The Very First Changes in the Tongue with the Development of Cancer

We describe the case of an elderly man with a 3-month history of pain at the tip of his tongue due to a lingual cancer. The lesion appeared slightly depressed and reddish. Our images show the very first changes in the tongue with the development of cancer. Patients with tongue pain often visit the internal medicine department first, so highlighting this case will help physicians detect lingual cancer quickly

Advanced Oropharyngeal Cancer Can Be Easily Missed During Esophagogastroduodenoscopy

The case of an elderly man with an advanced oropharyngeal cancer that was missed during esophagogastroduodenoscopy is described. He was referred for endoscopic resection of superficial esophageal squamous cell neoplasms. He died a month after referral due to an advanced oropharyngeal cancer with a metastatic lesion to the brain. Patients with esophageal squamous cell carcinoma are high risk for head and neck cancer. The pharynx is the most common site for cancer in the head and neck region. Consequently, the pharynx should be observed carefully when patients with esophageal squamous cell carcinoma undergo esophagogastroduodenoscopy

Insect-induced daidzein, formononetin and their conjugates in soybean leaves.

In response to attack by bacterial pathogens, soybean (Gylcine max) leaves accumulate isoflavone aglucones, isoflavone glucosides, and glyceollins. In contrast to pathogens, the dynamics of related insect-inducible metabolites in soybean leaves remain poorly understood. In this study, we analyzed the biochemical responses of soybean leaves to Spodoptera litura (Lepidoptera: Noctuidae) herbivory and also S. litura gut contents, which contain oral secretion elicitors. Following S. litura herbivory, soybean leaves displayed an induced accumulation of the flavone and isoflavone aglycones 4',7-dihyroxyflavone, daidzein, and formononetin, and also the isoflavone glucoside daidzin. Interestingly, foliar application of S. litura oral secretions also elicited the accumulation of isoflavone aglycones (daidzein and formononetin), isoflavone 7-O-glucosides (daidzin, ononin), and isoflavone 7-O-(6'-O-malonyl-β-glucosides) (malonyldaidzin, malonylononin). Consistent with the up-regulation of the isoflavonoid biosynthetic pathway, folair phenylalanine levels also increased following oral secretion treatment. To establish that these metabolitic changes were the result of de novo biosynthesis, we demonstrated that labeled (13C9) phenylalanine was incorporated into the isoflavone aglucones. These results are consistent with the presence of soybean defense elicitors in S. litura oral secretions. We demonstrate that isoflavone aglycones and isoflavone conjugates are induced in soybean leaves, not only by pathogens as previously demonstrated, but also by foliar insect herbivory

A Fluid-Dynamical Subgrid Scale Model for Highly Compressible Astrophysical Turbulence

We formulate and implement the Euler equations with SGS dynamics and provide numerical tests of an SGS turbulence energy model that predicts the turbulent pressure of unresolved velocity fluctuations and the rate of dissipation for highly compressible turbulence. We test closures for the turbulence energy cascade by filtering data from high-resolution simulations of forced isothermal and adiabatic turbulence. Optimal properties and an excellent correlation are found for a linear combination of the eddy-viscosity closure that is employed in LES of weakly compressible turbulence and a term that is non-linear in the Jacobian matrix of the velocity. Using this mixed closure, the SGS turbulence energy model is validated in LES of turbulence with stochastic forcing. It is found that the SGS model satisfies several important requirements: 1. The mean SGS turbulence energy follows a power law for varying grid scale. 2. The root mean square (RMS) Mach number of the unresolved velocity fluctuations is proportional to the RMS Mach number of the resolved turbulence, independent of the forcing. 3. The rate of dissipation and the turbulence energy flux are constant. Moreover, we discuss difficulties with direct estimates of the turbulent pressure and the dissipation rate on the basis of resolved flow quantities that have recently been proposed. In combination with the energy injection by stellar feedback and other unresolved processes, the proposed SGS model is applicable to a variety of problems in computational astrophysics. Computing the SGS turbulence energy, the treatment of star formation and stellar feedback in galaxy simulations can be improved. Further, we expect that the turbulent pressure on the grid scale affects the stability of gas against gravitational collapse.Comment: 19 pages, 16 figures, submitted to A&

Refined Holographic Entanglement Entropy for the AdS Solitons and AdS black Holes

We consider the refinement of the holographic entanglement entropy for the holographic dual theories to the AdS solitons and AdS black holes, including the corrected ones by the Gauss-Bonnet term. The refinement is obtained by extracting the UV-independent piece of the holographic entanglement entropy, the so-called renormalized entanglement entropy which is independent of the choices of UV cutoff. Our main results are (i) the renormalized entanglement entropies of the AdS$_{d+1}$ soliton for $d=4,5$ are neither monotonically decreasing along the RG flow nor positive definite, especially around the deconfinement/confinement phase transition; (ii) there is no topological entanglement entropy for AdS$_5$ soliton even with Gauss-Bonnet correction; (iii) for the AdS black holes, the renormalized entanglement entropy obeys an expected volume law at IR regime, and the transition between UV and IR regimes is a smooth crossover even with Gauss-Bonnet correction; (iv) based on AdS/MERA conjecture, we postulate that the IR fixed-point state for the non-extremal AdS soliton is a trivial product state.Comment: 48 pages, 24 figures; v2: few typos corrected; v3: mistake on the choice of dominant phase is corrected, differential subtraction scheme is introduced to remove the UV cutoff-ambiguity, some of the conclusions on RG flow are changed; v4: statement about C theorem revised; v5 Final version to NP

大腸腫瘍性病変の拾い上げ診断における透明フードを併用した自家蛍光内視鏡の有用性:前向き無作為化比較試験

BACKGROUND: Colonoscopy is one of the most reliable methods for detection of colorectal neoplasms, but conventional colonoscopy can miss some lesions. OBJECTIVE: To evaluate the efficacy of autofluorescence imaging (AFI) with a transparent hood (TH) for detection of colorectal neoplasms. DESIGN: A 2 × 2 factorial designed, prospective, randomized, controlled trial. SETTING: This study was conducted at the Osaka Medical Center for Cancer and Cardiovascular Diseases, a tertiary cancer center. PATIENTS: A total of 561 patients. INTERVENTIONS: Patients were allocated to 1 of 4 groups: (1) white light imaging (WLI) alone--colonoscopy using WLI without a TH; (2) WLI+TH--colonoscopy using WLI with a TH; (3) AFI alone--colonoscopy using AFI without a TH; and (4) AFI+TH--colonoscopy using AFI with a TH. Eight colonoscopists used each allocated method. MAIN OUTCOME MEASUREMENT: The difference in neoplasm detection rate (number of detected neoplasms per patient) between the WLI alone and AFI+TH groups. RESULTS: Neoplasm detection rate (95% confidence interval) in the AFI+TH group was significantly higher than in the WLI alone group (1.96 [1.50-2.43] vs 1.19 [0.93-1.44]; P = .023, Tukey-Kramer multiple comparison test). Relative detection ratios (95% confidence interval) for polypoid neoplasms based on Poisson regression model were significantly increased by mounting a TH (1.69 [1.34-2.12], P < .001), and relative detection ratios for flat neoplasms were significantly increased by AFI observation (1.83 [1.24-2.71], P = .002). LIMITATIONS: Open trial performed in single cancer referral center. CONCLUSION: AFI colonoscopy with a TH detected significantly more colorectal neoplasms than did conventional WLI colonoscopy without a TH.博士（医学）・乙1327号・平成26年3月17

Abnormal Cystatin C Levels in Two Patients with Bardet-Biedl Syndrome

Bardet-Biedl syndrome (BBS) is an autosomal recessive disorder characterized by central obesity, mental impairment, rod-cone dystrophy, polydactyly, hypogonadism in males, and renal abnormalities. The causative genes have been identified as BBS1-14. In the Western countries, the prevalence of this disease ranges from 1/13,500 to 1/160,000, while only a few Japanese patients have been reported in the English-language literature. The incidence of renal dysfunction or anomalies in previous reports varies considerably ranging from ∼20% to universal occurrence. We here report that two Japanese patients who had BBS with normal BUN and creatinine levels had elevated levels of cystatin C, a sensitive marker of glomerular filtration rate. A urine albumin level increased only in the elder patient. Thus, cystatin C may be useful for detecting renal abnormalities in patients with an apparent normal renal function. Because this disease is diagnosed by accumulation of symptoms, such a sensitive marker might help early diagnosis of BBS

Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis.

Background:  Barium radiographic studies have suggested the importance of evaluating areae gastricae pattern for the diagnosis of gastritis. Significance of endoscopic appearance of areae gastricae in the diagnosis of chronic atrophic fundic gastritis (CAFG) was investigated by image-enhanced endoscopy. Materials and Methods:  Endoscopic images of the corpus lesser curvature were studied in 50 patients with CAFG. Extent of CAFG was evaluated with autofluorescence imaging endoscopy. The areae gastricae pattern was evaluated with 0.2% indigo carmine chromoendoscopy. Micro-mucosal structure was examined with magnifying chromoendoscopy and narrow band imaging. Results:  In patients with small extent of CAFG, polygonal areae gastricae separated by a narrow intervening part of areae gastricae was observed, whereas in patients with wide extent of CAFG, the size of the areae gastricae decreased and the width of the intervening part of areae gastricae increased (p < 0.001). Most areae gastricae showed a foveola-type micro-mucosal structure (82.7%), while intervening part of areae gastricae had a groove-type structure (98.0%, p < 0.001). Groove-type mucosa had a higher grade of atrophy (p < 0.001) and intestinal metaplasia (p < 0.001) compared with foveola type. Conclusions:  As extent of CAFG widened, multifocal groove-type mucosa that had high-grade atrophy and intestinal metaplasia developed among areae gastricae and increased along the intervening part of areae gastricae. Our observations facilitate our understanding of the development and progression of CAFG

Genotype–phenotype correlation for extracolonic aggressive phenotypes in patients with familial adenomatous polyposis

Familial adenomatous polyposis (FAP) patients develop various life-threatening extracolonic comorbidities that appear individually or within a family. This diversity can be explained by the localization of the adenomatous polyposis coli (APC) variant, but few reports provide definitive findings about genotype–phenotype correlations. Therefore, we investigated FAP patients and the association between the severe phenotypes and APC variants. Of 247 FAP patients, 126 patients from 85 families identified to have APC germline variant sites were extracted. These sites were divided into six groups (Regions A to F), and the frequency of severe comorbidities was compared among the patient phenotypes. Of the 126 patients, the proportions of patients with desmoid tumor stage ≥III, number of FGPs ≥1000, multiple gastric neoplasms, gastric neoplasm with high-grade dysplasia, and Spigelman stage ≥III were 3%, 16%, 21%, 12%, and 41%, respectively, while the corresponding rates were 30%, 50%, 70%, 50%, and 80% in patients with Region E (codons 1398–1580) variants. These latter rates were significantly higher than those for patients with variants in other regions. Moreover, the proportion of patients with all three indicators (desmoid tumor stage ≥III, number of FGPs ≥1000, and Spigelman stage ≥III) was 20% for those with variants in Region E and 0% for those with variants in other regions. Variants in Region E indicate aggressive phenotypes, and more intensive management is required