Development of eosinophilic granulomatosis with polyangiitis during the clinical course of microscopic polyangiitis: A case report

Rationale: Eosinophilic granulomatosis with polyangiitis (EGPA) is belongs to the antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) subgroups. EGPA, unlike other subgroups of AAV, including microscopic polyangiitis (MPA) and granulomatosis with polyangiitis, has the unique feature that both ANCA and eosinophilic inflammation are involved in its pathogenesis. Although AAV often relapses, there are currently no reports of EGPA developing during other subgroups of AAV. Herein, we document a case of EGPA that developed during the clinical course of MPA.Patient concerns: A 61-year-old Japanese woman was diagnosed with MPA based on interstitial lung disease and myeloperoxidase-ANCA positivity. After starting immunosuppression therapy, including prednisolone and tacrolimus, she was expected to achieve clinical remission. Nonetheless, she occasionally experienced MPA relapse, which required an increased prednisolone dose, rituximab, intravenous cyclophosphamide, and plasma exchange. Three years after MPA onset, she developed renal amyloidosis; thus, subcutaneous tocilizumab was added to her regimen. Following clinical remission, the administration interval of her subcutaneous tocilizumab therapy was extended and immunosuppressants were discontinued. She then developed bronchial asthma and mild eosinophilia (eosinophilic count: ~1000/μL). Further, a year later, she underwent total hip replacement using a titanium implant. Subsequently, she developed abnormal sensation in both hands, numbness, and muscle weakness, as well as palpable purpura and massive eosinophilia (eosinophilic count: ~8500/μL).Diagnosis: We diagnosed the patient with EGPA based on 5 items (asthma, multiple mononeuropathies, sinus abnormality, and extravascular eosinophils) of the 1990 American College of Rheumatology classification criteria.Interventions: We administered 400 mg/kg intravenous immunoglobulin for 5 consecutive days, 300 mg mepolizumab subcutaneously every 4 weeks, and 40 mg/day prednisolone following pulsed methylprednisolone therapy (1000 mg/day for 3 consecutive days).Outcomes: After these treatments, the patient’s symptoms improved, and eosinophilic count and inflammatory markers declined.Lessons: The present case suggests that EGPA can be induced by the development of eosinophilic inflammation in other subgroups of AAV.Abbreviations: AAV = ANCA-associated vasculitis, ANCA = antineutrophil cytoplasmic autoantibody, CCL = chemokine (C–C motif) ligands, CRP = C-reactive protein, EGPA = eosinophilic granulomatosis with polyangiitis, IL = interleukin, ILC2 = group 2 innate lymphoid cells, ILD = interstitial lung disease, MPA = microscopic polyangiitis, MPO = myeloperoxidase, mPSL = methylprednisolone, PSL = prednisolone, TAC = tacrolimus, TCZ = tocilizumab, Th2 = T helper 2

Effects of locomotor training on the functional recovery from the spinal cord injury

This mini-review surveys several representative rehabilitation studies using a treadmill or other methods of locomotor exercises in humans and experimental animals with spinal cord injury. The methods and effect of locomotor training employed in individual studies are explained and the importance of the sensory input and body weight loading in the stimulation of the central pattern generator is emphasized. The establishment of neural networks by regenerating and/or spared axons is the basis of locomotor improvement. Although regenerating axons are found within the lesion, it is difficult to demonstrate the development of new neural connections. Muscle activity is another important factor in recovery from spinal cord injury. Robotic trainings of rats on a treadmill is not considered suitable for a rehabilitation study, because the robotic movement of the hind limbs differs from natural quadrupedal walking. Clinically, driven gait orthosis is used effectively for locomotor training of patients with SCI

<Articles>In Pursuit of Another Conversation : Social Justice as Educational Discussion

This paper explores a point of discussion between the views expressed in lectures by Paul Standish and Yasuo Imai. Although they initially share the same scepticism about the contemporary educational discourse concerning social justice, their philosophical deliberations seem ultimately to diverge. With reference to the works of Minoru Murai, this paper explores the foundational questions that Imai and Standish have in common throughout their arguments. To begin this bridging process, I will first create an imaginary conversation between Imai and Murai about justice and violence in education. After that, I will examine how Murai would engage with Standish on the matter of social justice in educational studies. At the end of the paper, I will discuss a way to integrate at the philosophical level Imai's and Standish's arguments with Murai's further educational discussion

A Philosophical Analysis of the Educational Debates in Japan Over Patriotism and Peace

153 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2008.After exploring these different educational goals, I examine whether such a conflict is inevitable or is driven by forces beyond educational justification. Several social and political factors inherent in this debate are presented and then explored to reveal what might be reasonably justified in terms of both patriotic and peace education.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

A Philosophical Analysis of the Educational Debates in Japan Over Patriotism and Peace

153 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2008.After exploring these different educational goals, I examine whether such a conflict is inevitable or is driven by forces beyond educational justification. Several social and political factors inherent in this debate are presented and then explored to reveal what might be reasonably justified in terms of both patriotic and peace education.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Conditionally replicating adenovirus prevents pluripotent stem cellâderived teratoma by specifically eliminating undifferentiated cells

Incomplete abolition of tumorigenicity creates potential safety concerns in clinical trials of regenerative medicine based on human pluripotent stem cells (hPSCs). Here, we demonstrate that conditionally replicating adenoviruses that specifically target cancers using multiple factors (m-CRAs), originally developed as anticancer drugs, may also be useful as novel antitumorigenic agents in hPSC-based therapy. The survivin promoter was more active in undifferentiated hPSCs than the telomerase reverse transcriptase (TERT) promoter, whereas both promoters were minimally active in differentiated normal cells. Accordingly, survivin-responsive m-CRA (Surv.m-CRA) killed undifferentiated hPSCs more efficiently than TERT-responsive m-CRAs (Tert.m-CRA); both m-CRAs exhibited efficient viral replication and cytotoxicity in undifferentiated hPSCs, but not in cocultured differentiated normal cells. Pre-infection of hPSCs with Surv.m-CRA or Tert.m-CRA abolished in vivo teratoma formation in a dose-dependent manner following hPSC implantation into mice. Thus, m-CRAs, and in particular Surv.m-CRAs, represent novel antitumorigenic agents that could facilitate safe clinical applications of hPSC-based regenerative medicine