End-stage kidney at the onset of nephrotic syndrome in a 4-year-old girl

A previously healthy Japanese girl aged 4 years suddenly developed idiopathic nephrotic syndrome (INS) associated with acute renal failure (ARF). Despite prompt initiation of hemodialysis and prednisolone treatment, her ARF did not recover. A percutaneous renal biopsy performed within a month from the onset of INS revealed lesions of end-stage kidney, which is unusual for the acute stage of INS. Although the etiology of her ARF remains speculative, an acute exacerbation of an underlying chronic disease, such as non-nephrotic focal segmental glomerulosclerosis might be the cause.     

Effects of running exercise on the mandible and tibia of ovariectomized rats

To examine the effects of running exercise on the mandible and tibia of ovariectomized (OVX) rats, 26-week-old sham-operated (Sham) and OVX rats 1 week post-ovariectomy were subjected to non-exercise (Sham-Cont and OVX-Cont) and exercise (Sham-Exc and OVX-Exc) for 8 weeks. OVX induced a significant decrease in alkaline phosphatase (ALP) and an increase in tartrate-resistant acid phosphatase (TRAP) activity and a reduction of 17β-estradiol in the serum. In OVX-Cont rats, histology and bone mineral density (BMD) showed bone loss in the proximal tibia, and histology, soft X-ray photographs and bone marrow area (BMA) revealed enlargement of the bone marrow cavity in the neck of the condylar process. In OVX-Exc rats, exercise significantly increased ALP activity, decreased TRAP activity and markedly elevated serum progesterone levels. Histology and BMD in the tibia and histology, X-ray photographs and BMA in the mandible were comparable to those in Sham rats. In Sham-Exc rats, unexpected decreases were observed in serum enzymes and hormones, but the histology and BMD in the tibia and histology, X-ray photographs and BMA in the mandible were very similar to those in Sham-Cont rats, suggesting a decrease of bone turnover with no change of bone mass in the tibia and mandible. We conclude that exercise has a beneficial effect not only on bone loss in the tibia, but also on differential changes in the neck of the condylar process, perhaps by increasing serum levels of progesterone in OVX rats. Received: May 29, 2000 / Accepted: November 6, 2000     

Intracellular interaction of EMILIN-1 with fibrillin-1 in human periodontal ligament cells

The elastic system fibers comprise oxytalan, elaunin and elastic fibers, differing in their relative microfibril and elastin contents. Human periodontal ligaments (PDLs) contain oxytalan fibers (pure microfibrils), which are composed mainly of fibrillin-1, the major component of microfibrils. We recently demonstrated that EMILIN-1, located at the interface between elastin and microfibrils, controls the amount of fibrillin-1 assembly in PDL fibroblast cell/matrix layers [8], although the mechanism involved was unclear. We subjected cultured PDL fibroblasts to immunofluorescence and immunoprecipitation assays in order to examine the intracellular interaction of EMILIN-1 with fibrillin-1. Immunofluorescence showed that EMILIN-1 was colocalized with fibrillin-1, both inside and outside the cells. Additionally, EMILIN-1 formed a complex with fibrillin-1 in the intracellular fraction. These results suggest that EMILIN-1 may form complexes with fibrillin-1 in cellular vesicles, thus contributing effectively to the initial assembly of pericellular fibrillin-1 during the process of oxytalan fiber formation.     

Intravenous immunoglobulin therapy leading to dramatic improvement in a patient with systemic juvenile idiopathic arthritis and severe pericarditis resistant to steroid pulse therapy

A 7-year-old Japanese boy with a 4-month history of systemic juvenile idiopathic arthritis (s-JIA) experienced disease flare with spiking fever, exanthema and arthralgia. He then developed progressive dyspnea due to severe pericarditis, and proinflammatory hypercytokinemia was suspected. Methylprednisolone pulse therapy was ineffective and echocardiography showed massive pericardial effusion had persisted. Alternatively, subsequent intravenous immunoglobulin (IVIG) therapy resulted in dramatic resolution of the pericardial effusion, and his general condition significantly improved within a few days. This case report may lend further support the use of IVIG for selected patients with s-JIA and severe pericarditis.     

Clinical impact of rehabilitation and ICU diary on critically ill patients: A systematic review and meta-analysis

Background

Various physical and mental sequelae reduce the quality of life (QOL) of intensive care unit (ICU) patients. Current guidelines recommend multi-angular approaches to prevent these sequelae. Some studies have demonstrated the clinical effectiveness of rehabilitation or the ICU diary against these sequelae, whereas others have not.

Aim

The aims of the present study were to establish whether rehabilitation or the ICU diary was useful for reducing the severity of anxiety, depression, and post-traumatic stress disorder (PTSD) in ICU patients. We also investigated whether these interventions improved the QOL of these patients.

Study design

We conducted a systematic review and meta-analysis of relevant randomized controlled trials published between January 1, 1985, and October 19, 2022, with the following search engines: PubMed, CHINAHL, all Ovid journals, and CENTRAL. The hospital anxiety and depression scale (HADS), the short-form health survey (SF-36), the EuroQol 5-dimensions, 5-levels (EQ-5D-5L), and the Impact of Event Scale-Revised (IES-R) were used as outcome measures. The quality of evidence across all studies was independently assessed using Review Manager software (v.5.4).

Results

We included 12 rehabilitation studies and five ICU diary studies. Rehabilitation had no significant effects on HADS-anxiety, HADS-depression, or EQ-5D-5L, but significantly improved the physical component summary (PCS) [MD = 3.31, 95%CI (1.33 to 5.28), p = .001] and mental component summary (MCS) [MD = 4.31, 95%CI: (1.48 to 7.14), p = .003] of the SF-36. The ICU diary significantly ameliorated HADS-anxiety [MD = 0.96, 95%CI: (0.21 to 1.71), p = .01], but did not affect HADS-depression, the IES-R, or the PCS or MCS of the SF-36.

Conclusions

The present study showed that rehabilitation initiated after discharge from the ICU effectively improved SF-36 scores. The ICU diary ameliorated HADS-anxiety. Neither rehabilitation nor the ICU diary attenuated HADS-depression or IES-R in this setting. Rehabilitation and the ICU diary partially improved the long-term prognosis of ICU patients.

Relevance to clinical practice

The present study provides evidence for the beneficial effects of rehabilitation and the ICU diary for ICU patients. Rehabilitation alone does not ameliorate anxiety, depression, or PTSD symptoms, but may improve QOL. The ICU diary only appeared to ameliorate anxiety.     

Pharmacokinetics and clinical evaluation of ceftriaxone in pediatric surgery

Pharmacokinetics and clinical studies on ceftriaxone (CTRX) in pediatric surgery were performed and the results obtained are summarized below. 1. In neonates, serum and urinary levels of CTRX were measured in 4 patients following injection (CTRX 20 mg/kg, intravenous bolus injection). Highest levels in serum were observed at 15 or 30 minutes, 59.4-212.5 micrograms/ml. Serum levels of CTRX then decreased very slowly, and serum half-lives (T 1/2) were 7.9-27.1 hours. Urinary recovery rates were 17.0-54.7% in 12 hours. 2. Bile levels of CTRX were also measured in 8 patients with congenital biliary atresia and a patient with congenital biliary dilatation (CBD). Highest levels of CTRX in bile, 10.2 and 13.2 micrograms/ml, were noted in 2 hours following injection to 2 patients. But in other patients, CTRX was undetectable in bile. Recovery rate in bile in 12 hours in a CBD patient was 0.19%. 3. The CTRX was administered to 7 patients (a case of infected lung cyst, 2 cases of peritonitis and 4 cases as prophylaxis to postoperative infection). Clinical results were good in all cases. No clinical and laboratory adverse reaction due to the administration of CTRX was observed. It is concluded that CTRX is a safe and effective antibiotic in pediatric surgery. However, care has to be practiced in determining dosage and interval of CTRX administration because of its pharmacokinetical characteristics.     

Effects of Halothane and Isoflurane on Hyperexcitability of Spinal Dorsal Horn Neurons after Incision in the Rat

Background: The aim of this study was to determine whether halothane and isoflurane used during and after surgical injury attenuate subsequent hyperexcitability of spinal dorsal horn (SDH) neurons by preventing development of central sensitization.

Methods: Activity of a wide-dynamic-range neuron of the SDH was isolated in decerebrate-spinal Sprague-Dawley rats, and neuronal activity (receptive field size and responses to nonnoxious and noxious stimuli) was recorded. A 1-cm-long incision was made through the skin, fascia, and muscle under anesthesia with halothane (1.1% or 2.2%) and isoflurane (1.4% or 2.8%). Anesthesia was discontinued just after the incision had been made or was continued until 30 min after the incision, and activity of the SDH neurons was measured for up to 2 h after the incision. In a control group, the incision was made without anesthesia.

Results: In the control group, the incision resulted in maximum excitation in the SDH neurons during surgery; spontaneous activity significantly increased for up to 30 min after the incision (P < 0.05) but did not significantly increase thereafter, returning to the preincision value. Halothane and isoflurane suppressed excitation of the neurons during the incision in a concentration-related manner. Administration of 2.2% halothane and 2.8% isoflurane during the incision and for up to 30 min after the incision almost abolished activity of the neurons for 30 min after the incision. The magnitude of neuronal activity 2 h after the incision was not significantly different among all groups, including the control group.     

Oculocardiac reflex caused by contact lenses

PURPOSE: To report two cases of patients who fell unconscious because of the oculocardiac reflex when attempting to wear contact lenses. CASE REPORTS: Case 1: A 15-year-old healthy boy came to our clinic to be fitted with contact lenses. As soon as a hard contact lens was inserted forcibly, he became unconscious. Case 2: A 22-year-old man fell unconscious the instant that the eye was compressed with a hard contact lens. Neither patient had used glasses or contact lenses before. Their blood pressure was decreased while unconscious. They recovered consciousness after about 10 min, and nausea and vomiting settled subsequently. Contact lens insertion was tried again carefully after 1 week avoiding compression of the eyes and there were no problems. They are currently using contact lenses without any problems. CONCLUSION: Insertion of contact lenses may rarely provoke the oculocardiac reflex.