Simple, rapid, and affordable point-of-care test for the serodiagnosis of typhoid fever

We developed a point-of-care test for the serodiagnosis of typhoid fever in the format of an immunochromatographic lateral flow assay. The flow assay for typhoid fever is based on the detection of Salmonella enterica serotype Typhi lipopolysaccharide-specific immunoglobulin M (IgM) antibodies. The assay was evaluated on serum samples collected in a hospital in South Sulawesi, Indonesia, where typhoid fever is endemic, and the results were compared with culture and Widal test. The sensitivity of this typhoid fever IgM flow assay for samples collected at 1st diagnosis from patients with culture-confirmed typhoid fever was determined to be 59.3%. The sensitivity ranged from 41.2% to 89.5%, depending on the duration of illness. A specificity of 97.8% was calculated based on results obtained for patients with clinical suspicion of typhoid fever that was later excluded. The assay is ideal for use as a point-of-care test in health care centers that lack the expertise and facilities to perform culture or the less specific Widal test. Because of its simplicity, the assay may also be used as a field test in remote areas.     

Reliability and validity of the Western Ontario Shoulder Instability Index (WOSI) in the Japanese population

Background  

The Western Ontario Shoulder Instability Index (WOSI) questionnaire is a disease-specific self-evaluated measurement tool used for patients with shoulder instability. The purpose of this study was to evaluate the reliability and validity of the WOSI Japanese version for the Japanese population.     

Giant pseudoaneurysm of the right ventricular outflow tract after repair of truncus arteriosus: evaluation by MR imaging and surgical approach.

One year after surgical repair of the truncus arteriosus, a 1-year 8-month-old boy was found to have a pseudoaneurysm of the right ventricular outflow tract (RVOT). Cine-magnetic resonance imaging (MRI) showed a narrow communication between the RVOT and aneurysm. MRI was useful to evaluate the anatomical and spatial relations between the pseudoaneurysm and the surrounding structures, therefore an appropriate approach was chosen. Thus, a median sternotomy approach was carried out and ordinary central cannulation was feasible to establish a cardiopulmonary bypass. The defect was successfully repaired with reconstruction using a monocuspid outflow patch. MRI provided useful information for deciding the surgical approach.     

Histological evaluation of intra-arterial infusion and systemic chemotherapy of pancreatic carcinomas]

Histological analyses of 16 autopsies of pancreatic carcinoma [9 cases after intra-arterial infusion chemotherapy (IAC), and 7 cases of systemic chemotherapy (SC)] were performed. Histological effects of chemotherapy (Shimosato) were seen in 15 cases, but less than 5 Grade II a. cases of IAC and 4 cases of SC showed Grade IIa, 3 cases of IAC and 3 cases of SC showed Grade I. The ratio of Grade IIa was almost the same in IAC and SC. But histologically, anaplastic change, sarcomatous change and Bizarre cells, immunohistologically positive to anti-EMA and Vimentin antibody, were dominant in IAC. And clinically, serum tumor markers (CEA, CA19-9) were fewer in almost all the cases in IAC. These results may suggest that the anti-tumor effect of IAC was greater than the histological appearance.     

Collagen metabolism in ethionine induced rat chronic pancreatic injury]

Under low choline diet, chronic pancreatic injury was induced by the intraperitoneal administration of ethionine of 10 mg/100 g body weight, 3 times a week for sequential 8 weeks in rats and histological changes, pancreatic hydroxyproline and collagenase activity were studied. Histologically, acute inflammatory changes were observed mainly in the early days, and infiltration of fibroblastoid cells was increased on the 28th day. Then, fat droplets deposition became remarkable. Though hydroxyproline concentration increased gradually after the injection of ethionine and showed maximal level on the 28th day when the slight fibrosis was noticed, it was decreased on the 56th day when collagenous tissue was replaced by fat droplets. On the other hand, collagenase activity showed two peaks, in the early phase and on the 56th day, and it showed bottom level on the 28th day. Collagen synthesis relatively dominated over degradation on the 28th day. It is suggested that the unbalance of collagen metabolism between synthesis and degradation may result in fibrosis.     

The review of seclusion and restraint in psychiatric practice]

In order to create the least restrictive setting in psychiatric practice, we investigated the effects of an assessment by a committee on seclusion and restraint. Using consistent procedures, the committees, which were established in 9 hospitals, reviewed seclusion and restraint maintained for periods of over 2 weeks during a 4-month period. Frequency and duration of seclusion and restraint, staff perceptions of and attitudes to the review system, and patient satisfaction were evaluated before and after the study period. As a result of this review process, the frequency of seclusion decreased slightly in 7 hospitals and 1 of the remaining 2 hospitals showed an increased frequency of seclusion days that were partially interrupted. Frequency of restraint decreased slightly in 5 hospitals, and of the remaining 3, 1 interrupted all periods of restraint, while the other 2 institutions showed an increase in interruption of restraint periods. As there were no common patients in 2 specialist psychiatric emergency hospitals between before and after the study periods, statistical analyses were performed. Only minor variables such as duration of partially interrupted periods of restraint, and duration of periods of restraint that were partially released showed a statistically significant increase. Although patient satisfaction showed a significant increase, staff attitudes to and perceptions of the review system became appreciably more negative. These findings suggest that although the review system had the potential to slightly reduce the use of seclusion and restraint, and to increase patient satisfaction, staff burnout was risked because staff effort was perceived to be disproportionately high in relation to the effect achieved. Furthermore, the possibility remains that the slight decrease of seclusion and restraint demonstrated did not necessarily reflect the appropriate use of these strategies, and were not necessarily lasting effects. However, as differences in opinion existed between the review system committee and treating clinicians regarding continuation of long term seclusion and restraint, the review system could have a role in monitoring the long term use of seclusion and restraint. Further investigation is needed into the long term effectiveness of procedures reviewing the use of seclusion and restraint in the psychiatric setting, taking into account both positive and negative outcomes.     

Supplemental utility of nested PCR for the pathological diagnosis of disseminated trichosporonosis

Disseminated trichosporonosis is known to be a severe opportunistic mycosis and has a high mortality rate. In autopsy cases, it is often difficult to diagnose as trichosporonosis because the causative Trichosporon species are pathologically similar to other fungi, especially the Candida species. Immunohistochemical analysis is essential for the differential diagnosis, but an antibody to Trichosporon is not available commercially. In the present study, we investigated the supplemental utility of nested polymerase chain reaction (PCR) for the pathological diagnosis of trichosporonosis from formalin-fixed and paraffin-embedded tissues. Total DNA was purified from 30 major organs in three autopsy cases, and Trichosporon DNA was specifically amplified by nested PCR using three sets of primers. Of 22 organs in which Grocott’s stain was positive for fungal infection, 170- and 259-bp PCR products were detected in 20 (91%) and 12 (55%) organs, respectively. In short-term fixation (about 1 day), these bands were highly detected in ten (100%) and nine (90%) organs, whereas the detection efficiency tended to decrease after long-term fixation and decalcification. No PCR product of 412 bp was detected in any organs. These findings suggest that nested PCR from short-term-fixed tissues is useful for supportive pathological diagnosis of disseminated trichosporonosis.     

Consolidation with 90Yttrium‐ibritumomab tiuxetan after bendamustine and rituximab for relapsed follicular lymphoma

Bendamustine and rituximab (BR) are widely used in patients with follicular lymphoma (FL) previously treated with conventional immunochemotherapy, but the role of consolidation radioimmunotherapy in these patients is unknown. This study evaluated the efficacy and safety of consolidation with ⁹⁰Yttrium‐ibritumomab tiuxetan (⁹⁰Y‐IT) after re‐induction therapy with BR in patients with previously treated FL. This study included adult patients with relapsed FL who had undergone one or two prior therapies. Re‐induction therapy with BR was administered every 4 weeks up to 4–6 cycles. If patients achieved at least partial response, ⁹⁰Y‐IT was administered as consolidation therapy. The primary endpoint was 2‐year progression‐free survival (PFS) after consolidation. A total of 24 FL patients (median age 60 years) who had undergone one (n = 17) or two (n = 7) prior treatments received BR. After BR therapy, 22 patients proceeded to consolidation with ⁹⁰Y‐IT, resulting in an overall 88% response rate to the protocol treatment. Within a median observation period of 46.8 months, the estimated 2‐year PFS rate after the consolidation among the 22 patients receiving ⁹⁰Y‐IT was 59% (95% confidence interval [CI], 38%–77%). Patients whose remission after previous treatment had lasted ≥2 years had a significantly higher 2‐year PFS rate than patients whose remission after previous treatment had been <2 years (68% vs. 33%, Wilcoxon p = 0.0211). Major adverse events during the protocol treatment and within 2 years after the consolidation were hematological toxicities, but they were generally acceptable. Consequently, the estimated 2‐year overall survival after the consolidation was 95% (95% CI, 74%–99%). In conclusion, in a subset of patients with previously treated FL, ⁹⁰Y‐IT consolidation after BR re‐induction conferred a durable remission, indicating that consolidation therapy using ⁹⁰Y‐IT may be a novel therapeutic option for patients with relapsed FL (UMIN000008793).