Patients with D-HCM were more symptomatic at diagnosis, although LV dilatation and impaired fractional shortening seemed more severe in patients with DCM. The prognosis for D-HCM patients was worse than that for patients with DCM despite similar or even more intensive treatment for heart failure.

Oral streptococci are present in large numbers in dental plaque and account for approximately 20% of the total number of salivary bacteria (25). Furthermore, several types of these bacteria interact with the enamel salivary pellicle to form a biofilm on tooth surfaces. Early biofilm formation occurs by attachment and colonization of a variety of streptococci and is dependent on both the species involved and the surface composition (2,12,26,33). The subsequent accumulation and growth of attached bacteria result in microcolonies that increase in size and eventually form a towering pillar-or mushroom-shaped biofilm (4). There is a strong relationship between the attachment, detachment, and aggregation of these organisms in plaque on tooth surfaces and the presence of dental decay in humans (14,24).Members of the mitis group of streptococci, which includes Streptococcus gordonii, Streptococcus mitis, Streptococcus oralis, Streptococcus parasanguis, and Streptococcus sanguis (16), are prominent components of the human oral microbiota and play a significant role as pioneer colonizers in the development of dental plaque (9, 34). Mutans streptococci (Streptococcus mutans and Streptococcus sobrinus) are also known to be primarily involved when the bacterial flora forms on the tooth surface. S. sanguis has been shown to have a strong association with saliva components; however, it was easily dissociated, compared with other streptococci, by using a BIAcore system, and although this organism showed a higher binding resonance unit (RU) value than S. mutans for association, it could be easily dissociated from saliva components (17).S. mutans, S. sobrinus, and S. gordonii produce surface protein antigens (PAc, AgI/II, B, P1, SpaP, and MSL-1), PAg (SpaA), and SspB (SspA), which have molecular masses of approximately 190 kDa (6,10,18,32,36,38), 170 kDa (22,44), and 180 kDa (5, 15), respectively, and interact with salivary components, including lysozyme (37, 40), amylase (37), 18,000-and 38,000-Da prolinerich proteins (32), and agglutinin (5). of in the alanine-rich repeating region (residues 219 to 464, A region) of the PAc molecule is an important region for the adherence of S. mutans to the tooth surface (39,43). Furthermore, the T-and B-cell epitopes overlap (39,41), and the epitope XYXXXLXXYXXXX, an essential sequence in the antigenic epitopes of the PAc protein, is recognized specifically by the inhibiting antibody (42). In the N-terminal region (residues 1 to 429) sequenced from S. gordonii M5 (previously designated S. sanguis), the cell surface adhesins SspB and SspA showed extensive homology [63 and 60% identity, respectively, with SpaP (PAc)] (6). The A region is composed of three long and two incomplete repeating sequences (26). Therefore, each repeating sequence contains sequences that are homologous to the amino acid sequence 365 TYEAALKQYEADL 377 of PAc(365-377), which is an important region for the initial attachment of S. mutans to the tooth surface (31, 36). The differences between the alanine-rich sequence in ...

Considerable attention has been focused on nonalcoholic fatty liver disease (NAFLD) which occasionally develops after pancreatoduodenectomy (PD). The present study aimed to clarify the prevalence, sequential change in properties and risk factors for NAFLD development after PD. We enrolled 196 patients who underwent PD and a computed tomography (CT) scan 1 month, 6 months and 1 year after surgery. NAFLD was defined as a liver‐to‐spleen attenuation ratio on plain CT of <0.9. We compared various clinical factors between the NAFLD group and the control group. Individual prevalence of NAFLD at 1 month, 6 months and 1 year after surgery was 12%, 21% and 15%. Significantly different factors by univariate analysis were as follows: 1 month: age, sex, total protein (TP), total cholesterol (TC) and copper (Cu); 6 months: sex, disease, surgical method, portal vein resection (PVR), frequency of defecation, TC and Cu; 1 year: age, sex, disease, surgical method, PVR, frequency of defecation, TP and Cu. Risk factors by multivariate analysis were as follows: 1 month: not elderly age, female sex and a decrease in Cu; 6 months: female sex and a decrease in Cu; 1 year: a decrease in Cu. NAFLD after PD frequently developed in women with a decrease in serum Cu and was influenced by various factors related to poor digestion and absorption associated with pancreatic exocrine insufficiency.

Surgical treatment of GLM should be considered when complete excision including the primary tumor appears to be possible, particularly in cases of solitary hepatic metastases.