Perioperative Antimicrobial Prophylaxis in Urology: a Multi-Center Prospective Study

Since there are few published reports regarding the impact of urologic surgery on perioperative infections, an epidemiologic analysis was performed on data from 1,156 open or laparoscopic operations in urology collected by the 21 hospitals participating in this study between September 2002 and August 2003. Prophylactic antibiotics were administered intravenously according to our protocol designed on the basis of the invasiveness and contamination levels. The surgical site infection (SSI) rates following clean, clean-contaminated and contaminated surgery were 1.2%. 5.8% and 23.4%, respectively, while the remote infection (RI) rates were 3.5%. 7.1% and 35.9%, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) was most frequently isolated from SSIs as well as RIs, whereas Enterococcus faecalis and Pseudomonas aeruginosa were more frequently discovered in RIs than in SSIs. Several risk factors for SSI and/or RI, such as older age, high ASA score, obesity, diabetes, preoperative chemotherapy, long operation time and much blood loss, were identified by univariate analysis.

Structure and morphogenesis of bacteriophage T4

Bacteriophage T4 is one of the most complex viruses. More than 40 different proteins form the mature virion, which consists of a protein shell encapsidating a 172-kbp double-stranded genomic DNA, a 'tail,' and fibers, attached to the distal end of the tail. The fibers and the tail carry the host cell recognition sensors and are required for attachment of the phage to the cell surface. The tail also serves as a channel for delivery of the phage DNA from the head into the host cell cytoplasm. The tail is attached to the unique 'portal' vertex of the head through which the phage DNA is packaged during head assembly. Similar to other phages, and also herpes viruses, the unique vertex is occupied by a dodecameric portal protein, which is involved in DNA packaging.

Decrease in circulating hematopoietic progenitor cells by trapping in the pulmonary circulation

BACKGROUND

When stem-cell grafts are infused into the venous circulation and stem/progenitor cells egress from BM, pulmonary capillary beds are the first microcirculation site that they encounter. This provides the potential for circulating progenitor cells to be trapped in the pulmonary circulation.

METHODS

We compared the number of progenitor cells [CD34(+) cells, colony-forming unit-granulocyte-macrophage (CFU-GM), CD34(+) CD41(+) cells and CFU-megakaryocyte (CFU-meg)] and their expression of cell-adhesion molecules (CAM) in samples taken simultaneously from radial arteries and central veins of 21 patients following PBSC mobilization.

RESULTS

The mean (+/- SD) frequency of progenitor cells in the radial arteries was reduced to 79% +/- 25% for CD34(+) cells, 73% +/- 27% for CFU-GM, 77% +/- 25% for CD34(+) CD41(+) cells and 70% +/- 29% for CFU-meg of the number in the central veins. This suggests that some progenitor cells might be trapped in the lung. No association between progenitor-cell expression of CAM and pulmonary trapping was observed.

DISCUSSION

Our data demonstrate pulmonary trapping of PBSC during mobilization, suggesting a potential inhibitory effect on PBSC harvest and medullary trafficking following graft infusion. However, the impact associated with pulmonary PBSC trapping may be negligible in the clinical setting if sufficient cells are infused.

Intense immunosuppression followed by purified blood CD34+ cell autografting in a patient with refractory juvenile rheumatoid arthritis

A 15-year-old boy with refractory juvenile rheumatoid arthritis (JRA) underwent intense immunosuppressive therapy followed by purified blood CD34+ cell autografting. He had been taking prednisolone (PDN) daily or every other day combined with methotrexate once a week to control the disease for 7 years. He suffered from psychological complications and a very short stature due to the adverse effects of these drugs. CD34+ cells were purified in bulk from G-CSF-mobilized PBSC using an Isolex 300. After the administration of cyclophosphamide (200 mg/kg) and anti-lymphocyte globulin (45 mg/kg), 3.6 x 10(6)/kg purified CD34+ cells were infused. His post-transplant course was uneventful except for herpes-zoster infection. He is now more than 1 year post transplant and has not taken any immunosuppressive medication. His rate of growth has increased (>10 cm/year) due to the effects of the cessation of PDN and the administration of recombinant human growth hormone (rGH), in contrast to the gain of 2 cm in the preceding 3 years with rGH treatment. Although the durability of this remission is unknown, intense immunosuppressive therapy followed by purified blood CD34+ cell autografting might be acceptable for adolescent patients with refractory JRA to achieve a drug-free period for physical and psychological maturation.

Low numbers of megakaryocyte progenitors in grafts of cord blood cells may result in delayed platelet recovery after cord blood cell transplant

Delayed platelet recovery is an inherent problem with cord blood cell transplantation (CBCT). To investigate this problem, the number of human megakaryocyte (MK) progenitor cells in cord blood (CB; n = 24) was measured and compared with that in G-CSF-mobilized peripheral blood stem cells (PBSC; n = 25). The median numbers of colony-forming units for MK (CFU-MK) that were detected by a serum-free assay system in CB and peripheral blood (PB) were 26 (range, 6-102)/10(5) nucleated cells (NC) and 37 (2-540)/10(5) mononuclear cells (MNC), respectively. The numbers of colony-forming units for granulocyte/macrophage (CFU-GM) were 88 (33-241)/10(5) NC in CB and 138 (6.3-1,250)/10(5) MNC in PB. The frequencies of CD34(+) cells in CB and PB were, respectively, 0.44% (0.10-1.07) and 0.98% (0.05-20.8). The numbers of CFU-MK in CB and PBSC were correlated with those of CD34(+) cells. The estimated number of infused CFU-MK in CBCT was 1/15 that of PBSC transplantation (PBSCT), based upon the above data and the widely used standard doses for both types of transplants. Further, the numbers of infused CFU-MK in patients who received allogeneic PBSCT at our institute were inversely correlated with the speed of platelet recovery. These data indicate that delayed platelet recovery after CBCT is simply due to the low number of CFU-MK contained in grafts.

HLA-mismatched CD34-selected stem cell transplant complicated by HHV-6 reactivation in the central nervous system

We report here a patient who suffered from PCR- confirmed human herpesvirus type 6 (HHV-6) meningoencephalitis after allogeneic purified CD34+ cell transplantation from his HLA-mismatched sibling donor, even though he had been on intense prophylaxis with i.v. ganciclovir (GCV), acyclovir (ACV) and gamma-globulin containing a specific antibody against HHV-6. Serological evaluation disclosed that both the donor and recipient had IgG antibody against HHV-6 before transplantation. His blood WBC count started to transiently increase on day 10, and all blood components had decreased by day 20. He then developed a severe headache and high blood pressure, and sporadic abnormal neurological findings including nystagmus and delirium. An analysis of cerebrospinal fluid (CSF) revealed 8 cells/microl, a glucose level of 130 mg/dl and a protein level of 201 mg/dl (normal, 50 mg/dl) on day 26. At the time, HHV-6 was detected only in CSF by a PCR-based method and he was diagnosed as having meningoencephalitis due to the local reactivation of HHV-6. Although he failed to respond to high-dose therapy with ACV (60 mg/kg/day) and gamma-globulin, the DNA of this virus disappeared from the CNS upon treatment with GCV (30 mg/kg/day) combined with the intraventricular infusion of alpha-interferon. His clinical course was further complicated with meningoencephalitis due to staphylococcus epidermidis, and he died of tentorial herniation on day 79 without the recovery of blood components. This experience may indicate that intense prophylaxis to prevent reactivation of HHV-6 in the CNS is essential for the management of such profoundly immunosuppressed patients.

Efficacy of the mobilization of peripheral blood stem cells by granulocyte colony-stimulating factor in pediatric donors

The advantages/disadvantages of the use of peripheral blood stem cells (PBSCs) for allogeneic transplantation still need to be clarified, particularly in children. We compared the kinetics, efficacy, and safety of PBSC mobilization by granulocyte colony-stimulating factor (G-CSF) and collection by apheresis between healthy pediatric and adult donors. A total of 19 pediatric (median age, 6 years) and 25 adult healthy donors (median age, 37 years) were given 10 micro/kg/day of G-CSF for 5 consecutive days for PBSC mobilization, which were harvested by apheresis on days 5 and/or 6. All of the donors tolerated the whole procedures. Serum trough levels of G-CSF determined by ELISA were significantly lower in the 16 pediatric donors evaluated than in adults (n = 16) on days 3 and 4 (P < 0.05). Although the WBC counts on days 4 and 5 were significantly higher in adults than in children (P = 0.006 and 0.004, respectively), the numbers of circulating CD34+ cells/unit of blood were identical. The number of blood CD34+ cells collected per unit of blood processed was identical in both donor populations. We propose that PBSCs could be effectively mobilized and collected in small children so that they could be donors for adult patients.

The C-terminal fragment of the precursor tail lysozyme of bacteriophage T4 stays as a structural component of the baseplate after cleavage

Tail-associated lysozyme of bacteriophage T4 (tail lysozyme), the product of gene 5 (gp 5), is an essential structural component of the hub of the phage baseplate. It is synthesized as a 63-kDa precursor, which later cleaves to form mature gp 5 with a molecular weight of 43,000. To elucidate the role of the C-terminal region of the precursor protein, gene 5 was cloned and overexpressed and the product was analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, immunoblotting, analytical ultracentrifugation, and circular dichroism. It was shown that the precursor protein tends to be cleaved into two fragments during expression and that the cleavage site is close to or perhaps identical to the cleavage site in the infected cell. The two fragments, however, remained associated. The lysozyme activity of the precursor or the nicked protein is about 10% of that of mature gp 5. Both the N-terminal mature tail lysozyme and the C-terminal fragment were then isolated and characterized by far-UV circular dichroism and analytical ultracentrifugation. The latter remained trimeric after dissociation from the N-terminal fragment and is rich in beta-structure as predicted by an empirical method. To trace the fate of the C-terminal fragment, antiserum was raised against a synthesized peptide of the last 12 C-terminal residues. Surprisingly, the C-terminal fragment was found in the tail and the phage particle by immunoblotting. The significance of this finding is discussed in relation to the molecular assembly and infection process.

Endogenous interleukin-8 (IL-8) surge in granulocyte colony-stimulating factor-induced peripheral blood stem cell mobilization

The relationship between stem cell mobilization with granulocyte colony-stimulating factor (G-CSF) and the endogenous production of interleukin-8 (IL-8), macrophage inflammatory protein-1alpha (MIP-1alpha), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma) was studied in normal donors for allogeneic peripheral blood stem cell (PBSC) transplantation. G-CSF was administered to 20 normal donors at a dose of 10 microg/kg/d for 5 days with aphereses on days 5 and 6 of G-CSF treatment. Cytokine serum levels were measured using an enzyme-linked immunosorbent assay (ELISA) before and during G-CSF treatment. Before treatment, the average level of IL-8 was 7.1 pg/mL, increasing to 207.0 pg/mL on day 5 and 189.1 pg/mL on day 6. Serum IL-8 levels correlated CD34(+) cell numbers (P =.0151 and P =.0005 on days 5 and 6, respectively) and colony-forming unit-granulocyte-macrophage (CFU-GM) numbers (P =.0019 and P =.0010 on days 5 and 6, respectively). Furthermore, preapheresis serum IL-8 levels correlated with the yield of CD34(+) cells (P =.0027). In contrast, before treatment, the average levels of MIP-1alpha, TNF-alpha, and IFN-gamma were 70.1, 4.03, and 3.84 pg/mL, respectively, and no significant changes in the levels of these cytokines were observed during G-CSF treatment. These studies suggest that IL-8 production may be critical to G-CSF-induced stem cell mobilization, although the underlying mechanism could not be clarified.

Antibacterial activity of some Garcinia benzophenone derivatives against methicillin-resistant Staphylococcus aureus

Benzophenone derivatives, garcinol (1) and isogarcinol (2) isolated from the pericarps of Garcinia purpurea (Guttiferae), and xanthochymol (3) and a mixture of isoxanthochymol (4) cycloxanthochymol (5) from the pericarps of G. subelliptica were evaluated for their antibacterial activity against methicillin-resistant Staphylococcus aureus. Among them, 3 showed the lowest minimum inhibitory concentration at 3.1-12.5 micrograms/ml. This concentration is nearly equal to that of the antibiotic, vancomycin.

Capillary gas chromatography quantification of cholesterol in copper-oxidized low-density lipoprotein

A simple analytical method, using capillary gas chromatography-mass spectrometry (GC-MS) was used to investigate the oxidative modification of cholesterol in copper-oxidized low-density lipoprotein (oxidized LDL). The incubation of LDL and 5 microM CuSO4 in 0.15 M NaCl/0.02 M Tris-HCl buffer at pH 7.4 led to the peroxidation of LDL as shown by the detection of a thiobarbituric acid-reactive substance (TBA-RS). Oxidized LDL was shown to cause a significant fall in the unesterified and esterified cholesterol content, while oxysterols such as 7-hydroxycholesterol (7-OH) and 7-ketocholesterol (7-Keto) were formed from cholesterol, these conversions occurred in a dose- and time-dependent manner. Both oxysterols were identified by GC-MS on a fused-silica capillary column. In addition, copper-oxidized high-density lipoprotein (oxidized HDL) also resulted in the generation of TBA-RS and oxysterols. In addition, changes in the composition and amount of oxysterols during the incubation of macrophages with oxidized LDL were investigated. The incubation of macrophages with oxidized LDL resulted in the accumulation of cholesterol, 7-OH and 7-Keto derivatives in macrophages and this accumulation also occurred in a dose-dependent manner. These results suggest that the measurement of oxysterols may afford an additional index of oxidized LDL, and that foam cell formation and early atherosclerotic lesions may be responsible for the accumulation of oxysterols in macrophages. In addition, this study shows that HDL is also modified when submitted to an oxidative process.

[Clinical epidemiology of bronchial asthma in children report. No. III. Comparison of prevalence of asthma with 1982 and 1990 and environmental factors]

In 1982, our group carried out a survey by the questionnaires and on the site medical check-ups to observe and occurrence of asthma and other allergic symptoms in elementary and junior high school children in Izu Ohshima island. Same procedure was repeated in 1990 for 1145 children of the same age group to see any data fluctuation. The occurrence of allergic symptoms with relation to living conditions was also researched.

RESULT

114 students (11.0%) had either suffered from asthma in the past, or were still currently exhibiting symptoms, this marked a 7.5% rise (108 students) over the 1982 research data. However, patients in need of current treatment numbered 48 (4.5%), which was similar to the 1982 data of 82 (4.3%). For other allergic symptoms, rhinitis showed a marked increase over the 1982 data. The relation between living conditions and asthma was analyzed by Multiple Factor Analysis Quantification Theory.

RESULT

1) Family history of allergy, 2) Selection of food products upon starting solids during infancy, 3) Infection of lower bronchus during infancy all seemed to have had much influence on the occurrence of asthma.

Influence of peripheral intravenous contrast injection on the QRS complex in healthy men

The influence of acute plasma expansion induced by the administration of sodium containing hyperosmolar contrast medium on Frank lead electrocardiograms was investigated in 10 healthy male volunteers. The major electrocardiographic changes after injection of the contrast medium were a significant decrease in the amplitudes of Rx, Ry, and Qz and the maximal spatial QRS voltage, and a significant increase in the amplitude of Sx. The echocardiographic left ventricular end diastolic dimension tended to be larger after the injection, whereas no significant change occurred in the left ventricular systolic dimension. The electrocardiographic changes in this study were the opposite of those expected with the Brody effect. Although the precise mechanism underlying these findings is unclear, the increased intracardiac blood volume may have caused a decrease in the QRS voltage by a short circuiting effect. Alternatively if the activation in the left ventricle is assumed to be predominantly tangential the QRS voltage should have decreased with the Brody effect. The Brody effect may lead to an erroneous interpretation of electrocardiograms in certain clinical settings.

[Non-invasive estimates of hemodynamics in normal pregnancy]

Pregnancy provides excellent opportunities for observing the hemodynamic alterations in cardiac function occurring during the physiologic stress imposed on the normal myocardium. Hemodynamically, the most important change in the maternal circulation during pregnancy is an increase in the circulating blood volume and cardiac output. In the average woman, the cardiac output at rest rises 30-50% above the normal non-gestational resting value. Echocardiography was performed for 25 normal pregnant women, ranging in age from 21 to 36 years (mean age of 28.7 years). Echocardiography was performed periodically through out pregnancy, at the gestational ages of the 10th, 24th, 32nd, 36th, and the 3rd postpartal weeks. Tracings were obtained in the left lateral and supine positions. All pregnancies were uncomplicated, and there was no twin pregnancy. The heart rate increased throughout gestation. However, the systolic and diastolic blood pressures did not change significantly throughout pregnancy. End-diastolic left ventricular dimension (LVDd) increased throughout gestation, with the peak at the 36th week of gestation. Left atrial dimension (LAD) and mVCF increased at the 36th week of gestation. Throughout gestation, the ejection fraction (EF) showed no significant change. There were no measurable differences in the cardiac size and function in the left lateral and supine positions. Increased LVDd and LAD throughout gestation were thought the reflexion of the increased blood volume and venous return which had its peak in the 36th week of gestation. The slightly larger cardiac size and end-diastolic volume seemed to induce the increased myocardial fiber stretch and, in turn, the increased mVCF. Our results indicated that chronic volume overload with increased circulating blood volume occurs in normal pregnancy, resulting in the large cardiac size and increased contractility of myocardial fiber.