Case Report Adult Dermatomyositis with Bleeding Ulcer in the Pharynx

Dermatomyositis (DM) is one of the idiopathic inflammatory myopathies caused by complement-mediated vasculopathy or vasculitis in the muscle. Although the gastrointestinal (GI) mucosa has been reported to be involved as a result of vasculitis or vasculopathy, ulceration in the pharynx is a rare manifestation of DM. A 54-year-old woman complaining of muscle weakness in the extremities, low-grade fever, and dysphagia was diagnosed as having DM. Despite medical treatment with corticosteroids and immunosuppressive agents, her DM progressed rapidly, leading to exacerbation of the dysphagia. About 3 weeks after undergoing tracheostomy as a preventive measure against aspiration, the patient developed intractable respiratory tract hemorrhage. Repeated laryngoendoscopy revealed a bleeding ulceration in the pharynx that required hemostasis with electric cautery under general anesthesia. No bleeding recurred thereafter. Histopathologically, the pharynx exhibited nonspecific inflammatory cell infiltration in the muscle tissue. This rare manifestation may be considered in cases of DM with unexplainable airway bleeding

A Chain of Dark Clouds in Projection Against the Galactic Center

In the J, H, and Ks bands survey of the the Galactic Center region over an area of 2deg x 5deg, we have found many dark clouds, among which a distinguished chain of dark clouds can be identified with a quiescent CO cloud. The distances of the clouds is estimated to be 3.2-4.2 kpc, corresponding to the Norma arm by our new method to determine distance to dark clouds using the cumulative number of stars against J-Ks colors. Adopting these estimated distances, the size is about 70 pc in length and the total mass of the cloud is 6x10^4 M_solar. Three compact HII regions harbor in the cloud, indicating that star forming activities are going on at the cores of the quiescent CO cloud on the spiral arm.Comment: 13 pages, 7 figures, accepted for publication in PAS

Usefulness of the waterless method for surgical hand washing：A comparison with the conventional scrub method

To evaluate the usefulness of the waterless hand washing method for surgical anti-sepsis, we conducted a microbial sampling study, comparing it to a conventional surgical scrub method. A total of 18 operating-room nurses were undertaking the following three-hand washing protocols : scrubbing with blushes using 4w/v% chlorhexidine gluconate (CHG) and also rubbing with CHG, followed by application of a 0.2w/v% CHG with ethanol (HS) preparation. (conventional method); rubbing with CHG and application of HS (two-stage surgical scrub method; TSS); rubbing with anti-septic soap and application of HS (waterless method; WL). Microbial sampling was conducted after hand washing using the glove juice method. No statistically significant differences in bacterial numbers were found among these three methods. The number of bacterially positive subjects was significantly higher in the conventional method than the TSS method. These results indicate that there are adverse effects of blush-scrubbing, as the detected bacteria were related to normal skin flora. As such, the WL method for hand anti-sepsis appears to be equivalent to the conventional surgical scrubbing method in terms of microbial detection. The WL method should therefore be introduced as a standard hand anti-sepsis method at the time of surgery because it is cost-effective as well as time-efficient

出産クラス受講前後の妊婦の自己効力感と指導者のProfessional Learning Climate との関連性

【目的】出産クラス受講前後の妊婦の自己効力感と指導者の Professional Learning Climate （以下、PLCとする）との関連性を明らかにする。 【方法】２００８年７月～９月に北陸の産科施設で開催された３１の出産クラスに参加した妊婦 ２４４名とクラス指導者３９名を対象に自記式質問紙調査を行った。妊婦には出産に対する自 己効力感と指導者に対して感じたPLCについて、クラス指導者にはクラスの指導経験年数 など属性項目を調査した。また、クラスの参加観察によりクラス内容や雰囲気、参加者や 指導者の交流タイプなどを調査した。 【結果】対象全体では、自己効力感と PLCに有意な関連は認めなかった。しかし、出産経験 別の検討では、初産婦にのみ自己効力感と PLCに有意な正相関を認めた。 PLCの要素別で は「リラックスできる空間の創造」、「ユーモアとウィット」の２要素と自己効力感との間 に有意な正相関を認めた。一方、経産婦においては自己効力感と PLCに関連性は認めな かった。さらに、クラス後の自己効力感の高さには、 PLCとクラス前の自己効力感が影響 していた。 　以上より、 PLCは出産クラスを運営する際に、指導者にとって身につけることが望まし い必要な要素であることが示唆された。 : The purpose of this study was to clarify the relationship between the professional learning climate (PLC) of educators and the self-efficacy of pregnant women before and after they took a childbirth class. : A self-completed questionnaire survey was conducted on 244 pregnant women who had participated in 31 childbirth classes held in a maternity hospital in the Hokuriku district, and 39 class educators. It investigated the pregnant women s feelings of self-efficacy to cope with childbirth and PLC with the educator, and such educator attributes as the number of years of experience in teaching childbirth classes. Class content and atmosphere, and the types of interaction between participants and educators, were investigated through participant observation of the classes. The survey was conducted from July to September 2008. : No significant relationship was observed between self-efficacy and PLC in all subjects. However, among women with parity, a significant positive correlation was observed between self-efficacy and PLC in nullipara. Among individual elements of PLC, significant positive correlations were observed between self-efficacy and “creation of a relaxing space” and “humor and wit.” Among multipara, no relationship was observed between self-efficacy and PLC. In addition, the level of self-efficacy after the class was affected by PLC and self-efficacy before the class. 　The present findings suggest that skill in creating PLC is an element which educators should acquire in order to conduct childbirth classes.[原著

Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient’s pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively

Circadian protection against bacterial skin infection by epidermal CXCL14-mediated innate immunity

体内時計は夜間に自然免疫を発動 --皮膚ケモカインによる自然免疫機構--. 京都大学プレスリリース. 2022-06-16.Biological clocks set for skin immunity. 京都大学プレスリリース. 2022-06-21.The epidermis is the outermost layer of the skin and the body’s primary barrier to external pathogens; however, the early epidermal immune response remains to be mechanistically understood. We show that the chemokine CXCL14, produced by epidermal keratinocytes, exhibits robust circadian fluctuations and initiates innate immunity. Clearance of the skin pathogen Staphylococcus aureus in nocturnal mice was associated with CXCL14 expression, which was high during subjective daytime and low at night. In contrast, in marmosets, a diurnal primate, circadian CXCL14 expression was reversed. Rhythmically expressed CXCL14 binds to S. aureus DNA and induces inflammatory cytokine production by activating Toll-like receptor (TLR)9-dependent innate pathways in dendritic cells and macrophages underneath the epidermis. CXCL14 also promoted phagocytosis by macrophages in a TLR9-independent manner. These data indicate that circadian production of the epidermal chemokine CXCL14 rhythmically suppresses skin bacterial proliferation in mammals by activating the innate immune system

A Distinct Structure Inside the Galactic Bar

We present the result of a near-infrared (J H Ks) survey along the Galactic plane, -10.5deg < l < +10.5deg and b=+1.0deg, with the IRSF 1.4m telescope and the SIRIUS camera. Ks vs. H-Ks color-magnitude diagrams reveal a well-defined population of red clump (RC) stars whose apparent magnitude peak changes continuously along the Galactic plane, from Ks=13.4 at l=-10deg to Ks=12.2 at l=+10deg after dereddening. This variation can be explained by the bar-like structure found in previous studies, but we find an additional inner structure at |l| < 4deg, where the longitude - apparent magnitude relation is distinct from the outer bar, and the apparent magnitude peak changes by only 0.1 mag over the central 8deg. The exact nature of this inner structure is as yet uncertain.Comment: 8 pages, 4 figures. accepted by ApJ

Analysis of T-cell alloantigen response via a direct pathway in kidney transplant recipients with donor-specific antibodies

Donor-specific antibodies (DSAs) are the main cause of graft loss over time. The direct pathway of alloantigen recognition is important in the pathogenesis of acute rejection. Recent studies have suggested that the direct pathway also contributes to the pathogenesis of chronic injury. Nevertheless, there are no reports on T-cell alloantigen response via the direct pathway in kidney recipients with DSAs. We analyzed the T-cell alloantigen response via the direct pathway in kidney recipients with DSAs (DSA+) or without DSAs (DSA−). A mixed lymphocyte reaction assay was implemented to assess the direct pathway response. DSA+ patients showed significantly higher CD8+ and CD4+ T cell responses to donor cells than DSA− patients. Furthermore, proliferating CD4+ T cells showed a marked increase in Th1 and Th17 responses in DSA+ patients than in DSA− patients. In a comparison between anti-donor and third-party responses, the anti-donor CD8+ and CD4+ T cell response was significantly lower than the anti-third-party response. In contrast, the donor-specific hyporesponsiveness was absent in DSA+ patients. Our study demonstrated that DSA+ recipients have a greater potential for developing immune responses against the donor tissues via the direct alloantigen recognition pathway. These data contribute to an understanding of DSAs pathogenicity during kidney transplantation

CNVs in Three Psychiatric Disorders

BACKGROUND: We aimed to determine the similarities and differences in the roles of genic and regulatory copy number variations (CNVs) in bipolar disorder (BD), schizophrenia (SCZ), and autism spectrum disorder (ASD). METHODS: Based on high-resolution CNV data from 8708 Japanese samples, we performed to our knowledge the largest cross-disorder analysis of genic and regulatory CNVs in BD, SCZ, and ASD. RESULTS: In genic CNVs, we found an increased burden of smaller (500 kb) exonic CNVs in SCZ/ASD. Pathogenic CNVs linked to neurodevelopmental disorders were significantly associated with the risk for each disorder, but BD and SCZ/ASD differed in terms of the effect size (smaller in BD) and subtype distribution of CNVs linked to neurodevelopmental disorders. We identified 3 synaptic genes (DLG2, PCDH15, and ASTN2) as risk factors for BD. Whereas gene set analysis showed that BD-associated pathways were restricted to chromatin biology, SCZ and ASD involved more extensive and similar pathways. Nevertheless, a correlation analysis of gene set results indicated weak but significant pathway similarities between BD and SCZ or ASD (r = 0.25–0.31). In SCZ and ASD, but not BD, CNVs were significantly enriched in enhancers and promoters in brain tissue. CONCLUSIONS: BD and SCZ/ASD differ in terms of CNV burden, characteristics of CNVs linked to neurodevelopmental disorders, and regulatory CNVs. On the other hand, they have shared molecular mechanisms, including chromatin biology. The BD risk genes identified here could provide insight into the pathogenesis of BD

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo