Low-dose tacrolimus for two cases of myasthenia gravis with invasive thymoma that relapsed shortly after thymectomy

Two patients with myasthenia gravis (Ossermann IIb) involving invasive thymoma who underwent extensive thymectomy manifested myasthenic crisis shortly after the procedure; however, both patients were treated with intravenous immunoglobulin and recovered from myasthenic crisis that had been deteriorating for about 1 week. Subsequently, the patients were administered a low-dose of tacrolimus (3 mg/day) in addition to prednisolone. Several months later, tacrolimus continued to control fluctuations of myasthenic symptoms and maintained remission in these patients. The serum titer of anti-Ach-receptor antibodies decreased in parallel with clinical improvement due to tacrolimus, and we accordingly reduced the dosage of prednisolone. Tacrolimus is a new immunosuppressive agent acting through the selective inhibition of helper-T-cell activation that can be reduced dosage of steroids and can maintain remission of myasthenia gravis with invasive thymoma.     

The effects of yoga on hypertensive persons in Thailand

To determine the effectiveness of a yoga program on blood pressure and stress, a group of hypertensive patients in Thailand were studied, with the experimental group showing significantly decreased mean stress scores and blood pressure, heart rate, and body mass index levels compared with the control group. Further studies are suggested to determine the effects of yoga on hypertension in Thailand.     

A quantitative ultrastructural study of the liver and the spleen in fatal falciparum malaria

We performed a retrospective study of 25 patients who died of severe falciparum malaria in Thailand and Vietnam using electron microscopy. The aims of the study were: to determine if there was any significant association between parasitized red blood cells (PRBC) sequestered in liver and spleen and particular pre-mortem clinical complications, and to compare the degree of parasite load between the liver and spleen within the same patients. PRBC sequestrations in each organ were compared with the pre-mortem parasitemia, to calculate the sequestration index (S.I.). The S.I. showed that the degree of PRBC sequestration in the spleen was higher than the liver (S.I. median = 3.13, 0.87, respectively) (p < 0.05). The results of quantitative ultrastructural study showed a significantly high parasite load in the liver of patients with jaundice, hepatomegaly and liver enzyme elevation (p < 0.05). We found a significant correlation between PRBC sequestration in the liver and a high serum bilirubin level, a high aspartate aminotransferase (AST) level and an increase in the size of the liver (Spearman's correlation coefficient = 0.688, 0.572, 0.736, respectively). Furthermore, a higher parasite load was found in the liver of patients with acute renal failure (ARF) compared to patients without ARF (p < 0.05). These findings suggest that PRBC sequestration in the liver is quantitatively associated with pre-mortem hepatic dysfunction and renal impairment. There was no significant difference between splenomegaly and PRBC sequestration. The size of a palpable spleen was not correlated with parasite load in the spleen. When ultrastructural features were compared between the two reticuloendothelial organs, we found that the spleen had more PRBC and phagocytes than the liver. The spleen of non-cerebral malaria (NCM) patients had more phagocytes than cerebral malaria (CM) patients. This observation reveals that the spleen plays a major role in malaria parasite clearance, and is associated with host defence mechanisms against malaria.     

Specific B-cell Epitope of Per a 1: A Major Allergen of American Cockroach (Periplaneta americana) and Anatomical Localization

Purpose

Cockroach (CR) is a common source of indoor allergens, and Per a 1 is a major American CR (Periplaneta americana) allergen; however, several attributes of this protein remain unknown. This study identifies a novel specific B cell epitope and anatomical locations of Per a 1.0105.

Methods

Recombinant Per a 1.0105 (rPer a 1.0105) was used as BALB/c mouse immunogen for the production of monoclonal antibodies (MAb). The MAb specific B cell epitope was identified by determining phage mimotopic peptides and pair-wise alignment of the peptides with the rPer a 1.0105 amino acid sequence. Locations of the Per a 1.0105 in P. americana were investigated by immunohistochemical staining.

Results

The rPer a 1.0105 (~13 kDa) had 100%, 98% and ≥90% identity to Per a 1.0105, Per a 1.0101, and Cr-PII, respectively. The B-cell epitope of the Per a 1.0105 specific-MAb was located at residues⁹⁹ QDLLLQLRDKGV¹¹⁰ contained in all 5 Per a 1.01 isoforms and Per a 1.02. The epitope was analogous to the Bla g 1.02 epitope; however, this B-cell epitope was not an IgE inducer. Per a 1.0105 was found in the midgut and intestinal content of American CR but not in the other organs. The amount of the Per a 1 was ~544 ℃g per gram of feces.

Conclusions

The novel Per a 1 B-cell epitope described in this study is a useful target for allergen quantification in samples; however, the specific MAb can be used as an allergen detection reagent. The MAb based-affinity resin can be made for allergen purification, and the so-purified protein can serve as a standard and diagnostic allergen as well as a therapeutic vaccine component. The finding that the Per a 1 is contained in the midgut and feces is useful to increase yield and purity when preparing this allergen.     

Risk scoring tool for forearm skin tears in Japanese older adults: A prospective cohort study

[Aim] Because painful skin tears frequently occur in older patients, the prevention of skin tears is fundamental to improve their quality of life. However, a risk assessment tool for skin tears has not been established yet in Japan. Therefore, we aimed to propose a risk scoring tool for skin tears in Japanese older adult. [Methods] We conducted a prospective cohort study with 6-month follow-up in two long-term care hospitals in Japan. A total of 257 inpatients were recruited. Patient and skin characteristics were collected at baseline, and the occurrence of forearm skin tears were examined during follow-up. To develop a risk scoring tool, we identified risk factors, and converted their coefficients estimated in the multiple logistic regression analysis into simplified scores. The predictive accuracy of the total score was evaluated. [Results] Of 244 participants, 29 developed forearm skin tears during the follow-up period, a cumulative incidence of 13.5%. Senile purpura, pseudoscar, contracture, and dry skin were identified as risk factors for skin tears. Their weighted scores were 6, 4, 5, and 6, respectively. The area under the receiver operating characteristic curve of the total score was 0.806. At a cut-off score of 12, the sensitivity was 0.86, and the specificity was 0.67. [Conclusion] Our forearm skin tear risk scoring tool showed high accuracy, whereas specificity was low. This tool can contribute to prevent forearm skin tears in Japanese older adults.     

A case of erythropoietic protoporphyria with severe liver dysfunction

A 27-year-old man was admitted to our hospital for evaluation and treatment of liver dysfunction with jaundice and hepatosplenomegaly. The patient had severe photosensitivity from childhood. Upper gastrointestinal endoscopy revealed mild esophageal varices. The clinical manifestations, analyses of the urine and blood for porphyrins and skin biopsy led us to a diagnosis of erythropoietic protoporphyria. Because of acute deterioration of liver function, living donor liver transplantation was performed. The resected liver revealed cirrhosis. We report a rare case of erythropoietic protoporphyria with severe liver dysfunction and present a review of the literature.     

Effects of human contraceptive on reproduction and offspring in Chrysomya megacephala

ObjectiveTo investigate the effect of human contraceptive (HC) as ability to suppress the reproductive success of blow fly, Chrysomya megacephala (Fabricius) (C. megacephala) and offspring under controlled laboratory conditions.MethodsAdult C. megacephala were fed with low (0.036 mg/mL) and high dose (0.072 mg/mL) HC (Microgest®, Thailand), containing levonorgestrel and ethinyl estradiol, in their drinking water for 7 days. Three experiments were set; experiment I with fed only in parental males, experiment II with fed only in parental females and experiment III with fed in both males and females. All experiments were then maintained for 3 generations after crossing and inbreeding.ResultsA lower ovariole production and less fully mature ovarioles were evident in F1, F2 and F3 than control when parent males, females and both had been fed with high dose HC. Cellular changes during spermatogenesis in F1, F2 and F3 testes was confirmed using transmission electron microscopy (TEM), showing the low level of condensed chromatin, necrotic chromatin, irregularities and degenerated nuclear envelope in the nucleus. In the cytoplasm, mitochondrial swelling, rough endoplasmic reticulum swelling as well as vacuolated cytoplasm were noticed. As for the sperm per se, we found the degenerated nuclei and/or incomplete mitochondrial derivative, axoneme and vacuolated flagella. Regarding deformity in F1, F2 and F3 ovariole, ultrastructural alteration observed by scanning electron microscopy (SEM) included malformations involving fragile enveloping peritoneal sheath, cracked ovarioles, peel away chorion, crumbled eggshell and incomplete development; whereas TEM presented malformed and disorganized mass of cells, proteic yolk granules and vacuolated vesicles.ConclusionsAdminister of HC to adult C. megacephala caused ovariole reduction, less matured ovariole and affected cellular changes in testes and ovariole of offspring up to F3.     

Identification of novel therapeutically effective antibiotics using silkworm infection model

Most antibiotics obtained by in vitro screening with antibacterial activity have inappropriate properties as medicines due to their toxicity and pharmacodynamics in animal bodies. Thus, evaluation of the therapeutic effects of these samples using animal models is essential in the crude stage. Mammals are not suitable for therapeutic evaluation of a large number of samples due to high costs and ethical issues. We propose the use of silkworms (Bombyx mori) as model animals for screening therapeutically effective antibiotics. Silkworms are infected by various pathogenic bacteria and are effectively treated with similar ED(50) values of clinically used antibiotics. Furthermore, the drug metabolism pathways, such as cytochrome P450 and conjugation systems, are similar between silkworms and mammals. Silkworms have many advantages compared with other infection models, such as their 1) low cost, 2) few associated ethical problems, 3) adequate body size for easily handling, and 4) easier separation of organs and hemolymph. These features of the silkworm allow for efficient screening of therapeutically effective antibiotics. In this review, we discuss the advantages of the silkworm model in the early stages of drug development and the screening results of some antibiotics using the silkworm infection model.     

Mucocele of the appendix due to endometriosis:A rare case report

Mucocele of the appendix due to endometriosis is extremely rare,and there are only 10 previously reported cases in the English literature.We report a case of mucocele of the appendix due to endometriosis and provide the first review of the literature.A 43-year-old woman was admitted to the hospital because of recurrent right lower abdominal pain during her menstrual periods.Colonoscopy revealed submucosal tumorlike elevations of the appendiceal orifice.Computed tomography and magnetic resonance imaging of the abdomen suggested cystic lesions near the appendix.Consequently,mucocele of the appendix was suspected preoperatively.An open ileocecal resection was performed.Multiple cystic lesions were observed around the appendix.The cystic lesions contained mucus.Histopathological examination was consistent with a mucocele of the appendix due to endometriosis.The postoperative course was uneventful.We present the first review of the literature to clarify the clinical features.