An Adult Case of Kawasaki Disease in a Pregnant Japanese Woman: A Case Report

Kawasaki disease is an acute febrile disease predominantly seen in young children. We report a case of Kawasaki disease in a 32-year-old pregnant woman. She developed a generalized erythematous skin rash accompanied by high fever. Bilateral conjunctival congestion, tender cervical lymphadenopathy, an edematous lower lip and peripheral edema followed by desquamation were observed. She was successfully treated with aspirin and intravenous gammaglobulin (1 g/kg/day). Her course was not complicated by coronary artery aneurysm and she delivered a healthy baby. To the best of our knowledge, this is the first case of Kawasaki disease in a pregnant woman. We suggest that Kawasaki disease should be included in the differential diagnosis of a generalized, erythematous skin rash accompanied by high fever in adults

A liquid crystalline phase in spermidine-condensed DNA

Over a large range of salt and spermidine concentrations, short DNA fragments precipitated by spermidine (a polyamine) sediment in a pellet from a dilute isotropic supernatant. We report here that the DNA-condensed phase consists of a cholesteric liquid crystal in equilibrium with a more concentrated phase. These results are discussed according to Flory's theory for the ordering of rigid polymers. The liquid crystal described here corresponds to an ordering in the presence of attractive interactions, in contrast with classical liquid crystalline DNA. Polyamines are often used in vitro to study the functional properties of DNA. We suggest that the existence of a liquid crystalline state in spermidine-condensed DNA is relevant to these studies

Bulk gravitational field and dark radiation on the brane in dilatonic brane world

We discuss the connection between the dark radiation on the brane and the bulk gravitational field in a dilatonic brane world model proposed by Koyama and Takahashi where the exact solutions for the five dimensional cosmological perturbations can be obtained analytically. It is shown that the dark radiation perturbation is related to the non-normalizable Kaluza-Klein (KK) mode of the bulk perturbations. For the de Sitter brane in the anti-de Sitter bulk, the squared mass of this KK mode is $2 H^2$ where $H$ is the Hubble parameter on the brane. This mode is shown to be connected to the excitation of small black hole in the bulk in the long wavelength limit. The exact solution for an anisotropic stress on the brane induced by this KK mode is found, which plays an important role in the calculation of cosmic microwave background radiation anisotropies in the brane world.Comment: 11 page

Novel Calcium-Binding Ablating Mutations Induce Constitutive RET Activity and Drive Tumorigenesis

がんゲノム医療のさらなる拡大へ向けた一歩 --コンピュータ解析で意義不明変異のなかに治療標的となる新たな遺伝子変異を発見--. 京都大学プレスリリース. 2022-09-29.Distinguishing oncogenic mutations from variants of unknown significance (VUS) is critical for precision cancer medicine. Here, computational modeling of 71, 756 RET variants for positive selection together with functional assays of 110 representative variants identified a three-dimensional cluster of VUSs carried by multiple human cancers that cause amino acid substitutions in the calmodulin-like motif (CaLM) of RET. Molecular dynamics simulations indicated that CaLM mutations decrease interactions between Ca²⁺ and its surrounding residues and induce conformational distortion of the RET cysteine-rich domain containing the CaLM. RET-CaLM mutations caused ligand-independent constitutive activation of RET kinase by homodimerization mediated by illegitimate disulfide bond formation. RET-CaLM mutants possessed oncogenic and tumorigenic activities that could be suppressed by tyrosine kinase inhibitors targeting RET. This study identifies calcium-binding ablating mutations as a novel type of oncogenic mutation of RET and indicates that in silico–driven annotation of VUSs of druggable oncogenes is a promising strategy to identify targetable driver mutations

Simultaneous Sinus Lifting and Alveolar Distraction of a Severely Atrophic Posterior Maxilla for Oral Rehabilitation with Dental Implants

We retrospectively reviewed a new preimplantation regenerative augmentation technique for a severely atrophic posterior maxilla using sinus lifting with simultaneous alveolar distraction, together with long-term oral rehabilitation with implants. We also analyzed the regenerated bone histomorphologically. This study included 25 maxillary sinus sites in 17 patients. The technique consisted of alveolar osteotomy combined with simultaneous sinus lifting. After sufficient sinus lifting, a track-type vertical alveolar distractor was placed. Following a latent period, patient self-distraction was started. After the required augmentation was achieved, the distractor was left in place to allow consolidation. The distractor was then removed, and osseointegrated implants (average of 3.2 implants per sinus site, 80 implants) were placed. Bone for histomorphometric analysis was sampled from six patients and compared with samples collected after sinus lifting alone as controls (n=4). A sufficient alveolus was regenerated, and all patients achieved stable oral rehabilitation. The implant survival rate was 96.3% (77/80) after an average postloading followup of 47.5 months. Good bone regeneration was observed in a morphological study, with no significant difference in the rate of bone formation compared with control samples. This new regenerative technique could be a useful option for a severely atrophic maxilla requiring implant rehabilitation

Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration

Background/Aims This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. Methods Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others. Results The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). Conclusions The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes

早期離床に対する看護師の認識と課題 －プロジェクトＦの活動を通じて－

早期離床を院内に定着させることを目標に，看護部でプロジェクトＦを発足させ活動を行った．まず，現状把握のため看護師538名に対し早期離床の認識についてのアンケート調査を行った．有効回答は428名（有効回答率79.6％）から得られた．その結果，離床援助技術の卒後の教育は不十分で，ほとんどの看護師が体位変換や移乗を困難であると感じていた．また，早期離床に関する医師の指示や離床に関する記録が統一されていないことがわかった．早期離床を妨げる要因として，記録などの多忙な業務や，痛みや循環変動，複数のラインなど患者の要因が挙げられた．看護師が行う早期離床の現実と理想との間に大きな乖離があり，現状に満足していない状況が示唆された．調査の結果から，「離床援助技術の教育」「早期離床フローチャートの策定と運用」「離床に関する記録整備」を課題とし，組織をあげて改善への取り組みを行った．その経緯についても加えて報告する．In order to establish early mobilization in the hospital, the "project F" was created in the Nursing Department and activities were started. A questionnaire was held regarding early wake-up and valid response were obtained from 428 out of 538 people. According to the results, factors such as busyness due to nursing records were one of the reasons that hindered this. As a result, post-graduate education for mobilization skills was inadequate, and most nurses felt it was difficult to change positions or transfer. It was also found that doctors' instructions regarding early mobilization, and records related to mobilization, were not unified. Factors that hindered early mobilization included diligent work such as nursing records, patient factors such as pain and circulatory fluctuations, and multiple lines. There was a big divergence between the reality, and the ideals of early mobilization performed by nurses, suggesting that they are not satisfied with the current situation. Based on the results of the survey, the issues were "education of mobilization assistance technology", "development and operation of early mobilization flowchart", and "maintenance of records concerning mobilization", and the entire organization worked on improvement. We will also report on the process