Treatment of acute pulmonary thromboembolism (APTE) in patients with hemodynamic instability still remains controversial. We analyzed the outcome and validity of surgical pulmonary embolectomy for APTE. Between January of 2004 to December of 2010, 15 patients underwent emergency surgical pulmonary embolectomy using cardiopulmonary bypass with beating heart. Our operative indications were ; within 7 days from onset, hemodynamic instability, bilateral pulmonary artery obstruction or unilateral obstruction with central clot and right ventricular dysfunction. Ten patients presented in cardiogenic shock, two of whom showed cardiac arrest and required cardiopulmonary resuscitation before operation. One patient required percutaneous cardiopulmonary support. Median follow up period is 33 months (range 3 to 86 months). All patients survived the operation, but 3 patients died in the hospital on post operative day 11 (massive cerebral infarction), day 18 (brain hypoxia) and day 25 (multiorgan failure). Two of them had cardiac arrest and received cardiopulmonary resuscitation before operation. Hospital mortality was 20%. And all patients left the hospital on foot except one patient who had been bedridden by myotonic dystrophy before operation. No patients died or showed symptoms of pulmonary hypertension after discharge. Prompt diagnosis and surgical pulmonary embolectomy before threatening fatal condition improves the outcome of embolectomy.

Clostridium difficile is a major causative agent of antibiotic-associated diarrhea and has become the most common pathogen of healthcare-associated infection worldwide. The pathogenesis of C. difficile infection (CDI) is mediated by many factors such as colonization involving attachment to host intestinal epithelial cells, sporulation, germination, and toxin production. Bacterial cell surface components are crucial for the interaction between the bacterium and host cells. C. difficile has two distinct surface layer proteins (SLPs): a conserved high-molecular-weight SLP and a highly variable low-molecular-weight SLP. Recent studies have shown that C. difficile SLPs play roles not only in growth and survival, but also in adhesion to host epithelial cells and induction of cytokine production. Sequence typing of the variable region of the slpA gene, which encodes SLPs, is one of the methods currently used for typing C. difficile. SLPs have received much attention in recent years as vaccine candidates and new therapeutic agents in the treatment of C. difficile-associated diseases. Gaining mechanistic insights into the molecular functions of C. difficile SLPs will help advance our understanding of CDI pathogenesis and the development of vaccines and new therapeutic approaches. In this review, we summarize the characteristics and immunological roles of SLPs in C. difficile.
Clostridium difficile* ; Clostridium* ; Colon ; Diarrhea ; Epithelial Cells ; Germination ; Immunity, Innate ; Vaccines

BACKGROUND: The purpose of this study was to clarify the importance of preoperative pain control using corticosteroid injections in patients with persistent rest pain (RP) before arthroscopic rotator cuff repair (ARCR). METHODS: A total of 360 patients (374 shoulders) who underwent primary ARCR and were followed up for at least 2 years were enrolled. After one-to-one propensity score matching, 266 patients (145 men and 128 women, 273 shoulders) were included in the study. Their mean age was 65.2 ± 7.7 years (range, 42 to 88 years) at the time of surgery. The patients were divided into three groups: those who required several intra-articular or subacromial bursa corticosteroid injections preoperatively for refractory RP (group A+), those in whom RP was resolved preoperatively (group A−), and those who had no RP and did not require any injections (group B). The incidence of postoperative RP and preoperative and final follow-up American Shoulder and Elbow Surgeons (ASES) scores were compared among the three groups. RESULTS: The incidence of postoperative RP was significantly higher in group A+ (35/91 cases, 38.5%) than in group A− (10/91, 11.0%) and group B (7/91, 7.7%, p < 0.001 for both). The preoperative ASES score was significantly lower in group A+ (33.2 ± 14.2) than in group A− (53.9 ± 11.9) and group B (62.3 ± 11.2, p < 0.001 for both), and it was significantly lower in group A− than in group B (p = 0.000). The final follow-up ASES score was significantly lower in group A+ (92.1 ± 8.4) than in group A− (97.6 ± 5.4) and group B (99.0 ± 2.5, p < 0.001 for both). There was no significant difference in the final follow-up ASES score between group A− and group B (p = 0.242). CONCLUSIONS: Patients in whom preoperative RP could be resolved before surgery achieved postoperative outcomes comparable to those in patients who had no RP before surgery, whereas the outcomes in patients with refractory preoperative RP were inferior. The results suggest that preoperative pain control is important in patients undergoing ARCR.
Arthroscopy ; Elbow ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Pain Management ; Propensity Score ; Rehabilitation ; Rotator Cuff ; Shoulder ; Surgeons

A survey of pharmacy students’ and liberal arts students’ attitudes toward identifying diseases that can be effectively prevented using genetic analysis was performed using a multiple-choice questionnaire. We defined the diseases that can be prevented using genetic analysis and found that, for these diseases, the rate of selecting “do nothing” by people with disease-related genes was significantly lower than that of people for whom the genetic influence was unknown. We found that the nine conditions that we investigated (i.e., obesity, high blood pressure, diabetes, hypercholesterolemia, hypocholesterolemia, hypertriglyceridemia, arteriosclerosis, cancer, and liver disease) are diseases that can be effectively prevented using genetic analysis for all students. We also observed that the most common answer for disease prevention was related to dietary changes (including drinking restrictions). In conclusion, through our unique questionnaire, we identified various diseases that can be effectively prevented using genetic analysis. However, it was found that the act of answering a multiple-choice questionnaire does not improve knowledge of disease prevention measures. Therefore, we propose that, after the questionnaire, it is important to distribute written material that explains the cause of life-style-related diseases and their prevention in order to foster knowledge about disease prevention.

INTRODUCTIONInjuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.

METHODSIn this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.

RESULTSAmong the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm, while that of the non-dominant arm was 189.14 ± 39.56 mm(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.

CONCLUSIONMedial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.

Adolescent ; Athletes ; Athletic Injuries ; diagnostic imaging ; physiopathology ; Baseball ; Cross-Sectional Studies ; Elbow ; injuries ; Elbow Joint ; diagnostic imaging ; physiopathology ; Humans ; Male ; Radiography

In order to perform community health activities during the university festival, pharmacy students gathered data and conducted lectures in the form of small group discussions (SGD). They measured participants’ bone densitometry, and then provided them with information about how to effectively prevent bone disease. The aim of this study is to assess whether students’ lectures on the “prevention of calcium-related disease” led participants in the University Festival to understand the following: (1) the benefits of absorption of calcium, (2) the risks of absorption of calcium, (3) which vegetables are calcium-rich, and (4) the risks of calcium overdose. First, participants responded to pretests comprising questions on the 4 above-mentioned topics. Next, they were subjected to bone density measurement, and pharmacy students explained the importance of “prevention of calcium-related disease.” Finally, participants carried out posttests (with the same contents as the pretests), and received advice based on the results of their posttests and bone densitometry measurements. Total scores on the posttests (98.4 points) were significantly higher than those on the pretests (53.3 points). Based on this, researchers concluded that the pharmacy students’ lectures substantially improved participants’ understandings about “prevention of calcium-related disease.”