A Study of a Rhythm Perception Model

研究ノートNote

Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas – a case report and literature review

BACKGROUND: Fistula formation has been reported in intraductal papillary-mucinous neoplasms (IPMNs) with or without invasion of the adjacent organs. The presence or absence of invasion is mostly determined by postoperative histological examination rather than by preoperative work-up. CASE PRESENTATION: A 72 year-old Japanese woman showed remarkable dilatation of the main pancreatic duct (MPD) in the distal region of the pancreas. Subsequent ERCP also showed MPD dilatation, after which the patient suffered moderate pancreatitis. A subsequent gastroscopy revealed a small ulceration that had not been observed in a gastroscopy performed 3 months prior. Mucinous discharge from the ulceration suggested it might be the orifice of a fistula connected to the MPD. En bloc resection including the distal region of the pancreas, spleen, stomach and part of the transverse colon was performed under the pre- and intraoperative diagnosis of an invasive malignant IPMN. However, histopathology revealed the lesion to be of "borderline malignancy" without apparent invasion of the stomach. Light microscopy showed inflammatory cellular infiltrates (mainly neutrophils) around the pancreatogastric fistula, but there was no evidence of neoplastic epithelia lining the fistulous tract. CONCLUSION: This case highlights that a pancreatogastric fistula can develop after acute inflammation of the pancreas in the absence of cancer invasion. Further information regarding IPMN-associated fistulae is necessary to clarify the pathogenesis, diagnosis, appropriate surgical intervention and prognosis for this disorder

Primary small-cell neuroendocrine carcinoma of the duodenum – a case report and review of literature

BACKGROUND: Small-cell neuroendocrine carcinoma in the duodenum is an extremely rare neoplasm with poor prognosis. CASE PRESENTATION: A 57-year-old man presented with sudden onset gastrointestinal bleeding and fainting attacks. Duodenoscopy and hypotonic duodenography revealed a 3 × 3 cm protruding tumor with ulcerations situated opposite the ampulla of Vater in the second part of the duodenum. Local excision of the tumor was performed, followed by adjuvant chemotherapy with 5-fluoro uracil and leucovorin. Examination of the tumor by immunohistochemistry and electron microscopy indicated it to be neuroendocrine in nature, expressing synaptophysin and AE1/AE3, and containing dense core granules. The patient showed no sign of recurrence and has been disease-free for more than 48 months after surgery. CONCLUSIONS: Most cases of small-cell neuroendocrine carcinoma in the duodenum show rapid progression of the disease, and even radical surgery with or without chemotherapy do not prevent death. We report a rare subtype of small-cell neuroendocrine carcinoma. This subtype appears to have a much better prognosis, and may be amenable to local excision, if the lesion is away from the ampulla of Vater

アルツハイマー型認知症者を対象にした机上で実施可能なIADL検査の開発と妥当性の検討

The instrumental activities of daily living scale (IADL scale) for Alzheimer’s type of dementia (ATD) does not provide a simple and easy way for evaluators to directly evaluate the targeted individuals. Therefore, we developed an experimental method, which allows a desk evaluation of IADL (on-the-desk evaluation of IADL). The study involved a group of 24 subjects with normal control (MMSE, 28.9 ± 1.4) and a group of 21 subjects with ATD (MMSE, 19.8 ± 4.4). The desk evaluation of IADL involved 9 tasks, which included boiling water with an electric kettle, pulling the plug out of the outlet once the water boils, and making a telephone call. For the test, the subjects were instructed to figure out by themselves the sequence in which they would perform the tasks. The scoring was performed on the basis of the appropriateness or inappropriateness of their behavior in each task and the time it took them to complete each task. The maximum score was set to a total of 59 points. Additionally, in order to examine the validity of the test and the factors which may affect the desk assessment of IADL, various types of neuropsychological tests were performed. The IADL Scale and the Frenchay Activities Index (FAI) were used in the evaluation of IADL. The results showed significant difference in the scores between the 2 groups. The at-the-desk evaluation of IADL revealed a strong correlation between the IADL Scale and the FAI (r＝0.89, r＝0.82, p＜0.001), and a multiple regression analysis of the IADL scores from the desk evaluation showed a high explanation rate (R2＝0.84) by “the Behavioural Assessment of the Dysexecutive Syndrome, “the Wechsler Memory Scale-Revised/digit span backwards test,” the “Rivermead Behavioural Memory Test/appointment”, “Composing task”. The high correlation between the desk evaluation of IADL and the IADL evaluation scale and the results of the multiple regression analysis indicated that the desk evaluation of IADL reflected cognitive functions in ATD and was highly reliable and valid. アルツハイマー型認知症（ATD）用の手段的日常生活活動（IADL）スケールは、評価 者が直接対象者に対して簡便に評価可能なものはない。そこで、我々は机上で実施可能な IADL評価方法（机上IADL検査）の開発を試みた。対象は、健常群２４名（MMSE２８９. ±１４. ） とATD群２１名（MMSE１９８. ±４４. ）とした。机上IADL検査の課題は、電気ポットでお湯を 沸かす、お湯が沸いたらコンセントを抜く、電話をかける、などのIADLの課題を９つ設定 した。また、検査規則として、課題実施順番は自分で考えること、などを伝えた。得点化 は、各課題の適切・不適切行動と検査実施時間、実施順序を対象に行い、合計５９点満点と した。さらに、机上IADL検査に影響する因子と妥当性を検討するために、各神経心理学的 検査を実施し、IADL評価スケールとして、IADL ScaleとFenchay Activities Index（FAI） を実施した。その結果、２群の得点比較では有意差が認められた。また、机上IADL検査 は IADL Scale、FAI ともに強い相関を認め（r =０ ８.９、r =０ ８.２、p＜００.０１）、重回帰分析で は、机上IADL検査得点に対し「遂行機能症候群の行動評価」、「改訂ウェクスラー記憶検 査・逆唱課題」「リバミード行動記憶検査・約束課題」「構成課題」により、高い寄与率 （R２＝０８.４）が示された。机上 IADL 検査は、IADL 評価スケールとの相関が高いこと、重 回帰分析の結果から、ATDの認知機能をよく反映した併存妥当性の高い検査と考えられた

アルツハイマー病者のIADL に影響する高次脳機能障害についての検討 : 机上IADL 検査を用いて

はじめに：アルツハイマー病（AD）の軽度段階では、いくつかの手段的日常生活活動（IADL） の能力が低下し、高次脳機能の低下やうつがIADL に影響していると考えられている。し かし、IADL と高次脳機能、うつとの関連について検討した報告は少ない。そこで、我々 は「机上IADL 検査」を用いて、高次脳機能やうつがIADL にどのように影響しているの かについて検討した。方法：対象は軽度AD 群25 名と健常高齢者群22 名とし、7 種類の IADL 課題で構成され信頼性と妥当性が証明されている、「机上IADL 検査」と神経心理 学的検査、簡易うつ検査（GDS-15）を実施した。結果：軽度AD 群では、「服をしまう」、「ご みの分別」、「本の分別」の課題については、実施割合が高い結果となった。しかし、すべ てのIADL 課題で誤反応が健常高齢者より有意に多い結果となった。7 種類のIADL 課題 と神経心理学的検査とGDS-15、年齢との関連を検討したところ、神経心理学的検査によっ て相関の強さの違いがみられた。また各IADL 課題は、短期記憶との関連が強かった。 考察：軽度AD 者は、誤り行動を含みながらIADL タスクを実施していると考えられた。 また、軽度AD 者へのIADL 支援を行う際は、影響する認知機能の種類に配慮した検査の 選択が必要と考えられた

Suspected idiopathic sclerosing orbital inflammation presenting as immunoglobulin G4-related disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Idiopathic sclerosing orbital inflammation is a rare and ill-defined heterogeneous entity, and a distinct subset of orbital inflammation. Recently, attention has been focused on immunoglobulin G4-related disease complicated with fibrotic changes in some other organs with high serum immunoglobulin G4 levels. This report presents a case of suspected idiopathic sclerosing orbital inflammation complicated with high serum immunoglobulin G4 levels.</p> <p>Case presentation</p> <p>An 82-year-old Japanese woman had a 30-year history of chronic thyroiditis. She experienced right ptosis and eyelid swelling. These symptoms gradually developed over five years. The clinical and radiographic findings suggested that our patient had idiopathic sclerosing orbital inflammation. We were unable to obtain our patient's consent to perform a biopsy. While the serum immunoglobulin G level was within the normal limits, the serum immunoglobulin G4 level was significantly elevated. The serum immunoglobulin G4 levels decreased after the administration of oral prednisolone at a daily dose of 20 mg. In addition, the swelling and ptosis of the right upper eyelid disappeared gradually after four weeks. Our patient was then suspected to have idiopathic sclerosing orbital inflammation complicated with immunoglobulin G4-related disease and chronic thyroiditis.</p> <p>Conclusion</p> <p>An orbital pseudotumor of this type is indicative of idiopathic sclerosing orbital inflammation immunoglobulin G4-related disease. Immunoglobulin G4 may thus be considered a subclass of immunoglobulin G when the serum immunoglobulin G level is within normal limits.</p

Recent comparability of oceanographic nutrients data: Results of a 2003 intercomparison exercise using reference materials

An intercomparison exercise was conducted using the recently developed Reference Material for Nutrients in Seawater (RMNS). Discrepancies of reported values among laboratories were greater than the homogeneity of RMNS samples and the reported analytical precision of nutrients. The variability of in-house standards of the participating laboratories might be the most likely source of interlaboratory discrepancies. Therefore, the use of common reference materials, i.e. certified RM, is essential to establish and improve the comparability of nutrient data of the world's oceans

Glycine insertion makes yellow fluorescent protein sensitive to hydrostatic pressure

Fluorescent protein-based indicators for intracellular environment conditions such as pH and ion concentrations are commonly used to study the status and dynamics of living cells. Despite being an important factor in many biological processes, the development of an indicator for the physicochemical state of water, such as pressure, viscosity and temperature, however, has been neglected. We here found a novel mutation that dramatically enhances the pressure dependency of the yellow fluorescent protein (YFP) by inserting several glycines into it. The crystal structure of the mutant showed that the tyrosine near the chromophore flipped toward the outside of the β-can structure, resulting in the entry of a few water molecules near the chromophore. In response to changes in hydrostatic pressure, a spectrum shift and an intensity change of the fluorescence were observed. By measuring the fluorescence of the YFP mutant, we succeeded in measuring the intracellular pressure change in living cell. This study shows a new strategy of design to engineer fluorescent protein indicators to sense hydrostatic pressure