Acoustically detectable cellular-level lung injury induced by fluid mechanical stresses in microfluidic airway systems

We describe a microfabricated airway system integrated with computerized air-liquid two-phase microfluidics that enables on-chip engineering of human airway epithelia and precise reproduction of physiologic or pathologic liquid plug flows found in the respiratory system. Using this device, we demonstrate cellular-level lung injury under flow conditions that cause symptoms characteristic of a wide range of pulmonary diseases. Specifically, propagation and rupture of liquid plugs that simulate surfactant-deficient reopening of closed airways lead to significant injury of small airway epithelial cells by generating deleterious fluid mechanical stresses. We also show that the explosive pressure waves produced by plug rupture enable detection of the mechanical cellular injury as crackling sounds.     

Successful treatment of a patient with primary Sjögren's syndrome complicated with pericarditis during pregnancy

A 35-year-old woman with primary Sj?gren's syndrome (pSS) developed fever and chest pain during pregnancy. When the dose of prednisolone was reduced, she experienced chest pain with elevated CRP and D-dimer, resulting in admission to our hospital with marked cardiomegaly and pleural effusion. Because there was no evidence of other autoimmune disorders or infection, oral prednisolone was increased to 30 mg daily with heparin, and hypercoagulopathy was carefully monitored. The patient's condition improved rapidly, and she delivered a healthy baby. This is the first case to support the beneficial effect of prednisolone in pericarditis with pSS, and illustrates its safety during pregnancy.     

Clinical significance of high-sensitivity C-reactive protein in lifestyle-related disease and metabolic syndrome

OBJECTIVES: High-sensitivity C-reactive protein (hs-CRP), a biochemical marker of subclinical inflammation, is associated with atherosclerosis and cardiovascular disease. The present study evaluated the clinical usefulness of hs-CRP in lifestyle-related diseases and metabolic syndrome. METHODS: Hs-CRP was measured in 407 subjects who underwent a checkup at our Medical Office of Cardiology. Levels of hs-CRP were compared between various clinical conditions associated with lifestyle-related diseases and metabolic syndrome. RESULTS: Levels of hs-CRP were significantly high in the subjects with hypertension, hyperlipidemia, diabetes, obesity, and metabolic syndrome (p < 0.001). Both diabetes and metabolic syndrome were strongly associated with hs-CRP levels (diabetes: p = 0.0001, beta = 0.184; metabolic syndrome: p < 0.00001, beta = 0.264). In addition, hs-CRP levels were strongly associated with number of risk factors, and hs-CRP levels were significantly increased with increased number of risk factors. In patients with many risk factors, levels of hs-CRP were significantly higher in subjects with abdominal obesity than in normal subjects (p < 0.001). Waist circumference and hemoglobin A1c levels represented independent predictors for hs-CRP levels in subjects with metabolic syndrome (waist circumference: p < 0.00001, beta = 0.256; hemoglobin A1c: p < 0.00001, beta = 0.242). CONCLUSIONS: Levels of hs-CRP were strongly associated with lifestyle-related diseases, metabolic syndrome, and increased number of risk factors. These results suggest that measurement of hs-CRP may be useful in risk management for clinical practice.     

Fatal fulminant Clostridium difficile colitis during CHOP therapy for lymphoma: an autopsy case

Although Clostridium difficile colitis is a common problem during chemotherapy, fulminant expression is rarely observed. Here, we describe a 68-year-old woman who developed fatal colitis due to Clostridium difficile infection. The patient was treated with CHOP therapy for relapsed lymphoma. In the nadir phase, she developed severe bloody diarrhea with a high fever and died within 12 hours after the beginning of symptoms. Clostridium difficile was identified in her stool and an autopsy showed hemorrhagic necrosis on the whole colon and rectum. This case demonstrates the substantial incidence of an unexpected feature with Clostridium difficile infection even with popular chemotherapy.     

Increase of stroke incidence after weekend regardless of traditional risk factors: Takashima Stroke Registry, Japan; 1988-2003

BACKGROUND AND PURPOSE: The study purpose was to identify patterns of variation in stroke incidence among days of the week and examine if it is modified by conventional stroke risk factors: hypertension, diabetes, drinking and smoking. METHODS: Data were obtained from the Takashima Stroke Registry, which covers a stable population of roughly 55,000 residents of Takashima County in central Japan. A total of 1,773 stroke cases (men: 943 and women: 830) occurred between 1988 and 2003. We divided the days into 3 groups: 'weekend', 'after weekend' and 'rest of the week', and calculated stroke incidence rates and incidence rate ratios. To identify the effect of conventional risk factors on the variation, proportion of differences between observed and expected stroke incidences were considered. RESULTS: The stroke incidence for the after weekend group (250.1 per 100,000 person years, 95% CI: 222.0-278.3) was higher than for the other day groups among men. The after weekend increase was observed mainly among older men aged 65 years or more. Among the stroke subtypes, the incidence for cerebral infarction was highest in the after weekend group (857.2, 95% CI: 730.6-983.8) and was 1.37 times (95% CI: 1.12-1.68) higher than in the rest of the week group. Tendency of after weekend increase was observed regardless of the presence or absence of risk factor history. CONCLUSIONS: Week day variation for stroke was observed predominantly among older men regardless of presence and absence of risk factor history. Information about the weekly trend regarding episode of increased stroke incidence can be used as a surrogate predictor for stroke onset and would be helpful in designing more effective insights for preventive strategies.     

Ictal electroencephalographic correlates of posttreatment neuropsychological changes in electroconvulsive therapy: a hypothesis-generation study

OBJECTIVES: Electroconvulsive therapy (ECT) has been associated with memory and neuropsychological changes, but which features of ECT are associated with those changes have not been well investigated. The aim of this hypothesis-generation study was to examine correlations between ictal electroencephalographic (EEG) characteristics and cognitive side effects after ECT. METHODS: Eight patients with major depressive disorder were examined with the Wechsler Memory Scale-Revised (WMS-R), the Stroop test, the Trail Making Test, and verbal fluency before and after ECT treatment. Seven ictal EEG measurements (eg, slow-wave phase amplitude, postictal suppression) were manually rated by 3 independent psychiatrists. The correlations between ictal EEG measurements, changes in WMS-R subset scores, and non-memory-related neuropsychological assessments were examined with Spearman rank correlation. RESULTS: Verbal memory, general memory, attention/concentration, delayed memory of WMS-R subset scores, and the Stroop test scores improved significantly after ECT treatment. Postictal suppression and slow-wave amplitude correlated positively with delayed memory and visual/verbal discrepancy score. Slow-wave amplitude correlated negatively with letter fluency. The longer the polyspike wave duration, the higher the attention/concentration test results. CONCLUSIONS: Certain ictal EEG measurements were associated with changes in several neuropsychological test results that had improved 2 weeks after the final ECT treatment. A hypothesis-testing study with a larger sample is needed to verify the relationships between EEG measurements and neuropsychological test performance.