Early Stage of Pilomatricoma with an Empty Cyst Cavity and Unusual Clinical Appearance

We present an unusual case of cystic pilomatricoma. A 13-year-old Japanese boy was referred to our department for evaluation of a 10-day history of a small reddish nodule on his right cheek. Histopathological examination showed a well-circumscribed cystic structure showing a central empty cavity in the dermis. The wall of the cyst was composed of basophilic cells. Inner layers of the wall were covered with flattened epithelial cells having trichohyalin granules. Based on these findings, a diagnosis of cystic pilomatricoma was made. To our knowledge, there has been no report of cystic pilomatricoma with an empty cavity. Dermatologists should be aware of pilomatricoma in the early stage showing a central empty cavity

1α,25-dihydroxyvitamin D3 acts predominately in mature osteoblasts under conditions of high extracellular phosphate to increase fibroblast growth factor 23 production in vitro

Osteoblasts/osteocytes are the principle sources of fibroblast growth factor 23 (FGF23), a phosphaturic hormone, but the regulation of FGF23 expression during osteoblast development remains uncertain. Because 1α,25-dihydroxyvitamin D3 (1,25(OH)2D3) and inorganic phosphate (Pi) may act as potent activators of FGF23 expression, we estimated how these molecules regulate FGF23 expression during rat osteoblast development in vitro. 1,25(OH)2D3-dependent FGF23 production was restricted largely to mature cells in correlation with increased vitamin D receptor (VDR) mRNA levels, in particular, when Pi was present. Pi alone and more so in combination with 1,25(OH)2D3 increased FGF23 production and VDR mRNA expression. Parathyroid hormone, stanniocalcin 1, prostaglandin E2, FGF2, and foscarnet did not increase FGF23 mRNA expression. Thus, these results suggest that 1,25(OH)2D3 may exert its largest effect on FGF23 expression/production when exposed to high levels of extracellular Pi in osteoblasts/osteocytes

Squamous Cell Carcinoma Manifested as a Cutaneous Horn : A Key to Early Detection

We report a case of squamous cell carcinoma manifested as a cutaneous horn. A 92-year-old man was referred to our department for evaluation of a 3-month history of a keratotic cutaneous horn on the left side of his neck. The height of the cutaneous horn was larger than the diameter of erythema at the base. Histopathological examination showed a hyperkeratotic horn developing over a mass of large atypical keratinocytes with large hyperchromatic and pleomorphic nuclei. Based on these findings, a diagnosis of squamous cell carcinoma was made. A recent study showed that cutaneous horns in association with invasive squamous cell carcinoma had a tendency to have less height than the diameter of the base. In our case, however, the height of the cutaneous horn was larger than the diameter of the base, indicating that invasive squamous cell carcinoma sometimes shows a cutaneous horn that is higher than the diameter of the base. Thus, clinical finding of erythema at the base of the cutaneous horn would be a reliable feature for early detection of squamous cell carcinoma

Effectiveness of outpatient-based group cognitive-behavioral therapy in Japanese patients with mood disorders and neurotic disorders

Background: Although the effectiveness of group cognitive-behavioral therapy (GCBT) has been studied, evidence is still not sufficient. Objective: The aim of the present study is to consider the effectiveness of GCBT with mood disorders and neurotic disorders. Methods: The present study assessed a total of 32 patients who were classified as F3 (mood disorders) or F4 (neurotic disorders) according to the ICD-10, and who attended GCBT sessions offered at The Tokai University Hospital. Depression and mood in these patients were assessed before and after GCBT by using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Profile of Mood States (POMS). Results: A comparison of pre- and post-GCBT CES-D scores among all patients as well as within F3 and F4 groups showed a significant decrease in CES-D scores after GCBT. As for the POMS, a comparison of pre- and post-GCBT scores among all patients showed a significant improvement in “vigor” and “confusion” scores after GCBT. Discussion: The present study demonstrated that GCBT can relieve depression and improve some mood states. Furthermore, the GCBT sessions offered proved to be effective even when administered to a group of participants consisting of both mood disorders and neurotic disorder patients

Association of elevated plasma B-type natriuretic peptide levels with paroxysmal atrial fibrillation in patients with nonobstructive hypertrophic cardiomyopathy

Objectives: To investigate the relationship between the plasma B-type natriuretic peptide (BNP) level and the occurrence of atrial fibrillation (AF) in nonobstructive hypertrophic cardiomyopathy (HCM) patients. Methods: Patients (n=97) were classified into chronic AF (CAF; n=14), paroxysmal AF (PAF; n=18) and normal sinus rhythm (NSR; n=65) groups. The plasma BNP values were analyzed with logarithmic transformation. Results: The PAF group showed significantly higher plasma BNP levels than the NSR group [mean (range; -1 SD and +1 SD); 248.3 (143.5, 429.5) vs. 78.2 (27.9, 218.8 ng/L), p Conclusions: The present study indicated that plasma BNP level is clinically useful for identification of nonobstructive HCM patients who have a risk of PAF.</p

EGFR遺伝子陽性NSCLCにニボルマブが有効であった１例

Nivolumab is approved for the treatment of patients with advanced non-small cell lung cancer （NSCLC）who experience progression of disease on or after standard platinum-based chemotherapy. But there are still a few reports of nivolumab treatment in after EGFR-TKI treatment since NSCLC patients with EGFR mutations has been said to have poor effect on anti-PD-1/PD-L1 agents. Also, there are several reports of severe interstitial pneumonitis when Nivolumab is used after EGFR-TKI treatment. A88‐year‐old woman was diagnosed with lung adenocarcinoma with an EGFR exon21 L861Q mutation（clinical stage ⅢA ; cT4N0M0）. She had received Gefitinib for 18 months, until she had disease progression（PD）. Re-biopsy showed T790M-negative, ALK-negative and PD-L1 0%. Several other drugs were attempted after Gefitinib, but none of them showed any effect. Nivolumab treatment was initiated as her sixth chemotherapy, four and a half years after being diagnosed. Her tumor responded well to Nivolumab treatment and still remains effective without any severe side effects such as interstitial pneumonitis. Our case suggests that Nivolumab treatment is a treatment option for NSCLC patients with EGFR uncommon mutations who are refractory to EGFR-TKI treatment

Long-term monitoring of the short period SU UMa-type dwarf nova, V844 Herculis

We report on time-resolved CCD photometry of four outbursts of a short-period SU UMa-type dwarf nova, V844 Herculis. We successfully determined the mean superhump periods to be 0.05584(64) days, and 0.055883(3) for the 2002 May superoutburst, and the 2006 April-May superoutburst, respectively. During the 2002 October observations, we confirmed that the outburst is a normal outburst, which is the first recorded normal outburst in V844 Her. We also examined superhump period changes during 2002 May and 2006 April-May superoutbursts, both of which showed increasing superhump period over the course of the plateau stage. In order to examine the long-term behavior of V844 Her, we analyzed archival data over the past ten years since the discovery of this binary. Although photometry is not satisfactory in some superoutbursts, we found that V844 Her showed no precursors and rebrightenings. Based on the long-term light curve, we further confirmed V844 Her has shown almost no normal outbursts despite the fact that the supercycle of the system is estimated to be about 300 days. In order to explain the long-term light curves of V844 Her, evaporation in the accretion disk may play a role in the avoidance of several normal outbursts, which does not contradict with the relatively large X-ray luminosity of V844 Her.Comment: 10 pages, 11 figures, accepted for PAS