Antimicrobial susceptibility of respiratory Haemophilus influenzae strains isolated from pediatric respiratory tract infections

BACKGROUND: Haemophilus influenzae (H. influenzae) is the most frequent bacterial pathogen of respiratory tract infections in children. Detection of antimicrobial susceptibility of H. influenzae is necessary for institution of appropriate antibiotic treatments. METHODS: A total of 281 strains of H. influenzae isolated from sputum samples of 281 pediatric patients with respiratory tract infections were recruited for study. Antibiotic susceptibility was determined by assessing minimum inhibitory concentrations (MIC) of antimicrobial agents. MIC were measured by utility of Agar dilution susceptibility test. RESULTS: Of the total, 38 (13.5%) strains produced beta-lactamase (BLP), 56 (19.9%) strains were beta-lactamase non-producing, ampicillin resistant (BLNAR). The overall resistant proportion to ampicillin was 33.4%. The data indicated that sulbactam/ampicillin, cefotaxime, ceftriaxone and cefditoren are effective against BLP strains. In addition, a high prevalence of BLNAR H. influenzae strains was identified, with an overall isolation rate of 19.9%. Those strains mainly demonstrated intermediate level to ampicillin (ampicillin-MIC 相似文献   

Rhabdomyolysis associated with influenza A/H1N1 2009 infection in a pediatric patient

The influenza A/H1N1 2009 epidemic has spread to many countries since 2009, including Japan. We report an immune‐competent child involving rhabdomyolysis and compartment syndrome associated with influenza A/H1N1 2009. The patient was demonstrated rhabdomyolysis with myoglobinuria, hyperkalemia, cardiac dysfunction and compartment syndrome that arose during convalescence from influenza A/H1N1 2009 infection. Although RT‐PCR of muscle tissue yielded negative results for influenza A/H1N1 2009 RNA and no viral positive‐antigen cells were detected in the muscle lesions, the clinical picture suggested rhabdomyolysis associated with influenza A/H1N1. Rhabdomyolysis should be considered in the evaluation of muscle symptoms such as myalgia associated with novel influenza A/H1N1 2009 virus infection, particularly in critically ill patients.     

Weight-based high- and low-dose ribavirin in combination with peginterferon α-2b therapy for genotype 2 chronic hepatitis C: A randomized trial

Aim: The optimal ribavirin dose in the treatment of patients infected with hepatitis C virus (HCV) genotype 2 remains to be elucidated. We aimed to seek the optimal ribavirin dose required for this genotype in a randomized trial. Methods: We compared the efficacy and tolerability of the 24‐week peginterferon α‐2b (1.5 µg/kg/week) therapy in combination with a weight‐based higher dose (600–1000 mg) and lower dose (400–800 mg) of ribavirin for genotype 2 patients. Noninferior margin was set at 10%. Results: A total of 120 patients were randomized to a higher‐dose or a lower‐dose group. Sustained virological response (SVR) by intention‐to‐treat analysis was achieved in 47/58 (81.0%, 90% confidential interval [CI]: 72.6–89.5) patients in the higher‐dose group and 41/60 (68.3%, 90% CI: 58.5–78.2) patients in the lower‐dose group (difference, ?12.7%; 90% CI, ?25.7 to 0.3). Relapse rates were 10% and 21.6% in the higher‐dose and the lower‐dose groups, respectively. Multiple logistic regression analysis showed that ribavirin dose/kg body weight was the only significant predictor of SVR (≥9.5 mg/kg per day vs <9.5 mg/kg per day; odds ratio = 3.34; 95% CI, 1.41–7.92; P = 0.006). Twenty‐one (36.2%) in the higher‐dose group required ribavirin dose reduction because of anemia, whereas seven patients (11.7%) did in the lower‐dose group (P < 0.01). Three of the higher‐dose group and two of the lower‐dose group required premature termination of therapy. Conclusions: Weight‐based lower‐dose ribavirin regimen was not equivalent to the higher‐dose counterpart in the treatment of HCV genotype 2. We discourage treating these patients with low‐dose ribavirin regimens. The peginterferon therapy in combination with ribavirin at a weight‐based higher dose (600–1000 mg) remains the standard‐of‐care treatment for this genotype.     

Left non-recurrent inferior laryngeal nerve in a patient with right-sided aortic arch and aberrant left subclavian artery

Non-recurrent inferior laryngeal nerve (NRILN) is rare but one of the important anatomical variations in thyroid and parathyroid surgery. Almost all cases were observed on the right side with aberrant right subclavian artery and left NRILN have been reported in only five cases so far. Here, we reported a 38 year-old Japanese male with left NRILN accompanying adenomatous goiter. He was referred to our hospital for the surgical treatment of left thyroid goiter. Preoperative computed tomography revealed right-sided aortic arch and aberrant left subclavian artery with no signs of complete situs inversus viscerum, suggesting possible left NRLN. Left hemithyroidectomy was performed using nerve monitoring system. Intraoperatively, left recurrent laryngeal nerve was not identified along tracheoesophageal groove, but directly originated from vagal nerve and was running horizontally to larynx. Mobility of vocal cords were not impaired and postoperative course was uneventful. During thyroid surgery for the patients with right-sided aortic arch, meticulous care should be taken using nerve monitoring system to avoid nerve injury.     

Age-related decline in white matter integrity in a mouse model of tauopathy: an in vivo diffusion tensor magnetic resonance imaging study

Elevated expression of human hyperphosphorylated tau is associated with neuronal loss and white matter (WM) pathology in Alzheimer's disease (AD) and related neurodegenerative disorders. Using in vivo diffusion tensor magnetic resonance imaging (DT-MRI) at 11.1 Tesla we measured age-related alterations in WM diffusion anisotropy indices in a mouse model of human tauopathy (rTg4510) and nontransgenic (nonTg) control mice at the age of 2.5, 4.5, and 8 months. Similar to previous DT-MRI studies in AD subjects, 8-month-old rTg4510 mice showed lower fractional anisotropy (FA) values in WM structures than nonTg. The low WM FA in rTg4510 mice was observed in the genu and splenium of the corpus callosum, anterior commissure, fimbria, and internal capsule and was associated with a higher radial diffusivity than nonTg. Interestingly, rTg4510 mice showed lower estimates for the mode of anisotropy than controls at 2.5 months suggesting that changes in this diffusivity metric are detectable at an early stage preceding severe tauopathy. Immunogold electron microscopy partly supports our diffusion tensor imaging findings. At the age of 4 months, rTg4510 mice show axonal tau inclusions and unmyelinated processes. At later ages (12 months and 14 months) we observed inclusions in myelin sheath, axons, and unmyelinated processes, and a “disorganized” pattern of myelinated fiber arrangement with enlarged inter-axonal spaces in rTg4510 but not in nonTg mice. Our data support a role for the progression of tau pathology in reduced WM integrity measured by DT-MRI. Further in vivo DT-MRI studies in the rTg4510 mouse should help better discern the detailed mechanisms of reduced FA and anisotropy mode, and the specific role of tau during neurodegeneration.     

Functional and oncological outcomes after retropharyngeal node dissection for papillary thyroid carcinoma

European Archives of Oto-Rhino-Laryngology - Papillary thyroid carcinoma frequently metastasizes to central and lateral neck lymph nodes, but metastasis to retropharyngeal lymph nodes (RPLN) is...     

Sentinel lymph node biopsy and low axillary node sampling for breast cancer

Since sentinel lymph node(SLN) biopsy has a higher negative predictive value than that of four-node sampling, SLN biopsy might become the new acknowledged standard of clinical care for patients with early breast cancer. SLN biopsy is widely used in Western countries despite the lack of data from randomized trials. Clinical practice guidelines document that SLN biopsy should be performed with prudent informed consent and thorough surgical technique. Before surgeons replace axillary dissection with SLN biopsy as the staging procedure at their institution, they should perform backup axillary dissection until a detection rate of more than 90% and a false-negative rate of less than 5% are achieved. Recently, SLN biopsy has more often been indicated for multicentric breast cancer, larger tumors, prior excisions, and noninvasive carcinoma. While SLN biopsy is widely used in Western countries, there is little experience in Japan. If randomized studies, clinical practice guidelines, and the coverage of lymphoscintigraphy under health insurance were introduced, SLN biopsy would be used more widely in Japan.