Drop Metastasis of Adrenocorticotropic Hormone-Producing Pituitary Carcinoma to the Cauda Equina

The diagnosis of pituitary carcinoma cannot be made easily histologically, and most cases of pituitary carcinoma are diagnosed only after the clinical detection of metastasis. Distant metastasis of pituitary tumor occurs in 0.1% to 0.2% of cases and has been reported in the liver, bone and central nervous system, with only one case of metastasis to the cauda equine reported. This study describes a rare case of the drop metastasis of adrenocorticotropic hormone-producing pituitary adenocarcinoma to the cauda equina, causing cauda equina syndrome

Comparison of performance of the 2016 ACR-EULAR classification criteria for primary Sjögren\u27s syndrome with other sets of criteria in Japanese patients

Objectives To compare the performance of the new 2016 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for primary Sjögren\u27s syndrome (SS) with 1999 revised Japanese Ministry of Health criteria for diagnosis of SS (JPN), 2002 American-European Consensus Group classification criteria for SS (AECG) and 2012 ACR classification criteria for SS (ACR) in Japanese patients.Methods The study subjects were 499 patients with primary SS (pSS) or suspected pSS who were followed up in June 2012 at 10 hospitals in Japan. All patients had been assessed for all four criteria of JPN (pathology, oral, ocular, anti-SS-A/SS-B antibodies). The clinical diagnosis by the physician in charge was set as the ‘gold standard’.Results pSS was diagnosed in 302 patients and ruled out in 197 patients by the physician in charge. The sensitivity of the ACR-EULAR criteria in the diagnosis of pSS (95.4%) was higher than those of the JPN, AECG and ACR (82.1%, 89.4% and 79.1%, respectively), while the specificity of the ACR-EULAR (72.1%) was lower than those of the three sets (90.9%, 84.3% and 84.8%, respectively). The differences of sensitivities and specificities between the ACR-EULAR and other three sets of criteria were statistically significant (p<0.001). Eight out of 302 patients with pSS and 11 cases out of 197 non-pSS cases satisfied only the ACR-EULAR criteria, compared with none of the other three sets.Conclusions The ACR-EULAR criteria had significantly higher sensitivity and lower specificity in diagnosis of pSS, compared with the currently available three sets of criteria

Evaluation of larval quality of viviparous scorpionfish Sebastiscus marmoratus

The aim of this study was to develop an acute test for larval quality in the viviparous scorpionfish Sebastiscus marmoratus. Rearing experiments until day 13 post parturition were conducted to investigate the survival of larvae for 13 different batches, and tolerance to starvation of larvae was examined and expressed by the survival activity index (SAI). The morphological characters, enzyme activity, and swimming behavior of larvae on day 0 and 1 were also observed, followed by the correlation analysis between SAI. Larvae with high SAI (?26) showed significantly higher survival on day 13 than larvae with low SAI, which confirmed that SAI is a reliable index that can be used to evaluate larval quality, similar to the former findings. The esterase activity (r = -0.713, P < 0.01), swim frequency (r = -0.735, P < 0.01) and swimming speed (r = -0.588, P < 0.05) of larvae on day 0 were significantly and negatively correlated with SAI. It was concluded that enzyme activity and behavioral characters of larvae just after parturition can be a real-time index for evaluating the larval quality of this species

ナイチンゲール病棟の設計思想とプライバシー ―時代背景にみるプライバシーの捉え方－

【要旨】著者らは，看護学生を対象にナイチンゲールが考案したナイチンゲール病棟に関するイメージ調査を行った結果，患者のプライバシー確保に関して否定的な回答がみられた．そこでナイチンゲールがプライバシーをどのように捉えているかを，ナイチンゲール著作集で確認すると，看護師側のプライバシーについてのみ記述され，患者側のプライバシーを守ることについての記述はなかった．そこで，ナイチンゲール病棟が提唱された 1860 年代からの英国文学作品 6 作品を用い，羞恥心への認識と，質問紙により現代の看護学生が感じる羞恥心レベルについて調査し，ナイチンゲール病棟の設計 思想と現代におけるプライバシーの捉え方について検討した．文献検討では，その時代前後で，病院の患者の階級や求められる医療が変化し，プライバシーが必要になった．ナイチンゲール病棟を提唱した時期はちょうどその過渡期であり，プライバシーへの十分な配慮がなされていなかったことが示唆された．看護学生のアンケート調査では，患者が治療を受ける場合，特に身体の一部が露出されるときに羞恥心が あると答えていた．ナイチンゲール病棟については，看護者の目が行き届き安心感を与えるが，患者のプラ イバシーがないと捉えていた．Abstract: We administered a questionnaire survey of a hospital ward designed by Florence Nightingale called “Nightingale ward” to nursing students, and obtained negative responses regarding securing patient privacy. Given the results above, we reviewed Nightingale’s publications to learn her perspective on privacy. Our review showed that privacy was described only from the standpoint of nurses and there was no reference to patient privacy protection. In order to investigate privacy issues with the Nightingale ward, we reviewed six British literary works published during the 1860s, the period in which the Nightingale ward was proposed, to investigate how people at that time thought about embarrassment, and surveyed the extent of patients’ embarrassment that was perceived by the present-day nursing students. Literature review showed that the social classes of inpatients and required medical care changed around the period of time in which Nightingale lived, leading to increased significance of privacy protection. The time when the Nightingale ward was proposed was exactly in the transition stage, and privacy had not been given adequate attention. According to the survey results, the nursing students felt that patients were embarrassed during treatment, especially when parts of their body were exposed. Openness of the Nightingale ward may bring a sense of ease for patients but it also poses difficulty in securing their privacy. The results indicated that this issue may be a potential factor to make patients feel embarrassed, and the Nightingale ward was therefore considered to “lack privacy.

成人女性の常温と寒冷における体温調節反応の比較

The purpose of this study was to observe the differences of thermoregulatory responses between normal condition (24℃RH 50%) and cold temperature condition (-30℃). Subjects were 18 healthy Japanese adult women (age : 21.5±1.1 yrs, stature : 158.9±3.3 cm, weight : 52.3±8.0 kg, fat% : 25.7±4.4%). The clothing conditions were 0.18 clo for normal condition and 2.0 clo for cold condition. The exposure time was 40 minutes for the first normal condition, 20 minutes for cold condition and 40 minutes for the second normal condition. The subjects kept a sitting position. Measurement items were rectal temperature, skin temperature, oxygen uptake and subjective sensations. We determined atsugari (susceptibility to the heat) and samugari (susceptibility to the cold) according to the subjective sensations during the first normal condition exposure. The grouping of atsugari and samugari did not always agree with the self-reported atsugari and samugari of each subject. The atsugari group had a tendency to show high peripheral skin temperature, low rectal temperature and warmer thermal sensation than samugari group. However, it was not significant. Oxygen uptake was significantly higher (p<0.05) in samugari group than atsugari group

Nutritional Heterogeneity Among Aspergillus fumigatus Strains Has Consequences for Virulence in a Strain- and Host-Dependent Manner

Acquisition and subsequent metabolism of different carbon and nitrogen sources have been shown to play an important role in virulence attributes of the fungal pathogen Aspergillus fumigatus, such as the secretion of host tissue-damaging proteases and fungal cell wall integrity. We examined the relationship between the metabolic processes of carbon catabolite repression (CCR), nitrogen catabolite repression (NCR) and virulence in a variety of A. fumigatus clinical isolates. A considerable amount of heterogeneity with respect to the degree of CCR and NCR was observed and a positive correlation between NCR and virulence in a neutropenic mouse model of pulmonary aspergillosis (PA) was found. Isolate Afs35 was selected for further analysis and compared to the reference strain A1163, with both strains presenting the same degree of virulence in a neutropenic mouse model of PA. Afs35 metabolome analysis in physiological-relevant carbon sources indicated an accumulation of intracellular sugars that also serve as cell wall polysaccharide precursors. Genome analysis showed an accumulation of missense substitutions in the regulator of protease secretion and in genes encoding enzymes required for cell wall sugar metabolism. Based on these results, the virulence of strains Afs35 and A1163 was assessed in a triamcinolone murine model of PA and found to be significantly different, confirming the known importance of using different mouse models to assess strain-specific pathogenicity. These results highlight the importance of nitrogen metabolism for virulence and provide a detailed example of the heterogeneity that exists between A. fumigatus isolates with consequences for virulence in a strain-specific and host-dependent manner

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target