Epstein-Barr Virus-Positive Mucocutaneous Ulcer: A Unique and Curious Disease Entity

Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBVMCU) was first described as a lymphoproliferative disorder in 2010. EBVMCU is a unifocal mucosal or cutaneous ulcer that often occurs after local trauma in patients with immunosuppression; the patients generally have a good prognosis. It is histologically characterized by proliferating EBV-positive atypical B cells accompanied by ulcers. On the basis of conventional pathologic criteria, EBVMCU may be misdiagnosed as EBV-positive diffuse large B-cell lymphoma or other lymphomas. However, its prognosis differs from that of EBV-associated lymphomas, in that patients with EBVMCU frequently show spontaneous regression or complete remission without chemotherapy. Therefore, EBVMCU is now recognized as a low-grade malignancy or a pseudo-malignant lesion. Avoiding unnecessary chemotherapy by distinguishing EBVMCU from other EBV-associated lymphomas will reduce the burden and unnecessary harm on patients. On the basis of these facts, EBVMCU was first described as a new clinicopathological entity by the World Health Organization in 2017. In this review, we discuss the clinicopathological characteristics of previously reported EBVMCU cases, while focusing on up-to-date clinical, pathological, and genetic aspects

The process of overcoming difficulties faced by novice home economics teachers in elementary schools

The purposes of this paper is to ascertain the difficulties faced by novice home economics teachers in elementary schools and the process for overcoming those difficulties. Our methodology uses the Trajectory Equifinality Model (TEM) to analyze interviews conducted with three newly hired home economics teachers at a public elementary school in H City in fiscal 2014. When they first assumed their posts, the three teachers had not been uncomfortable teaching classes in home economics, but after gaining the support of other teachers, they reached the point where they were eager to teach home economics classes the following year based on what they learned during their first year. The teachers experienced various challenges during that time. Teacher A had problems mainly with practice classes; Teacher B had problems mainly with how to deal with the students; and Teacher C had problems with practice classes, lecturetype classes, and developing relationships with the students. Although the difficulties experienced by the three novice home economics teachers differed depending on their attitude toward home economics and conditions in the workplace, ways to overcome these difficulties consisted of the following three points: the building of a support system for discussions about home economics; the building o f a s ystem t o f acilitate a better understanding of students’ actual lives; and the creation of a system that encourage participation in training.This article translated into Japanese is published in the journal Gakushu Shisutemu Kenkyu,Vol.5

高周波聴力の左右差 : 一側性の蝸牛障害の評価への応用

High-frequency audiometry has the potential to detect hearing impairment at its early stage. However, several problems prevent the clinical application of high-frequency audiometry. In this study, the dispersion and left-right difference in the high-frequency sensitivity were investigated in normal hearing volunteers. In our results, the difference between the left and right ears varied only slightly among individuals or age groups, while dispersion of hearing threshold values became marked with an increase in frequency. The results suggest that the measurement of left-right difference in high-frequency sensitivity may be useful for the evaluation of unilateral impairment. To investigate this usefulness, the left-right differences were measured in the patients complaining of unilateral cochlear symptom with normal hearing. Considering the results of normal hearing, we determined that abnormal left-right difference in high-frequency sensitivity was over 20 dB. In 12 patients with unilateral tinnitus, 7 showed left-right differences, and 6 had tinnitus in the ear with increased thresholds. Our results suggested a relationship between tinnitus with normal hearing and hearing impairment in the high-frequency range.博士（医学）・乙1335号・平成26年3月17

Effects of Eating or Skipping Breakfast on Heart Rate and Oxygen Uptake

The purpose of this study was to compare changes in heart rate, oxygen uptake, blood pressure and oral temperature between subjects eating breakfast and subjects skipping breakfast when they exercise each day at 11:00 AM and 2:00 PM. The study design included two different groups, a breakfast group and a skipping group. Subjects rested for five minutes, and they exercised on a pendulum ergometer for twenty minutes. After exercising, the resistance was returned to zero for a one minute cool down followed by five more minutes of complete rest(recovery phase). Oral temperatures of the skipping group were lower than those of the breakfast group at 11:00 AM. Diet induced thermogenesis (DIT), which increases core body temperature, is generated by eating breakfast. In the skipping group, the resting heart rates at 11:00 AM were lower than at 2:00 PM. A significant difference in heart rate after the first minute of exercise was seen between 11:00 AM and 2:00 PM in the skipping group. These results suggested that when skipping breakfast, the heart rate response immediately after beginning exercise is slow in the morning. Although all subjects did cooling down for one minute after exercising, oxygen uptake during the recovery phase in the skipping group at 11:00 AM was significantly higher than at rest. These results suggest that eating breakfast has a physiological influence on both heart rate and oxygen uptake

Upregulated Expression of Activation-Induced Cytidine Deaminase in Ocular Adnexal Marginal Zone Lymphoma with IgG4-Positive Cells

Immunoglobulin G4-related disease (IgG4-RD) is a systemic disorder characterized by tissue fibrosis and intense lymphoplasmacytic infiltration, causing progressive organ dysfunction. Activation-induced cytidine deaminase (AID), a deaminase normally expressed in activated B-cells in germinal centers, edits ribonucleotides to induce somatic hypermutation and class switching of immunoglobulin. While AID expression is strictly controlled under physiological conditions, chronic inflammation has been noted to induce its upregulation to propel oncogenesis. We examined AID expression in IgG4-related ophthalmic disease (IgG4-ROD; n = 16), marginal zone lymphoma with IgG4-positive cells (IgG4+ MZL; n = 11), and marginal zone lymphoma without IgG4-positive cells (IgG4- MZL; n = 12) of ocular adnexa using immunohistochemical staining. Immunohistochemistry revealed significantly higher AID-intensity index in IgG4-ROD and IgG4+ MZL than IgG4- MZL (p < 0.001 and = 0.001, respectively). The present results suggest that IgG4-RD has several specific causes of AID up-regulation in addition to inflammation, and AID may be a driver of oncogenesis in IgG4-ROD to IgG4+ MZL

Pulmonary Manifestations of Plasma Cell Type Idiopathic Multicentric Castleman Disease: A Clinicopathological Study in Comparison with IgG4-Related Disease

Plasma cell type idiopathic multicentric Castleman disease (PC-iMCD) occasionally manifests as parenchymal lung disease. This study aimed to elucidate the detailed clinicopathological features of lung lesions in PC-iMCD and compare the findings with those in immunoglobulin (Ig) G4-related disease (IgG4-RD), the most difficult differential diagnosis of PC-iMCD. We analyzed the clinicopathological findings and immunohistochemical expression patterns of interleukin-6 (IL-6) and Igs in lung specimens from 16 patients with PC-iMCD and 7 patients with IgG4-RD. Histologically, pulmonary PC-iMCD could not be differentiated from IgG4-RD based on lesion distribution patterns, the number of lymphoid follicles and obliterative vasculitis, or fibrosis types. The eosinophil count was higher in the IgG4-RD group than in the PC-iMCD group (p = 0.004). The IgG4/IgG-positive cell ratio was significantly higher in the IgG4-RD group (p < 0.001). The IgA-positive cell count and IL-6 expression intensity were higher in the PC-iMCD group than in the IgG4-RD group (p < 0.001). Based on these findings, we proposed a new diagnostic approach to differentiate lung lesions of PC-iMCD and IgG4-RD. Our approach can be utilized to stratify patients with suspected lung-dominant PC-iMCD to identify candidates for strong immunosuppressive treatment, including IL-6 blockade, at an early stage

尿閉を来たしたハイリスク患者に対する尿道ステント(アンジオメッドメモサーム)の使用経験

著者らは, 尿閉を来したハイリスク患者に対して, 尿道ステント(アンジオメッド・メモサーム)留置を試みて, 良好な結果が得られた.対象症例15例のうち, 2名は再度尿閉を来し, 1名はステントへの結石付着が原因でステントを抜去せざるをえなかったが, 残る12名はステント留置後から良好な排尿状態を保持することができた.また, BPHだけでなく, 原疾患がNGBと思われる症例に対しても効果を期待できることが確認できた.以上, 非侵襲的で簡便なこの手技は, 本来尿道カテーテルを留置されるべきハイリスク患者に自排尿を促せる, すなわちQOLを高めることのできる優れた手技であると示唆されたTransurethral resection of the prostate (TUR-P) has been established as the golden standard for the treatment of urinary retention in patients with benign prostatic hyperplasia (BPH). However, TUR-P is not performed on patients with certain high-risk complications. We have obtained favorable results using urethral stent (Angiomed-Memotherm) implantation to treat high-risk urinary retention patients. Here, we review the results obtained on 15 patients treated using this procedure. Two patients experienced recurrent urinary retention; in one patient, the stent had to be removed due to stone formation; in the remaining 12 patients, urination was favorable after stent implantation. Also, urethral stent implantation was found to be useful in 4 of the 7 patients with neurogenic bladder (rather than BPH) as the underlying disease. The present technique is convenient and noninvasive, and we strongly believe that it can improve the patient's quality of life (QOL) by facilitating urination in high-risk patients who would otherwise require urethral catheterization

Remaining structures at the N- and C-terminal regions of alpha-synuclein accurately elucidated by amide-proton exchange NMR with fitting

AbstractAlpha-synuclein is analyzed in physiological conditions by CLEANEX-PM methodology, in which the amide-proton exchange can be monitored at millisecond scale. The relationship between kex and [OH]− is confirmed as a linear correlation with slope 1, indicating EX2 regime. There are significant residual structures at the N- and C-terminal regions. The structure at the C-terminal region is more stable than that of the N-terminal region. The middle part including NAC region is not completely protected. The data acquired at various pH and mixing time conditions followed by linear fitting give accurate information about residual structures