Junko Ono

Analysis of the expression of CagA and VacA and the vacuolating activity in 167 isolates from patients with either peptic ulcers or non-ulcer dyspepsia

Objectives:The goals of this study were: 1) to examine the prevalence of cytotoxin-associated protein (CagA), vacuolating cytotoxin (VacA), and the vacuolating cytotoxin activity (VCA) in vitro of infecting Helicobacter pylori isolates and 2) to clarify the relation between the expression of these virulence factors and the occurrence of peptic ulceration.Methods:One hundred sixty-seven clinical isolates of H. pylori from patients with peptic ulcer disease (gastric ulcer, 62 cases; duodenal ulcer, 48 cases) and nonulcer dyspepsia (57 cases) were studied regarding their genetic and phenotypic properties.Results:Type 1 bacteria, which had both CagA and VCA, and type 2 bacteria, which did not express either CagA or VCA, represented 62.9% and 7.8%, respectively; the remaining 29.4% had an intermediate phenotype, expressing either CagA independent of the presence of VCA (CagA+VCA−) or vice versa (CagA−VCA+). CagA+VCA− and CagA−VCA+ bacteria represented 17.4% and 12.0%, respectively, both of which were more numerous than the type 2 category. The proportion of the CagA-positive isolates was significantly higher in both the duodenal ulcer (97.9%) and gastric ulcer (83.9%) patients than in the non-ulcer dyspepsia patients (61.4%) (p < 0.01). On the other hand, the proportion of VacA/VCA-positive isolates was not significantly different between peptic ulcer disease and non-ulcer dyspepsia.Conclusions:The currently used classification of this bacterium based on the concomitant expression of CagA and VacA/VCA into the two major types is not adequate. The CagA-positive phenotype thus may be important as a virulence marker for peptic ulcer disease independent of the presence of VacA/VCA.

Long-term culture of pancreatic islet cells with special reference to the β-cell function

SummaryIslet cells of adult rat pancreas, dissociated with EDTA-Dispase, were cultivated in Microtest wells for over 2 months. In our cultures, islet cells were free-floating and cohered with each other to reorganize histotypic aggregates resembling the nondissociated islets. Morphologically, excellent preservation of islet cells in the aggregates was confirmed during the culture using both light and electron microscopy. The function of islet β-cells, as demonstrated by the synthesis and release of insulin, also was retained throughout the culture period. Islet β-cells cultured for long periods exhibited better response to the shortterm stimulation of theophylline than to a high concentration of glucose, as observed in the islets of fetal or newborn rat pancreas.

Standardization of Laboratory Data and Establishment of Reference Intervals in the Fukuoka Prefecture: A Japanese Perspective

Abstract Standardization of 22 clinical chemistry analytes and five serum protein constituents has been performed in the Fukuoka Prefecture, which has a population of approximately five million. The standardization project was established to determine reference intervals for these analytes by educating physicians, medical technologists and staff of medical institutions, and by daily or monthly monitoring the use of common control samples through e-mail. Standardization extended to 97％ of the institutions in the prefecture. Results for 14 of the 22 clinical chemistry analytes have become highly reliable and differences between institutions decreased. Standardization of other analytes is now in progress. Regional collaboration based on international guidelines led to a significant improvement in interlaboratory comparability. Areas where further improvements are needed have been identified.

Long-Term Culture of Isolated Pancreatic Islet Cells

Summary Successful long-term culture of isolated pancreatic islet as well as dissociated islet cells was accomplished with the use of Microtest II trays which provides the very small amount of culture medium that is easily conditioned. In the culture of isolated islet, the ultrastructure of the islet cells was completely preserved up to the 30th day and vigorous secretion of insulin was maintained even on the 75th day. While in the islet cell culture, insulin secretion gradually decreased from the 12th day. The latter procedure makes inoculation of a definite number of dissociated pure islet cells possible, thus opening the way to the quantitative evaluation of B cell function in vitro.

Age × Gender Interaction Effect on Resuscitation Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Although an interaction between gender and age has been shown to influence resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA), this interaction has not been investigated in Asian populations. In this prospective, observational study, data from all cases of OHCA in Japan between 2005 and 2012 were obtained from the Japanese National Registry. We determined the relative excess risk due to interaction and the ratio of odds ratios (ORs) to assess the interaction effect of gender and age on the incidence of return of spontaneous circulation (ROSC) before hospital arrival, 1-month survival, and neurologically intact survival 1xa0month after OHCA. Male gender was associated with decreased ROSC and lower 1-month survival rates in patients with OHCA of presumed cardiac origin. Older age was associated with lower 1-month and neurologically intact survival rates in male patients with OHCA of presumed cardiac and noncardiac origin and with increased ROSC in male patients with OHCA of presumed cardiac origin. The relative excess risk due to interaction for ROSC in patients with OHCA of presumed cardiac origin was statistically significant (OR 0.19, 95% confidence interval [CI] 0.06 to 0.32). The ratio of ORs for ROSC was statistically significant in patients with OHCA of presumed cardiac origin (OR 1.25, 95% CI 1.05 to 1.47) and of noncardiac origin (OR 0.40, 95% CI 0.17 to 0.92). In conclusion, the interaction effect between age and gender on ROSC was positive in OHCA cases of presumed cardiac origin and negative in those of noncardiac origin.

Interaction of defibrillation waveform with the time to defibrillation or the number of defibrillation attempts on survival from out-of-hospital cardiac arrest

AIMnEarly biphasic defibrillation is effective in out-of-hospital cardiac arrest (OHCA) cases. In the resuscitation of patients with OHCA, it is not clear how the defibrillation waveform interacts with the time to defibrillation to influence patient survival. The second, and any subsequent, shocks need to be administered by an on-line physician in Japan. Thus, we investigated the interaction between the defibrillation waveform and time to or the number of defibrillation on resuscitation outcomes.nnnMETHODSnThis prospective observational study used data for all OHCAs that occurred between 2005 and 2014 in Japan. To investigate the interaction effect between the defibrillation waveform and the time to defibrillation or the number of defibrillations on the return to spontaneous circulation (ROSC), 1-month survival, and cerebral performance category (CPC) (1, 2), we assessed the modifying effects of the defibrillation waveform and the time to or the number of defibrillation on additive scale (i.e., the relative excessive risk due to interaction, RERI) and multiplicative scale (i.e., ratio of odds ratios (ORs)).nnnRESULTSnIn total, 71,566 cases met the inclusion criteria. For the measure of interaction between the defibrillation waveform and the time to defibrillation, ratio of ORs for ROSC was 0.84 (0.75-0.94), implying that the effect of time to first defibrillation on ROSC was negatively modified by defibrillation waveform. For the interaction between the defibrillation waveform and the number of defibrillations, RERI and ratio of ORs for CPC (1, 2) was -0.25 (-0.47 to -0.06) and 0.79 (0.67-0.93), respectively. It is implied that the effect of number of defibrillation on CPC (1, 2) was negatively modified by defibrillation waveform.nnnCONCLUSIONSnAn increased number of defibrillations was associated with a decreased ROSC in the case of biphasic and monophasic defibrillation, while an increased number of defibrillations was related to an increased 1-month survival rate and CPC (1, 2) only in the case of biphasic defibrillation. When two or more defibrillations were performed, a biphasic waveform was more effective in terms of long-term survival than a monophasic waveform.

[A case of hyperosmolar non-ketotic diabetic coma with diffuse rhabdomyolysis].

広範な骨格筋壊死を伴つた非ケトン性高浸透圧性糖尿病昏睡の1例Aする.症例は72才,男性.臨床症状およびCTscan所見より脳腫瘍を疑われ,ステロイドの大量投与をうけたが,急速に意識障害をきたしたので入院した.入院時深昏睡で,著明な高血糖と高浸透圧血症を認めたが血液ガスは正常で,尿中ケトン体も陰性であつた.非ケトン性高浸透圧性糖尿病昏睡と診断し,ただちに経静脈内少量インスリン持続投与と0.45%生理食塩水の大量輸液を開始した.血糖と血漿浸透圧は漸次正常化したが,入院後4日目より尿の色調が茶褐色となつたため,血中,尿中ミオグロビンを測定したところ,いずれも著明な高値を示した.同時に血清CPK,アルドラーゼも高値を示したので骨格筋の障害を疑い, 9日目に左大腿四頭筋より筋生検を施行した.その結果骨格筋の広範な壊死を認め, acute rhabdomyolysisと診断された.その後意識状態は漸次改善したが,発症9ヵ月後においても四肢の著しい筋力低下を残した.非ケトン性高浸透圧性糖尿病昏睡で,ミオグロビン尿を呈した症例はこれまで本邦では報告が見当らず,外国例についてもこのような重篤な筋力低下を残した報告は見当らない.本症例の底範な骨格筋障害は入院時の著明な低カリウム血症,ショック状態,深昏睡に伴うgluteal compartment内圧の上昇に加えて,治療に伴う急速な筋細胞内水分量と電解質の変化などがその要因と考えられるが,とりわけhypokalemic necrotizing myopathyの関与が大きいと考えられた.