Fatal hemorrhagic pneumonia caused by Stenotrophomanas maltophilia in a patient with non-Hodgkin lymphoma

Stenotrophomonas maltophilia is increasingly emerging as a multiresistant pathogen in the hospital environment. In immunosuppressed patients, this bacterium may cause severe infections associated with sepsis and multiple organ dysfunction. We report on a 57-year-old woman treated with intensive chemotherapy for non-Hodgkin lymphoma who developed severe neutropenia, hemorrhagic pneumonia, and acute respiratory failure, which led to her death within 36 h of onset of pneumonia. Postmortem examination revealed bilateral extensive intraalveolar hemorrhage associated with severe infection by the gram-negative bacterium Stenotrophomonas maltophilia. In vitro susceptibility testing showed resistance to carbapenem, cephalosporines and aminoglycosides, but sensitivity to minocycline, ciprofloxacin, levofloxacin, and trimethoprim/sulfamethoxazole (cotrimoxazole). Early diagnosis and adequate antibiotic treatment were difficult, as the clinical course was rapid and fulminant, and this bacterium is resistant to multiple antibiotics. To improve prognosis in such cases, it will be necessary to develop an effective prophylactic strategy for high-risk patients.     

Long‐Term Safety and Efficacy of Bixalomer in Hyperphosphatemic Patients With Chronic Kidney Disease Not on Dialysis

Bixalomer, a metal‐free, nonabsorbable phosphate binder, is approved in Japan to treat hyperphosphatemia in dialysis patients. Bixalomer is effective and has a favorable safety profile in predialysis patients with hyperphosphatemia. This study examined the long‐term effectiveness and safety of bixalomer in predialysis patients with hyperphosphatemia. This was a 48‐week, multicenter, open‐label, phase 3 study in Japanese predialysis patients with hyperphosphatemia. Patients received bixalomer at an initial dose of 1500 mg/day, which was titrated to a maximum of 7500 mg/day depending on patients’ serum phosphorus responses to bixalomer. A total of 105 patients received bixalomer treatment, and 39 completed the study. The most common reason for discontinuation was initiation of dialysis. Mean serum phosphorus concentrations decreased from 5.15 mg/dL at baseline to 4.67 mg/dL at Week 12 and then fluctuated slightly around this level until it reached 4.58 mg/dL at Week 48. The proportion of total patients achieving the target serum phosphorus concentration (≥2.5 to <4.6 mg/dL) increased after treatment to a maximum of 66.2% at Week 20 and subsequently decreased to 51.3% by Week 48. Most adverse events (AEs) occurred in the first 12 weeks of treatment. The incidence of AEs did not increase with long‐term treatment. Common AEs reported included nasopharyngitis (29.5%), constipation (19%), and upper respiratory tract inflammation (12.4%). These findings suggest that long‐term treatment with bixalomer is effective, well tolerated, and has no new safety concerns. Bixalomer may be an alternative treatment option for the long‐term management of hyperphosphatemia in patients with chronic kidney diseases.     

Clinical Significance of Fibroblast Growth Factor (FGF) Expression in Colorectal Cancer

In this study, we serologically and pathologically examined the clinical significance of fibroblast growth factor (FGF) expression in patients with colorectal cancer. Serum basic FGF (bFGF) levels in 92 surgical colorectal cancer patients and 31 controls were measured, and the relationship between those levels and clinicopathological factors were examined. Immunohistochemical study was also conducted on specimens from 51 cancer patients, and the association between bFGF staining and serum levels were investigated. An examination of clinicopathological factors revealed significant differences in bFGF levels between stage 0-IIIb and stage IV cancers (P = 0.013). Lymphatic invasion was one factor that differed significantly. Patients with a tumor 30 mm or smaller had a bFGF level of 7.65 ± 1.11 pg/ml while patients with a tumor 31 mm or larger had a bFGF level of 8.53 ± 3.22 pg/ml; significant differences in these bFGF levels were noted (P < 0.05). Patients with a tumor that had no lymphatic invasion (ly0) had a bFGF level of 7.25 ± 0.66 pg/ml, those with a tumor that had minimal lymphatic invasion (ly1) had a bFGF level of 7.99 ± 1.68 pg/ml, and those with a tumor that had moderate lymphatic invasion (ly2) had a bFGF level of 9.17 ± 4.23 pg/ml. bFGF levels differed significantly for tumors with no/minimal lymphatic invasion (ly0-ly1) and those with moderate lymphatic invasion (ly2) (P < 0.0001). Serological examination of bFGF levels during the proliferation of colorectal cancer revealed that moderate lymphatic invasion can be readily distinguished.Among the mechanisms responsible for the progression of cancer, cell motility is an important factor that allows cancer cells to detach from the primary tumor and invade nearby tissue. Growth factors that facilitate this motility include epidermal growth factor (EGF), transforming growth factor β (TGF-β), and hepatocyte growth factor (HGF). Fibroblast growth factors (FGFs) have significant interaction with cell growth, differentiation, and functioning, and they play a vital role in processes such as maintaining tissue and repairing damage. Recent reports have indicated that FGFs are involved in pathologies associated with excessive cell growth and angiogenesis, such as tumor formation. The current study examined FGF expression serologically and pathologically in patients undergoing surgery for colorectal cancer, and this study also examined the clinical significance of that expression.     

Different educational programs on medical ultrasound examination for radiological technologists and medical technologists

Radiological technologists (RTs) and medical technologists (MTs) are legally allowed to work as sonographers performing medical ultrasound examination. Despite the total number, much fewer RTs work as sonographers than MTs. To explore the reason, we investigated educational programs, universities, and colleges for both specialties. First, we established five categories of sonographers' competency: 1) Anatomy for imaging diagnosis, 2) Diseases and diagnosis, 3) Imaging, 4) Structure and principle of the equipment, and 5) Evaluation of image quality, using competence reported by the International Society of Radiographers and Radiological Technologists (ISRRT) and diagnostic competency required of sonographers in Japan. Using these categories, we analyzed the content and total instruction time by lectures and seminars based on information written in the syllabi, and explored the differences in education related to sonographers' competency in both programs. "Anatomy for imaging diagnosis" was taught in 15 RT programs (93.8%), and 6 MT programs (31.6%). "Diseases and diagnosis" was taught in 13 RT programs (86.7%), and 8 MT programs (53.3%). "Imaging" was taught in 14 RT programs (100%), and 13 MT programs (76.5%). "Structure and principle of the equipment" was taught in 12 RT programs (85.7%), and 6 MT programs (31.6%). "Evaluation of image quality" was taught in 11 RT programs (84.6%), and 3 MT programs (15.0%). The average instruction time for RT was longer than for MT programs in all categories. RTs are educated and have a foundation to be sonographers at graduation, and may have the possibility to expand their career in this field.