A Case of Pancreatic Carcinoma with Bilateral Hilar 18F-FDG and 67Ga Hyperaccumulation

Article信州医学雑誌 66(2): 151-155(2018)journal articl

Radiologic Findings of IgG4-Related Disease

Autoimmune pancreatitis (AIP), characterized by an autoimmune phenomenon of prominent lymphocytes, IgG4-bearing plasma cell infiltration and storiform fibrosis, has been widely reported as a specific type of chronic pancreatitis. Typical image findings of this disease are reported as diffuse pancreatic swelling and a capsule-like rim on CT or MRI. However, AIP presents with a variable morphology, such as focal, segmental and multifocal swellings. Because imaging findings for AIP can look like those of pancreatic cancer, AIP has often been treated with unnecessary surgical resection. In addition, AIP is complicated by the involvement of various other organs besides the pancreas that show lymphoplasmacytic infiltration and fibrosis. These are frequently misdiagnosed as inherent lesions of corresponding organs. Furthermore, these extra-pancreatic lesions show systemic distribution and share common features of IgG4- bearing plasma cell infiltration as well as favorable responses to corticosteroid, indicating the presence of systemic condition, IgG4-related diseases. AIP is now recognized as an IgG4-related disease. Detailed evaluations of imaging findings of CT, MRI and Gallium-67 (Ga-67) scintigraphy for the involvement of these various organs are useful for a correct diagnosis of this systemic disease.ArticleCurrent Immunology Reviews. 7(2):186-203 (2011)journal articl

Radiologic Findings of IgG4-Related Disease

Autoimmune pancreatitis (AIP), characterized by an autoimmune phenomenon of prominent lymphocytes, IgG4-bearing plasma cell infiltration and storiform fibrosis, has been widely reported as a specific type of chronic pancreatitis. Typical image findings of this disease are reported as diffuse pancreatic swelling and a capsule-like rim on CT or MRI. However, AIP presents with a variable morphology, such as focal, segmental and multifocal swellings. Because imaging findings for AIP can look like those of pancreatic cancer, AIP has often been treated with unnecessary surgical resection. In addition, AIP is complicated by the involvement of various other organs besides the pancreas that show lymphoplasmacytic infiltration and fibrosis. These are frequently misdiagnosed as inherent lesions of corresponding organs. Furthermore, these extra-pancreatic lesions show systemic distribution and share common features of IgG4- bearing plasma cell infiltration as well as favorable responses to corticosteroid, indicating the presence of systemic condition, IgG4-related diseases. AIP is now recognized as an IgG4-related disease. Detailed evaluations of imaging findings of CT, MRI and Gallium-67 (Ga-67) scintigraphy for the involvement of these various organs are useful for a correct diagnosis of this systemic disease.ArticleCurrent Immunology Reviews. 7(2):186-203 (2011)journal articl

Characteristic findings in images of extra-pancreatic lesions associated with autoimmune pancreatitis

Purpose: Autoimmune pancreatitis is a unique form of chronic pancreatitis characterized by a variety of extra-pancreatic involvements which are frequently misdiagnosed as lesions of corresponding organs. The purpose of this study was to clarify the diagnostic imaging features of extra-pancreatic lesions associated with autoimmune pancreatitis. Materials and methods: We retrospectively analyzed diagnostic images of 90 patients with autoimmune pancreatitis who underwent computer-assisted tomography, magnetic resonance imaging, and/or gallium-67 scintigraphy before steroid therapy was initiated. Results: AIP was frequently (92.2%) accompanied by a variety of extra-pancreatic lesions, including swelling of lachrymal and salivary gland lesions (47.5%), lung hilar lymphadenopathy (78.3%), a variety of lung lesions (51.2%), wall thickening of bile ducts (77.8%), peri-pancreatic or para-aortic lymphadenopathy (56.0%), retroperitoneal fibrosis (19.8%), a variety of renal lesions (14.4%), and mass lesions of the ligamentum teres (2.2%). Characteristic findings in CT and MRI included lymphadenopathies of the hilar, peri-pancreatic, and para-aortic regions; wall thickening of the bile duct; and soft tissue masses in the kidney, ureters, aorta, paravertebral region, ligamentum teres, and orbit. Conclusions: Recognition of the diagnostic features in the images of various involved organs will assist in the diagnosis of autoimmune pancreatitis and in differential diagnoses between autoimmune pancreatitis-associated extra-pancreatic lesions and lesions due to other pathologies.ArticleEUROPEAN JOURNAL OF RADIOLOGY. 76(2):228-238 (2010)journal articl

Photoinduced swing of a diarylethene thin broad sword shaped crystal:a study on the detailed mechanism

We report a swinging motion of photochromic thin broad sword shaped crystals upon continuous irradiation with UV light. By contrast in thick crystals, photosalient phenomena were observed. The bending and swinging mechanisms are in fact due to molecular size changes as well as phase transitions. The first slight bending away from the light source is due to photocyclization-induced surface expansion, and the second dramatic bending toward UV incidence is due to single-crystal-to-single-crystal (SCSC) phase transition from the original phase I to phase IIUV. Upon visible light irradiation, the crystal returned to phase I. A similar SCSC phase transition with a similar volume decrease occurred by lowering the temperature (phase IIItemp). For both photoinduced and thermal SCSC phase transitions, the symmetry of the unit cell is lowered; in phase IIUV the twisting angle of disordered phenyl groups is different between two adjacent molecules, while in phase IIItemp, the population of the phenyl rotamer is different between adjacent molecules. In the case of phase IIUV, we found thickness dependent photosalient phenomena. The thin broad sword shaped crystals with a 3 mu m thickness showed no photosalient phenomena, whereas photoinduced SCSC phase transition occurred. In contrast, large crystals of several tens of mu m thickness showed photosalient phenomena on the irradiated surface where SCSC phase transition occurred. The results indicated that the accumulated strain, between isomerized and non-isomerized layers, gave rise to the photosalient phenomenon

A Proteomic Approach for the Diagnosis of ‘Oketsu’ (blood stasis), a Pathophysiologic Concept of Japanese Traditional (Kampo) Medicine

‘Oketsu’ is a pathophysiologic concept in Japanese traditional (Kampo) medicine, primarily denoting blood stasis/stagnant syndrome. Here we have explored plasma protein biomarkers and/or diagnostic algorithms for ‘Oketsu’. Sixteen rheumatoid arthritis (RA) patients were treated with keishibukuryogan (KBG), a representative Kampo medicine for improving ‘Oketsu’. Plasma samples were diagnosed as either having an ‘Oketsu’ (n = 19) or ‘non-Oketsu’ (n = 29) state according to Terasawa's ‘Oketsu’ scoring system. Protein profiles were obtained by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) and hierarchical clustering and decision tree analyses were performed. KBG treatment for 4 or 12 weeks decreased the ‘Oketsu’ scores significantly. SELDI protein profiles gave 266 protein peaks, whose expression was significantly different between the ‘Oketsu’ and ‘non-Oketsu’ states. Hierarchical clustering gave three major clusters (I, II, III). The majority (68.4%) of ‘Oketsu’ samples were clustered into one cluster as the principal component of cluster I. The remaining ‘Oketsu’ profiles constituted a minor component of cluster II and were all derived from patients cured of the ‘Oketsu’ state at 12 weeks. Construction of the decision tree addressed the possibility of developing a diagnostic algorithm for ‘Oketsu’. A reduction in measurement/pre-processing conditions (from 55 to 16) gave a similar outcome in the clustering and decision tree analyses. The present study suggests that the pathophysiologic concept of Kampo medicine ‘Oketsu’ has a physical basis in terms of the profile of blood proteins. It may be possible to establish a set of objective criteria for diagnosing ‘Oketsu’ using a combination of proteomic and bioinformatics-based classification methods

Collagen adhesion gene is associated with blood stream infections caused by methicillin-resistant Staphylococcus aureus

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) causes hospital- and community-acquired infections. It is not clear whether genetic characteristics of the bacteria contribute to disease pathogenesis in MRSA infection. We hypothesized that whole genome analysis of MRSA strains could reveal the key gene loci and/or the gene mutations that affect clinical manifestations of MRSA infection. Methods: Whole genome sequences (WGS) of MRSA of 154 strains were analyzed with respect to clinical manifestations and data. Further, we evaluated the association between clinical manifestations in MRSA infection and genomic information. Results: WGS revealed gene mutations that correlated with clinical manifestations of MRSA infection. Moreover, 12 mutations were selected as important mutations by Random Forest analysis. Cluster analysis revealed strains associated with a high frequency of bloodstream infection (BSI). Twenty seven out of 34 strains in this cluster caused BSI. These strains were all positive for collagen adhesion gene (cna) and have mutations in the locus, those were selected by Random Forest analysis. Univariate and multivariate analysis revealed that these gene mutations were the predictor for the incidence of BSI. Interestingly, mutant CNA protein showed lower attachment ability to collagen, suggesting that the mutant protein might contribute to the dissemination of bacteria. Conclusions: These findings suggest that the bacterial genotype affects the clinical characteristics of MRSA infection. (c) 2019 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases