Genetic Isolation between the Western and Eastern Pacific Populations of Pronghorn Spiny Lobster Panulirus penicillatus

The pronghorn spiny lobster, Panulirus penicillatus, is a circumtropical species which has the widest global distribution among all the species of spiny lobster, ranging throughout the entire Indo-Pacific region. Partial nucleotide sequences of mitochondrial DNA COI (1,142–1,207 bp) and 16S rDNA (535–546 bp) regions were determined for adult and phyllosoma larval samples collected from the Eastern Pacific (EP)(Galápagos Islands and its adjacent water), Central Pacific (CP)(Hawaii and Tuamotu) and the Western Pacific (WP)(Japan, Indonesia, Fiji, New Caledonia and Australia). Phylogenetic analyses revealed two distinct large clades corresponding to the geographic origin of samples (EP and CP+WP). No haplotype was shared between the two regional samples, and average nucleotide sequence divergence (Kimura's two parameter distance) between EP and CP+WP samples was 3.8±0.5% for COI and 1.0±0.4% for 16S rDNA, both of which were much larger than those within samples. The present results indicate that the Pacific population of the pronghorn spiny lobster is subdivided into two distinct populations (Eastern Pacific and Central to Western Pacific), with no gene flow between them. Although the pronghorn spiny lobster have long-lived teleplanic larvae, the vast expanse of Pacific Ocean with no islands and no shallow substrate which is known as the East Pacific Barrier appears to have isolated these two populations for a long time (c.a. 1MY)

免疫抑制剤投与中に急性呼吸促迫症候群を合併した粟粒結核の１例

症例は75歳，女性．MPO-ANCA 関連血管炎に対して半年間，ステロイド薬が投与されていた．４日前から発熱，呼吸困難が出現，意識障害も伴ってきたため，当院を受診した．画像上，両側肺にびまん性の中枢側に有意な浸潤影とすりガラス陰影を認め，急性呼吸促迫症候群（ARDS）の合併を疑われた．人工呼吸管理となり，挿管中に採取した喀痰抗酸菌検査で塗抹陽性，結核菌PCR陽性の結果が得られ，血液や尿からも結核菌が検出され，粟粒結核によるARDS と診断した．治療は入院後の第３病日からINH ＋ RFP ＋ EB による抗結核療法を開始し，人工呼吸管理および血液透析をしながら経過観察をしていたが，播種性血管内凝固症候群も併発し，第14病日に死亡した．ARDS を合併する粟粒結核の症例も散見されることから，鑑別診断に粟粒結核も念頭におきながら診療することが重要と思われた．A 75-year-old woman, who was treated with corticosteroid therapy for six months for MPO-ANCA related vasculitis, visited to our hospital with fever, dyspnea and consciousness disturbance four days ago. She was diagnosed with acute respiratory distress syndrome (ARDS) from radiological findings such as diffuse bilateral hilar dominant infiltration shadow and ground-glass opacity. She was admitted to the intensive care unit (ICU) and put on mechanical ventilation for acute respiratory failure. The aspiration sputum after incubation turned out to be positive for acid-fast bacilli, which were identified as Mycobacterium tuberculosis (MTB) using a polymerase chain reaction test. As the same results in the clinical specimens of peripheral blood and urine were obtained, we made final diagnosis of miliary tuberculosis complicated with ARDS. Although we initiated the anti-tuberculosis treatment using INH, RFP, EB with mechanical ventilation and hemodialysis treatment, she died of multiple organ failure complicated with disseminated intravascular coagulation (DIC). Due to the fact, that we have encountered few cases of miliary tuberculosis complicated with ARDS, it is important that we suspect severe miliary tuberculosis in patients with immunosuppressive treatment

急速に増大する腫瘤影を呈した肺Mycobacterium avium症の1例

症例は66歳,男性.慢性閉塞性肺疾患とい草塵肺で経過観察をしていた.6カ月前の胸部CTでは明らかな異常を認めなかったが,新たに左上葉の気腫性病変周囲に腫瘤性病変を認めた.気管支鏡検査にて,局所検体からM.avium が検出されたものの生検で肉芽腫病変を認めなかったため,CTガイド下肺生検を実施した結果,肺MAC症と最終診断した.近年,孤立性腫瘤形成型肺MAC症の症例を散見するようになってきているが,本症例のごとく短期間で急速に増大することもあることから,抗酸菌を含めた肺感染症に対する積極的な検査が必要と思われる.A 66-year-old man was admitted to our hospital for follow-up on chronic obstructive pulmonary disease with a recent-showing abnormal chest shadow. He had received a periodic chest computed tomography (CT) six months prior due to a past history of COPD and Igusa pneumoconiosis. Although there was no mass shadow on the chest CT six months ago, a solitary tumorous shadow appeared surrounding the emphysematous lesions in the left upper lobe. M. avium was detected from local specimens viabronchoscopic examination, but because a granulomatous lesion was not observed, we performed a CT-guided lung biopsy and made a final diagnosis of pulmonary MAC disease. We recently observed that pulmonary MAC disease presents as a solitary tumorous shadow. However, as there are cases of pulmonary MAC disease presenting as a rapidly growing tumorous shadow within a short time, it is necessary to perform aggressive examinations for infectious diseases including an acid-fast bacilli examination

胸部リンパ節病変の診断における超音波気管支内視鏡ガイド 下経気管支針生検(EBUS-TBNA)の有用性

近年,超音波気管支内視鏡ガイド下経気管支針生検(Endobronchial Ultrasonography-guided Transbronchial Needle Aspiration,以下EBUS-TBNA)は縦隔および肺門リンパ節病変に対するアプローチ法として開発され,病理学的および微生物学的な確定診断に用いられる.EBUSTBNAを実施できるか否かの判断や,施行後の診断率には標的リンパ節の大きさや周囲もしくは内部血管などが影響するが,それらに関する報告は少ない.2010年10月～2013年8月に,当科でEBUSを施行した69例のTBNA施行率,診断率,不成功の理由を後方視的に検討した.TBNAを施行できたのは60例であり(87%),そのうち54例(93%)で診断が確定できた.肺癌が42例(67%)と最多で,以下サルコイドーシス7例,他臓器癌のリンパ節転移3例,抗酸菌感染症1例,悪性リンパ腫1例であった.EBUS施行例のリンパ節の直径は21.3±6.0mmで,非確診例の標的リンパ節は有意に小さかった(17.5±3.7vs22.9±5.1mm,p<0.0001).部位別では下部気管傍リンパ節と気管支分岐部リンパ節で実施した症例が多かったが,部位による診断率の差は認めなかった.最終診断率では,肺癌が91%(46例中42例),サルコイドーシスが70%(10例中7例)であった.TBNAの不成功の理由は,「標的リンパ節が小さい」,「血管損傷の可能性が高い」,「患者の鎮静不可」であった.重篤な有害事象は1例も認めなかった.縦隔および肺門リンパ節病変の診断において,EBUS-TBNAは有用であると考えられた.Endobronchial ultrasonography - guided transbronchial needle aspiration (EBUSTBNA) is a new method for tissue biopsy of thoracic lymph node lesion. However, the clinical usefulness of this method and associated issues are still relatively unknown. Sixty-nine cases received EBUS in our hospital between October 2010 and August 2013. The relationship was analyzed between the diagnostic rate and the size or location of the lymph node targeted. TBNA was performed in 60 of the 69 cases, out of those the pathological and microbiological diagnosis were obtained in 54 cases (93%). The final diagnosis consisted of lung cancer in 42 cases (67%) followed by sarcoidosis in 7, metastasis of the other organ\u27s malignancy in 3 and mycobacterium infection in 1, and lastly malignant lymphoma in 1. The mean lymph node diameter was 21.3 ± 6.0 mm, and the inability to obtain the correct diagnosis was significantly smaller than obtaining the correct diagnosis. (17.5 ± 3.7 vs 22.9 ± 5.1 mm, p < 0.0001). In regard to the location of the lymph nodes, "lower paratrachea" and " subcarinal" were common, but was not chief concern with the diagnostic rate. Futhermore, the diagnostic rate was 91% (42 of 46) in lung cancer and 70% (7 of 10) in sarcoidosis. We could not perform EBUS-TBNA because of "small lymphnode" and "high risk of vascular damage" in addition to "insufficient patient\u27s sedation". No severe adverse events had occurred. EBUS-TBNA is useful for the thoracic lymph node lesion diagnosis

The molecular and cellular mechanisms of itch and the involvement of TRP channels in the peripheral sensory nervous system and skin

Itch is an unpleasant cutaneous sensation that can arise following insect bites, exposure to plant ingredients, and some diseases. Itch can also have idiopathic causes. Itch sensations are thought to protect against external insults and toxic substances. Although itch is not directly lethal, chronic and long lasting itch in certain diseases can worsen quality of life. Therefore, the mechanisms responsible for chronic itch require careful investigation. There is a significant amount of basic research concerning itch, and the effect of various itch mediators on primary sensory neurons have been studied. Interestingly, many mediators of itch involve signaling related to transient receptor potential (TRP) channels. TRP channels, especially thermosensitive TRP channels, are expressed by primary sensory neurons and skin keratinocytes, which receive multimodal stimuli, including those that cause itch sensations. Here we review the molecular and cellular mechanisms of itch and the involvement of TRP channels in mediating itch sensations

健康な若年男性にみられた結節・気管支拡張型肺M.kansasii 症の１例

症例報告Case Reportjournal articl

健康な若年男性にみられた結節・気管支拡張型肺M.kansasii 症の１例

　症例は32歳，男性．既往歴は特になく，喫煙歴もなかった．自覚症状はなかったが，定期的にとられた胸部Ｘ線写真で異常影を指摘され，当科受診となった．検査所見では，クオンティフェロン®（QFT®）が判定保留であった．CT 上，左下葉に気管支拡張を伴った小葉中心性粒状影を認めた．確定診断を得るため，気管支鏡検査を実施したところ，生検組織で多核巨細胞を含む類上皮細胞性肉芽腫がえられ，気管支肺胞洗浄液（Bronchial Alveolar Lavage fluid; BALF）から抗酸菌塗抹陽性，培養陽性，DNA–DNA hybridization（DDH）法にてMycobacterium kansasii（M.kansasii ）が同定された．肺M.kansasii 症と診断後，イソニアジド（Isoniazid：INH），リファンピシン（Rifampicin：RFP），エタンブトール（Ethambutol：EB）による治療を開始し，１年間継続したところ，陰影の改善が得られた．従来，肺M.kansasii 症は喫煙男性において上葉に薄壁空洞を呈しやすいといわれてきたが，今回私共は健常な若年男性の左下葉に結節・気管支拡張型の肺Mycobacterium avium complex（MAC）症に類似した画像所見を呈した症例を経験した．非結核性抗酸菌症の治療は，菌種により治療法は異なるため，気管支鏡検査を含めた積極的な診断法を行うことにより，原因菌を同定することが重要と考えられた．　A-32-year-old male was referred to our hospital due to the presence of an abnormal shadow on chest radiograph. The patient did not have clinical symptoms, underlying disease, or smoking history. Laboratory findings were unremarkable, except for the QuantiFERON-TB Gold In-Tube test®. Chest computed tomography revealed the presence of centrilobular nodule with bronchiectasis in the left lower lobe. We performed a bronchoscopic examination to reach a definitive diagnosis. Subsequently, the epithelioid granuloma, (including Langhans giant cells) was obtained through biopsy. In addition, DNA–DNA hybridization (DDH) showed that the fast-acid bacilli of bronchoalveolar lavage fluid (BALF) was smear-positive and culture-positive for Mycobacterium kansasii (M. kansasii ). After the diagnosis of pulmonary M. kansasii disease, we administered Isoniazid, Rifampicin and Ethambutol over the course of 1 year. Eventually, the abnormal shadow was improved. Although pulmonary M. kansasii disease is associated with the development of thin-wall cavity lesions in the upper lobe of males with smoking history, we observed a rare case showing similar radiological findings to those of the nodular-bronchiectatic type of pulmonary Mycobacterium avium complex disease. The treatment was different by the kinds of nontuberculous mycobacteria. Therefore, it was important to identify the causative microorganism by performing positive diagnostic methods, including bronchoscopy