgery patients who received perioperative landiolol with a control group (saline administration, no drug administration, or other treatment). Two independent reviewers selected the studies for inclusion. Data regarding POAF and safety outcomes were extracted. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel method (fixed effects model).

Results

Six trials with a total of 560 patients were included in the meta-analysis. Landiolol administration significantly reduced the incidence of POAF after cardiac surgery (OR 0.26, 95% CI 0.17–0.40). The effectiveness of landiolol administration was similar in three groups: all patients who underwent coronary artery bypass grafting (CABG) (OR 0.27, 95% CI 0.17–0.43), patients who underwent CABG compared with a control group who received saline or nothing (OR 0.28, 95% CI 0.17–0.45), and all patients who underwent cardiac surgery compared with a control group who received saline or nothing (OR 0.27, 95% CI 0.17–0.42). Only two adverse events associated with landiolol administration were observed (2/302, 0.7%): hypotension in one patient and asthma in one patient.

Conclusion

Landiolol administration reduces the incidence of POAF after cardiac surgery and is well tolerated.     

Tubercular prostatic abscess following intravesical Bacillus Calmette-Guerin therapy

We report a case of tubercular prostatic abscess in a male patient who had undergone intravesical Bacillus Calmette-Guerin therapy for bladder carcinoma in situ. The abscess was successfully treated with transurethral resection of the prostate for drainage and subsequent antituberculous regime of chemotherapy.     

Chemical and physiological relevance of glucose degradation products in peritoneal dialysis

Fibrosis and vascular sclerosis are main complications that limit the long-term application of peritoneal dialysis (PD). Low biocompatibility has been largely attributed to the presence of glucose degradation products (GDPs), which are formed during the heat sterilization of PD fluids. GDPs readily modify proteins in the peritoneum, leading to a decline of their biological function. After absorption, GDPs can also promote systemic protein glycation. Additionally, GDPs may augment DNA glycation, a process enhanced in uremia. Apart from their glycating activity, GDPs induce cytotoxicity and interfere with cell signaling in peritoneal mesothelial cells. Targeted screening revealed the nature of the?6?major GDPs with α-dicarbonyl structure as 3-deoxyglucosone, 3-deoxygalactosone, glucosone, glyoxal, methylglyoxal, and 3,4-dideoxyglucosone-3-ene. Valid quantification of these GDPs was achieved by ultrahigh-performance liquid chromatography/diode array detector/tandem mass spectrometry. Identification and quantification of single GDPs allow a structure-dependent risk evaluation. As a consequence, PD fluids and processes can be improved to reduce the GDP burden of patients undergoing PD.