Scrub typhus induced by peripheral blood stem cell transplantation in the immunocompromised patient: diagnostic usefulness of nested polymerase chain reaction

Scrub typhus (Orientia tsutsugamushi) is a Gram‐negative rickettsial disease in parts of Asia, transmitted from wild rodents to human by mites. This is a case report of scrub typhus contraction in an acute leukemia patient by transfusion of peripheral blood stem cells collected during the incubation period. Although human‐to‐human transmission of scrub typhus by needle‐stick injury or transplacental transmission has previously been reported, this is the first case confirmed by polymerase chain reaction (PCR) and DNA sequencing. This type of incident shows the need to heighten awareness of the threat of rickettsial agents in transfused blood. Nested PCR is a useful diagnostic method to confirm the diagnosis during incubation period and in the early phase of disease, especially for immunocompromised patients.     

Umbilical portion of recipient's left portal vein: a useful vascular conduit in dual living donor liver transplantation for the thrombosed portal vein.

We considered performing living donor liver transplantation (LDLT) in a larger-size recipient. When the recipient was large-sized, or when the donor liver was severely steatotic or had a right-to-left volume discrepancy. We devised dual living donor liver transplantation (DLDLT) to make up for graft size insufficiency and to secure the donor's safety. However, portal vein thrombosis (PVT) presented a challenge for DLDLT because of the need for intact right and left portal veins for the implantation of both liver grafts. Our 52-year-old male patient with hepatitis B cirrhosis had suffered from repeated esophageal and gastric variceal bleeding and underwent 2 trials of a transjugular intrahepatic portosystemic shunt (TIPS). He developed TIPS occlusion and PVT involving the area just above the spleno-mesenteric confluence to the right and left PV. Also, the right PV orifice was destructed and difficult to isolate because of severe periportal inflammation and neointima growth in the TIPS mesh. The patient's two sons were inadequate for donation because of right-to-left volume discrepancy. Therefore, DLDLT using 2 left lobes was necessary to compensate for graft-size insufficiency and to secure donor safety, and we substituted an intact umbilical portion of recipient's left PV for the destroyed right PV. The patient recovered well, and liver function has been normal for more than a year. In conclusion, the umbilical portion of recipient's left PV can be a useful vascular substitute for the reconstruction of a thrombosed main portal branch in DLDLT.     

A case of hemorrhagic gallbladder paraganglioma causing acute cholecystitis.

Gallbladder paraganglioma is a very rare tumor and so far only a few cases have been reported. Most of these were asymptomatic and were found incidentally during operation. Recently, we experienced a gallbladder paraganglioma that gave rise to hemorrhage, which in turn caused acute cholecystitis. Our case involved a 45 year-old female patient complaining of an intermittent right upper abdominal pain. After a preoperative evaluation, cholecystectomy and lymphadenectomy were performed under the impression of gallbladder cancer with acute cholecystitis. Postoperative pathologic examination revealed a hemorrhagic gallbladder paraganglioma accompanied by acute cholecystitis. Immunohistochemical staining of the chief cells for neuron specific enolase, chromogranin and synaptophysin were positive. Sustentacular cells also stained positively for S100 protein.     

Under‐recognized soft‐tissue structures inferior and lateral to the head of the clavicle: Anatomy with computed tomography correlation

This study was undertaken to provide an anatomical explanation for two soft‐tissue structures anecdotally found on axial computed tomography (CT) scan, which are inferior (SI) and lateral (SL) to the head of the clavicle and adjacent to the sternoclavicular joint (SCJ). Three sets of cryosection images were reviewed to identify the anatomical structures corresponding to SI and SL. To demonstrate that SI and/or SL communicate with the SCJ cavity in the living, 312 consecutive chest CT scans were assessed for coexistence of SCJ and SI/SL air. To prove that under‐recognition of SI and SL is due to the use of thick‐section CT scan, another 50 consecutive chest CT scans were evaluated: visibility of SI and SL, and continuity between them on thick (5 mm)‐section images were compared with those on thin (0.75 mm)‐section images. The anterior portions of SI and SL were extensions from the SCJ cavity in the cryosection images, with the articular cartilage and disc occupying variable volumes of SI. The posterior portions of the SI and SL corresponded to the thyroid strap muscles. Air was present in 1 SI, 6 SLs, and 10 SCJs. Four of five patients with SI or SL air had coexisting SCJ air. Thick sections provided significantly poor visibility of SI and SL and continuity compared with thin‐section images. SI and SL are constant shadows on thin‐section CT scan, and their anterior and posterior portions represent extensions of the SCJ cavity and the strap muscles, respectively. The use of thick sections may be responsible for the under‐recognition of SI and SL on CT scan. Clin. Anat. 23:803–810, 2010. © 2010 Wiley‐Liss, Inc.     

A Unique Instrumental Malfunction during Robotic Prostatectomy

Over the past decade, the introduction of robotics in the field of medicine has provided a new approach to patients requiring surgery, and both its advantages and disadvantages are currently under study by many groups worldwide. The use of robotics has especially been considered by the urological community as a treatment option in radical prostatectomy. The current case report is one in which the da Vinci Surgical System™, with fourth arm use was employed in radical prostatectomy. This case presents a unique occurrence in which a bolt of the Prograsper forcep became loose during an operation, leading to diminished device functionality and later impedance of its removal. A circumstance such as this has not previously been reported, so we introduce for other robotic surgeons our unique instrumental malfunction case during a robotic prostatectomy.     

[HDL‐C/apoA‐I]: A multivessel cardiometabolic risk marker in women with T2DM

Aims

Although women have higher high‐density lipoprotein cholesterol (HDL‐C) than have men, their HDL particles are also prone to become small, dense, and dysfunctional in case of type 2 diabetes mellitus (T2DM). To assess the vascular risk related to HDLs of different sizes/densities without direct measurement, we adjusted HDL‐C to its main apolipoprotein (apoA‐I) as [HDL‐C/apoA‐I]. This ratio estimates HDL sizes and provides indices as to their number, cholesterol load, and density.

Methods

We stratified 280 Caucasian T2DM women according to [HDL‐C/apoA‐I] quartiles (Q) to determine how they are segregated according to cardiometabolic risk, β‐cell function, glycaemic control, and vascular complications. Five parameters were derived from combined determination of HDL‐C and apoA‐I: HDL size, HDL number, cholesterol load per particle (pP), apoA‐I pP, and HDL density.

Results

An adverse cardiometabolic profile characterized QI and QII patients whose HDLs were denser and depleted in apoA‐I, whereas QIII patients had HDLs with characteristics closer to those of controls. QIV patients had HDLs of supernormal size/composition and a more favourable phenotype in terms of fat distribution; insulin sensitivity (64% vs 41%), metabolic syndrome, and β‐cell function (32% vs 23%); exogenous insulin (44 vs 89 U·d^?1); and glycaemic control (glycated haemoglobin, 56 vs 61 mmol·mol^?1), associated with lower prevalence of microvascular/macrovascular complications: all‐cause microangiopathy 47% vs 61%; retinopathy 22% vs 34%; all‐cause macroangiopathy 19% vs 31%; and coronary artery disease 6% vs 24% (P < .05).

Conclusion

[HDL‐C/apoA‐I] can stratify T2DM women according to metabolic phenotype, macrovascular and coronary damage, β‐cell function, microangiopathic risk, and retinopathy. This ratio is a versatile and readily available marker of cardiometabolic status and vascular complications in T2DM women.     

Methylene chloride fraction of the leaves of Thuja orientalis inhibits in vitro inflammatory biomarkers by blocking NF-κB and p38 MAPK signaling and protects mice from lethal endotoxemia

Aim of the study

Thuja orientalis (TO) has been a recognized herbal medicine across Northeast Asian countries for thousands of years and used for the treatment of various inflammatory diseases through as yet undefined mechanisms. In this study, we set out to determine whether the anti-inflammatory effects of this plant are mediated to suppress mitogen-activated protein kinases (MAPKs) and nuclear factor-κB (NF-κB) activation in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells.

Materials and methods

RAW 264.7 cells were pretreated with the methylene chloride fraction of TO (MTO) and stimulated with LPS. Nitric oxide (NO) release was determined by the accumulation of nitrite in the culture supernatants and tumor necrosis factor-α (TNF-α) and IL-6 secretion were determined by immunoenzymatic assay. Inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) expression were evaluated via RT-PCR and Western blotting. NF-κB activation was also evaluated by reporter gene assay and electrophoretic mobility shift assay (EMSA). In addition, the protective effect of MTO was evaluated by use of the LPS-induced endotoxin shock model in mice.

Results

We found that MTO significantly suppressed LPS-stimulated NO and IL-6 production without affecting cell viability. MTO inhibited the expression of LPS-induced iNOS and COX-2 protein and their mRNA expression. Also, TNF-α and IL-6 secretion were decreased by MTO in both PMA and ionomycin-stimulated splenocytes. As a result, MTO inhibited pro-inflammatory cytokines such as TNF-α and IL-6, which is hypothesized as being due to the suppression of LPS-induced p38 MAPK and NF-κB activation. Moreover, MTO improved the survival rate during lethal endotoxemia by inhibiting the production of TNF-α in an animal model and our LC-MS analysis showed that a major component of MTO was pinusolide.

Conclusions

We demonstrate here the evidence that the methylene chloride fraction of Thuja orientalis (MTO) potentially inhibits the biomarkers related to inflammation in vitro and in vivo, and might be provided as a potential candidate for the treatment of inflammatory diseases.     

Dysbindin gene variants are associated with bipolar I disorder in a Korean population

The dysbindin gene (DTNBP1) has been associated with schizophrenia in several populations. Because the clinical characteristics of schizophrenia and bipolar disorder overlap in many respects and findings from genetic studies have suggested common genes between them, we conducted a case control association study of bipolar disorder in Korea to investigate the genetic association between DTNBP1 and bipolar disorder. In total, 163 patients with bipolar disorder and 350 controls were evaluated. We genotyped three single nucleotide polymorphisms of DTNBP1 (SNP A, P1763, and P1320) and analyzed the allele, genotype, and haplotype associations with bipolar disorder. We found significant genotypic associations with P1763 and P1320, but no association with SNP A in the bipolar I group. When we included bipolar II and schizoaffective disorder in the affected phenotype, the significance decreased. A positive association was observed between the SNP A-P1763 haplotype and the bipolar I phenotype. This haplotype association was lost when we either broadened our phenotype or included P1320 in a haplotype. The positive results of the present study lost significance after a Bonferroni correction for multiple testing. These findings are consistent with previous findings that showed a positive association of DTNBP1 with bipolar disorders. Moreover, our results suggest that DTNBP1 may contribute more to bipolar I disorder than bipolar II disorder or schizoaffective disorder. Further comprehensive studies will be required to clarify these association, however, it seems likely that DTNBP1 is a susceptibility gene for bipolar disorder.     

The effect of isolancifolide on the apoptosis in HL-60 cells through caspase-8-dependent and -independent pathways

Isolancifolide is a compound extracted and isolated from Actinodaphne lancifolia, which is a traditional oriental medicine. To determine whether isolancifolide has therapeutic potential as an anticancer molecule, we assessed its apoptotic effects on HL-60 cells, a human leukemia cell line. Apoptotic activities were investigated using DNA fragmentation assay, immunoblotting, and flow cytometry. We found that the inhibitory concentration 50% of isolancifolide was approximately 20 M. The time- and dose-dependent effects of isolancifolide on apoptosis were determined by DNA fragmentation and propidium iodide staining, and the involvement of caspases and the Bcl-2 family in isolancifolide-induced apoptosis was assessed by Western blotting. During exposure to isolancifolide, the pro-forms or full length of caspases-8, -3, and Bid were decreased, as assessed by Western blotting, while the levels of cleaved forms of caspases-8, -3, and PARP were increased. We observed that the release of cytochrome c and Smac/DIABLO from the mitochondria to the cytosol was accompanied by the loss of mitochondrial membrane potential. The caspase specific inhibitors, z-IETD-fmk and z-LEHD-fmk, blocked the accumulation of sub-G1 cells and the release of cytochrome c, but not that of Smac/DIABLO. These results indicate that isolancifolide induces apoptosis of HL-60 cells through both death receptor and mitochondria pathways, in caspase-8-dependent and -independent manners, suggesting that isolancifolide may be useful in anticancer strategies.