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CAR FIRE FATALITY: A CASE REPORT ON URINARY TRACT INFECTION
Get PDFA woman in her 70s, with a history of lung c ancer, pancreatic cancer, and diabetes mellitus, was
discovered deceased in the driver's seat of her car. She went out with her family in the morning
but felt unwell and attempted to drive home. As she drove, the car burst into flames, prompting
a passerby to call an ambulance. Her head and anterior surfaces of the extremities exhibited
burns, with the thorax and abdomen showing III-IV degree burns on the anterior surface and
I-II degree burns on the dorsal surface in some areas. There were fractures of the sternum, left
clavicle, and bilateral ribs, and damage to the mesentery. Soot was observed in the trachea and
bronchi, and examination revealed no traumatic changes in any viscera. The blood's carboxyhemoglobin
(COHb) concentration was 15%. Histological examination indicated neutrophils in the
blood vessels of the brain, heart, and liver, as well as neutrophil infiltration in the renal parenchyma.
Consequently, the determined cause of death was a urinary tract infection.
The chest severity rating, determined by the Abbreviated Injury Scale (AIS), was 6, signifying
multiple rib fractures on both sides. The injury severity score (ISS), which is the sum of the
squares of the highest AIS code in each of the three most severely injured body regions, was
determined. The ISS score was 75 due to an AIS code of 6 for the chest. Generally, an ISS score
of 25 or higher is associated with a high mortality rate. Consequently, even in the absence of
the car fire, saving her life would have been challenging. Through this case, the importance of
meticulous observation becomes evident, especially when histological examination is conducted
during the autopsy of a burnt corpse
糖尿病性腎症におけるTG/HDL-C比と心血管疾患および腎予後との関連
Get PDFIncreased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) are dyslipidemias characteristic of diabetes. Here, we aimed to examine associations of TG/HDL-C ratio with cardiovascular disease (CVD) and kidney dysfunction among patients with diabetic nephropathy. This retrospective observational study consists of patients with biopsy-proven diabetic nephropathy at Nara Medical University Hospital. Exposure of interest was TG/HDL-C ratio measured at kidney biopsy. Outcome variables were kidney histological findings, incident CVD and end-stage kidney disease (ESKD). Multivariable logistic regression models and Cox proportional hazard models were used to examined these associations. A total of 353 subjects were divided into quartiles based on TG/HDL-C ratio: Quartile 1 (reference), <1.96; Quartile 2, 1.96-3.10; Quartile 3, 3.11-4.55; and Quartile 4, ≥4.56. TG/HDL-C ratio was not a predictor of any histological findings in fully adjusted models. During median follow-up periods of 6.2 and 7.3 years, 152 and 90 subjects developed CVD and ESKD, respectively. Higher TG/HDL-C ratio was independently associated with higher incidences of CVD even after adjustments for potential confounders (hazard ratio [95% confidence interval] for Quartile 3 vs. reference; 1.73 [1.08-2.79] and Quartile 4 vs. reference; 1.86 [1.10-3.17]). Although there was a weak association between TG/HDL-C ratio and ESKD in the univariable model, the association was not significant in fully adjusted models. In conclusion, among patients with biopsy-proven diabetic nephropathy, higher TG/HDL-C ratio was independently associated with higher incidences of CVD but not with kidney outcomes, suggesting different impact of TG/HDL-C ratio on cardiorenal outcomes.権利情報：© The Author(s), under exclusive licence to The Japanese Society of Hypertension 2023. This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1038/s41440-023-01197-
小児メサンギウム増殖性糸球体腎炎ではhigh-shear血流条件下で血小板血栓形成能が亢進する
Get PDFIntroduction: Blood coagulation is associated with glomerulonephritis (GN) pathophysiology. Using whole-blood-based rotational thromboelastometry, we recently reported that the degree of hypercoagulability in pediatric patients with immunoglobulin A nephropathy (IgAN), a GN, might be associated with pathological severity. To further clarify the coagulation status of mesangial proliferative glomerulonephritis (MesPGN), we assessed the platelet thrombus fonnation (PTF) under high-shear flow using a microchip-based flow chamber system (T-TAS®). Methods: Thirty-four pediatric patients definitively diagnosed with MesPGN by renal biopsy at Nara Medical University Hospital between 2015 and 2022 were enrolled, and 29 patients (case group; median age, 8.0 years) were assessed. Microchips coated with collagen (PL-chip) were used to assess PTF at high-shear in whole blood. The times to increase by 10 and 30 kPa (T10 and T3o) from baseline were calculated and compared with those of the pediatric controls. Changes in the parameters during the treatment course and the relationship between pathological severity and the parameters were evaluated. Results: T10 and T3o parameters in the PL-chip were significantly shorter and the area under the curves were greater in the case group than those in the control group (both p <0.05). Each parameter was enhanced during the 3-week treatment but improved after the end of treatment. No significant relationship was observed between pathological severity and these parameters. Little PTF difference was observed between IgAN and Henoch-Schonlein purpura nephritis. Conclusions: Pediatric MesPGN increased the potential for PTF under high-shear flow conditions.権利情報：This is the accepted manuscript version of an article published by Karger Publishers in [Nephron
/2024/148(6)/415-425 DOI: 10.1159/000534494] and available on https://doi.org/10.1159/00053449
社会的隔離マウスの興奮性・抑制性回路におけるNARPに関連した変化： 自閉スペクトラム症の病態に対する発達上の洞察と示唆
Get PDFBackground: Social isolation during critical periods of development is associated with alterations in behavior and neuronal circuitry. This study aimed to investigate the immediate and developmental effects of social isolation on firing properties, neuronal activity-regulated pentraxin (NARP) and parvalbumin (PV) expression in the prefrontal cortex (PFC), social behavior in juvenile socially isolated mice, and the biological relevance of NARP expression in autism spectrum disorder (ASD). Methods: Mice were subjected to social isolation during postnatal days 21-35 (P21-P35) and were compared with group-housed control mice. Firing properties in the PFC pyramidal neurons were altered in P35 socially isolated mice, which might be associated with alterations in NARP and PV expression. Results: In adulthood, mice that underwent juvenile social isolation exhibited difficulty distinguishing between novel and familiar mice during a social memory task, while maintaining similar levels of social interaction as the control mice. Furthermore, a marked decrease in NARP expression in lymphoblastoid cell lines derived from adolescent humans with ASD as compared to typically developing (TD) humans was found. Conclusion: Our study highlights the role of electrophysiological properties, as well as NARP and PV expression in the PFC in mediating the developmental consequences of social isolation on behavior.権利情報：© 2024 Yamaguchi, Okamura, Yamamuro, Okumura, Komori, Toritsuka, Takada, Nishihata, Ikawa, Yamauchi, Makinodan, Yoshino, Saito, Matsuzaki, Kishimoto and Kimoto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms
股関節骨折患者の筋肉量増加のための術後リハビリテーションプログラム：後方視的研究
Get PDFBackground: Hip fractures are most likely to occur in older people, and after hip surgery muscle mass and the ability to perform activities of daily living often decline. In this study, we conducted inpatient rehabilitation after surgery for hip fracture and measured changes in muscle mass and physical performance. Methods: We retrospectively analyzed patients aged 65 years or older who underwent surgery (prosthetic replacement or internal fixation) and inpatient rehabilitation for hip fracture at our hospital between August and December 2020. The training included a joint range of motion exercise, muscle-strengthening exercise, gait training, early mobilization training, and neuromuscular electrical stimulation. We measured the following factors after one and six weeks postoperatively: muscle mass, body weight, fat mass, grip strength, bilateral knee extension strength, ability to walk, and ability to perform activities of daily living. Results: Seventeen patients were included. Median age was 84 years (interquartile range, 72-90). Lower limbs skeletal muscle mass increased (median 4.8 kg to 4.9 kg, p = 0.045), while upper limbs skeletal muscle mass and body weight decreased (median 1.2 kg to 1.1 kg, p = 0.0027), (median 46.8 kg to 45.5 kg, p = 0.0039), respectively. Total skeletal muscle mass and fat mass remained unchanged. Grip strength was maintained, and knee extension muscle strength on the healthy and affected sides increased (healthy side median 10.7 kgf to 13.7 kgf, p = 0.019; affected side median 5.5 kgf to 9.5 kgf, p < 0.001). All patients exhibited improved ability to perform activities of daily living; however, 52.9% of patients regained their pre-injury walking ability. Conclusions: Our rehabilitation program increased lower limb skeletal muscle mass in patients with hip fractures.権利情報：© Copyright 2024. Sajiki-Ito et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
ビタミンＤ欠乏は腸管バリア破壊とエンドトキシンの肝への過剰流入を介してアルコール関連肝障害を増悪させる
Get PDFEndogenous lipopolysaccharide (LPS) that translocates via the disrupted intestinal barrier plays an essential role in the progression of alcohol-related liver disease (ALD). Vitamin D deficiency is observed in ALD, and it participates in regulating gut barrier function. The current study aimed to examine the association between vitamin D deficiency and endotoxemia in patients with ALD-related cirrhosis. Moreover, the effect of vitamin D deficiency on ethanol (EtOH)- and carbon tetrachloride (CCl4)-induced liver injury relevant to gut barrier disruption in mice was investigated. Patients with ALD-related cirrhosis (Child-Pugh Class A/B/C; n=56/15/7) had lower 25(OH)D levels and higher endotoxin activities than non-drinking healthy controls (n=19). The serum 25(OH)D levels were found to be negatively correlated with endotoxin activity (R=-0.481, P<.0001). The EtOH/CCl4-treated mice developed hepatic inflammation and fibrosis, which were significantly enhanced by vitamin D-deficient diet. Vitamin D deficiency enhanced gut hyperpermeability by inhibiting the intestinal expressions of tight junction proteins including ZO-1, occludin, and claudin-2/5/12/15 in the EtOH/CCl4-treated mice. Consequently, it promoted the accumulation of lipid peroxidases, increased the expression of NADPH oxidases, and induced Kupffer cell infiltration and LPS/toll-like receptor 4 signaling-mediated proinflammatory response. Based on the in vitro assay, vitamin D-mediated vitamin D receptor activation inhibited EtOH-stimulated paracellular permeability and the downregulation of tight junction proteins via the upregulation of caudal-type homeobox 1 in Caco-2 cells. Hence, vitamin D deficiency exacerbates the pathogenesis of ALD via gut barrier disruption and hepatic overload of LPS.本文は発行元が定める公開猶予期間終了後に公