Possible Paternal Hepatitis B Virus Infection with Different Clinical Courses between Siblings: A Report of Two Cases.

The incidence of hepatitis B virus (HBV) infection is expected to decrease in the future owing to the preventive measures adopted against mother-to-child transmission of HBV and implementation of universal HBV vaccination for children. However, no countermeasure has been established against horizontal infection in nonvaccinated children. We report the case of two siblings who had different clinical courses of possible paternal HBV infection. The younger sibling developed acute hepatitis, whereas the older sibling was an asymptomatic HBV carrier. To eradicate HBV, HBV vaccination of all children and HBV infection screening of fathers and other family members should be encouraged.

Granulomonocytapheresis Using the Single-Needle Method for a Girl with Ulcerative Colitis.

Granulomonocytapheresis (GMA) is an effective treatment for inducing remission in patients with refractory ulcerative colitis (UC). Furthermore, GMA has very few side effects and can be performed without using drugs except anticoagulants. However, GMA is sometimes challenging to perform, especially in children, as it usually requires securing two blood vessels. We attempted GMA by the single-needle method in a girl with UC, which is performed by securing only one blood vessel. In the present case, GMA could be performed 10 times without any side effects. Our case shows that GMA with the single-needle method was feasible in children with UC.

Refeeding syndrome in a 12-year-old girl with distal renal tubular acidosis.

Distal renal tubular acidosis is a risk factor for refeeding syndrome. Frequent measurement of serum phosphorus levels at the initiation of nutrition and rapid administration of phosphate preparations are required to prevent organ failure.

Improvement of the depth resolution of swept-source THz-OCT for non-destructive inspection.

We construct a terahertz swept source optical coherence tomography system using a continuous-wave diode multiplier source in the 600-GHz band for defect inspection in multilayer objects and evaluate its performance. Using this system, we image a multilayer plastic sample to demonstrate the effectiveness of nondestructive three-dimensional imaging. To enhance the depth resolution, we apply an annihilating filter to the analysis and confirm that two surfaces of a 1-mm-thick plastic plate can be resolved. In addition, the repeatability of measured thicknesses is 0.22 mm. These values are approximately one-half and one-tenth of the resolution achievable by conventional Fourier analysis, respectively.

Eosinophilic gastroenteritis with persistent abdominal pain: a case report.

Two months ago, a 9-year-old boy experienced intermittent abdominal pain regardless of food intake, without diarrhea, bloody stool, or nausea. Blood test results revealed a peripheral blood eosinophil count of 660 cells /µL, which was marginally elevated, without inflammatory reaction, occult blood, or enteric pathogens. The intestinal mucosa from the terminal ileum to the rectum was endoscopically normal, but mucosal biopsy revealed eosinophilic infiltration of the terminal ileum and whole colon with ≥20 eosinophils/high power field (HPF). Subsequent upper gastrointestinal endoscopy revealed normal endoscopic mucosa from the esophagus to the second part of the duodenum, but mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/HPF. Based on the above findings, he was diagnosed with eosinophilic gastroenteritis (EGE). The cause of EGE and mechanisms of eosinophil infiltration have yet to be fully elucidated. For these nonspecific abdominal symptoms, evidence of eosinophilic infiltration of the gastrointestinal mucosa, specifically 20 eosinophils/HPF in each intestinal mucosa, is required for the definitive diagnosis of EGE. Even if only persistent abdominal pain develops, EGE diagnosis should be confirmed with the analysis of mucosal biopsy in addition to the review of allergic disease history and peripheral blood eosinophil counts.

Rotavirus Vaccine Effectiveness against the Risk of Hospitalization and the Impact of Using Public Funds for the Vaccine on a Regional Rotavirus Gastroenteritis Epidemic in Japan.

An epidemic of rotavirus (RV) gastroenteritis occurred from April to July 2015 across a wide area of Hokkaido, surrounding the Abashiri-Kosei General Hospital. The RV vaccine for children in Shari and Koshimizu was provided at public funds by their local governments, while children in Abashiri were charged for the vaccine. This study examined the effectiveness of the RV vaccine against the risk of hospitalization based on a retrospective cohort study and the impact of using public funds for RV vaccination on a regional RV gastroenteritis epidemic. The vaccination coverage was significantly higher in children in Shari and Koshimizu than in Abashiri (87.8% vs. 42.7%, respectively, p < 0.001). The RV gastroenteritis-related risk of hospitalization was slightly lower in children from Shari and Koshimizu than in those from Abashiri (1.6% vs. 3.2%, respectively, p = 0.07). In addition, the risk of hospitalization in the vaccinated children was significantly lower than that in the unvaccinated children (0.7% vs. 4.8%, respectively, p < 0.001); indicating that the RV vaccine effectiveness against the risk of hospitalization was 96.5% (95% confidence interval 45.7%-99.8%). In conclusion, the use of public funds for the provision of RV vaccine increased the vaccination coverage, which, in combination with high vaccine effectiveness, led to a decrease in the number of hospitalizations in children during a regional RV gastroenteritis epidemic.

A Case of Nonalcoholic Steatohepatitis in Central Precocious Puberty Aggravated by Gonadotropin-releasing Hormone Analog.

We report the case of a girl with central precocious puberty (CPP) and nonalcoholic steatohepatitis (NASH) aggravated by gonadotropin-releasing hormone analog (GnRHa). She was diagnosed with CCP and began treatment with GnRHa at the age of 8 years and 9 months. She already had mild liver dysfunction and was obese at that time; however, liver dysfunction was aggravated during GnRHa initiation. Her liver dysfunction improved after the discontinuation of GnRHa. Liver biopsy was performed twice during GnRHa initiation and findings suggested NASH. In this case, NASH may have been aggravated by the mechanism of estrogen suppression by GnRHa besides obesity. In conclusion, NASH should be ruled out in obese CPP patients with abnormal liver function before starting GnRHa therapy. CPP patients treated with GnRHa require close examination for the early diagnosis of NASH or its progression.

Successful treatment of normokalemic periodic paralysis with hydrochlorothiazide.

BACKGROUND: Periodic paralysis (PP) is an autosomal dominant muscle disorder characterized by periodic muscle weakness attacks associated with serum potassium level variations. It is classified into hypokalemic (hypoKPP), hyperkalemic (hyperKPP), and normokalemic (normoKPP) forms based on the ictal serum potassium level. HyperKPP and normoKPP are caused by mutations of the same gene SCN4A, the gene encoding the skeletal muscle voltage-gated sodium channel. Prophylactic treatment with thiazide diuretics is highly effective in preventing attacks in hyperKPP. However, the efficacy and safety of such diuretics in normoKPP remain unclear. CASE: We describe a familial case of normoKPP wherein the affected individuals showed periodic muscle weakness attacks, with an early childhood onset, and a lack of serum potassium level variation during the paralytic attacks. Sequencing analysis of SCN4A gene revealed a heterozygous missense mutation (c. 2111C > T, p. Thr704Met) in all symptomatic family members. Oral administration of hydrochlorothiazide, a thiazide diuretic, markedly improved the paralytic attack frequency and duration in the affected individuals without adverse effects. CONCLUSION: Our case demonstrates the efficacy of hydrochlorothiazide in the prophylactic treatment of normoKPP caused by the SCN4A mutation of p.Thr704Met, the most frequent mutation of hyperKPP.

[A case of primary unknown cancer difficult to distinguish from lung cancer].

A 26-year-old man was admitted to our hospital with dyspnea, fever, and weight loss. A chest X-ray showed multiple tumor shadows, and a computed tomography (CT) scan showed swelling of the mediastinal and hilar lymph nodes, a mass in the retroperitoneum, and an embolus in the inferior vena cava. A biopsy from the left cervical lymph node revealeda poorly differentiated adenocarcinoma. Metastatic lung cancer was suspected, but in spite of the examinations, its primary site was unknown. Serum alfa-fetoprotein(AFP)was slightly elevated, but an AFP stain of the tumor was negative. The patient's respiratory failure rapidly worsened, and therefore, additional examinations could not be performed. The patient received chemotherapy with carboplatin and paclitaxel. His condition improved, but the tumor increased in size after 5 courses of chemotherapy. He received chemotherapy with docetaxel as second-line treatment, but it was not effective. The third-line chemotherapy regimen with carboplatin and gemcitabine was effective. In total, he received 7 lines of chemotherapy, and he lived for approximately 12 months since receiving the first chemotherapy regimen. After he died, we were able to perform OCT-4 immunohistochemistry on a tumor biopsy specimen from the lymph node, which came back positive for OCT-4. Therefore, we made a final diagnosis of extragonadal germ cell cancer syndrome.

THz phase-contrast computed tomography based on Mach-Zehnder interferometer using continuous wave source: proof of the concept.

In this study, we propose a THz computed tomography (CT) method based on phase contrast, which retrieves the phase shift information at each data point through a phase modulation technique using a Mach-Zehnder interferometer with a continuous wave (CW) source. The THz CT is based on first-generation CT, which acquires a set of projections by translational and rotational scans using a thin beam. From the phase-shift projections, we reconstruct a spatial distribution of refractive indices in a cross section of interest. We constructed a preliminary system using a highly coherent CW THz source with a frequency of 0.54 THz to prove the concept and performed an imaging experiment using phantoms to investigate its imaging features such as artifact-immune imaging, quantitative measurement, and selective detection.

A phase I study of amrubicin and fixed dose of irinotecan (CPT-11) in relapsed small cell lung cancer: Japan multinational trial organization LC0303.

PURPOSE: To determine the maximum tolerated dose of amrubicin (AMR) with a fixed dose of irinotecan (CPT-11). METHODS: Patients having pathologically proven small cell lung cancer (SCLC) relapsed after one or two chemotherapies, and Eastern Cooperative Oncology Group performance status of 0 to 2 were eligible for the study. CPT-11 was delivered as 50 mg/m2 on days 1 and 8, every 21 days. AMR was delivered on day 1. Doses of AMR were level 1: 80 mg/m2, level 2: 90 mg/m2, and level 3: 100 mg/m2. Dose elevation was determined using the modified continuous reassessment method. Tolerability was assessed after the first cycle. Another two cycles were conducted when disease progression or unacceptable toxicities were not observed. RESULTS: Eighteen patients (mean age: 66.3 years) were enrolled. A total of 40 courses were conducted. Grade 3/4 toxicities of the first cycle were leukocytopenia: 11 (61%, grade 3/4: 8/3); neutropenia: 15 (83%, grade 3/4: 6/9); and thrombocytopenia: three (17%, grade 3/4: 2/1). Other grade 3 toxicities observed were febrile neutropenia, one; infection, three; diarrhea, one; and dyspnea, one. Dose-limiting toxicity was observed in two of six patients at level 2 (neutropenia and febrile neutropenia) and in one of six at level 3 (thrombocytopenia and infection). The maximum tolerated dose was level 3, and so, the recommended dose for phase II trials was judged to be 90 mg/m2. Objective response was obtained in four of eight patients who were able to evaluate responses. Median survival time was 13 months, with 68% at 1-year survival rate. CONCLUSIONS: This combination was well tolerated and showed encouraging activities in SCLC. Randomized phase II trials are being planned in chemonaive SCLC.

Depth-resolving THz imaging with tomosynthesis.

We demonstrated a depth-resolved 3D imaging technique based on absorption contrast using tomosynthesis. Tomosynthesis is similar to computed tomography except that the number of projections is much smaller. We constructed a tomosynthesis imaging system, which detects a transmitted continuous THz wave. We applied a backprojection method that was suitable for the constructed detection configuration, to reconstruct an image. Using this system, we imaged a test sample made from paper and reproduced characters written by pencil.

Noninvasive mail inspection system with terahertz radiation.

Using the high penetrability of the terahertz waves and the characteristic absorption spectra in this frequency range, we have built a noninvasive mail inspection system targeting drugs and explosives. The system is composed of two stages; in the first stage, the scattering of a continuous terahertz wave is used for selecting mail that contains concealed powder; in the second stage, the absorption spectrum of the suspicious mail is measured and the material is identified using a terahertz spectrum database. We evaluated the performance and the limits of the inspection system.

Role of the hemin-binding protein 35 (HBP35) of Porphyromonas gingivalis in coaggregation.

Hemin-binding protein 35 (HBP35) in Porphyromonas gingivalis is one of the outer membrane proteins and has been reported to be a non-fimbrial coaggregation factor. In this study, a P. gingivalis HBP35-deficient mutant (MD774) was constructed from wild-type strain FDC381 by insertion mutagenesis in order to provide a better understanding of this protein's role in coaggregation. The intact cells and vesicles in FDC381 were found to have strong aggregation activities with Gram-positive bacteria. But neither the vesicles nor the intact cells showed aggregation activity in MD774. In addition, MD774 reduced autoaggregation activity. Immunoblot analysis of MD774 showed the presence of a non-maturated 45-kDa fimbrillin protein. Electron microscopy showed that the MD774 had no long fimbriae on the cell surface. Arg- and Lys-gingipain activity in MD774 was significantly decreased, compared with FDC381. Real-time RT-PCR demonstrated a significant reduction in the expression of gingipain-associated genes rgpA, rgpB, and kgp. In conclusion, we suggest that the reduction in coaggregation was caused by the combined reduction of a variety of molecules, including HBP35, gingipains, and fimbriae. Our results suggest that the HBP35 protein directly influences not only coaggregation as an adhesion molecule but also indirectly influences the expression of other coaggregation factors.

Surfactant gel adsorption of platinum(II), (IV) and palladium(II) as chloro-complexes and kinetic separation of palladium from platinum using EDTA.

A micellar solution of cetylpyridinium chloride (CPC) can separate into two phases due to a temperature change or to the addition of salts. Platinum(II), (IV) and palladium(II) reacted with chloride ions to form stable anionic complexes of PtCl4(2-), PtCl6(2-) and PdCl4(2-), respectively, and were adsorbed onto the CPC gel phase. The CPC phase plays the role of an ion-exchange adsorbent for the anionic complexes. By such a procedure, the precious metals of platinum and palladium could be separated from base metals such as copper, zinc and iron. The kinetic separation was performed by a ligand exchange reaction of the palladium(II) chloro-complex with EDTA at 60 degrees C. The anionic palladium(II)-EDTA complex could not bind the opposite charged CP+ and was desorbed from the CPC phase. In the aqueous phase, the recovery of palladium(II) by the double-desorption was 101.1 +/- 1.2%. The platinum(II) and (IV) chloro-complexes were stable for at least 30 min and remained in the CPC phase.

Near-infrared laser tomographic imaging with right-angled scattered coherent light using an optical heterodyne-detection-based confocal scanning system.

We demonstrate, what is to the best of our knowledge, a novel optical tomographic method for the visualization of the inner structure of scattering media such as biological tissue in the near-infrared region. We constructed a scanning confocal imaging system with a cross-axes arrangement using optical fibers. This system is based on the optical heterodyne technique and enables the detection of very weak coherence photons that are generated in the spatially restricted confocal region and scattered laterally (90 degrees ) against an incident beam. To evaluate the fundamental imaging capabilities of the system, we assessed measurements from scattering phantoms composed of an Intralipid suspension with varying volume concentrations. The results of this study demonstrate that the right-angled scattered light adheres to the Lambert-Beer law and that the present system can detect light propagating through a distance of approximately 31l of the mean free path. An inclusion as small as 100 microm can be discriminated in a scattering media with an optical thickness of 4. We investigated the potential of the proposed system for imaging biological tissues in preliminary experiments using samples of chicken breast tissue.

Large cell neuroendocrine thymic carcinoma coexisting within large WHO type AB thymoma.

Large cell neuroendocrine carcinoma (LCNEC) is a rare type of thymic epithelial tumor. It is recognized as a different entity from other thymic tumors on account of it having a more aggressive biologic behavior and poor prognosis. We report an extremely rare case of a very small, "large cell neuroendocrine thymic carcinoma" coexisting within a large thymoma that could not be detected by usual biopsy. Surgery as the initial treatment has the significance of definitive diagnosis and curative treatment for LCNEC of the thymus. To make a successful differential diagnosis, application of detailed immunohistochemical stains may be of aid, since thymic epithelial tumor is not always morphologically homogenous.

Videopericardioscopy using endothoracic sonography for lung cancer staging.

We performed videopericardioscopy using an endothoracic sonographic probe for the staging of left hilar nonsmall cell lung cancer. This method will be useful for an accurate diagnosis of direct tumor invasion into the intrapericardial great vessels and lead to the institution of appropriate treatment.

The ion-pair formation between dodecylsulfate and ammine-complexes of copper(II), nickel(II), zinc(II), palladium(II) and platinum(II), and the extraction behavior of the ammine-complexes by using sodium dodecylsulfate.

A micellar solution of sodium dodecylsulfate (SDS) exhibits the property of being separated into two phases due to a temperature change or the addition of salts. The ammine-complexes of copper(II), nickel(II) and palladium(II) reacted with the dodecylsulfate anion to form the corresponding ion-pair, and were extracted into the SDS gel phase. The SDS plays the roles of a pairing-ion for the ammine-complexes and of an extraction medium. The ion-pair extraction mechanism was investigated; the extractability of metals was given by the function of the solubility products of the ion-pairs. This method was applied to the mutual separation of Ni(II)/Cu(II) and Pd(II)/Pt(II). The driving force for the extraction was an electrostatic interaction between the cationic complex and the surfactant anion. The use of the SDS gel as ion-exchanger is also expected.

Elimination of Pancoast tumor by carboplatin, paclitaxel, and concurrent radiation.

Preoperative chemoradiotherapy with carboplatin (AUC 1.5), paclitaxel (40 mg/m2), and concurrent extracorporeal radiation (40 Gy) was used to treat a Pancoast tumor (clinical T3N0M0), without causing adverse events. Then left upper lobectomy was performed along with mediastinal lymph node dissection plus resection of the chest wall and Th1 nerve root. Histological examination revealed a pathological complete response. This multimodal regimen was feasible and achieved a good response, so it seems worthwhile to evaluate the clinical effectiveness of the therapy in a cohort study.