Revisiting depressive-prone bipolar disorder: polarity of initial mood episode and disease course among bipolar I systematic treatment enhancement program for bipolar disorder participants.

BACKGROUND: We examined the hypothesis that a first depressive rather than manic episode in bipolar disorder might herald a subsequent course notable for greater burden of depressive symptoms. METHODS: We analyzed retrospective data on the polarity of first mood episode obtained from 704 bipolar I subjects entering the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. Subjects with an initial manic or depressive episode and those in whom both poles occurred within the same year were compared. RESULTS: Depressive-onset bipolar disorder was more common in women and those with earlier onset of illness. Adjusting for these differences, it was significantly associated with more lifetime depressive episodes and a greater proportion of time with depression and anxiety in the year prior to study entry. CONCLUSIONS: Polarity of first mood episode may be useful in distinguishing subsets of bipolar patients at risk for a more chronic course.     

Ciguatera toxin in Cheilinus rhodochrous (Po'ou wrasse)

Cheilinus rhodochrous (po'ou, wrasse) was examined by various assays for the presence of toxins associated with ciguatera fish poisoning. These assays were a stick enzyme immunoassay (S‐EIA); and extraction, chromatography on silica gel, and examination of the fractions by stick enzyme immunoassay, mouse toxicity assay, and guinea pig atrial assay. The active toxic principles were found in the 10% (v/v) and 50% (v/v) methanol/chloroform eluates of viscera and flesh, and had characteristics similar to ciguatoxins found in carnivores.     

A cardiovascular collapse during cemented total hip replacement in a diabetic patient

Key words  cardiac arrest - bone cement - diabetes     

Evaluation of two prognostic indices for adult T‐cell leukemia/lymphoma in the subtropical endemic area,Okinawa, Japan

Aggressive adult T‐cell leukemia/lymphoma (ATL) has an extremely poor prognosis and is hyperendemic in Okinawa, Japan. This study evaluated two prognostic indices (PIs) for aggressive ATL, the ATL‐PI and Japan Clinical Oncology Group (JCOG)‐PI, in a cohort from Okinawa. The PIs were originally developed using two different Japanese cohorts that included few patients from Okinawa. The endpoint was overall survival (OS). Multivariable Cox regression analyses in the cohort of 433 patients revealed that all seven factors for calculating each PI were statistically significant prognostic predictors. Three‐year OS rates for ATL‐PI were 35.9% (low‐risk, n = 66), 10.4% (intermediate‐risk, n = 256), and 1.6% (high‐risk, n = 111), and those for JCOG‐PI were 22.4% (moderate‐risk, n = 176) and 5.3% (high‐risk, n = 257). The JCOG‐PI moderate‐risk group included both the ATL‐PI low‐ and intermediate‐risk groups. ATL‐PI more clearly identified the low‐risk patient subgroup than JCOG‐PI. To evaluate the external validity of the two PIs, we also assessed prognostic discriminability among 159 patients who loosely met the eligibility criteria of a previous clinical trial. Three‐year OS rates for ATL‐PI were 34.5% (low‐risk, n = 42), 9.2% (intermediate‐risk, n = 109), and 12.5% (high‐risk, n = 8). Those for JCOG‐PI were 22.4% (moderate‐risk, n = 95) and 7.6% (high‐risk, n = 64). The low‐risk ATL‐PI group had a better prognosis than the JCOG‐PI moderate‐risk group, suggesting that ATL‐PI would be more useful than JCOG‐PI for establishing and examining novel treatment strategies for ATL patients with a better prognosis. In addition, strongyloidiasis, previously suggested to be associated with ATL‐related deaths in Okinawa, was not a prognostic factor in this study.     

The prevalence of Toxoplasma antibody in patients with various ocular diseases in central Japan

Background: Ocular toxoplasmosis has been considered to be a largely asymptomatic infection because of the high seroprevalence of Toxoplasma antibodies and the low rate of clinical diagnosis. On the other hand, Toxoplasma infection has been reported to be associated with the other ocular disease. To investigate the association of Toxoplasma infection with the development of various ocular diseases, we studied Toxoplasma seroprevalence in patients with various ocular diseases. Methods: We investigated Toxoplasma seroprevalence in 982 patients with various ocular diseases in central Japan. Then we compared the seroprevalence of anti-Toxoplasma antibodies. Results: Of 982 patients with various ocular diseases, 122 (12.4%) had serological evidence of previous exposure to Toxoplasma gondii. There were no statistically significant differences among the patients with various ocular diseases. However, the seroprevalence in patients aged 40 to 99 years with macular degenerative lesions was significantly higher than that in patients without these lesions (P<0.05, Yates' correction). Conclusion: This result suggests that Toxoplasma infection could play some role in the development of a type of macular degenerative lesion.     

Asunaprevir and daclatasvir for recurrent hepatitis C after liver transplantation: A Japanese multicenter experience

The safety and efficacy of an IFN‐free regimen using asunaprevir (ASV) and daclatasvir (DCV) for recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) have not been evaluated in Japan. A multicenter study of LT recipients (n = 74) with recurrent HCV genotype 1b infection treated with ASV‐DCV for 24 weeks was performed. Medical history was positive for pegylated interferon and ribavirin (Peg‐IFN/RBV) in 40 (54.1%) patients, and for simeprevir (SMV) with Peg‐IFN/RBV in 12 (16.2%) patients. Resistance‐associated variants (RAVs) were positive at D168 (n = 1) in the NS3, and at L31 (n = 4), Y93 (n = 4), and L31/Y93 (n = 1) in the NS5A region of the HCV genome. Sixty‐one (82.4%) patients completed the 24‐week treatment protocol. Although sustained viral response (SVR) was achieved in 49 (80.3%) patients, it was achieved in only two (16.7%) patients among those with histories of receiving SMV (n = 12). Univariate analysis showed that a history of SMV (P < .01) and the presence of mutations in NS5A (P = .02) were the significant factors for no‐SVR. By excluding the patients with either a history of SMV‐based treatment or RAVs in NS3/NS5A, the SVR rate was 96.4%. By excluding the patients with a history of SMV and those with RAVs in NS3/NS5A, viral clearance of ASV‐DCV was favorable, with a high SVR rate.