Pegylated interferon plus ribavirin for genotype Ib chronic hepatitis C in Japan

AIM:To evaluate the efficacy of pegylated interferon α-2b(peg-IFNα-2b) plus ribavirin(RBV) therapy in Japanese patients with chronic hepatitis C(CHC) genotype Ib and a high viral load.METHODS:One hundred and twenty CHC patients(58.3% male) who received peg-IFNα-2b plus RBV therapy for 48 wk were enrolled.Sustained virological response(SVR) and clinical parameters were evaluated.RESULTS:One hundred(83.3%) of 120 patients completed 48 wk of treatment.53 patients(44.3%) achieved SVR.Early virological response(EVR) and end of treatment response(ETR) rates were 50% and 73.3%,respectively.The clinical parameters(SVR vs non-SVR) associated with SVR,ALT(108.4 IU/L vs 74.5 IU/L,P = 0.063),EVR(76.4% vs 16.4%,P < 0.0001),adherence to peg-IFN(≥ 80% of planned dose) at week 12(48.1% vs 13.6%,P = 0.00036),adherence to peg-IFN at week 48(54.7% vs 16.2%,P < 0.0001) and adherence to RBV at week 48(56.1% vs 32.1%,P = 0.0102) were determined using univariate analysis,and EVR and adherence to peg-IFN at week 48 were determined using multivariate analysis.In the older patient group(> 56 years),SVR in females was significantly lower than that in males(17% vs 50%,P = 0.0262).EVR and adherence to Peg-IFN were demonstrated to be the main factors associated with SVR.CONCLUSION:Peg-IFNα-2b plus RBV combination therapy demonstrated good tolerability in Japanese patients with CHC and resulted in a SVR rate of 44.3%.Treatment of elderly female patients is still challenging and maintenance of adherence to peg-IFNα-2b is important in improving the SVR rate.

Identification of key pathways and gene expression in the activation of mast cells via calcium flux using bioinformatics analysis

Mast cells are the main effector cells in IgE-associated allergic disorders,and we have reported that mucosal mast cells(MMCs)play a more important role in the development of food allergy(FA).IgE with antigen or calcium ionophore stimulation can lead to the activation of MMCs via a calcium-dependent pathway.The purpose of the present study was to identify gene signatures with IgE/antigen(dinitrophenyl-bovine serum albumin,DNP-BSA)or calcium ionophore(A23187)on the activation of MMCs.Differentially expressed genes between the two types of samples were identified with microarray analysis.Gene ontology functional and pathway enrichment analyses of differentially expressed genes were performed using the database for annotation,visualization,and integrated discovery software.The results showed that IgE/antigen and A23187 could induce degranulation,increase vacuoles,and elevate the cytosolic calcium concentration in MMCs.Furthermore,GeneChip analysis showed that the same 134 mRNAs were altered with IgE/DNP-BSA and A23187,suggesting that DNP-BSA/IgE and A23187 affect the same signal pathway partly in degranulation.KEGG analysis showed that the data were enriched in NF-κB,TNF,MAPK,transcription factor activity,DNA binding,and nucleic acid binding,suggesting that activation of MMCs is a complex process.The results provide new insights on MMCs activation.

Evaluation of Fever and Its Related Factors during 4 Weeks after Primary Total Hip Arthroplasty

The purpose of this study was to describe the incidence and characteristics of postoperative fever (POF;≥38℃) and clarify the correlation between POF and febrile-related factors during 4 weeks after primary total hip arthroplasty (THA). A total of 56 patients were included in the study (67 THAs). The preoperative diagnosis for all patients was osteoarthritis. The average follow-up period was 90 months. No patients developed deep infection during the follow-up period. The maximum mean peak daily temperature was 37.7℃ on the day of the surgery and the next day. Fifty-two percent of patients experienced POF, with most developing a maximum temperature (MT) on the day of surgery and the latest occurring by postoperative day (POD) 3. Only C-reactive protein (R = 0.384, p = 0.001) among the febrile-related factors had a weak correlation with MT. Four hips showed a POF of >38℃ later than POD 7;all four of these patients were diagnosed with a urinary tract infection. POF is common and may be part of a normal inflammatory response to tissue injury after THA. More than half of patients may develop POF within 1 week, with most developing MT on POD 0 and the latest occurring by POD 3. In addition, urinary tract infections might be an initial reason for POF in the subsequent 3 weeks.

A Twenty-Year Follow-up Case Study of an Office Worker Who Returned to Work despite Serious Memory Disorder Caused by Herpes Encephalitis

This study followed a 52-year-old male patient, who had suffered from severe impairment in recent memory due to se- quelae of herpes encephalitis, for 20 years. He returned to his highly intellectual work and performed well despite his doctor’s prediction. While the patient showed consistently poor results on various neuropsychological memory tests, he demonstrated incredible performance at work. This case exemplifies an extreme case that declarative memory is formed with the support of semantic memory, procedural memory, and his strong interests. Additionally, it offers lessons that results on memory tests do not necessarily correspond to the actual level of competence. The focal sites were found on both sides of the medial temporal lobe, predominantly on the left side. The T2-weighted magnetic resonance images (MRI) obtained 9 years after the onset confirmed widespread damage to the left brain including parahippocampal gyrus, hippocampus, spindle gyrus, and amygdaloid complex, with microlesions extending from the right parahippocampal gyrus to its antero-interior rim. However, the damage to hippocampus was presumed to be minor.