Tailor-Made Mesh for Pelvic Organ Prolapses: Correlation between Patient’s Height and Mesh Size

Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for pelvic organ prolapses. Since commercial kits are not readily available in Japan, we have planned tailor-made mesh by information of each patient before every TVM surgery. The aim of this report is to inform methods to design mesh for individual patients with pelvic organ prolapses. We also investigated the correlations among mesh size and height, weight, and body mass index (BMI). Before the operation, we obtained a KUB (abdominal X-ray). Three factors were measured from this X-ray: the first was the distance between the bilateral ischial spine, the second was the distance between the obturator foramen, and the third was the length of the arcus tendineus fascia pelvis (ATFP). These three factors always should be considered for designing of mesh. The correlations among the bilateral ischial spine distance, obturator foramen distance, ATFP length, height, weight, and BMI were assessed using the Pearson correlation coefficient. Although these three factors described above are necessary to design a mesh for individual patients, the bilateral ischial spine and obturator foramen distance correlated with the height of the patient. On the other hand, since the length of ATFP differs in each patient and is not correlated with height, we should consider this length when we design the mesh. Well-designed, tailor-made mesh will probably fit each pelvic organ prolapsed patient very well.

Intraoperative Fluoroscopic Monitoring during TVM Surgery: Safer Procedure Even for Beginners

Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for female pelvic organ prolapse. In 2004, this procedure was developed by a French group, and standardized surgical kits are now commercially available in many countries. Although it is less invasive, one of the shortcomings of this procedure is that it involves a single surgeon groping around with their fingers without any intraoperative monitoring. Therefore, using Intraoperative fluoroscopic monitoring during TVM surgery makes it safer, even for beginners. In this case, we performed TVM for the anterior vaginal wall. First, we used the c-arm of a fluoroscope to insert bilateral ureteral stents. A urethral catheter was then used for both urine drainage and contrast medium injection. In all procedures, we were able use fluoroscopic imaging whenever necessary. We were able to easily confirm the positions of the prolapsed bladder and the bilateral ureteral stents with fluoroscopic imaging, and the ischial spine was easy to locate before the procedure. We were also able to confirm the position of the top of the needle with fluoroscopic imaging whenever necessary. If a surgeon is worried about the risk of bladder injury during TVM surgery, they should inject contrast medium into the bladder at the start of the procedure. Intraoperative fluoroscopic monitoring during TVM surgery is easy and makes the procedure safer, even for beginners. Moreover, fluoroscopic imaging also allows intraoperative training. To avoid exposing the body to excess radiation, we must minimize the total length of the fluoroscopic examination.

猪隐秘杆菌型出血性坏死性脾炎

六月龄去势公猪表现昏睡、食欲不振、站立困难。尸检发现脾脏边缘呈多重出血灶。从脾脏、肾脏、肌肉和肝脏中分离出革兰氏阳性杆菌,对分离株(TO16177)的16S rDNA基因序列比较分析发现,其可能与未发表过的隐秘杆菌属HJ57-14E菌株(登记号:gi18873551)(比较675bp个碱基,相似性达99.7%)为同一个属。脾脏组织切片的组织学检查发现呈广泛性坏死和炎症,其中革兰氏阳性杆菌显而易见。肝脏中可见多病灶的坏死斑。免疫组织化学检测发现,分离株与抗化脓性隐秘杆菌属(Arcanobacterium pyogenes)和内氏放线菌(Actinomyces naeslundii)的多克隆抗体具有交叉反应,且与后者的交叉反应更强烈。相似的反应也见于扁桃体的化脓灶中分离株,偶尔也见于脾脏和淋巴结中的分离株。本研究结果表明,这种未公开发布的隐秘杆菌属的细菌会引起生长肥育猪多器官功能衰竭,而后继发急性出血性坏死性脾炎。

Leadless cardiac pacemaker implantations after infected pacemaker system removals in octogenarians

Background Management of pacemaker(PM)infections among advanced aged patients possesses particular clinical challenges due to higher rates of concurrent cardiovascular disease and medical comorbidities.Novel leadless cardiac pacemakers(LCPs)may provide new opportunities for better management options in this population,however,there is limited data especially in Asian populations to guide the decision making.Methods We reviewed 11 octogenarians(median age:86[minimum 82–maximum 90]years;male:73%;median body mass index(BMI):20.1 kg/m^(2))who received Micra Transcatheter Pacing System(Medtronic Inc,Minneapolis,MN)implantations following transvenous lead extractions(TLEs)for PM infections.Results All patients had more than two medical comorbidities(average 3.7 comorbidities).The indications for LCP implantations were atrioventricular block in four patients,atrial fibrillation bradycardia in five,and sinus node dysfunction in two.Eight patients(73%)were bridged with temporary pacing using active fixation leads(median interval of 14.0 days),while one with severe dementia underwent a concomitant LCP implantation and TLE during the same procedure.Successful TLEs and LCP implantations were successfully accomplished in all without any complications.The median time from the TLE procedure to discharge was 22 days(minimum 7–maximum 136).All patients remained free of infections during a mean follow-up period of 17.2±6.5 months.Conclusions LCP implantations were safe and effective after removing the entire infectious PM system in all octogenarians.The novel LCP technology may offer an alternative option for considering a re-implantation strategy after transvenous PM infections in elderly patients,particularly those with severe frailty and PM dependency.

Dispersal Ability and Genetic Structure in Mytilid Mussels of Whale-Fall Communities

Since organic falls are ephemeral and distributed sporadically, organisms in organic-fall communities must acquire high dispersal ability to migrate from one organic fall to another. However, the dispersal ability of obligate organic-fall organisms has not been investigated thoroughly and the stability of the genetic structure of their communities is unknown. In this study, in order to elucidate the dispersal ability and genetic structure in the organic-fall communities, we carried out population genetic analyses based on sequences of mitochondrial NADH dehydrogenase subunit 4 in two mytilid mussels.?Adipicola pacifica was obtained from whale and cow bones artificially settled in Japanese waters off Cape Noma (CN) and in the Nansei-Shoto Trench (NS) and Sagami Bay (SB), and Benthomodiolus geikotsucola from natural whale bones in the Torishima Seamount (TS);both species are symbiotic with chemoautotrophic bacteria. Genetic differentiation (Fst) indicated almost no annual change in genetic structure between 2003, 2004, 2005, and 2007 collections of A. pacificafrom CN (depth 225 - 229 m), although the 2010 collection had somewhat different genetic structure from the others. Similarly, there was not significant genetic differentiation between 1993 and 2005 collections of B.geikotsucola from TS (depth 4020 m). The Fst and gene bidirectional mean rate of gene flow (Nm) indicated high gene flow and no significant genetic differentiation between A. pacifica specimens collected from CN, NS, and SB. The results suggest that the genetic structure is stable and A. pacifica has high dispersal ability. The mismatch distribution suggests that A. pacificaexpanded their distribution from SB to NS via CN, as expansion time (τ = 2ut) decreased from SB to CN and NS.

Quantitative Evaluation of Bitterlich Sampling for Estimating Basal Area in Sparse Boreal Forests and Dense Tropical Forests

Bitterlich sampling is an extensively used technique in worldwide forest inventories. Although it has been proved that estimates of basal area from Bitterlich sampling are mathematically unbiased, its precision for individual forest stands may be fairly poor. An extension of validation efforts to different forest biomes could therefore provide more comprehensive assessment and understanding of the Bitterlich sampling technique. In this study, this technique was quantitatively evaluated by using simulated sparse boreal forests and dense tropical forests from an empirical forest structure model (EFSM). Theoretical estimation of basal areas and practical estimation influenced by the hidden-tree effect were both compared with true basal areas of the simulated forests. The evaluation results indicated that: 1) Bitterlich sampling can yield acceptable accuracy and precision when the count number (CN) of trees was set to 10 for the studied boreal and tropical forests with distinct characteristics, 2) the theoretical estimation of basal area can be improved by increasing the CN values for both forests, and 3) when the hidden-tree effect is encountered, the accuracy for tropical forests will be decreased by increasing the CN values, whereas the accuracy for boreal forests can still be improved. Accordingly, a relatively high CN, at a reasonable cost, is recommended for sparse boreal forests to improve the accuracy of basal area estimation. In contrast, for dense tropical forests, a CN of ten is appropriate to mitigate the hidden-tree effect.

Surveillance of Fluoroquinolone-Resistant Clinical Isolates of <i>Pseudomonas aeruginosa</i>

Ciprofloxacin (CPFX) and pazufloxacin (PZFX) have strong antibacterial activity against Pseudomonas aeruginosa. We investigated the sensitivity of P. aeruginosa to CPFX and PZFX in 373 strains isolated from inpatients (321 strains) and outpatients (52 strains) during September 2010 to September 2011 at Toho University Ohashi Medical Center. The percentage of CPFX-non-susceptible (≥3.91 μg/mL) among inpatients was 22.4%, but that among outpatients was 1.9%. As the major resistance mechanism to fluoroquinolones in P. aeruginosa involves modification of type II topoisomerases (DNA gyrase and topoisomerase IV), we examined mutations in the quinolone-resistance-determining regions (QRDRs) of gyrA and parC of P. aeruginosa isolates. Among the 373 isolates, 73 isolates had reduced CPFX-susceptibility and 88 had reduced PZFX-susceptibility. Sequencing of gyrA and parC revealed base substitutions that resulted in amino acid replacements in QRDR of GyrA in 70 P. aeruginosa isolates, while Thr83Ile (in GyrA) and Ser87Leu (in ParC) substitutions were found in 12 strains. These replacements were clearly associated with reduced susceptibility to CPFX and PZFX. However, we also found strains with high MICs to quinolones without mutations in either gyrA or parC. We then investigated the effect of efflux pumps in CPFX-resistance in these isolates. In the presence of an efflux pump inhibitor, MIC values in 12 of 66 strains decreased to 1/23. We also sequenced genes related to overexpression of efflux pumps, viz., mexZ, mexR, and nfxB. Eight of the strains without mutations in QRDRs had a mutation in mexZ, 7 strains had a mutation in mexR, but no mutation was identified in nfxB.

Expression of Large Conductance, Voltage- and Ca²⁺-Activated K⁺(BK) Channels in Human Urinary Bladder: Alteration of Subunit Expression Profile in Association with Bladder Outlet Obstruction

Purpose: Large conductance, voltage- and Ca2+-activated K+ (BK) channel is thought to have a central role to regulate urinary bladder smooth muscle functions, and its dysfunction may lead to increase of urination frequency and overactive bladder. The present study aims to investigate the expression pattern of BK channel subunits in the human urinary bladder, and how it changes in association with bladder outlet obstruction (BOO). Materials and Methods: Human bladders were obtained from 7 controls without prostatic enlargement and lower urinary tract symptoms and 4 BPH patients with clinically diagnosed overactive bladder who were verified by the International Prostate Symptom Score (IPSS) and prostate volume. The expression and location of BK channel protein complex was examined using immunohistochemistry with affinity-purified anti-BKα antibodies. A real-time RT-PCR was used to quantify the expression of each BK channel subunit (α and β1 - 4) gene in the mucosal and muscle layers of human urinary bladder. Results: Immunohistochemical staining for BK-α protein complex was localized in the muscle and submucosal regions of urinary bladder. RT-PCR analysis revealed the presence of α-, β1-, and β4-subunit genes of BK channel in the mucosal layer, α- and β1-subunit in the muscle layer. The expressions of α- and β1-subunit genes in the muscle (α: p = 0.0003, β1: p = 0.0003) and mucosal (α: p = 0.03, β1: p = 0.02) layers significantly decreased in BOO bladders compared with controls. The expression levels of α- and β1-subunit in mucosal layer were statistically correlated with storage score of IPSS (α;r = 0.84, p = 0.002, β1;r = 0.84, p = 0.002), and so were in muscle layer (α;r = 0.934, p 0.0001, β1;r = 0.917, p = 0.00018). Conclusions: BK channels, which are mainly composed of α- and β1-subunits, are expressed in both the mucosal and muscle layers of human urinary bladder. Decreased expression of BK channel in BOO might be implicated in the mechanisms underlying the development of overactive bladder.

Modeling three-dimensional forest structures to drive canopy radiative transfer simulations of bidirectional reflectance factor

Three-dimensional(3-D)Monte Carlo-based radiative transfer(MCRT)models are usually used for benchmarking in intercomparisons of the canopy radiative transfer(RT)simulations.However,the 3-D MCRT models are rarely applied to develop remote sensing algorithms to estimate essential climate variables of forests,due mainly to the difficulties in obtaining realistic stand structures for different forest biomes over regional to global scales.Fortunately,some of important tree structure parameters such as canopy height and tree density distribution have been available globally.This enables to run the intermediate complexities of the 3-D MCRT models.We consequently developed a statistical approach to generate forest structures with intermediate complexities depending on the inputs of canopy height and tree density.It aims at facilitating applications of the 3-D MCRT models to develop remote sensing retrieval algorithms.The proposed approach was evaluated using field measurements of two boreal forest stands at Estonia and USA,respectively.Results demonstrated that the simulations of bidirectional reflectance factor(BRF)based on the measured forest structures agreed well with the BRF based on the generated structures from the proposed approach with the root mean square error(RMSE)and relative RMSE(rRMSE)ranging from 0.002 to 0.006 and from 0.7%to 19.8%,respectively.Comparison of the computed BRF with corresponding MODIS reflectance data yielded RMSE and rRMSE lower than 0.03 and 20%,respectively.Although the results from the current study are limited in two boreal forest stands,our approach has the potential to generate stand structures for different forest biomes.