In vitro activities of oral cephem and telithromycin against clinical isolates of major respiratory pathogens in Japan

The in vitro antibacterial activities of oral cephem antibiotics and ketolide telithromycin against major respiratory pathogens possessing beta-lactam-resistant mutations (within the pbp gene) and/or macrolide-resistant genes (erm and mef) were examined in clinical isolates collected at 66 institutes in all over the Japan between 2002 and 2003. Telithromycin showed the strongest antibacterial activity against methicillinsusceptible Staphylococcus aureus strains with and without macrolide-resistant genes, such as ermA or ermC gene. All the cephem antibiotics showed potent antibacterial activity against Streptococcus pyogenes, with minimum inhibitory concentrations (MICs) of 0.015 mg/L or lower. Cefdinir had a much higher MIC90 against genotypic penicillin-resistant Streptococcus pneumoniae (gPRSP) than cefditoren and cefcapene (8 mg/L cefdinir vs. 1 mg/L cefditoren and cefcapene). The majority of gPRSP harbored either ermB or mefA, and the antibacterial activity of telithromycin against these strains was decreased however some susceptibility was still sustained. Cefditoren exerted the strongest antibacterial activity against beta-lactamase-negative ampicillin-resistant Haemophilus influenzae, with an MIC90 of 0.5 mg/L. These results underline the importance of checking the susceptibility and selecting an appropriate antibiotic against target pathogens.     

Bradykinin improves left ventricular diastolic function under long-term angiotensin-converting enzyme inhibition in heart failure

Both systolic and diastolic cardiac dysfunction coexist in various degrees in the majority of patients with heart failure. Although ACE inhibitors are useful in the treatment of heart failure, the roles of bradykinin in the systolic and diastolic properties of left ventricular function under long-term treatment of ACE inhibitor have not been fully elucidated. We therefore evaluated the changes in left ventricular function, histomorphometry, and the expression of several failing heart related genes, by use of an orally active specific bradykinin type 2 receptor antagonist, FR173657 (0.3 mg/kg per day), with an ACE inhibitor, enalapril (1 mg/kg per day), in dogs with tachycardia-induced heart failure (270 ppm, 22 days) and compared the effects to enalapril alone. Although there were no differences observed in blood pressure, left ventricular dimension, and percentage of fractional shortening, FR173657 significantly increased left ventricular filling pressure (P<0.01), prolonged the time constant of relaxation (P<0.05), and suppressed the expression of endothelial NO synthase and sarcoplasmic reticulum Ca(2+)-ATPase mRNA (P<0.05). FR173657 also upregulated collagen type I and III mRNA (P<0.05) and increased the total amount of cardiac collagen deposits (P<0.05) in left ventricle compared with that in the enalapril-treated group. In conclusion, endogenous bradykinin contributes to the cardioprotective effect of ACE inhibitor, improving left ventricular diastolic dysfunction rather than systolic dysfunction, via modification of NO release and Ca(2+) handling and suppression of collagen accumulation.     

Performance test for radon measuring instruments using radon chamber at PTB

An intercomparison on radon ((222)Rn) measuring instruments was carried out at the Physikalisch Technische Bundesanstalt, Germany (PTB). Two types of alpha track detectors based on a passive (222)Rn-thoron ((220)Rn) discriminative measurement technique were used: these were the commercially available Raduet and Radopot detectors that were developed and calibrated by the National Institute of Radiological Sciences, Japan (NIRS). The (222)Rn grab sampling and continuous measurement methods were also compared using the PTB pulse ionization chamber. The results using the passive detectors showed that there was a good agreement between the time-integrated (222)Rn concentrations obtained from the Raduet detectors and the PTB pulse ionization chamber, as in the case with the Radopot detectors. In the grab sampling measurements, the agreement between the (222)Rn concentrations measured using the NIRS gas storage ionization chamber and the PTB pulse ionization chamber was within 5% as in the case with the NIRS scintillation cell measurement. Similar to the measurements of the passive detectors and grab sampling, little distinct difference in the (222)Rn concentration was observed for the NIRS continuous electrostatic collection monitor.     

Comparison of active renin concentration and plasma renin activity as a prognostic predictor in patients with heart failure.

BACKGROUND: Plasma renin activity (PRA) may be limited to angiotensinogen levels, which decrease in patients with heart failure (HF) because of liver congestion. METHODS AND RESULTS: To evaluate whether the plasma active renin concentration (ARC) is a more useful prognostic predictor than PRA, the plasma levels of ARC, PRA, angiotensin II, aldosterone, brain natriuretic peptide (BNP), norepinephrine, and hemodynamic parameters were measured in 214 consecutive HF patients who were already taking angiotensin-converting enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB). Median follow-up period was 1,197 days. Of the clinical variables, including pulmonary capillary wedge pressure, right atrial pressure, left ventricular ejection fraction, and neurohumoral factors, only high plasma levels of log ARC (p<0.0001) and log BNP (p=0.0009), but not log PRA, were significant independent prognostic predictors. Log ARC/PRA ratio was significantly higher in nonsurvivors than in survivors. Log ARC/PRA significantly correlated with pulmonary capillary wedge pressure (r=0.305, p<0.0001), right atrial pressure (r=0.222, p=0.0011), and log BNP (r=0.242, p=0.0004). CONCLUSIONS: Plasma ARC is superior to PRA and a high plasma ARC is an independent prognostic predictor in HF patients who are already receiving ACEI or ARB.     

Clinical significance and epidemiologic analyses of Mycobacterium avium and Mycobacterium intracellulare lung disease from post-marketing surveillance

Background

In Japan, nontuberculous mycobacterial lung disease is mostly attributable to Mycobacterium avium complex (MAC), i.e., M. avium or M. intracellulare. However, clinical features of the disease caused by these two pathogens have not been studied sufficiently yet.

Placement of a Sodium Hyaluronate Solution onto the Liver Surface as a Supportive Procedure for Radiofrequency Ablation of Hepatocellular Carcinomas Located on the Liver Surface: A Preliminary Report

PurposeTo evaluate safety and efficacy of the placement of sodium hyaluronate solution onto the liver surface as a supportive procedure for radiofrequency (RF) ablation of hepatocellular carcinomas (HCCs) located on the liver surface as a possible alternative to RF ablation via laparoscopic approach or with the creation of artificial ascites.Materials and MethodsChanges in temperature of a sodium hyaluronate layer placed onto an egg white were measured during coagulation of the egg white by an RF ablation needle. A phase I study was performed to evaluate the safety of intraperitoneal injection of a maximum of 20 mL of sodium hyaluronate solution into humans by observing for the occurrence of intraperitoneal inflammation and adhesion. After these studies, RF ablation with ultrasound-guided injection of sodium hyaluronate onto the liver surface was performed, targeting 28 HCC nodules located on the liver surface. Treatment outcomes and complications of this procedure were investigated.ResultsIn the in vitro experiment, the maximum temperature of sodium hyaluronate solution was 41°C during RF ablation. No intraperitoneal inflammation or adhesions were observed after intraperitoneal injection of sodium hyaluronate in the phase I study. HCC was completely ablated with sufficient margins after one session of RF ablation, without any burn injuries to the abdominal wall or adjacent organs. Local recurrence was observed in one of 28 patients (3.6%) during 30.1 months of follow-up.ConclusionsRF ablation can be safely and effectively performed on HCCs located close to the liver surface with placement of sodium hyaluronate onto the liver surface, thereby preventing burn injuries to abdominal wall or adjacent organs.     

Validation of continuous and noninvasive hemoglobin monitoring by pulse CO-oximetry in Japanese surgical patients

We evaluated the accuracy of noninvasive and continuous total hemoglobin (SpHb) monitoring with the Radical-7^® Pulse CO-Oximeter in Japanese surgical patients before and after an in vivo adjustment of the first SpHb value to match the first reference value from a satellite laboratory CO-Oximeter. Twenty patients undergoing surgical procedures with general anesthesia were monitored with Pulse CO-Oximetry for SpHb. Laboratory CO-Oximeter values (tHb) were compared to SpHb at the time of the blood draws. Bias, precision, limits of agreement and correlation coefficient of SpHb compared to tHb were calculated before and after SpHb values were adjusted by subtracting the difference between the first SpHb and tHb value from all subsequent SpHb values. Trending of SpHb to tHb and the effect of perfusion index (PI) on the agreement of SpHb to tHb were also analyzed. Ninety-two tHb values were compared to the SpHb. Bias ± 1SD was 0.2 ± 1.5 g/dL before in vivo adjustment and ?0.7 ± 1.0 g/dL after in vivo adjustment. Bland–Altman analysis showed limits of agreement of ?2.8 to 3.1 g/dL before in vivo adjustment and ?2.8 to 1.4 g/dL after in vivo adjustment. The correlation coefficient was 0.76 prior to in vivo adjustment and 0.87 after in vivo adjustment. In patients with adequate perfusion (PI ≥1.4) the correlation coefficient was 0.89. In vivo adjustment of SpHb significantly improved the accuracy in our cohort of Japanese surgical patients. The strongest correlation between SpHb and tHb values was observed in patients with adequate peripheral perfusion suggesting that low perfusion may affect the accuracy of SpHb monitoring.     

Public Awareness and Knowledge of Prostate Cancer in Japan: Results of a Survey at Short-Stay Examination Facilities

Background:
This study was undertaken to determine public awareness and knowledge of prostate cancer, which has not been adequately studied in Japan.
Methods:
Assessment was made of public awareness and perception of prostate cancer in Japan, based on health examination data for participants in a short-stay physical examination program ("human dry dock"). A multiple-choice, thirty-point questionnaire survey was conducted at 3 human dry dock medical facilities situated in urban areas.
Results:
Many Japanese adults appeared to be inadequately aware of prostate cancer and of the means available for its early detection. One third of the participants were unfamiliar with this malignancy. Logistic regression analysis indicated smoking to be the only covariate associated with lack of knowledge of prostate cancer (P< 0.05). Seventy-one percent of the subjects had heard of digital rectal examination, but only 1 6% and 8%, respectively, were familiar with the terms transrectal ultrasonography and PSA testing. Japanese people may possibly be less informed about prostate cancer than African-American males. Both human dry dock facilities and subject gender were significantly associated with knowledge of digital rectal examination (P<0.05). Knowledge of transrectal ultrasonography was found to depend on participation in human dry dock programs and level of education (P< 0.05). Smoking, participation in human dry dock programs under employer direction, and health status were all identified as determinants for knowledge of PSA testing (P< 0.05).
Conclusion:
Educational programs should be established and put into effect to instill adequate awareness of prostate cancer in Japan. In a better-informed society, more effort would be directed toward prevention and thus early stage prostate cancer would be detected more often.